Social networks and their influence on drinking behaviors: Differences related to cognitive impairment in clients receiving alcoholism treatment

Objective: Mechanisms of behavioral change that support positive addiction treatment outcomes in individuals with co-occurring alcohol-use disorders and cognitive impairment remain largely unknown. This article combines person- and variable-centered approaches to examine the interrelated influence of cognitive impairment and social support on stability of and changes in drinking behaviors of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatients and aftercare clients (N = 1,726) during the first year after their entry into treatment. Method: Latent class analysis identified homogeneous groups of clients based on the nature and extent of social support for abstinence or drinking at treatment entry. Cognitive impairment and drinking outcomes were compared across latent classes, and the interaction between impairment and social support on drinking outcomes was examined using mixture probit regression. Results: Three independent social support classes (frequent positive, limited positive, and negative) were identified. In the outpatient sample, the frequent positive support class had greater cognitive impairment at treatment entry versus other classes, and extent of impairment significantly predicted improved drinking outcomes in this class. In the aftercare sample, the frequent positive and negative support classes had heightened impairment, yet cognitive impairment significantly predicted relatively poorer drinking outcomes in the negative support class only. Conclusions: Cognitive impairment may increase the influence of the social network on the drinking outcomes of persons receiving treatment for alcohol-use disorders, but more research is needed to understand client characteristics that determine whether this influence is more likely to be manifest as increased salience of helping agents or of hindering agents in the social network.