Social identification and support withinthe Therapeutic CommunityGenevieve Dingle & Cassandra Perrymandingle@psy.uq.edu.auSchool of PsychologyThe University of QLD

Background• SUDs affect around 5% of the Australian

population, and follow a chronic relapsing course• Medical and psychosocial treatments are effective

yet rates of uptake are relatively low, and relapse following treatment is a common outcome

• Interest in what can be done to sustain abstinence after treatment?

Mutual support groups and social connections

•Moos (2007) Addiction: review of active ingredients in AA/NA groups highlighted:▫Bonding and support▫Obtaining an abstinence focused role model▫Doing service work

Analyses of Project MATCH data▫Kelly et al (2011) Addiction: (N=1726)

Among both out-patients and after care patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy

• Stout et al (2012) JSAD▫ Social network variables uniquely predicted 5-12%

variance in drinking outcomes across 3 years▫ AA attendance following treatment accounted for a

further 1-6% variance

Best et al (2012) DAR: recovery stories of 205 adults in Glasgow with history of alcohol and heroin dependence

•Greater engagement in meaningful activities was associated with better functioning, and

was associated with quality of life, followed by number of peers in recovery in the social network.

Litt et al (2009) JCCP:

• Apart from Litt et al, these studies were done retrospectively.

• Little is known about the process of social identity and network change during abstinence.

• Little is known about whether these changes relate to immediate wellbeing and treatment retention, or only to longer term (A&D) outcomes

Purpose of this study was to investigate this process in adults entering a Therapeutic Community

Key questions:1. How socially connected are people when

they enter the TC?2. How does social identification as a member

of the TC change over time?3. How does social inclusion within the TC

change over time?4. How do these things relate to life

satisfaction, and retention in the TC?

MeasuresDemographics and Relationships

• Addiction Severity Index 5th ed (McLellan et al 1992)Social identification (Doosje et al, 1995)

• E.g. - “I identify with other members of the Logan House community”

Social inclusion (Sheldon & Bettencourt, 2002) E.g. “To what extent do you feel a sense of belonging tothe community?”

Wellbeing – Satisfaction with Life Scale (Diener, 1985)▫ E.g. “In most ways my life is close to ideal”Retention in the TC (days)

Sample (n=99; ongoing study)Gender: 60% male, 40% femaleAge: average = 37 years (range 21 to 63 years)Ethnicity: • White Aust: 89%• Aboriginal / Torres Strait Is: 5.5%• Asian / Pacific Is: 5.5%Education: average 10.8 yearsEmployment: • Full time work 34%• Part time work 22%• Controlled environment 16%• Retired / disability pension 14%• Unemployed 12%• Student 2%

Substance use problems:

Alcohol to intox

Heroin

Methadone

Other opiates

Barbiturates

Other sedatives

Cocaine

Amphetamines

Cannabis

Hallucinogens

Inhalants

Polysubstance

0 2 4 6 8 10 12 14 16

Lifetime Use (years)

Q1. How connected are they when they enter the TC?

• Single (never married) 61%• Separated / divorced 24%• Married / stable relationship 11%

86% have no dependents

How do you spend most of your time?• 25% “With Family”• 29% “With Friends”• 44% “Alone”

45% of the sample live with someone with an alcohol or drug use problem65% experienced serious relationship conflict in past 30 days96% experienced serious relationship conflict in lifetime

Q2. How does social identification as a member of the TC change over time?

Entry 4 weeks 6 weeks 8 weeks 10 weeks

Exit01234567

Identify_TC Identify_Old

Identification with the TC increased over time:

F(3)=4.014, p=.01

No significant change in identification with Old / Drug using networks

Identif with Old network at Exit related to retention: r= -.767, p=.002

Q3. How does social inclusion change over time?

Entry 4 weeks 6 weeks 8 weeks 10 weeks

Exit14

15

16

17

18

19

PNS_Inclusion

F(3)=5.852, p=.001

Q4. How do these things relate to life satisfaction, and retention in the TC?

Entry 4 weeks 6 weeks 8 weeks Exit0

5

10

15

20

25

SWLS

SWLS

Life satisfaction increased over first 6 weeks:

F (2)=3.738, p=.03

Social Inclusion related to SWLS at Entry:

r =.253, p< .05

Social Inclusion not related to retention (days)

Summary

• Residents of TC are socially isolated sample• They quickly form strong identification / inclusion as member of

the TC• Identification with old substance using networks is lower and

doesn’t change over time• Relationship between social inclusion and life satisfaction at

entry to TC• Lack of relationship between social id / inclusion and retention in

the TC• Retaining old ties is related to shorter retention time• Need to reanalyse when larger N!

Huge thanks to....Residents who participated in the study.Managers Dave Warby, Ivor Shaw, and the Staff of Logan HouseUQ research team: Alex Short, Glynn Chambers, Julieta Castellini, Lynndall Dwyer