Social networks and methadone treatment outcome: the costs and benefits of social ties.

This study assessed the impact of social ties on substance abuse treatment outcome. Two models which predict alternative hypotheses were evaluated. 1) Based on the self-medication model, it was hypothesized that social support would aid in coping with painful affect and decrease the need for drugs. 2) Based on a social learning model, it was hypothesized that drug use in the social network would threaten abstinence due to modeling and conditioning effects. Seventy methadone maintenance patients were given baseline measures of mood, stress, social support, and drug use in the network and followed prospectively for 3 months with weekly urine drug screens. Social support was correlated with positive affect (r = .59, p < .001), and stress with negative affect (r = .46, p < .001), but no measures of social support, affect, or stress correlated with the proportion of drug positive urines. However, patients with at least one drug user among the closest significant others had 63 +/- 38% positive urines versus 35 +/- 36% positive among those without a drug-using significant other (t = -3.2, p < .002). Substance use in the social network had a substantial negative impact on treatment outcome. Consistent with the social learning model and the traditional "persons, places, and things," this suggests interventions should get drug-using significant others into treatment and teach patients coping skills to reduce their negative influence.