“by the Company She Keeps”: Client and Provider Perspectives of Facilitators and Barriers to Personal Network Change for Women in Treatment for Substance Dependence

Purpose:  Previous research has identified that women with substance use disorders (SUD) tend to have small support networks (Savage & Russell, 2005), to be surrounded by a substance using network members, to lack support to remain in treatment (Kissin, Svikis, Morgan & Haug, 2001), and to lack support for sobriety within their networks (Majer, Jason, Ferrari, Venable, & Olson, 2002). While social support may be beneficial to individuals’ well-being, interpersonal relationships contain potential risks (Lincoln, 2000); Sun (2007) reported that women with SUD perceived interpersonal conflicts with intimate partners and family members as major relapse triggers.  This study examined the experiences of women in treatment for SUD and their clinicians regarding personal networks and recovery over time.  The following questions were examined: 1. What personal network qualities were important for women in maintaining recovery over time?; 2.  How did their personal networks influence their treatment and recovery maintenance both positively and negatively?; and 3. What barriers to creating network changes did women encounter during treatment and post treatment?

Methods:  This study was part of a larger NIDA funded longitudinal study.  Six focus groups using purposive sampling were conducted at three agencies currently enrolled in the larger study.  Three groups of agency clinicians (N=21) and three groups of women in treatment from each agency (N=15) were conducted.  Procedures outlined by Kruger & Casey (2009) for planning the focus groups, developing questions, and facilitating groups were utilized.  Responses were audio taped, transcribed and entered into Atlas ti.  Thematic analysis guided the data coding and four coders used an iterative process to identify major themes.  Participants consented to audio taping, and university IRB approval was obtained prior to data collection. 

Results:  Important qualities in network relationships included reciprocity, mutual trust, positive influences beyond sobriety, and honesty.  Positive personal network influences included having members who were also in recovery, “positive people” who encouraged larger life changes beyond abstinence, and having family members who supported both treatment involvement and recovery.  Negative influences included network members who encouraged substance use; women reported that “negative individuals” who “gossip” and “lie” triggered negative mood states and potential relapse.  Barriers to network changes included limited community resources, limited personal resources such as money and transportation that decreased opportunities to meet more and different people, and persistent difficulties in trusting new people due to histories of abuse and betrayal.  Clinicians identified similar themes as the women themselves, but appeared most concerned with limitations in community resources and service networks that limited options for women to engage in healthier personal network relationships.

Conclusion:  These findings highlight both helpful and detrimental characteristics of social networks to recovery for women with SUD and facilitators and barriers to making network changes. Effective interventions with this population might focus both on internal barriers to personal network change such as mistrust and fear and environmental barriers such as limited community resources and limited concrete resources such as transportation.  Future research might evaluate the effectiveness of social network interventions to long-term recovery for women with SUD.