Title: A pilot study of a social network intervention for heroin users in opiate substitution treatment
Funder: Department of Health (England)

Abstract: Background Heroin addiction causes a huge burden on society, with a treatment budget of £400 million/year. Opiate substitution treatment (OST) is an effective harm reduction measure, but more emphasis needs to be given to moving people away from drug use and into healthy and productive lives. NICE has highlighted the evidence for psychosocial treatments for heroin dependence, and family/social network interventions are promising for two reasons: (i) by involving family and friends in the treatment process there are opportunities for generalization of the effects beyond an episode of professional treatment (ii) treatment may reduce the considerable physical & psychological health burden of drug misuse on family & friends. Despite this, the vast majority of NHS treatment is individually-based Aims In order to prepare for a definitive trial of a social network intervention for heroin addiction this pilot study will test 5 elements: (1) feasibility of training NHS clinicians with no past experience of working with family members/friends to deliver an evidence-based intervention (Social Behaviour and Network Therapy, SBNT) (2) feasibility of recruiting patients engaged in drug treatment services for at least a year but still reporting heroin use to a trial of SBNT, with a 12 month follow-up (3) whether SBNT reduces heroin use 3 and 12 months after treatment, and potential mediating factors (4) methodology for evaluating quality of life measures that move beyond purely health outcomes (5) feasibility of measuring changes in health and functioning of network members before and after SBNT Plan of Investigation All patients engaged in OST but still using heroin in two NHS community drug treatment teams (Solihull & Leicester) will be invited to take part. Two clinicians per team will be trained in a 4-session manual-driven intervention (SBNT), and a further 2 in a 4-session case management intervention. Participants will be randomised to one of the two interventions or treatment as usual. Forty patients will be recruited to each of three arms, and interviewed at baseline and 3 and12 months after the start of the intervention. The primary outcome will be illicit heroin use (urinalysis & self-report), but secondary outcomes will include physical & mental health, crime, quality of life and social network composition. The impact of the treatment on family and other network members will be evaluated Potential Impact Short-term impact: we will have tested the ability of NHS clinicians to deliver SBNT in routine practice, going some way to overcoming traditional resistance to working with and supporting family and other network members Longer-term impact: information will be gathered about the feasibility of a larger multicentre trial. In particular this will include whether the participants in the target population can be recruited in sufficient numbers, the utility of the measures used (including health economic instruments and methods), the size of any reductions in heroin or prescribed opiate use, and the feasibility of evaluating the impact of treatment on the participant’s social network members


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH