Activating Community Support for Substance Users

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. Efforts to improve
outcomes are often thwarted by strong social networks that reinforce substance use and other
high-risk drug use and sexual behaviors. 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
under-explored 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. Social support is reliably associated with
good health behaviors and more positive and sustained substance abuse treatment outcomes. 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. This
protocol 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., Narcotics Anonymous
(NA)/Alcoholics Anonymous (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 randomized clinical trial (RCT) better isolating the clinical
benefits of activating existing social support and facilitating community involvement.

Inclusion Criteria (for the ATS participant):

- ATS treatment participation of more than 4-weeks

- Submission of at least one drug-positive urine sample

- Expressed willingness to include a drug-free support person in treatment

Exclusion Criteria (for the ATS participant):

- Pregnancy

- Acute medical problem that requires immediate and intense medical management (e.g.,
AIDS defining illness; unstable diabetes)

- Presence of a formal thought disorder, delusions, hallucinations, or imminent risk of
harm to self or others

- Unable to read.

Exclusion Criteria (for the CSPs)

- Submission of a drug-positive urine sample

- Pregnancy

- Acute medical problem that requires immediate and intense medical management (e.g.,
AIDS defining illness; unstable diabetes)

- Presence of a formal thought disorder, delusions, hallucinations, or imminent risk of
harm to self or others

- Unable to read.