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Network Support Treatment (NST) for Alcohol Dependence

Network Support Treatment (NST) for Alcohol Dependence is a manual-driven, one-on-one outpatient treatment designed to help clients achieve alcohol abstinence. Over 12 60-minute sessions, NST therapists work with clients to increase their participation in Alcoholics Anonymous (AA), increase the number of abstinent friends in their social network, increase their self-efficacy, and improve their coping strategies to resist drinking. Clients are encouraged to become more involved in social networks and group activities that do not include drinking (e.g., AA meetings, family activities, walks or lunches with nondrinking friends, participation in church groups) as well as nondrinking activities they can engage in alone (e.g., completing job applications, going on job interviews, attending classes).

NST is partly based on the Twelve Step Facilitation Therapy (TSF) intervention from Project MATCH, a national, 8-year, randomized clinical trial of three treatments for alcoholism funded by the National Institute on Alcohol Abuse and Alcoholism. NST differs from TSF in the emphasis placed on AA meeting attendance. NST presents AA meeting attendance as one of many abstinence-reinforcing social networks and activities that can help the client avoid drinking. In addition, the spiritual philosophy of AA is minimized, and if an NST client is opposed to attending AA, the AA focus is dropped altogether. NST sessions are delivered over a period of 12-16 weeks (12 weeks in the study reviewed for this summary) and include the participation of the client's spouse or significant other whenever possible.

Descriptive Information

Areas of Interest	Substance abuse treatment
Outcomes	Review Date: November 2010 1: Alcohol abstinence
Outcome Categories	Alcohol
Ages	26-55 (Adult) 55+ (Older adult)
Genders	Male Female
Races/Ethnicities	Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Outpatient
Geographic Locations	Urban Suburban
Implementation History	NST was first implemented in 2002 at the University of Connecticut Health Center in a federally funded clinical trial. In the course of the trial, over 140 individuals received the intervention.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Review Date: November 2010

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. M. (2009). Changing network support for drinking: Network Support Project 2-year follow-up. Journal of Consulting and Clinical Psychology, 77(2), 229-242.

Supplementary Materials

Litt, M. D. (2010). Network support for alcohol treatment: Mechanisms and effectiveness (Network Support II)--Treatment session fidelity checklists. Farmington: University of Connecticut Health Center.

Litt, M. D., Kabela-Cormier, E., & Kadden, R. M. (2009). Network support for alcohol treatment (Network Support II): Mechanisms and effectiveness--Network Support Treatment manual. Farmington: University of Connecticut Health Center.

Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. (2007). Changing network support for drinking: Initial findings from the Network Support Project. Journal of Consulting and Clinical Psychology, 75(4), 542-555.

Miller, W. R., & Del Boca, F. K. (1994). Measurement of drinking behavior using the Form 90 family of instruments. Journal of Studies on Alcohol, 12(Suppl.), 112-118.

Tonigan, J. S., Miller, W. R., & Brown, J. M. (1997). The reliability of Form 90: An instrument for assessing alcohol treatment outcome. Journal of Studies on Alcohol, 58(4), 358-364.

Outcomes

Outcome 1: Alcohol abstinence
Description of Measures	Alcohol abstinence was measured using Form 90, a structured interview that uses a calendar-based method for assisting in the self-report of daily drinking over the prior 90 days. Alcohol abstinence was measured in two ways: percentage of days abstinent (PDA) and continuous abstinence. Collateral reports from a significant other were used for a third of the study participants (randomly selected) to verify self-reported alcohol use versus nonuse. Breathalyzer readings were taken at all in-person follow-up assessments. After the in-person baseline and posttreatment assessments, alternating telephone and in-person follow-up assessments were conducted every 3 months for 2 years (i.e., up to 27 months after baseline).
Key Findings	In a randomized clinical trial, alcohol-dependent participants were assigned to one of three outpatient treatment conditions: Network Support Therapy (NST), NST plus contingency management (NST plus CM), or case management (CaseM). For all three conditions, treatment consisted of 12 60-minute, one-on-one sessions, and participants were required to demonstrate sobriety through breath analysis as a condition for treatment. The findings from this study included the following: Across the 2-year follow-up period, NST participants reported higher PDA for the prior 90 days than either NST plus CM or CaseM participants (p < .02). The NST versus NST plus CM group difference was associated with a small effect size (Cohen's d = 0.28). From posttreatment to 2-year follow-up, NST participants had significant increases in PDA relative to participants in the other two conditions (p < .05). Across the 2-year follow-up period, a higher percentage of NST participants than NST plus CM and CaseM participants reported continuous abstinence (p < .03). This difference was associated with a small effect size (Cohen's h = 0.30). For the 90 days prior to the 2-year follow-up, the reported PDA among NST participants was 80%, compared with a PDA of slightly greater than 60% among participants in the other two conditions (p < .05). For the 90 days prior to the 2-year follow-up, 40% of NST participants reported continuous abstinence, compared with less than 30% of participants in the other two conditions (p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.2 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	26-55 (Adult) 55+ (Older adult)	58% Male 42% Female	86% White 8% Black or African American 4% Hispanic or Latino 2% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

1. Reliability of measures	4. Missing data and attrition
2. Validity of measures	5. Potential confounding variables
3. Intervention fidelity	6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Alcohol abstinence	3.5	3.5	3.5	2.0	3.0	3.5	3.2

Study Strengths

The self-report measurement instruments used in the study are state of the art, with strong psychometric properties. The use of breathalyzer readings at the in-person follow-up assessments, along with random sampling of collateral reports from significant others, strengthened concurrent validity of the alcohol abstinence outcome. Agreement between client self-reports and collateral reports was greater than 90% at the 18- and 24-month follow-up assessments. Intervention fidelity was very strong, with careful attention given to training the therapists and monitoring treatment delivery; for example, the therapists followed fidelity checklists during the sessions, a third of all treatment sessions were audiotaped, and a supervising therapist reviewed each taped session for fidelity. Separate analyses were performed for study completers and noncompleters to rule out between-group differences. The randomized clinical design controlled for potential confounds. The data modeling and statistical analyses were sophisticated.

Study Weaknesses

Although the study had an intent-to-treat design and used sophisticated statistical modeling that can accommodate missing data, all randomized participant data were not included in the evaluation of the outcome measures.

Readiness for Dissemination

Review Date: November 2010

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Form 90-AF: Follow-up Interview Assessment of Drinking and Related Behaviors

Form 90-AI: Drinking Assessment Interview--Intake

Important People Initial Interview

Litt, M. (n.d.). Network Support Treatment for Alcohol Dependence training program [PowerPoint slides]. Farmington: University of Connecticut Health Center.

Litt, M. D., Kabela-Cormier, E., & Kadden, R. M. (2009). Network support for alcohol treatment: Mechanisms and effectiveness (Network Support II)--Network Support Treatment manual. Farmington: University of Connecticut Health Center.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
2.0	2.0	2.3	2.1

Dissemination Strengths

The manual provides some guidance and direction for implementation outside a controlled research environment. Training and consultation are available from the developers. The session-specific fidelity checklists can be used to ensure adherence to the model.

Dissemination Weaknesses

Although the manual provides some guidance on implementing NST outside a research environment, the implementation materials and quality assurance tools themselves have not been adapted for use in other settings. The number of intervention sessions is inconsistently described in the implementation materials provided. Only the "core" sessions (sessions 1-4 and termination) of the intervention are described in detail within the manual. The training presentation relies on lecture format, which does not promote adult learning or help with generalization from research to practice contexts. Very little guidance is provided on the use and interpretation of the quality assurance tools.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Network Support manual	Free	Yes
Treatment Session Fidelity Checklists package	Free	Yes
Training PowerPoint presentation	Free	No
Copies of outcome evaluation articles	Free	No
On-site training	$1,200 per day plus travel expenses	No
On-site consultation	$1,200 per day plus travel expenses	No
External supervision and quality control/fidelity monitoring (off-site analysis of videotaped treatment sessions)	$300 per hour	No
Phone and email support	Free	No
Form 90 (intake and follow-up)	Free	No
Important People interview form	Free	No

Additional Information

NST was first implemented in 2002 at the University of Connecticut Health Center in a federally funded clinical trial. In the course of the trial, over 140 individuals received the intervention.

Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Elise Kabela-Cormier, Ph.D.
(860) 679-2657
kabela@uchc.edu

To learn more about research, contact:
Mark D. Litt, Ph.D.
(860) 679-4680
litt@nso.uchc.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.