title: Association between social influences and drinking outcomes across three years.
abstract: OBJECTIVE
  Multiple studies have shown social network variables to mediate and predict drinking outcome, but, because of self-selection biases, these studies cannot reliably determine whether the influence is causal or correlational. The goal of this study was to evaluate evidence for a causal role for social network characteristics in determining long-term outcomes using state-of-the-art statistical methods.
  
  
  METHODS
  Outpatient and aftercare clients enrolled in Project MATCH (N = 1,726) were assessed at intake and at 3, 6, 9, 12, and 15 months; the outpatient sample was also followed to 39 months. Generalized linear modeling with propensity stratification tested whether changes in social network ties (i.e., number of pro-abstainers and pro-drinkers) at Month 9 predicted percentage of days abstinent and drinks per drinking day at 15 and 39 months, covarying for Alcoholics Anonymous (AA) attendance at Month 9.
  
  
  RESULTS
  An increase in the number of pro-drinkers predicted worse drinking outcomes, measured by percentage of days abstinent and drinks per drinking day, at Months 15 and 39 (p < .0001). An increase in the number of pro-abstainers predicted more percentage of days abstinent for both time periods (p < .01). The social network variables uniquely predicted 5%-12% of the outcome variance; AA attendance predicted an additional 1%-6%.
  
  
  CONCLUSIONS
  Network composition following treatment is an important and plausibly causal predictor of alcohol outcome across 3 years, adjusting for multiple confounders. The effects are consistent across patients exhibiting a broad range of alcohol-related impairment. Results support the further development of treatments that promote positive social changes and highlight the need for additional research on the determinants of social network changes.
authors.affiliation: Pacific Institute for Research and Evaluation, Decision Sciences Institute, Pawtucket, RI, USA. stout@pire.org
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.forename: Molly
authors.initials: M
authors.lastname: Magill
authors.forename: Maria E
authors.initials: ME
authors.lastname: Pagano
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D010045:Outpatients; D011446:Prospective Studies; D012944:Social Support; D013695:Temperance; D013997:Time Factors; D016896:Treatment Outcome