Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach

Abstract

Background: The community reinforcement approach (CRA) is an evidence-based practice for the treatment of substance use disorders 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. Objectives: The purpose of this study was to examine whether an internet-based version of the CRA plus contingency management is associated with improved social functioning of individuals seeking substance use disorder treatment in a multi-site clinical effectiveness trial. Methods: Social functioning was measured using the 54-item Social Adjustment Scale 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 3 and 6 months post treatment. Results: Results showed no significant association between treatment and total social functioning score or any subscale scores. Being male was significantly associated with better social functioning overall at the end of treatment (p = .024). Higher levels of psychological distress at baseline predicted significantly worse social functioning at the end of treatment overall (p = .037). Conclusions: The addition of an internet-based version of the CRA was not associated with greater improvements in social functioning compared to standard outpatient care after 12 weeks of treatment. Implications for internet-delivered CRA are discussed.

Keywords:

• Community reinforcement approach
• contingency management
• substance use disorders
• social functioning
• technology-assisted interventions

Declaration of interest

Dr. Nunes has received medication for research studies from Alkermes/Cephalon, Duramed Pharmaceuticals, and Reckitt-Benckiser. The other authors report no financial relationships with commercial interest.

Additional information

Funding

This work was supported by grants from the National Drug Abuse Treatment Clinical Trials Network (CTN), NIDA: U10 DA013035 (Edward V. Nunes and John Rotrosen), U10 DA015831 (Kathleen M. Carroll and Roger D. Weiss), U10 DA013034 (Maxine L. Stitzer and Robert P. Schwartz), U10 DA013720 (José Szapocznik and Lisa R. Metsch), U10 DA013732 (Theresa Winhusen), U10 DA020024 (Madhukar H. Trivedi), U10 DA013714 (Dennis M. Donovan and John Roll), U10 DA015815 (James L. Sorensen and Dennis McCarty), U10 DA013045 (Walter Ling), and K24 DA022412 (Edward V. Nunes).