Activating Community Support for Substance Users
Condition: Substance Use Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      Efforts to improve methadone maintenance outcomes are often thwarted by strong social
      networks that reinforce substance use and other risk behaviors. The proposed study the
      feasibility and preliminary efficacy of a practical community support intervention that
      employs an alteration model of social network change. The intervention works with patients
      and at least one drug-free family or friend to support participation in community activities
      designed to mobilize recovery support and expand personal drug-free social networks.
    

Detailed description: 
      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.
    

Intervention name(s): Community Support Intervention Group; Substance Use Disorder Educational Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This 12-week community support intervention is designed to activate and harness the powerful influences of drug-free family and friends to enhance recovery support and participation in community activities. Addiction Treatment Services (ATS) participants and their CSPs will be directed to participate in recovery-oriented community activities together 2 times per week and work together toward developing regular drug-free social support for the ATS participant. The group provides an opportunity for both the participant and CSP to discuss their experiences participating in the scheduled activities. For those electing not to engage in community activities, problem-solving strategies will be used to remove obstacles to participation, with other group members providing support and encouragement.; This 12-week educational group is designed as an attention-control group. Group topics include: 1) definition of substance dependence, 2) the disease model, 3) medical aspects, 4) mood, 5) personality, 6) self-esteem, 7) relapse prevention, 8) HIV/AIDS, 9) anger, 10) negative thinking, 11) nutrition, and 12) assertiveness. Participants will be assigned 2 homework assignments each week based on the topic.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Meets criteria of a phase II non-pharmacological treatment intervention.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Drug-free community support; Methadone maintenance; Social networks