Independent and Interactive Effects of Neighborhood Disadvantage and Social Network Characteristics on Problem Drinking After Treatment

Abstract

Socioecological approaches to public health problems like addiction emphasize the importance of person-environment interactions. Neighborhood and social network characteristics may influence the likelihood of relapse among individuals in recovery, but these factors have been understudied, particularly with respect to conceptualizing social network characteristics as moderators of neighborhood disadvantage. Drawing from a larger prospective study of individuals recruited from outpatient treatment (N=451) and interviewed 1, 3, 5, and 7 years later, the aim of this study was to examine the independent and interactive effects of neighborhood and social network characteristics on continued problem drinking after treatment. Models using generalized estimating equations controlling for demographic and other risk factors found the number of heavy drinkers in one's network increases risk of relapse, with the effects being significantly stronger among those living in disadvantaged neighborhoods than among those in non-disadvantaged neighborhoods. No independent effects were found for neighborhood disadvantage or for the number of network members supporting reduced drinking. Future research is needed to examine potential protective factors in neighborhoods which may offset socioeconomic disadvantage as well as to investigate the functions that network members serve in helping to improve long-term treatment outcomes.

Can Alcohol Use Disorder Recovery Include Some Heavy Drinking? A Replication and Extension up to 9 Years Following Treatment

“…It may be the case that individuals in profile 2 are adversely affected by lower socioeconomic status and opportunity (Best and Lubman, 2012; Lancaster, 2017), such that even if these individuals do the hard work of recovery (McKay, 2017), including dramatic reductions in alcohol consumption, the functional outcomes are not as good for these individuals given preexisting social disadvantage, inequities, systemic racism, and/or comorbid mental health symptoms. Some recent work has begun to investigate the links between socioeconomic status, behavioral economic indicators, and recovery (Mericle et al, 2018; Tucker et al, 2020), and this is an area that demands further inquiry.…”

Testing a Socioecological Model of Relapse and Recovery from Alcohol Problems

“…These results suggest that, particularly for treatment clients living in high-risk neighborhoods, supportive social networks are important to long-term recovery, reiterating earlier findings from an outpatient treatment subsample. 58 Although most treatment programs work to actively engage clients with recovery support resources such as AA after treatment, 80 - 82 it is less common that programs address neighborhood risk factors for relapse. Neighborhood-based delivery of services and community-based recovery support systems are key elements in recovery-oriented systems of care to prevent relapse.…”

“…These criteria are consistent with prior studies. 33,58,65 Follow-up interviews were conducted one, three, five, and seven years after baseline, using computer assisted telephone interviewing; 783 respondents (84.6%) completed at least one follow-up interview. Respondents were tracked every three months using postcard mailings and telephone check-ins.…”

“…19,57 We did not find any studies comparing effects of social network characteristics with those of exposure to high-risk neighborhoods in relation to relapse or recovery from alcohol problems, although in our prior work with these data, we have shown that social networks and neighborhood contexts jointly influence alcohol use. 33,58 Understanding the neighborhood and social network context of alcohol problems among heavy and dependent drinkers can inform service planning to provide continuing care after treatment and support long-term recovery from alcohol problems by people in high-risk neighborhoods.…”

Improving recovery outcomes among MSM: The potential role of recovery housing

“…Solidarity and cohesiveness within the gay community can serve as a critical resource (Kelly, Carpiano, Easterbrook, & Parsons, 2014; Meyer, 2003; Toomey, Ryan, Diaz, & Russell, 2018), but substance use is common in places where MSM may go to spend time with their peers, such as in bars and clubs (Green, 2003; Greenwood et al, 2001; Halkitis & Parsons, 2002) as well as in gay neighborhoods and other social enclaves (Carpiano, Kelly, Easterbrook, & Parsons, 2011). These settings may not only elevate risk for SUD but may also complicate addiction recovery, as drinkers in one’s social network is a consistent predictor of substance use and relapse (Delucchi & Kaskutas, 2010; Delucchi, Matzger, & Weisner, 2004; Mericle, Kaskutas, Polcin, & Karriker-Jaffe, 2018).…”