Personal Social Networks and Relapses in Women with Substance Dependence: Application of the Theory of Planned Behavior

Background: Establishing positive network resources and rebuilding drug-free networks are critical components of recovery for women with substance use disorders (SUDs). Theory of planned behavior (TPB) posits that behaviors are determined by behavioral intentions, which are determined by three factors: attitude toward the behavior, subjective norms, and perceived behavioral control. This study applied TPB to examine whether women’s personal social network characteristics (as subjective norms) were related to intentions towards, and/or a relapse to, substance use using a prospective design. Most studies showing TPB to be effective in predicting substance use have been limited by use of cross-sectional or retrospective research designs.

Methods: Women with SUD who received treatment at three county-funded, women-only intensive treatment programs (N = 300), were interviewed at intake and at follow-ups 1, 6, and 12 months later. Three constructs- attitude (problem recognition), perceived behavioral control (abstinent self-efficacy), and subjective norms (personal network characteristics)- were examined as predictors of intentions towards substance use and relapses to substance use. Relapse was measured at 12 months post treatment intake via self-report. Substance use attitude (α = .81) and abstinent self-efficacy (α = .97) were assessed at one-week post treatment intake. Subjective norm and intention to use were assessed at 6 months post treatment intake. Subjective norms were operationalized with three network variables: number of professional/treatment-related network members, the number of people providing sobriety support, and network density (the ratio of the number of present ties divided by all possible ties among network members). Intention to use was assessed as the number of times attending self-help groups, like 12-step meetings, in the past 30 days.

Results: Approximately 30% (n = 86) of the participants were in relapse of substance use at 12 month. Results from Bayesian estimation path analysis indicated that attitude and self-efficacy at intake were not related to intention, but self-efficacy was directly related to relapses to substance use by the 12th month after intake. Higher number of network members providing sobriety support was related to lower intentions at six months (β = - .06, p < .01). An interaction between the number of treatment-related persons and density on intention was found (β = .13, p < .01). Higher density strengthened the positive relationship between the number of treatment-related persons in the network and intentions. The intention towards substance use was related to a relapse to substance use at 12 months (β = .31, p < .01). The estimated model explained 17.4% of variance in relapse, χ² = 1433.69 (df = 572, p < .001, CMIN/df = 2.506), CFI = .90, TLI = .88, and RMSEA = .06.

Conclusions: The current study supports application of the TPB in understanding relapse to substance use and the utility of personal social networks in predicting relapse. TPB-based interventions focusing on building social network that are cohesive with more treatment-related members and with sobriety support may enhance treatment outcomes of women with SUDs.