This proposal is for a competitive renewal of R01 AA12827, Network and Contingency Management for Alcohol Treatment. This renewal is intended to extend our previous findings, and to explore the mechanisms of network support treatment. The overarching purpose of the Network Support Project is to determine if a treatment directed at changing the patient's social network, from one that reinforces drinking behavior to one that reinforces sobriety, can create the conditions necessary for long-term treatment success. Our initial study involved a Network Support treatment patterned after the 12-Step facilitation treatment used in Project MATCH. The initial study is at the end of the 2-year follow-up. Results indicated the following: Network Support conditions yielded better outcomes than a Case Management condition. Analyses of social network variables at posttreatment indicated that the NS conditions did not reduce social support for drinking relative to the CaseM condition, but did increase social support for abstinence, as well as AA involvement. Both the network support variables and AA involvement variables were significantly correlated with drinking outcomes. The findings indicate that drinkers'social networks can be changed by a treatment that is specifically designed to do so, and that these changes contribute to improved drinking outcomes. Certain other findings emerged, however. Despite our efforts, a large number of patients were never able to change their social networks, in part because of difficulty establishing social relationships (almost 30% had 2 or fewer abstinent friends throughout the 2 years of the study). The absence of a coping skills based control group leaves open the possibility that specific network building activities may not be needed (i.e., people may increase their sober social network just as a function of developing general skills). Finally, we do not know how changes in the social environment actually translate into outcomes. This study will address the issues raised in our first Network Support study. 160 patients will be assigned to one of two conditions. The first is a Network Support (NS) treatment enhanced with a social skills training component to help patients develop new acquaintances and social networks. This NS condition will be compared to a packaged CBT program for alcoholics (PCBT) that incorporates a number of relapse-prevention skills, but does not address social networks per se. In order to better understand the complex interpersonal influences of social networks on drinking and recovery after treatment, we will use daily process measurement via interactive voice response (IVR) before and after treatment. Recorded each day will be drinking, craving for alcohol, mood state, coping responses and a number of questions characterizing the person's social contacts for that day. IVR recordings will be also be made three times per week by patients during treatment to record performance of skills practice assignments (homework). The IVR data will be used to determine what changes patients in treatment make in their thoughts, feelings and coping behaviors. Results are thus expected to show how social networks may operate to support long-term abstinence.
Public Health Relevance Relapse after treatment is a serious issue for alcoholic patients, and for society. A treatment program that helps the patient change his or her social network from one that reinforces drinking behavior to one that reinforces sobriety can create the conditions necessary for long-term treatment success.
