Social Network Mechanisms of Behavior Change in Alcohol Use Disorder Recovery: A Longitudinal Observational Cohort Study

Social factors play a pivotal role in both development of and recovery from alcohol use disorder (AUD), and social network analysis (SNA) provides a rigorous framework to understand these influences. The current study applied SNA to understand recovery from AUD, with a secondary aim of examining sex differences in social network influences. A cohort of adults with AUD making a significant recovery attempt ( N  = 501) were followed over six waves during a one year period (83% retention) and completed assessments of egocentric SNA of their 20 closest alters and drinking behaviors. Hierarchical models run within a Bayesian imputation framework examined social network characteristics in relation to three recovery outcomes: abstinence, reduction in World Health Organization (WHO) drinking levels, and reductions in drinks/week. Follow-up analyses were stratified by sex. Three social network characteristics predicted abstinence: interaction frequency with alters, number of alters in mutual help organizations (MHOs), and number of family member alters. The latter two factors were also predictive of WHO drinking level and drinks/week. Alter heavy drinking days was negatively associated with reductions in WHO drinking level. Sex differences revealed greater network heavy drinking only impeded WHO level reductions for females, whereas having more MHO program members in one’s network only facilitated recovery for males. These findings reveal the importance of social networks, particularly the family, in AUD recovery. Results also highlight sex differences in how social networks influence recovery, with greater vulnerability to heavy drinking influences in females and greater benefit from MHO engagement for males.