CHAMPAIGN, Ill. - The National Institutes of Health has awarded a $712,000 grant to a University of Illinois researcher who is developing a program to help young adults with alcohol problems stay in treatment and recover with help from their friends.
Douglas C. Smith, a professor in the School of Social Work at the U. of I. and a licensed social worker, is developing a cognitive behavioral treatment called the Peer-Enhanced Community Reinforcement Approach. It is an adaptation of CRA, a treatment shown to be effective with adolescents and older adults that strives to make a sober lifestyle more appealing than continued substance abuse by including clients' family members in the treatment process to provide social support and positive reinforcement for sober behaviors.
Rarely do clinical researchers integrate friends in alcohol treatment, despite evidence that social support is critical to curbing problem drinking, Smith wrote. The peer-enhanced CRA study will be among the first to investigate the efficacy of including friends in clients' treatment to support non-using behaviors, participate in non-alcohol-related activities with them and intervene if the client relapses or discontinues treatment.
Alcohol misuse often peaks in emerging adulthood, defined as the 18-25 year age range, yet few treatments are geared to the needs of this population.
Emerging adults account for about a fifth of all publicly funded outpatient admissions, and they tend to have poorer treatment retention and post-treatment outcomes than younger adolescents or older adults receiving the same treatment.
Accordingly, most studies on emerging adults with alcohol problems have focused on middle class college students - although the majority (53 percent) of alcohol abusers in that age group are not students.
"Treatments that are developed specifically for college students may not be applicable to those emerging adults found in publicly funded treatment centers," who tend to be ethnic minorities, exhibit less academic and social competence, experience rockier transitions to adulthood, and have higher rates of psychiatric illnesses and familial histories of alcohol abuse than college students, Smith wrote.
"Young adults have the highest alcohol and drug use, but it tapers off as they get older," typically after they take on adult roles as spouses and parents, Smith said. "It is really hard to tell which young adults will continue on to have chronic alcohol problems and which will not, so using a treatment approach that does not assume that all alcohol-dependent individuals will always be alcoholics may be attractive to young adults."
Studies indicate that young adults with alcohol dependence face some difficult challenges: They are more likely to live with people and have peers that abuse alcohol or drugs, and are more likely to engage in social activities that encourage drinking. While some are able to find social support in self-help groups such as Alcoholics Anonymous, many choose not to go AA's 12-step route, perhaps because they find few peers their age to identify with at meetings or because they disagree with the groups' philosophy of lifelong abstinence, Smith said.
Emerging adults may need specialized treatment that takes into account their unique social milieu and offers alternate forms of support. Ongoing support from same-age, non-using peers whom they already know may be more effective at retaining people in treatment and teaching them to find alternatives to drinking than programs that require them to cultivate new relationships, Smith said.
Sixty clients for the study are being selected from young adults ages 18-25 that seek publicly funded treatment for alcohol-use disorders or binge drinking through Prairie Center Health Systems' outpatient clinic in Champaign, Ill. Those who meet the study's criteria and agree to participate will be asked to identify a same-sex friend in their age group with whom they have contact at least weekly, who they believe is supportive of their recovery and may be willing to participate in three individual or joint counseling sessions.
The clients will be asked to commit to abstinence for the duration of treatment, which will be delivered in 12 sessions over a three-month period. The peers may be light or moderate alcohol users, which, for the purpose of the study, are defined as not having used alcohol or other drugs more than 12 days during the prior 90 days. If the peer is found to meet the diagnostic criteria for a substance abuse disorder during the assessment process, they may still be able to participate in a support role for the client, but only if they agree to complete treatment themselves.
The friends' counseling sessions comprise an initial assessment of their and the clients' motivations and readiness for change, an examination of the client's alcohol use patterns, techniques for reinforcing clients' pro-social and help-seeking behaviors, and an optional session about relapse prevention and re-engaging the client in treatment if he resumes drinking or drops out. Clients' treatment will include identifying the rewards of sobriety, practicing refusal skills, identifying and engaging in pleasurable activities that compete with alcohol use and job skills training.
"We're going to encourage the peer to hang out with the client a lot, but only when they're not drinking or using drugs," Smith said. "We want to work with the peer to understand that they can play an important role in whether their friend reduces their use by rewarding abstinence."
As an incentive for the pairs to engage in pro-social recreation and attend all counseling sessions, they have opportunities to earn recreation vouchers, in addition to incentives for completing individual components of the study.
The clients and their friends will be interviewed at three months and six months after treatment to assess retention rates, participants' and peers' alcohol and drug use over time, their participation in alcohol- and drug-free social activities, clients' perceptions of treatment appropriateness, peer behaviors that supported sobriety or discouraged drinking and whether peers were beneficial or detrimental to the treatment process.