Correlates of Social Support Among Clients of a Methadone Clinic Serving Small Urban and Rural Communities

Background and Purpose: Social support from family, friends, and others promotes retention in treatment, longer durations of abstinence, and other positive outcomes for those in substance use disorder treatment (Cavaiola et al., 2015; Min et al., 2013). Social support is especially critical for individuals undergoing methadone maintenance treatment for opioid use disorder, due to stigmatization of this treatment modality. Studies have shown that the benefits of social support can persist at least five years after treatment initiation (Flynn et al., 2003). However, little is known about social support for those in methadone maintenance treatment in small urban and rural areas. In these smaller communities, the availability of medication treatments is often limited and negative attitudes toward medication treatment are common (Lister et al., 2019). The present study examines factors associated with social support among adults receiving methadone maintenance treatment, specifically from small urban and rural communities in a Midwestern state.

Methods: Adults 18 and older (N=267) were recruited at a methadone clinic in a small Midwestern city to complete an electronic survey. Participants were offered assistance as needed (e.g. due to vision, technology or reading challenges). Surveys assessed two measures of social support, the Social Support for Recovery Scale (min. score=9, max. score=36) (Laudet et al., 2000) and the Friends’ Support for Recovery Scale (min. score=8, max. score=40) (Humphreys et al., 1999), and potential correlates of social support. Multiple imputation was used to handle missing data. Linear regression was used to assess the association between social support and demographic variables, feelings of shame related to receiving methadone maintenance treatment, the frequency of hearing negative comments about receiving methadone maintenance treatment, and past-year opioid use.

Results: Mean social support for recovery was M = 25.38 (SD = 5.28) and mean friends’ support for recovery was M = 25.91 (SD = 5.33). The sample was 59.6% female, 40.4% male; 85.0% White, 15.0% non-White; and mean age was 38.51 years (SD = 9.95). 77.5% had at least a high school diploma, and 48.3% had used non-prescribed opioids in the past year. Male gender (β = -.1.39, p = .03), past-year shame (β = -.27, p = .01), and the frequency of hearing negative comments about methadone treatment (β = -.37, p = < .001) were significantly associated with recovery support. Past-year shame (β = -.27, p = .02) and the frequency of hearing negative comments about methadone treatment (β = -.27, p < .001) were significantly associated with support from friends. Age, race, education, and past-year opioid use were unrelated to either outcome.

Conclusions and Implications: Clients with stronger feelings of shame and who more frequently hear negative comments about methadone maintenance treatment may also have lower levels of social support. These clients may be particularly vulnerable and need additional supports to maintain recovery. Interventions designed to enhance social support among individuals in methadone maintenance treatment may want to also address shame and internal stigma. Those with higher levels of shame may benefit from interventions that address this feeling.