Alcoholism is particularly prevalent in the US. Its causes are complex and substance abuse in general is often coincident with an underlying mental illness. It's crucial that when sufferers seek treatment, they select options that have a high rate of efficacy. This is because relapse is a major risk factor for recovering alcoholics. It is the argument of this paper that in order for recovering alcoholics to obtain the full benefit from any treatment program they will need strong support from their social network. This often means that members of a patient's support network may also need to be educated. This is so that members of the patient's network of family and friends do not contribute to the potential risk of relapse by encouraging risky behaviors. This paper will explore the role of such social networks in patient recovery programs.
An estimated 30% of Americans are documented to have met the criteria for what is officially referred to as an alcohol use disorder (AUD) (Kelly & Yeterian, 2011). In addition, as noted above, alcoholics usually have underlying mental health issues. These additional issues also require treatment that may take years to address for a successful recovery (O'Farrell & Schein, 2011).
A person is in recovery if they at one time were addicted to alcohol, but have not consumed that substance within a single year. Best et al. (2012) define recovery as involving the three elements of well-being, sobriety, and citizenship. Recovery typically has three stages according to the Betty Ford Institute Consensus Group. The stages are early recovery, which lasts up to 3 years, a sustained recovery, which lasts from 3-5 years, and a stable recovery which is from 5 years and longer. The main priorities for patients in recovery are employment, housing, education and social relationships (Best et al., 2012). As such, treatment programs are urged to provide the necessary resources and strategies to make functional and responsible living viable for those in recovery. Thus while symptom reduction is crucial it is only considered a means to an end (Best et al., 2012).
According to research reported by Polcin, Korcha, Bond, Galloway & Lapp (2010) sustained abstinence for patients with an alcohol addiction is greatly enhanced by providing alcohol and drug free living spaces. These spaces are provided in sober-living houses (SLH) in which residents don't have a limit on how long they can stay. Treatment is shown to be far more successful if the recovering alcoholic also has a strong support network. However, as noted below, studies have shown it's difficult to build and maintain such a network. Indeed many recovering alcoholics come from social environments in which their ability to maintain abstinence will be undermined. The odds of relapse are shown to be high for patients who return to their regular home life after a period in an outpatient treatment program ends.
SLHs provide a safe space where patients can pursue lifestyle changes at critical periods in their recovery. A stay in an SLH is subject to certain conditions, such as regular attendance at a 12-step recovery program. Polcin et al (2010) argues that they are an underutilized resource for the treatment of both substance abuse and ex-offenders populations. An SLH can also provide the resources needed to build a supportive social network. This network will include other patients in various stages of recovery or individuals with no substance abuse issues at all. The literature strongly suggests that these are the best types of social networks for individuals in recovery. This is because the network only includes members who already understand the difficult issues and challenges that patients in recovery face. These social group members can provide positive reinforcement and don't themselves need to be educated.
This indicates that the factors implicated in a successful long-term change and recovery were, to a large degree, social. Best et al. (2012) report research assessing the efficacy of network support relative to the usual case management methodology. The conclusion was that the inclusion of just one clean and sober individual to the patient's social network cut relapse rates by 27% through a year of recovery. The greatest gains in recovery were accomplished by those patients who experienced a high social and environmental quality of life. Indeed some evidence points to reported rates of well-being that surpassed those of the general population. This research is also supported by others in the literature (Bischof et al., 2007; Polcin et al., 2010; O' Farrell & Schein, 2011; Kelly & Yeterian, 2012; Misch, 2009).
Polcin, Galloway, Bond, Korcha & Greenfield (2010) report research that, while social influences are important to encouraging an alcoholic to seek treatment, confrontation is generally not encouraged. By confrontation, the authors refer to the intervention employed by family and/or close friends to urge an alcoholic to enter a treatment program. There is some disagreement in the studies regarding the usefulness of this technique. Some say it is efficacious and others indicate it leads to more drinking. But health care providers generally do not support confronting an alcoholic or addict with social pressure. This type of approach is counter-productive because it can result in arguments and shore up addict resistance to outside help. Therefore where support networks can best provide support is by means of positive reinforcement.
According to research conducted by Best et al (2012), the social networks of former drinkers had 10.5 non-drinkers, 30.2 former drinkers who were also in recovery, and only 4.3 current drinkers. Nearly 40% of former drinkers reported no current drinkers in their social networks. Also individuals who were in recovery 5 years or longer had the greatest number of non-users of any type of controlled substance in their social networks. These participants also reported the highest quality of life. This suggests a great role for social influence in recovery. Research on obesity and smoking cessation also corroborates this role and urges that the building social resources be incorporated into treatment programs.
Nevertheless, for alcoholics who have a non-drinking spouse, support for abstinence may have to be developed. For this behavioral couples therapy (BCT) may be a solution. BCT involves both the recovering patient and their primary partner working together to build support for a fully abstinent lifestyle (O’Farrell & Schein, 2011). This methodology can also be used for any cohabiting partners of the recovering patient. BCT can be used to repair certain underlying issues in the relationship between a substance abuser and a non-drinking spouse. It has been efficacious in reducing certain social costs associated with alcoholism such as domestic violence and children who suffer from chronic psychological distress due to a parent's alcoholism.
The broader involvement of the family in the treatment of an recovering alcoholic is still being studied by treatment professionals. Evans, in a study of substance abuse and family involvement in the UK, notes that programs that involve relatives in recovery efforts are scant. Most programs in both the UK and the US are targeted on individuals with support provided by community based programs. As Evans notes, in order for families to provide positive support they may need support themselves. Indeed the impact that alcoholism can have on family life can be quite devastating. The longer the addiction lasts, the more dysfunctional the social network relationships will be around the alcoholic. Family members who live with an alcoholic notably suffer from feelings of loneliness, isolation, stress, guilt and depression. Therefore any support services that involve family members, in an alcoholic individual's recovery, will need to be group targeted rather than individually-focused.
In a study of specific social support for recovering alcoholics, Groh, Jason, Davis, Olson, & Ferrari (2007) contrasted the efficacy of general and specific social support networks of recovering alcoholics. The authors define general support as support for an individual's well-being and is found primarily in one's friends. It should be noted that friends, in this case, were developed by means of the treatment networks 12-Step programs. This general support is thus primarily found from amongst other recovering alcoholics. The influence of general social support on an alcoholic's recovery was found to be largely positive (Groh et al., 2007).
Specific support refers to one's family and friends from the pre-treatment period of the patient's life. The influence of this type of support could be positive, but the researchers found it was often quite negative. Indeed the best means for a full recovery by the alcoholic was to shed the pre-treatment era social networks that possibly enabled the disease after it developed. The authors found that relapse tended to be more likely for an individual that maintained contact with their specific social network members than for those that developed general support networks.
In conclusion, although the participation of family and friends in the recovery of alcoholics can be helpful, the literature has found opposite results. The optimum recovery chances for a patient involve an complete lifestyle shift. This shift typically involves removing the pre-treatment era social network from the patient's life. This network is in turn replaced with a new one built during the treatment and post-recovery phases. The research has found this new network to be far more beneficial to the patient's long term recovery prospects than the pre-treatment one. If the patient's pre-treatment family and friends are involved, then they should also be admitted to a treatment program. This ensures that any collateral problems that developed during their friend's or relative's addiction can also be addressed. It is not generally accepted that a recovering alcoholic's family can be that helpful in the recovery process otherwise.
Best, David, Jane Gow, Tony Knox, Avril Taylor, Teodora Groshkova & William White. (2012, May). Mapping the recovery stories of drinkers and drug users in Glasgow: Quality of life and its associations with measures of recovery capital. Drug and Alcohol Review, 31, pp. 334-341. DOI: 10.1111.
Bischof, Gallus, Hans-Jürgen Rumpf, Christian Meyer, Ulfert Hapke & Ulrich John. (2007). Types of natural recovery from alcohol dependence: A cluster of analytic approach. Addiction, 102, 904–908.
Groh, David R. Leonard A. Jason, Margaret I. Davis, Bradley D. Olson, Joseph R. Ferrari. (2007). Friends, family, and alcohol abuse: An examination of general and alcohol-specific social support. The American Journal on Addictions, 16, 49–55.
Kelly, John F. & Julie D. Yeterian. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health, 33(4), 350-355.
Misch, Donald A. (2009). On-campus programs to support college students in recovery. Journal Of American College Health, 58(3), 279-280.
O’Farrell, Timothy J. & Abigail Z. Schein. (2011). Behavioral couples therapy for alcoholism and drug abuse. Journal of Family Psychotherapy, 22, 193–215. DOI: 10.1080/08975353.2011.602615
Polcin, Douglas L., Rachael Korcha, Jason Bond, Gantt Galloway, & William Lapp. (2010, Aug.). Recovery from addiction in two types of sober living houses: 12-Month outcomes. Addiction Research and Theory, 18(4), 442-455. DOI:10.3109/16066350903398460.
Polcin, Douglas L., Gantt P. Galloway, Jason Bond, Rachael Korcha & Thomas K. Greenfield. (2010, Mar.). How do residents of recovery houses experience confrontation between entry and 12-month follow-up? Journal of Psychoactive Drugs, 42, 49-62.