A solution to alcoholism?
If you want to live long and healthily, get loads of friends. That was the finding of a massive meta-analysis of around 150 studies involving over a third of a million people. Good social connections predict longevity. Dependent drinking shortens lives. Is the process of finding sober friends helpful as a solution to alcoholism?
Mark Litt and colleagues from the University of Connecticut tested this out a few years back. They took 210 alcohol dependent men and randomised them to three outpatient treatment options. The first treatment was essentially treatment as usual: case managing (CaseM) patients to help them achieve their goals. The second was network support (NS). What was that about?
This manualized, 12-week, individually delivered treatment focuses on helping alcohol-dependent patients change their social network from one supportive of drinking to one supportive of abstinence. [It is] more reliant on enhancing involvement in AA and other established social infrastructures to change the social network.
The third intervention was contingency management plus network support. Follow up was at twelve months post treatment. What did they find?
Drinking rates of 186 participants at 12 months posttreatment indicated that both Network Support conditions yielded better outcomes than CaseM. Analyses of social network variables at post treatment indicated that the NS conditions did not reduce social support for drinking relative to CaseM, but did increase social support for abstinence and AA involvement, both of which were significantly correlated with drinking outcomes.
Stunning
And the stunning sentence in this study that ought to make commissioners and treatment providers take notice?
The addition of just one abstinent person to a social network increased the probability of abstinence for the next year by 27%.
The study evidenced that it was straightforward to do this:
The findings suggested 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.
Two years down the line
The authors published a follow up paper with results at two years. How were the patients doing another year down the line in the network support arm compared to the two other arms?
Patients in the Network Support condition reported an average of 80% abstinent days two years after treatment had ended (versus just over 60% for the other two conditions), and 40% were reporting complete abstinence in the 90 days preceding their two-year follow-up (versus under 30% for the other two conditions).
Conclusions
The authors are clear on the meaning of the findings:
The present study indicates that a manualized treatment focused specifically on changing the social environment can lead to lasting adaptive changes in the social network of alcohol dependent patients, and that these changes are predictive of lasting improvement in drinking outcome. No other study to date has been able to demonstrate lasting effects on drinkers’ social environments. As in our earlier report (Litt et al., 2007), AA attendance and increasing the number of non-drinking friends in the social network were strong (direct and indirect) predictors of outcome, appearing to result in increased abstinence in part due to effects on self-efficacy.
What does it mean?
It looks like we can confident in encouraging clients coming to treatment services who want to get sober to find non-drinking friends. Where can they be found? In mutual aid groups and recovery community social settings. There are some challenges I would pose to treatment services:
- We need to see the importance of this – my impression is that there isn’t much awareness of the evidence around the value of social networks
- We need to start to see that one to one support in treatment is only a small part of a bigger whole. My feeling is that we place too much emphasis on this at the expense of other things
- We need to build bridges between treatment and mutual aid and other recovery community resources
- We need to value recovering people and invite them, as peer supporters, recovery champions and connectors, into treatment settings to help with this process
Litt, M., Kadden, R., Kabela-Cormier, E., Petry, N. (2007). Changing network support for drinking: Initial findings from the Network Support Project. Journal of Consulting and Clinical Psychology, 75 (4), 542-555 DOI: 10.1037/0022-006X.75.4.542
Litt, M., Kadden, R., Kabela-Cormier, E., Petry, N. (2009). Changing network support for drinking: Network Support Project 2-year follow-up. Journal of Consulting and Clinical Psychology, 77 (2), 229-242 DOI: 10.1037/a0015252