Ensuring Sobriety-Supportive Relationships

RESEARCH UPDATE

Proactively maintaining positive relationships is vital to maintaining sobriety in patients with substance use disorder (SUD), according to a recent multicenter Norwegian study.¹ Persons with SUD often have fewer social support resources than those without the disorder, and their existing social networks often are negative, marked by domestic violence and isolation. This scenario challenges maintaining sobriety.

General research on the subject shows that patients who struggle to recover need to change their social network to initiate and maintain sobriety.² Recent research, however, shows that the quality of the social network makes or breaks the will toward sobriety.³ Still, stable recovery from addiction has been the least studied phenomenon in substance abuse research, according to Petterson and colleagues.¹ In particular, few studies have been conducted on the abstinence experiences of persons with SUD and how their investment in recovery contributes to their path to stability. This data can play an essential role in determining what works and what does not in addiction care. The research team, therefore, devised a “narrative” exploratory study to get a real-world view of the role of social relationships in maintaining sobriety.

The study included 18 participants (10 men and 8 women) recruited from a longitudinal Norwegian cohort study called the Comorbidity Study: Substance Dependence and Co-occurrent Mental and Somatic Disorders (COMORB). These 18 were among 35 of 148 persons in the COMORB study who met the study criteria, the main one of which was maintenance of sobriety for at least 5 years post-SUD intervention.

The participants reported an active period of substance abuse of 13 to 36 years (average 21 years), followed by an abstinence period of 5 to 18 years (average 12 years). The substance of choice had mainly been heroin for 6 participants, alcohol for 5, amphetamines for 1, and cannabis for another. Five participants had a history of mixed use of several substances.

Semistructured face-to-face, hour-long interviews were conducted with these participants. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses.

In the interviews, each participant was asked to consider his or her experiences with abstinence from substance use, including decisions and reasons regarding abstinence or moderation and strategies and requirements for remaining abstinent.

The narratives were recorded and transcribed and then discussed and assessed by the peer consultants at meetings, which included the study participants who authored the narratives. Themes were systematically extracted from the content.

What the researchers learned from this exercise was that the relationships that were most helpful for initiating abstinence involved recognition by a peer or a caring relationship with a health service provider or sibling. Sibling relationships were, in fact, more useful and important than those with parents or partners, possibly because sibling relationships may tend to be more positive or neutral while those with parents or partners may have a more negative emotional impact. The study authors also pointed out that sincerely caring relationships with healthcare providers in which the healthcare provider does not compromise or blur the professional relationship were of great value to a patient’s effort towards sobriety.

Self-agency to protect oneself from the influence of negative relationships, connecting with others without feeling shame or guilt, keeping supportive people close, and being selective and discerning about who to converse with about one’s substance abuse experiences were key take-aways from the study.

Change of scenery, a commitment to “reinventing” oneself, and establishment of strict rules of engagement with one’s contacts-such as prohibiting friends from bringing alcohol to one’s home with a zero-tolerance policy for those who do-were successful techniques reported by study participants.

Given the findings, the study researchers recommended that SUD healthcare providers more rigorously factor in the patient’s familial and social network when designing treatment approaches and more closely focus on individualizing services to better support positive social support networks in recovering patients with SUD.

References:

1. Pettersen H, Landehim A, Skeie I, et al. How social relationships influence substance use disorder recovery: a collaborative narrative study. Subst Abuse. 2019;13:1178221819833379.

2. Davis, KE, O’Neill, SJ. Special section on relapse prevention: a focus group analysis of relapse prevention strategies for persons with substance use and mental disorders. Psychiatr Serv. 2005;56:1288–1291.

3. Weston S, Honor S, Best D. A tale of two towns: a comparative study exploring the possibilities and pitfalls of social capital among people seeking recovery from substance misuse. Subst Use Misuse. 2018;53:490–500.