Social Network Ties and Treatment for Alcohol Dependence

Background and Purpose: While effective treatments for alcohol dependence exist, only 28% of individuals with alcohol dependence seek treatment (Cohen, Feinn, Arias, & Kranzler, 2007). One reason why individuals avoid treatment is that alcohol consumption levels are not perceived as severe enough to warrant treatment (Kaskutas et al, 1997). Efforts to change perceptions of alcohol consumption emphasize a “systems-thinking approach,” suggesting that social interaction individuals have with others is a powerful determinant in perceptions concerning health (Pescosolido, 1992). Consistent with this approach, this study examines how social network ties influence the relationship between alcohol consumption levels and treatment use. It is hypothesized that among individuals with alcohol dependence: (1) High alcohol consumption is positively related to treatment use. (2) The strength of this relationship is moderated by social network ties, suggesting a high probability of treatment use for individuals with high alcohol consumption and many social network ties, and a low probability of treatment use for individuals with high alcohol consumption and few social network ties.

Methods: 1,433 respondents from Wave 2 of the National Epidemiological Survey on Alcohol Related Conditions (NESARC) with past-year alcohol dependence were assessed for past-year daily alcohol consumption levels, past-year treatment use of any type, sociodemographics, clinical characteristics, and social network ties. Social network ties are defined as a count of social groups for which individuals report participation within during the past 2 weeks. Bivariate analyses examined correlates of treatment use. Multivariate logistic regression analyses examined the moderating role of social network ties on the relationship between alcohol consumption and treatment use while adjusting for sociodemographic and other clinical variables. All analyses used sampling weights provided in the NESARC to obtain standard error estimates for the population.

 Results: Bivariate analyses showed individuals high in alcohol consumption, younger in age, with a past-year co-occurring drug use disorder, major depression, or anxiety disorder and men were most likely to seek treatment. Adjusting for sociodemographic and clinical variables, logistic regression analysis showed social network ties moderate the relationship between level of alcohol consumption and treatment use. The relationship between alcohol consumption and treatment use was much stronger among individuals with many network ties, compared to individuals with few network ties. To identify who is most likely to have few network ties and a high level of alcohol consumption, a post-hoc linear regression analysis examining predictors of social network ties, controlling for levels of alcohol consumption showed this group most likely to be individuals with low income and co-occurring drug use or anxiety disorder.

Conclusions and Implications: Results from this cross-sectional analysis suggest that individuals high in alcohol consumption with few social network ties represent an at-risk group where a need for treatment is high, but the probability of treatment use is low. From a social work practice perspective, these findings offer insight into populations to reach when designing interventions consistent with the federal goals within Healthy People 2020 to increase the number of individuals who seek treatment for alcohol-related problems.