The Influence of Formal and Informal Concrete Support On Discharge Disposition Among Women in Substance Abuse Treatment

Background and Purpose: Substance abuse treatment outcomes among female substance users are influenced by supports available from personal network members. Source of support may play an important role in women’s treatment outcome. The purpose of this study is to examine the specific impact of concrete (tangible) support from family (informal) and treatment related network members (formal) on discharge disposition.

Methods: Data were collected from 172 women who received treatment at three county-funded substance abuse treatment programs. Computer assisted personal interviews were completed at four time-points as part of a larger NIDA funded longitudinal study: at treatment intake and 1, 6 and 12 months post treatment intake. Discharge disposition (Completed treatment vs. Incompleted treatment) was obtained from county drug board administrative data. Personal network data, including family concrete support and treatment related network concrete support (professional helpers and peers from treatment /12step programs) were collected via EgoNet, a free network software program. Covariates included trauma symptom checklist, legal involvement, education, duration of substance use disorder, partners who are substance users, and partner sobriety support. Variables that were correlated to the outcome at p<.2 were considered as covariates.  Hierarchical logistic regression was performed to assess the relative contributions of family concrete support and treatment related network concrete support.  

Results: 54.7% of study participants identified as African American. The overall mean age of all participants was 37.6 years (SD=10.18).  The majority (77%) was dually diagnosed and 47.1% had not graduated from high school. Mean of trauma symptom scores was 47.86 (SD=22). Approximately 47% of participants had current legal involvement. Mean duration of substance use disorders was 7.15 (SD = 8.4) years. About 58 % of women had at least one partner and among that group, 40% had substance using partners and 45% received sobriety support from their partners. Mean number of treatment professionals was 1.23 (SD=1.9) and mean number of peers from treatment or 12 step program was 3.21 (SD=4.2) among the women’s identified 25 network members. More than half of the women (53%) completed treatment.  Hierarchical logistic regression analyses indicated that women with greater levels of treatment related network concrete support (OR=3.56, 95% CI = 1.59-7.97) and fewer trauma symptoms (OR=0.98, 95% CI= 0.96-0.99) were more likely to complete treatment. In addition, current legal involvement (OR=1.94, 95% CI= 1.002-3.75) was related to a greater likelihood of treatment completion. Treatment related network concrete support was statistically significant on substance abuse treatment completion while family concrete support did not indicate any statistical significance.

Conclusions and Implications: Findings indicate positive influence of concrete support from treatment professionals and peers on treatment completion among women with substance use disorders. While these findings need further replication, practice implications from this study indicate that providing resources and links to concrete services is an important component of substance abuse treatment.  Future research will examine differences in the nature of support provided by family vs. treatment related network members.