Social network variables in alcoholics anonymous: a literature review

Alcoholics Anonymous (AA) is the most commonly used program for substance abuse recovery and one of the few models to demonstrate positive abstinence outcomes. Although little is known regarding the underlying mechanisms that make this program effective, one frequently cited aspect is social support. In order to gain insight into the processes at work in AA, this paper reviewed 24 papers examining the relationship between AA and social network variables. Various types of social support were included in the review such as structural support, functional support, general support, alcohol-specific support, and recovery helping. Overall, this review found that AA involvement is related to a variety of positive qualitative and quantitative changes in social support networks. Although AA had the greatest impact on friend networks, it had less influence on networks consisting of family members or others. In addition, support from others in AA was found to be of great value to recovery, and individuals with harmful social networks supportive of drinking actually benefited the most from AA involvement. Furthermore, social support variables consistently mediated AA's impact on abstinence, suggesting that social support is a mechanism in the effectiveness of AA in promoting a sober lifestyle. Recommendations are made for future research and clinical practice.     

Treatment settings for persons with alcoholism: evidence for matching clients to inpatient versus outpatient care

This study compared inpatient, intensive outpatient, and standard outpatient treatment settings for persons with alcoholism and tested a priori hypotheses about the interaction of setting with client alcohol involvement and social network support for drinking. Participants (N = 192) were assigned randomly in cohorts to 1 of the 3 settings. The settings did not differ in posttreatment primary drinking outcomes, although inpatients had significantly fewer jail and residential treatment days combined than outpatients. Clients high in alcohol involvement benefited more from inpatient than outpatient care; the opposite was true at low alcohol involvement levels. Network drinking support did not moderate setting effects. Clients low in cognitive functioning also appeared to benefit more from inpatient than outpatient care. Improved outcomes might be achieved by matching degree of alcohol involvement and cognitive functioning to level of care.     

Alcohol-focused spouse involvement and behavioral couples therapy: evaluation of enhancements to drinking reduction treatment for male problem drinkers

This study evaluated the effects of alcohol-focused spouse involvement and behavioral couples therapy (BCT) in group drinking reduction treatment for male problem drinkers. Sixty-four male clients and their female partners were randomly assigned to 1 of 3 conditions: treatment for problem drinkers only (PDO), couples alcohol-focused treatment, or the latter combined with BCT. Clients whose partners were included in treatment evidenced fewer heavy drinking days and more abstinent/light drinking days in the year following treatment, relative to PDO clients. The combination of alcohol-focused spouse involvement and BCT yielded no better outcomes than alcohol-focused spouse involvement alone. Drinking consequences, spouse behavioral support for drinking reduction, and relationship satisfaction showed no effects of treatment condition.     

Social support appraisals and network resources

The conceptual and empirical distinction of social support networks and subjective appraisals of support is increasingly evident in the social support literature. Support appraisals appear especially important in promoting well-being and may serve as the focus of preventive interventions. Yet little is known about the support network resources that promote positive appraisals of support. One hundred thirty-eight community residents participated in a telephone interview, yielding extensive data on the size, composition, and relationship characteristics of networks providing five kinds of support, satisfaction with support, and perceptions of support from family, friends, and others. Regression and canonical correlation analyses yielded complex findings. Support perceptions, and to a much lesser extent satisfaction, were associated with a variety of resource variables, most prominently the size of emotional and socializing networks, the reciprocity and complexity of network relationships, and the proportion of close friends and family members in the network. The implications of the findings for support-based interventions are briefly discussed.     

The health-related functions of social support

Social support research has been hampered by a lack of clarity both in the definitions of social support and in the conceptualization of its effects on health outcomes. The present study compared social network size and three types of perceived social support—tangible, emotional, and informational —in relation to stressful life events, psychological symptoms and morale, and physical health status in a sample of 100 persons 45–64 years old. Social network size was empirically separable from, though correlated with, perceived social support and had a weaker overall relationship to outcomes than did support. Low tangible support and emotional support, in addition to certain life events, were independently related to depression and negative morale; informational support was associated with positive morale. Neither social support nor stressful life events were associated with physical health. It was concluded that social support research would benefit from attention to the multidimensionality of support and greater specificity in hypotheses about the relationship between types of support and adaptational outcomes.Writing of this paper was supported in part by National Institute on Aging Research Grant AG 00799 and Public Health Service Training Grant MH 13561.     

Peer and family support in children and adolescents with type 1 diabetes

OBJECTIVE: To examine social support and peer and family involvement in relation to diabetes management within a developmental context. METHODS: Sixty-eight youths ages 8 to 17 diagnosed with type 1 diabetes participated. This study represents the phase 1 data from a multisystemic, home-based intervention. Data included parent and youth report of disease management and conflict, youth-reported perceptions of support, peer participation in the intervention, and HbA1c. RESULTS: Adolescents perceived greater diabetes-related peer support than did school-age children. Perceived peer and family support were not correlated with metabolic control. Peer participation in the intervention was correlated with metabolic control. CONCLUSIONS: There is a developmental shift in perceptions of peer support. Increased perceptions of peer and family support overall may not result in improved metabolic control. Social support interventions should focus on the types of support that are most highly associated with positive health outcomes.     

Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.     

The relationship between parent-reported social support and adherence to medical treatment in families of adolescents with type 1 diabetes

OBJECTIVE: To investigate the relationships between both mother-reported spousal support and social network support, and mother-adolescent diabetes-related conflict, discrepancies in decision-making autonomy (DDMA), and adolescent adherence to diabetes treatment. METHOD: Fifty-one mothers of adolescents with IDDM completed self-report measures of social support, diabetes-related conflict, and adolescent autonomy for diabetes care. Analyses tested conflict and DDMA as mediators between mother-reported social support and adolescent adherence to treatment. RESULTS: Increased levels of mother-adolescent conflict were associated with poorer treatment adherence and both mother-reported diabetes-related conflict and DDMA predicted adolescents' glycemic control. Higher levels of mother-reported spousal support were associated with less conflict and greater adherence to treatment. Sobel's test indicated a statistical trend for conflict as a mediator between spousal support and adolescent treatment adherence (p < .07). DDMA did not predict mother-adolescent conflict and did not emerge as a mediator between mother-reported social support and adolescent adherence. CONCLUSIONS: This study highlights the role of spousal support for mothers of adolescents with IDDM and indicates that the level of spousal support mothers receive may play an important role in the health care behaviors of their adolescents.     

Role of religious social support in longitudinal relationships between religiosity and health-related outcomes in African Americans

This study tested a longitudinal model of religious social support as a potential mediator of the relationship between religious beliefs and behaviors, and multiple health-related outcomes (e.g., depressive symptoms, functioning, diet, alcohol use, cancer screening). A national probability sample of African Americans enrolled in the religion and health in African Americans study completed three waves of telephone interviews over a 5-year period (N = 766). Longitudinal structural equation models indicated that religious behaviors, but not beliefs, predicted the slowing of a modest overall decline in positive religious social support, while negative interactions with congregational members were stable. Positive religious support was associated with lower depressive symptoms and heavy drinking over time, while negative interaction predicted increases in depressive symptoms and decreases in emotional functioning. Positive religious support mediated the relationship between religious behaviors and depressive symptoms and heavy drinking. Findings have implications for mental health interventions in faith-based settings.     

Motivational enhancement for 12-step involvement among patients undergoing alcohol detoxification

Forty-eight patients undergoing inpatient detoxification for alcohol dependence were assigned to either brief advice (BA) to attend Alcoholics Anonymous or a motivational enhancement for 12-step involvement (ME-12) intervention that focused on increasing involvement in 12-step self-help groups. Attendance at 12-step groups did not differ significantly by treatment condition over 6 months of follow-up, nor did drinking outcomes. There was a significant interaction between 12-step experience and treatment condition, indicating that ME-12 was associated with relatively better alcohol outcomes at the low ends of 12-step experience, whereas BA was associated with relatively better outcomes at the high ends of 12-step experience. Results indicate that among patients undergoing alcohol detoxification, ME-12 may be beneficial only for those who have little experience with 12-step groups.     

Social support, personality and the prediction of psychological distress: an interactionist approach

Theoretical considerations as well as recent research suggest that the concept of social support, instead of being viewed solely as a stress buffer, should be seen as an important etiological factor in symptom development in its own right. Consequently, the present study set out to examine the influence of six personality factors, derived by a principal component analysis of the 16PF, on the relationship between social support and symptoms of psychological distress in a student sample (N = 139). The results indicated a significant interaction between extraversion and social support; extraverts showed a substantially heightened sensitivity to social support variations. This finding appears to emphasize the usefulness of an interactionist approach that integrates person and context variables for the prediction of psychological distress.     

A systematic review of social support interventions for caregivers of people with dementia: Are they doing what they promise?

ObjectiveSocial support interventions for caregivers of persons with dementia (PwD) are important because informal carers often rely on their social networks for support. This systematic review synthesises findings from research on social support interventions, and examines their methodological quality and effectiveness on caregiver social support and well-being variables.MethodsA systematic literature search utilised five databases. Papers were selected when the primary aim of the intervention was to improve social support. Quality of papers was assessed by the Level of Evidence grade and the criteria list from the Cochrane Back Review Group.Results39 papers were identified and classified into 4 social support intervention categories: befriending and peer support, family support and social network interventions, support groups, and remote interventions using the internet or telephone. Content, intensity, uptake, effectiveness and quality of interventions varied widely. In general, the level of evidence was low. Most studies measured effect on well-being variables, while few examined social support outcomes. Multi-component social support interventions were most effective. Evidence suggested, also a caregiver benefit from remote interventions. Generally, results were inconsistent; some papers demonstrated beneficial results, while others demonstrated no improvement on social support and well-being variables. Social support outcomes were more positively evaluated when qualitative outcome measures rather than quantitative measures were used.ConclusionsAlthough multi-component social support interventionsmay improve caregiver well-being, there is insufficient evidence to conclude whether a change in social support is the underlying mediating factor. The inclusion, validation and operationalization of caregiver social support measures deserve more attention.     

A randomized trial comparing day and residential drug abuse treatment: 18-month outcomes.

Extending an earlier report of 6-month outcomes, this study reports 12- and 18-month follow-up data for clients (N = 188) entering a therapeutic community drug treatment program who were randomly assigned to day or residential treatment conditions. Outcomes included Addiction Severity Index composite scores and measures of depression, psychiatric symptoms, and social support. Both groups showed significant change over time. The pattern of change indicated decreased problem severity in the 1st 6 months and then maintenance of lowered problem severity. Comparisons between groups indicated greater improvement for residential treatment clients on social problems and psychiatric symptoms but no differences on the remaining outcomes. Although residential treatment may offer some specific advantages, the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients.     

Daily hassles and social support as predictors of adjustment in children with pediatric rheumatic disease

OBJECTIVE: To test hypotheses that social support moderates the effects of microstressors on the psychosocial adjustment of children with pediatric rheumatic diseases (PRDs) and that among multiple sources of support, classmate and parent support are significant predictors of adjustment, after controlling for demographic and disease severity variables. METHODS: Children with PRDs (N = 160 children; 8-17 years) were recruited from three pediatric rheumatology centers and completed measures of daily hassles, social support, depressive symptoms, and state and trait anxiety; their parents completed measures of internalizing and externalizing behaviors. RESULTS: Fewer daily hassles and higher social support predicted fewer adjustment problems. Among the sources of support, classmate and parent support were significant predictors. Tests for moderation were significant only for a Hassles x Classmate Support interaction in the prediction of depression. A plot of the interaction between hassles and classmate support showed that children with high classmate support had lower levels of depression than children with low classmate support under high or low levels of daily hassles. Furthermore, children with high classmate support had lower levels of depression under conditions of low versus high daily hassles. DISCUSSION: Results are consistent with a main effect rather than buffering model for social support. CONCLUSIONS: Interventions should focus on management of daily hassles and increasing social support for children with PRDs.     

Childbirth and changes of women's social support network and mental health

A questionnaire surveys of women was conducted, 58 persons at one month, 73 at four month, and 42 at one year after childbirth, in order to investigate the relationship between social support and mental health. Main results concerning stress-buffering effects of social support were as follows. At one month after childbirth, marital intimacy showed stress-buffering effect. At four months, beneficial factors were; informational and emotional support and social companionship from family members other than husband or mother, and informational and emotional support from a friend who was the second closest. At one year were; instrumental, informational, and emotional support and social companionship from other person who was not among those already mentioned, and informational and emotional support and social companionship from still another who was the second important. These results suggested that social support network of women underwent successive changes after childbirth. In addition, a model of changing social support network was presented, and it suggested that changing support network so that one could obtain appropriate support was effective on stress buffer.     

Alcoholics anonymous involvement and positive alcohol-related outcomes: cause,consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men

A positive corelation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes.     

Social support and depression among the black and white elderly

This study of urban elderly persons (age 60+) examines Black/White differences with regard to a set of social support factors, physical health, and ego strength and their relationship t o depression. Data were collected in interviews of community residents of Nashville. The two groups of elderly respondents were very similar relative to age, marital status, education, and income levels. The groups did not differ on the number of medical problems, presence of depression, or social support variables, except for ego strength, in which White respondents had poorer ego strength than did Black respondents. Regression analyses revealed different sets of depression correlates for the groups. Although ego strength was a common correlate of depression for both groups, among Black respondents, lower social support in the areas of reliability, assurance, and guidance was associated with higher levels of depression. Among White respondents, poor social integration, reduction in support network size, and increase in medical problems contributed to higher depression. A discussion of these findings is provided.     

Symptomatology,social support and social support seeking: long-term results of a prospective study among primary mental health care patients

The long-term association between social support and symptomatology is studied. Social support variables were: experienced understanding, satisfaction, number of contacts, social support seeking and severity of interpersonal conflicts. Data were collected at the start of a short-term behavioural therapy (T1) and 6 (T2) and 18 months later (T3). In addition, a comparison is made between patients who had finished their therapy by the second measurement and those who were by that time still in therapy. A fine-grained analysis demonstrated that of all social support variables interpersonal problems were most strongly related to symptomatology, in particular to interpersonal sensitivity. The tendency to seek social support becomes associated with well-being in the long term. The best predictors of sumptomatology at T3 were the initial severity of symptomatology, the change in severity of symptomatology between T1 and T2 and the severity of symptomatology at T2. The social support variables did not have any prognostic significance. All social support variables retained their high temporal stability. Results are translated into practical suggestions that might help maximize gains of short-term behavioural therapy within primary mental health care.     

Psychological distress, life stressors, and social support in new immigrants with HIV

The expression of psychological distress is culture-dependent. Ethiopian Jewish immigrants' expression of distress is anchored in their unique culture. The authors' aim in this study was to assess the psychological distress of HIV-positive (HIV+) Ethiopian Jewish immigrants in Israel, using a culture-based tool, and to examine the relations of psychological distress, psychosocial variables, and T lymphocyte subset counts and viral load. Participants were 56 HIV+ patients. The authors assessed psychological distress by the self-report questionnaire, which they adjusted for the Ethiopian immigrants (SRQ-E). The authors also assessed adherence to treatment regimen, number of life stressors, and degree of perceived social support, T lymphocyte subset counts, and viral load in plasma. The overall level of psychological distress was in the high range of the SRQ-E scale and was considerably higher in men than in women. Psychological distress was related to more life stressors and lower perceived social support. Women reported having more social support, had better T(CD4+) lymphocyte count and T(CD4+)/T(CD8+) ratio, and lower viral load than did men. Better HIV indicators were related to shorter duration of HIV+ since diagnosis, better adherence, and more social support, but not to psychological distress. The culture-based tool allowed identification of the high degree of psychological distress among the HIV+ Ethiopian immigrants. Researchers need to assess the adaptability of culture-based questionnaires to determine psychological distress in HIV+ patients.     

Peer relationship antecedents of delinquent behavior in late adolescence: is there evidence of demographic group differences in developmental processes?

A longitudinal prospective design was used to test the generalizability of low levels of social preference and high levels of antisocial peer involvement as risk factors for delinquent behavior problems to African American (AA) and European American (EA) boys and girls (N = 384). Social preference scores were computed from peer reports in middle childhood (ages 6-9). Parents and adolescents reported antisocial peer involvement in early adolescence (ages 13-16) and adolescents reported on their own delinquent behavior in late adolescence (ages 17 and 18). Analyses tested for differences across four groups (AA boys, EA boys, AA girls, EA girls) in construct measurement, mean levels, and associations among variables. Few measurement differences were found. Mean-level differences were found for social preference and delinquent behavior. AA boys were least accepted by peers and reported the highest level of delinquent behavior. EA girls were most accepted by peers and reported the lowest level of delinquent behavior. Associations among peer experiences and delinquent behavior were equivalent across groups, with lower levels of social preference and higher levels of antisocial peer involvement associated with more delinquent behavior. Person-centered analyses showed the risk associated with low social preference and high antisocial peer involvement to be similar across groups, providing further evidence of the generalizability of the peer relationship experiences as risk factors for subsequent delinquent behavior problems.