Family & friends in social networks: us & them
the US....or Some Thoughts on Families and
Social Networks based on UKATT data
New Directions in the Study of Alcohol Group – Alcohol Spills Over –
Birmingham, 37th Annual International Conference – April 2013
Aims for my presentation
To provide an overview of social network composition of
people entering alcohol treatment using UKATT IPA data
To use UKATT data on who are the most important people for
those with alcohol problems entering treatment to provide a
very cautious estimate of number of significant others affected
by alcohol problems
To explore the potential role of friends (drinking and nondrinking) in influencing outcomes from alcohol treatment –
describe previous work and some preliminary analyses
Finally I will briefly mention 3 trials I am involved in testing in
some way social network interventions as a form of help for
people using substances
UKATT Research Team (Principal
Investigators)
•
•
•
•
•
•
•
•
Alex Copello
Christine Godfrey
Nick Heather
Ray Hodgson
Jim Orford
Duncan Raistrick
Ian Russell
Gillian Tober
West Midlands
York
Newcastle
South Wales
Birmingham
Leeds
York/Bangor
Leeds
Seventy five percent of the UKATT PI Network
Important People and Activities Inventory (IPA) Clifford and Longabaugh, 1991
IPA asks the participant to nominate up to 10
people with whom the client has spent most time
in the last 3 months. Then it also asks to indicate
the 4 most important from those nominated.
IPA then collects detailed information about each of
these people e.g. frequency of contact, drinking
frequency and quantity, how much the person is
liked, how encouraging and supportive of not
drinking and coming to treatment
Participants entering the UKATT trial were asked about the people they had
spent most time with over the previous three months (aged at least 12 years
old). They named these ‘important’ people and described each of them using
demographic and drinking-related characteristics.
Overall 4677 important people were named. All 740 participants could name
at least 1 important person; the highest number named was 12. Participants
could most frequently name 10 people, and the mean number named was 6.5
(standard deviation 3.6).
This graph shows numbers of important people named by participants:
120
Participants
100
80
60
40
20
0
1
2
3
4
5
6
7
8
9
10
11
12
Important people
Participants then decided which of these people were the four most important
and listed them in order.
The four most important people: how were they
related to focal drinkers?
This graph shows how the participants were related to their four most
important people. Percentages of named relationships are shown for the 1st,
2nd, 3rd and 4th most important people to the focal drinker:
70
partner/ex-partner
60
50
40
fam ily eg. child, parent,
s ibling
30
friend
20
other
10
0
1s t
2nd
3rd
4th
The majority of focal drinkers named their partner as their most important
person, although family members were also a frequent choice. Very few focal
drinkers named their partner as least important person of the four. Members
of close family were frequently named as second or third most important, and
friends were commonly named as third or fourth.
Who were the most important family members?
Relationships of important people to focal drinkers could be further broken
down into relationships of family members. This graph shows percentages
of type of family member (from overall relationship) who were named as
each important person:
25
20
children
15
parent
s ibling
10
other/family
5
0
1s t
2nd
3rd
4th
Parents were most frequently named as first and second most important,
children as second or third most important, and siblings as third most
important. Other family members were more likely to be named as the fourth
than as the most important person.
Were important people male or female?
The most important person named by focal drinkers was more commonly
female; two-thirds of people named were female (66.58%) and a third
were male (33.42%). The second, third, and fourth most important people
named by focal drinkers were equally likely to be either male or female.
Graph showing
percentage of
males and
females that
were named
as each
important
person (1st,
2nd, 3rd, or 4th
most
important):
70
60
50
40
male
30
female
20
10
0
1st
2nd
3rd
4th
How often were they seen by the focal drinkers?
Participants saw their most important person frequently, with over half
(58.92%) seeing them every day. Many also saw their second most important
person every day (34.51%). The third most important person was most
frequently seen 3-6 times a week (32.71%). Fourth most important people
were often seen 1-2 times a week (34.52%) or 3-6 times a week (32.45%). It
was rare for any important people not to have been seen in the past 3 months
(under 1% for each person).
70
60
50
40
30
20
10
0
1st
2nd
not at all in past 3
months
once in past 3
months
less than monthly
about once a month
every other week
1-2 times a week
3-6 times a week
every day
3rd
4th
What was their drinking status?
All four important people were most often considered ‘light drinkers’. They were
also more often moderate drinkers than abstainers, although abstainers made
up 16.8% of four most important people. The most important people were the
most frequent abstainers (20.84%), and the least frequent heavy drinkers
(10.83%).
This graph shows the percentages of important people (1st, 2nd, 3rd and 4th)
who fell into each drinking category:
45
40
35
30
25
20
15
10
5
0
1st
2nd
3rd
4th
recovering abstainer
alcoholic
light
drinker
moderate
drinker
heavy
drinker
don't know
How often did they drink alcohol?
Important people often drank regularly. All important people most commonly drank
alcohol ‘1-2 times a week’, although the most important people less frequently
drank ‘1-2 times a week’ (24.22%) than the others. The most important people
were also described as having ‘not drunk alcohol in the past 3 months’ more
frequently than were the other three people. Second and third most important
people were the most frequent daily drinkers (17.46; 17.21%).
This graph shows percentages of important people (1st, 2nd, 3rd, 4th) in each
drinking category:
30
25
1st
20
2nd
15
3rd
10
4th
5
0
not in
past 3
months
once in
past 3
months
about
once a
month
about
every
other
w eek
1-2 times 3-6 times
per
per
w eek
w eek
daily
don't
know
How much were they liked by the focal drinkers?
60
50
1s t
40
2nd
30
3rd
20
4th
10
0
totally
liked
very
m uch
quite a
bit
m ixed
feelings
dis liked
dis liked
a lot
totally
dis liked
How important were they to the focal drinkers?
60
50
1s t
40
2nd
30
3rd
20
4th
10
0
extrem ely
im portant
very
im portant
im portant
s om ewhat
im portant
not very
im portant
not at all
im portant
How did they react to the focal clients’ drinking?
60
50
1st
40
2nd
30
3rd
20
4th
10
0
left or made you
leave
didn't accept
neutral
accepted
encouraged
don't know
How did they react to them not drinking?
70
60
50
1st
40
2nd
30
3rd
20
4th
10
0
left or made
you leave
didn't accept
neutral
accepted
encouraged
don't know
How did they feel about the focal drinker getting alcohol
treatment?
Important people rarely opposed treatment. The most important person was
particularly supportive (78.89% supported treatment), and even fourth most
important people were predominantly supportive (53.18%). Just over 10% of all
important people felt neutral towards treatment. The third and fourth most
important people were more likely than the first/second not to know about
treatment.
This graph shows the percentages of important people (1st, 2nd, 3rd and 4th who fell
into each category:
90
80
70
60
50
40
30
20
10
0
1st
2nd
3rd
4th
opposes
treatment
mixed
neutral
supports but supports
prefers
treament in
alternative this program
doesn't
know
So, overall....
• Participants recruited to UKATT had people in
their social networks
• Based on participants’ reports, most had
people in their networks that did not have
alcohol problems
• Most had people in their networks that were
supportive of the focal client’s treatment
Day, Copello, Chohan et al., 2012. European Addiction Research
Opiate Substitution Treatment in the UK
118 participants identified a total of 820 network members
Mean network size was 6.9.
Of this group,
47
378
97
189
16
51
42
(6%) were sexual partners
(46%) immediate family members
(12%) extended family members
(23%) friends
(2%) colleagues from work
(6%) treatment professionals or members
of self-help groups
(5%) others
So, two thirds of the social network was made up of family members
Social Behaviour and Network
Therapy
SBNT involves bringing members of the focal drinker’s social
network into their treatment. The UKATT data indicated that
all 740 participants had at least one person who was
important to them.
SBNT requires that these people be:
1. free from alcohol problems
2. in regular contact with the focal drinker
Further analysis of the data suggested there were 716 focal
drinkers with an important person who drank no more than
moderately, and who they saw at least weekly.
This means that approximately 96.7% of all focal drinkers
entering UKATT may have had a potential network member.
Orford (Potential Supportive Network
Members)
• Detailed analysis of 50 cases of UKATT
• 39 (78%) had at least one IP judged Definitely
Suitable (14 had 1; 13 had 2; 11 had 3 and 1
had 4)
• 9 (18%) others with al least one IP judged
Probably Suitable
• 2 (4%) others with one IP judged Possibly
Suitable
Important People
Can we have a go at estimating
numbers of people affected by those
entering UK treatment and who they
are?
The most important people likely to be
affected
For 740 clients entering treatment for alcohol problems:
Of the four most important people nominated:
Included those people who had daily contact with the
focal drinker
Excluded those people who were ‘heavy drinkers’
themselves or the drinking status was ‘unknown’
1st Imp.Person 397 (45 exc.)
2nd Imp.Person - 205 (40 exc.)
3rd Imp.Person 140 (21 exc.)
4th Imp.Person – 84
(21 exc.)
Total
826 (127 exc.)
The 4 most important people who have daily contact
with the focal drinker
Chart Title
500
450
400
350
300
heavy drinkers
250
Non-heavy drinkers
200
150
100
50
0
1st IP
2nd IP
3rd IP
4th IP
This suggests that a very cautious
estimate of people significantly
affected
• For every person walking through the door of
an alcohol treatment agency on average
slightly more than one other person can be
significantly affected
• For 740 focal drinkers 826 significant others
are affected
• Of the 826: 686 (83.05%) are family members
and 140 (16.9%) friends
Categories of family members who were not heavy drinkers
and had daily contact with the focal drinker (N = 686)
300
270
250
200
Partners
156
Children >12
146
150
Parents
Siblings
Other family
100
58
56
Siblings
Other family
50
0
Partners
Children >12
Parents
Those with whom the focal client had
daily contact and were heavy drinkers
Family Members
Friends
Adult Family Members Affected.
Illegal Drugs - UKDPC work.
What is the extent of the problem?
•
Drug treatment
population
General
population
50,373 partners
55,012 parents
35,208 ‘other’
573,671 partners
610,970 parents
259,133 ‘other’
•
•
•
Total = 140,593 Total =1,443,774
Key findings from UK DPC study
about adult family members of
drug misusers.
What about alcohol misuse?
Up to 1 million children are
affected by parental drug misuse
& up to 3.5 million by parental
alcohol misuse (Manning et al.,
2009).
It is estimated that the impact of
drug misuse on the family costs
the UK £1.8 billion but also
brings a resource saving to the
NHS of £747 million through the
care provided.
Estimates of adult family members affected in
alcohol treatment population
UKDPC drugs estimate – using treatment figures -2009
50,373 partners
(35.8%)
55,012 parents
(39.1%)
35,208 ‘other’
(22.04)
_____________________________________________
Total = 140,593
UKATT alcohol estimate – using treatment figures – 2011-12
46,200 partners
(43.8%)
20,818 parents
(19.7%)
22,249 sons-daughters over 12
(19.2%)
16,256 ‘other’
(15.4%)
______________________________________________
Total = 105,523
Overall proportion of
family-focused practice – increases after targeted
program of work within an organisation
(from Claire Hampson’s work)
% family-focused practice
*
*^
34
26
19
Baseline (117/611)
Training & Supervision period
(108/410)
Post-intervention (257/765)
*Significantly greater than baseline. ^Significantly greater than training period.
...and finally, the issue of social
support....
Boca Juniors stadium - Argentina
The addition of just one alcohol
abstinent person to the social network
may increase the likelihood of
abstinence by 27% (Litt et al., 2007).
‘Getting by (or getting high) with a little help
from my friends’....(Mohr et al., 2001; Journal of
Studies on Alcohol)
To evaluate friendships:
• Boyfriends, girlfriends, spouses and family members
were excluded.
• Friends were then categorised according to drinking
status (moderate or heavy as ‘drinking friends’ – other
categories as ‘non-drinking friends’)
• Proportion of drinking and non-drinking friends in the
network – number of friends divided by total network
members
• This was done for the total number of friends and for
the friends amongst the four most important people
• Finally, variables for ratings of liking and importance of
drinking and non-drinking friends were created
MATCH
Drinking Friends
Non-drinking Friends
Baseline
9-month
Baseline
9-month
% of friends in the
total network
24.63
17.98
23.03
33.37
Years known friends
9.28
10.24
9.08
8.61
Amount of contact
5.40
5.20
5.48
5.32
Of all people in the
network
UKATT
Drinking Friends
Of all people in the
network
% of friends in the
total network
Years known
friends
Amount of contact
Non-drinking Friends
Baseline
12-month
Baseline
12-month
23.1
22.4
17.0
20.7
10.5
11.1
8.8
9.7
5.39
5.19
5.37
5.14
Amount of contact: 0 = not at all, 1 = once in past 6 months, 2 = less than monthly, 3 = once a month,
4 = every week, 5 = 1-2 times/week, 7 = daily;
MATCH
Drinking Friends
Of the 4 most
important people
% of friends in 4
most important
people
Liking of friends
Importance of
friends
Non-drinking Friends
19.00 (23.53)
14.81 (23.21)
19.85 (23.51)
21.47 (27.05)
5.42 (1.10)
5.77 (1.05)
5.74 (1.01)
5.85 (1.05)
4.00 (1.10)
4.54 (1.14)
4.41 (1.08)
4.70 (1.12)
UKATT
Drinking Friends
Of the 4 most
important people
% of friends in 4
most important
people
Liking of friends
Importance of
friends
Non-drinking Friends
Baseline
12-month
Baseline
12-month
17.5
15.6
13.1
14.3
5.61
5.91
5.85
5.97
4.04
4.88
4.50
4.79
Liking: 1 = totally dislike, to 7 = totally like. Importance: 1 = not at all, to 6 = extremely.
Mohr et al, 2001 –Summary of findings
• Those participants who continued to have a higher
proportion of drinking friends and higher proportion of
important drinking friends at follow-up drank more
drinks per drinking day (DDD) than those who reduced
the proportion of drinking friends.
• Those participants with a higher proportion of nondrinking friends at follow-up showed a reduced
number of drinks per drinking day and that a higher
rated importance of non-drinking friends from baseline
to follow-up was associated with increased proportion
of days abstinent at follow-up.
Are friends important for drinking
outcomes?
With Dr Ed Day and Dr Clare Mackie (IoP)
As a first step we have done a replication of the Mohr et
el. analyses. Using the whole sample (N = 735) we
examined whether 12 month friendships can mediate
the relationship between baseline friendships and
follow-up drinking by testing 4 models. MPLUS was used
to test the models and to deal with missing data with a
method that involves estimating the model with
maximum likelihood (assuming that the data is missing at
random) which uses all the available data in the model to
provide the covariance/regression estimates, without
imputing the data
So far....
• Model 1: Proportion of drinking friends as a mediator with DDD
and then PDA as outcome variables
• Model 2: Proportion of non drinking friends as a mediator with
DDD and then PDA as outcome variables
• Model 3: Proportion of important drinking friends as a mediator
with DDD and then PDA as outcome variables
• Model 4: Proportion of important non-drinking friends as a
mediator with DDD and then PDA as outcome variables
Control variables
* Baseline drinking variables: DDD and PDA
* Treatment condition (MET or SBNT)
* Demographics: age, gender, marital status, education, ethnicity
Proportion of drinking
friends – follow-up
Proportion of drinking
friends - Baseline
Percentage Days
Abstinence - PDA
What we found so far....
Of the 4 models tested the only significant
mediation models involved proportion of
drinking friends and proportion of important
drinking friends on PDA at 12 months
Current Research Studies with family and social
network components in Birmingham and
beyond....
• NIHR - HTA 11/60/01 Adaptation and feasibility study
of a family and social network intervention for young
people misusing alcohol and drugs. £528,563. 30
months from 06/13.
• NIHR - A pilot study of a social network intervention for
heroin users in opiate substitution treatment. NHS
Research for Patient Benefit. £250,000. 3 years from
01/12.
• NIHR - A study to assess the Feasibility and impact of a
motivational intervention on problem drug and alcohol
use in adult mental health in-patient units. NHS
Research for Patient Benefit. £234,269. 2 years from
06/12.
Thank you for listening…
‘Despite the recognition of carers’ needs and the growth of carer organisations,
however, there is a rather limited evidence base assessing the impact on carers
and families of people who misuse drugs and on interventions intended to
support them, and even less attention given to the needs of families and carers in
their own right.’
Nice 2008.