The Impact of Social Support and Social Network Characteristics on Trauma Symptoms Among Violence Exposed Women with Substance Use Disorders

Background and Purpose: Women with substance use disorders (SUD) experience higher rates of violence exposure and post-traumatic stress symptoms (PTSS) than their non-substance using peers. Exposure to violence in women with SUD is associated with both PTSS and symptom severity, and leads to lower rates of treatment adherence, poorer treatment outcomes, and higher risk for relapse. The stress buffering hypothesis suggests that social support and social network relationships may mitigate the impact of violence exposure on the development of PTSS. However, little is known about the factors that might lessen the impact of violence exposure on PTSS among women with SUD. The purposes of this study were to examine the potential direct effects of social support, recovery specific social support, and social network characteristics on PTSS, and to examine these variables as potential buffers to the development of PTSS in response to violence exposure among women in treatment for substance use disorders. Methods: A sample of 375 women with SUD were recruited from three inner-city intensive treatment centers, in a midwestern city. Eligibility criteria for the original study required that women be at least 18 years old, speak English fluently, meet clinical criteria for SUD within the previous 12 months, have been in treatment for at least one week, and not been diagnosed with a major thought disorder. Using ordinary least squares regression, we sought to identify the direct effects of violence exposure, general social support, recovery specific social support, and social network composition on PTSS. Moderation was also examined using the Bootstrapping function in PROCESS macro for SPSS. Results: General social support (β=-.329, p<.001), recovery specific social support (β=-.154., p<.01) and greater duration of network relationships (β=-.146, p<.05) were associated with lower trauma symptom scores. Greater number of network members with whom participants felt very close was associated with lower trauma symptom severity (β=-.151, p<.01), and greater number of network members with whom participants had daily contact was associated with lower severity of trauma symptoms (β=-.196, p<.001). Recovery specific social network variables moderated the association between violence exposure and PTSS. Specifically, participants with a greater number of network members who did not use drugs or alcohol experienced lower trauma symptom severity across low, and moderate levels of violence exposure; participants with a greater number of network members with whom they had used substances experienced greater trauma symptom severity across low, moderate, and high levels of violence exposure. Conclusion and Implications: These data and previous research have identified that specific social network qualities are important to client functioning in relation to both recovery from SUD and from trauma symptom severity. While treatment providers tend to focus on proximal and concrete goals such as abstinence and mental health symptom reduction in SUD treatment programs, targeting the quality of interpersonal relationships within the client’s social network may be an important pathway through which substance use reduction, recovery, and symptom reduction occur. Maintaining social network relationships should be the focus of treatment interventions for women with SUD who have experienced violence.