Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach.
The Community Reinforcement Approach (CRA) is an evidence-based practice for the treatment of substance use disorders (SUDs) and achieving and maintaining abstinence, but few studies have systematically explored the effect of CRA on secondary, yet also important, outcomes, such as social functioning.
This study was a secondary data analysis of CTN-0044, “Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders.” The purpose was to examine whether an internet-based version of CRA plus contingency management (Therapeutic Education System, TES) is associated with improved social functioning of individuals seeking substance use disorder treatment in a multi-site clinical effectiveness trial.
Social functioning was measured using the 54-item Social Adjustment Scale (SAS) assessing role performance in six domains (work, social and leisure activities, extended family relationships, marital relationship, parenting, and immediate family). Generalized linear mixed models tested the effects of treatment, time, sex, baseline abstinence, baseline social functioning and baseline psychological distress on overall social functioning and across social functioning subscales at the end of the 12-week treatment phase and three and six months post treatment.
Results showed no significant association between treatment and total social functioning score or any subscale scores. Being male, however, was significantly associated with better social functioning overall at the end of treatment (p=.024). Additionally, higher levels of psychological distress at baseline predicted significantly worse social functioning at the end of treatment overall (p=.037).
Conclusions: While TES was not associated with improvement in social functioning outcomes among participants when compared to TAU, male participants and those with less psychological distress at baseline experienced greater improvements in social functioning at the end of treatment. When integrating TES into community treatment programs, it may be important to have counselors involved to guide clients when choosing modules; completing home practice is also a critical factor in improving outcomes and should be monitored. In addition, improved measures of social functioning may be needed for studies involving patients with substance use disorders as more traditional secondary outcomes, such as social functioning and quality of life, should be more systematically studied in research involving treatment for substance use disorders.
Related protocols: CTN-0044