Social Networks and Their Influence on Drinking Behaviors: Differences Related to Cognitive Impairment in Clients Receiving Alcoholism Treatment

Abstract

Objective-Mechanisms of behavioral change that support positive addiction treatment outcomes in individuals with co-occurring alcohol-use disorders and cognitive impairment remain largely unknown. This article combines person-and variable-centered approaches to examine the interrelated influence of cognitive impairment and social support on stability of and changes in drinking behaviors of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatients and aftercare clients (N= 1, 726) during the first year after their entry into treatment.Method-Latent class analysis identified homogeneous groups of clients based on the nature and extent of social support for abstinence or drinking at treatment entry. Cognitive impairment and drinking outcomes were compared across latent classes, and the interaction between impairment and social support on drinking outcomes was examined using mixture probit regression.

Social Support and Cognitive Impairment in Clients Receiving Treatment for Alcohol- and Drug-Use Disorders: A Replication Study

“…Clients listed up to 12 individuals in their social network during the past 6 months and reported the type (e.g., family, friend) and length of relationship; frequency of interaction; members' drinking and drug-using habits; how well liked and important the client considered each; and the 4 most important people's attitudes toward the patient's substance use, abstinence, and treatment. Eight binary variables from Buckman et al (2007) were derived from the raw Important People and Activities data for the LCA. For each of the eight respective variables, a code of "1" was given if (1) at least one network member was abstinent or a light substance user, supported the client's abstinence, and interacted three or more times per week with the client; (2) at least one network member was a heavy substance user, supported the client's substance use, and interacted three or more times per week with the client; (3) all members of the network supported abstinence; (4) all members of the network encouraged drinking/drug use; (5) two or more nonusers were within the social network; (6) three or more heavy substance users were within the network; (7) daily contact was maintained with at least four network members; or (8) daily contact was maintained with at least half of the members in the social network.…”

“…The present study examined the hypothesis that these three social support classes would be captured in a more heterogeneous sample of clients receiving treatment for an alcohol-use disorder, drug-use disorder, or dual alcohol-and drug-use disorders. Buckman et al (2007) further found that the stability of drinking over the fi rst year after treatment, as well as the average level of cognitive impairment at treatment entry, differed across the social support classes. Clients with a high probability of social networks that supported drinking were drinking more heavily, stably, and/or problematically over the year following treatment, and they were unable to maintain a moderate or unproblematic drinking status, compared with clients with a high probability of frequent contact with an abstinence-supporting network.…”

“…This hypothesis was tested using latent class analysis (LCA) to identify the nature of unobserved, naturally occurring social support networks in two Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) samples at treatment entry (Buckman et al, 2007). This person-centered approach to characterizing the operation of helping and hindering agents in the clients' social network identifi ed three independent latent classes.…”

“…The present study used data from an independent sample with the goal of replicating the observation of heterogeneous classes of social support that differ in their drinking behaviors and cognitive abilities (Buckman et al, 2007) in individuals seeking treatment for alcohol-and/or drug-use disorders. Accordingly, it was predicted that individuals who entered treatment with social networks that support abstinence would exhibit positive substance-use outcomes (i.e., fewer days of drinking/drug using), compared with those having social networks that support substance use.…”

“…Cognitive impairment at treatment entry was expected to be more evident in individuals with a high probability of having a social network that supported treatment goals when they entered treatment. In addition, this study extended the approach used in Buckman et al (2007) by examining not only impairment at treatment entry but also changes in cognitive impairment across the fi rst year after treatment entry. Furthermore, a more comprehensive neuropsychological battery was used to distinguish between cognitive impairment in the executive functioning and memory domains.…”