Opioid-dependent individuals in methadone maintenance have high rates of illicit drug and alcohol use. The individual and public health concerns of poorly and partially treated substance use include social, medical, psychiatric, and healthcare costs (e.g., Degenhardt et al., 2010). Efforts to improve outcomes are often thwarted by strong social networks that reinforce substance use and other high-risk drug use and sexual behaviors (De et al., 2007; Kelly et al., 2012). Many urban substance users lack the financial resources to simply move away from adverse community influences. While clinical providers are well aware of the power of social network influences, existing research provides relatively little direction about how to help substance users change ?people, places, and things.? An underexplored strategy to achieve this desired outcome is to mobilize social support found in the personal social networks of people with substance use disorder. A considerable amount of research demonstrates that people with substance use disorder routinely have drug- free family or friends in their social networks, and that these individuals are terribly underutilized for supporting recovery efforts (Bohnert et al., 2010; Kidorf et al., 2005a). Social support is reliably associated with good health behaviors (Lakey & Orehek, 2011) and more positive and sustained substance abuse treatment outcomes (Litt et al., 2009; Wasserman et al., 2001). The inclusion of drug-free family and friends also provides a pathway to modify social networks by facilitating activity with other drug-free people within and outside of the patient?s social network. This type of work supports an alteration model of network change (Valente, 2012). The present 3-year R34 application uses an alteration model to develop a promising 12-week community support intervention designed to activate and harness the powerful influences of drug-free family and friends to enhance recovery support and participation in community activities. This highly structured and manual-guided therapeutic group works with patients and at least one drug-free family member or friend (community support person -- CSP) to expand the quantity and quality of the patients? drug-free social network, and to reduce and eliminate interactions with active drug users. This outcome is achieved via a series of ?homework? assignments that require the patient and CSP to participate together in two drug-free activities per week that include the presence of other drug-free individuals (e.g., NA/AA, religious activities), and to discuss their experiences within the group setting. This intervention will be compared to Standard Care that includes a substance abuse education group with weekly homework.
Specific aims evaluate feasibility outcomes and the extent to which the intervention supports an alteration model. Short-term efficacy will be assessed using measures of perceived social support and network support for abstinence. Secondary outcomes will evaluate substance use and psychosocial outcomes. Data will support a larger-scale RCT better isolating the clinical benefits of activating existing social support and facilitating community involvement.
Efforts to improve methadone maintenance outcomes are often thwarted by strong social networks that reinforce substance use and other risk behaviors. The proposed R34 application studies the feasibility and preliminary efficacy of a practical community support intervention that employs an alteration model of social network change. The intervention works with patients and at least one drug-free family or friend to support participation in community activities designed to mobilize recovery support and expand personal drug-free social networks.
| Kidorf, Michael; Brooner, Robert K; Peirce, Jessica et al. (2018) Mobilizing community support in people receiving opioid-agonist treatment: A group approach. J Subst Abuse Treat 93:1-6 |
