Network Support as a Prognostic Indicator of Drinking Outcomes: The COMBINE Study

Abstract

ABSTRACT. Objective: To increase understanding of the interrelationship between a patient's social network and patient drinking, the Important People and Activities (IPA) instrument was developed. To meet the aims of the COMBINE (Combining Medications and Behavioral Interventions) Study, the IPA was modifi ed to create the Important People Inventory (IPI), which was used to measure the contextual infl uence of the patient's social network on patient outcomes and treatment effects. The aims of the present article were to describe the IPI and its differences from the IPA and to test the relationship of network support as measured by the IPI in predicting drinking during and following treatment. Method: Alcohol-dependent patients (N = 1,373) seeking outpatient treatment in the COMBINE randomized clinical trial were administered the IPI before treatment. Six network constructs were tested for predicting patient drinking. Results: As unique effects, alcohol-specifi c support, as measured by network drinking and opposition to patient drinking, is predictive of patient abstinent days during and following treatment and heavy drinking days following treatment. Other measures of network support have variable relationships to patient drinking at different phases: Some are predictive of patient drinking during treatment but diminish, whereas others are unrelated to drinking during treatment but become increasingly predictive of drinking as time from treatment increases. Conclusions: The IPI is a useful instrument for describing network support of alcohol-use disorder patients entering treatment. Measures of alcohol-specifi c support are prognostic of drinking outcomes. The patient's network support should be systematically assessed prior to tailored treatment planning. (J. Stud. Alcohol Drugs, 71, 837-846, 2010)

Recovery Identity and Wellbeing: Is It Better to be ‘Recovered’ or ‘in Recovery’?

“…This is consistent with the 'CHIME' mental health recovery model that assumes Connections is one of the five core components of effective recovery support (along with Hope, Identity, Meaning and Empowerment; Leamy et al, 2011). It is also consistent with a literature that suggests that the more strongly individuals in recovery develop positive and prosocial networks the stronger their recovery journeys will be (Longabaugh et al, 2010;Litt et al, 2007). As has been suggested in previous research with TC populations (Beckwith et al, 2015;Dingle et al, 2015), there was also a positive association between a stronger recovery identity and better reported wellbeing.…”

Overcoming alcohol and other drug addiction as a process of social identity transition: the social identity model of recovery (SIMOR)

“…Frequency of contact with a recovery-oriented social network is important because it determines exposure to both recovery values and processes (Longabaugh et al, 2010;Moos, 2007), and the creation of a social environment in which an emerging sense of self as 'nonusing' or 'in recovery' can be nurtured and shaped by the norms, values and expectations of the group (Best et al, 2008;. Furthermore, the benefits of social support for recovery (which may take the form of information or practical assistance, emotional support and a sense of belonging) appear to be dependent on the degree to which those providing support are perceived to be relevant, similar, and connected to the self.…”

“…The established importance of social network support for long-term recovery (see Dobkin et al, 2002;Litt et al, 2009;Longabaugh et al, 2010;Pagano et al, 2004) speaks to the underlying effect of social influence and social control on the transmission of recovery behaviours (Best & Lubman, 2012). More specifically, individuals are only likely to take on board the values, goals, messages, and support from networks of people with whom they can already identify.…”

Replication of psychometric properties and predictive validity of the Important People Drug and Alcohol Interview

“…The association between social support/influence and substance use has been well documented (Longabaugh et al, 2010;Owens & McCrady, 2014;Zywiak et al, 2002). The IPDA and its predecessors are the most commonly used measure of social support in substance use treatment research; however, the influence of social networks is complex and there is variability in how researchers use this measure to predict outcomes (e.g., Kelly, Stout, Magill, & Tonigan, 2011;Owens & McCrady, 2014;Project MATCH Research Group, 1997;Stout, Kelly, Magill, & Pagano, 2012).…”

“…Additionally, during the 12 months following treatment, the social network support for drinking variable demonstrated prognostic effects on percentage days abstinent in the outpatient arm and on drinks per drinking day in the aftercare arm (Project MATCH Research Group, 1997). Network support for drinking variables from a later generation IPA measure also demonstrated prognostic effects on drinking outcomes (Longabaugh, Wirtz, Zywiak, & O'Malley, 2010); this is exemplified in Project COMBINE (Anton et al, 2006), which enrolled 1,373 alcohol dependent clients, and examined the unique and combined effects of psychosocial and pharmacological interventions.…”