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Social Capital, Social Networks, and Substance Use: A Literature Review on the Use of Bonding, Bridging, and Linking Networks in Drug Treatment Services to

Prevent Relapse Among Young People and Adults

Lund University MPH - Global Public Health

September 2016

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IntroductionDrug use is a major global health issue. In 2013, it was determined that about 246 mil-

lion people had used an illicit drug and about 27 million people were dependent on drugs (UN-

ODC, 2015). Drug use can be defined as the “harmful or hazardous use of psychoactive sub-

stances, including alcohol and illicit drugs” (WHO, 2016). Whereas drug dependence can be de-

scribed as “a cluster of behavioral, cognitive, and physiological phenomena that develop after

repeated substance use” resulting in a desire to continue using a drug (WHO, 2016). The use of

illicit substances has an incredible impact on the health of an individual and society. Drug use is

one of the top health risk factors worldwide and is associated with other diseases like hepatitis

and HIV (UNODC, 2015). Drug dependent individuals also contribute annually to the growing

cost of health care with costs twice as much as patients without drug dependence (UNODC,

2015). It was also reported that “1 out of 10 people aged 15 to 64 years old are considered prob-

lem drug users” worldwide (UNODC, 2015). Thus, drug use is not just an individual problem but

an issue of local, national, and international proportions.

While drug dependence is widely known as a preventable problem it is not as widely un-

derstood to be a chronic condition. The United States reported that of its problem drug users who

sought intervention treatment services 40% to 60% of individuals relapsed (NIDA, 2012). This

large number of relapsing individuals demonstrates the need for comprehensive evidence-based

intervention programs that utilize a multi-disciplinary approach to treat chronic drug dependence.

Current intervention programs typically include pharmacological and psychosocial interventions

(EMCDDA, 2016). Psychosocial interventions “identify the problem [of drug dependence], treat

it, and assist with social reintegration” (EMCDDA, 2016). These interventions are adjustable in

their approach, utilize different theoretical methods, and have been shown to help the recovery

process (EMCDDA, 2016).

However, the theory of social capital is yet to be widely applied to these psychosocial

interventions. Social capital examines “the institutions, the relationships, the attitudes and values

that govern interactions among people and contribute to economic and social

development” (Grootaert & van Bastelar, 2001). In more basic terms, it is a resource gained

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through different social networks which can be broken down into three forms (Ferlander, 2007).

First, bonding networks consist of a homogenous group of close family and friends, i.e., parents

or siblings (Ferlander, 2007). Second, bridging networks consist of a heterogeneous group of

friends or associates, i.e, peers from school or work (Ferlander, 2007). Third, linking networks

consist of “colleagues with different hierarchal positions,” i.e, employers or teachers (Ferlander,

2007). There is also positive social capital, i.e, a supportive community network, or negative so-

cial capital, i.e., a network of problem drug users.

By taking a closer look at the specific forms of social networks: bonding, bridging, and

linking networks; it could be possible to improve gaps in intervention services and better prevent

relapse among users. This study aims to summarize recent research in the field in order to high-

light ways young people and adults can build positive social capital during drug treatment by

creating positive social networks to prevent relapse.

Methods A descriptive literature review was conducted to identify current trends in drug use,

treatment, and recovery. The search for scientific articles was done mainly through the LUB-

Search database, access was provided through Lund University. Scientific articles were included

in the literature review if they were published within the last six years, were peer-reviewed, and

written in English. Articles were also included depending on whether participants were young

people or adults, current drug users, in treatment, or former drug users in recovery. Additionally,

they were included if the article examined the role of social capital (positive and or negative) and

social networks on drug use.

The initial set of key words included in the search process were, social capital AND drug

abuse; four articles were selected from the results. A second set of key words used were, social

capital AND drug use AND young people; of the resulting articles two were chosen for rele-

vance. The third set of key words included, personal networks AND drug abuse; two of the re-

sulting articles were chosen. Eight articles were chosen for this review process by use of the

aforementioned key words which identified articles that were then scanned for relevance via title

and abstract.

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Additional information used to provide background on the issue of drug abuse, treatment,

and relapse prevention was extracted from the WHO, EMCDDA, the NIDA, The World Bank,

and the UNODC.

ResultsThe Impact of Social Capital on Drug User Status

Social capital influenced whether a young person used and/or abused alcohol or drugs

(Green, Mitchell, & Bruun, 2013; Mawson et al., 2015; Unlu & Sahin, 2015). Unlu and Sahin

identified five mediating factors - age, gender, ethnicity, income, and residential mobility - which

all impacted a young person’s social capital and substance use preferences (2015). Poverty was

the main barrier in acquiring positive social capital among problem drug users of lower socioe-

conomic status (Boeri et al., 2015; Unlu & Sahin, 2015). High social capital was associated with

a higher environmental quality of life, which included access to safe accommodation and envi-

ronment, income, transportation, and leisure activities (Mawson et al., 2015). Personal networks

associated with peer influence, family attachment, and participation in organized activities also

impacted social capital either in positive or negative ways, thus impacting the substance use of

young people (Unlu & Sahin, 2015). Overall, poor family circumstances and negative peer influ-

ences decreased the amount of social resources and opportunities for social interaction which led

to decreased social capital and an increase in substance use (Green, Mitchell, & Bruun, 2013;

Unlu & Sahin, 2015).

Best et al. found that participants in recovery had larger social networks with more peers

in recovery than active users when compared to participants that were in treatment (2015). This

social network make up was also related to the recovery groups reports of higher social capital

(Best et al, 2015). By examining further the make-up of networks it was established that associ-

ating more with a non-drug using network created higher rates of wellbeing among participants

(Mawson et al., 2015). Identifying with a particular network and the importance of that social

network were closely related to one another and influenced an increase in social capital (Mawson

et al., 2015). Individuals that continued relationships with active drug users and the connections

that maintained their own active drug use habits had higher negative social capital compared to

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their recovering counterparts (Flores et al., 2013). Overall, higher rates of substance use were

associated with lower social capital (Mawson et al., 2015). Former users had “restablished posi-

tive social capital relationships […] of family relations, employment, sobriety, and new sober

networks” and were possibly using these new networks to maintain drug abstinence (Flores et al.,

2013).

The Impact of Social Networks on Drug User Status

Strong supportive personal and social networks that contain abstinent or non-active drug

users were associated with a lower use of alcohol or drugs, higher likelihood of drug abstinence,

and maintenance after recovery (Best et al., 2015; Boeri et al., 2015; Chung et al., 2014; Flores et

al, 2013; Green, Mitchell, & Bruun, 2013; Mawson et al., 2015; Panebianco et al., 2015; Unlu &

Sahin, 2015). Most social network groups were made up of categories which include: family,

friends, drug treatment programs, community, and leisure activities (Boeri et al, 2015).

Bonded relationships included family and peer networks (Green, Mitchell, & Bruun,

2013). As young people aged, influences from personal networks changed (Unlu & Sahin,

2015). Until age 15, family attachment and peer influence played a large role in whether or not a

young person used alcohol or drugs (Unlu & Sahin, 2015). After age 16, this changed as more

people within the personal network were perceived to use substances, less intra-familial interac-

tions occurred, and young people participated less in activities (Unlu & Sahin, 2015). As family

attachment decreased and peer influence increased, substance use also increased among young

people (Unlu & Sahin, 2015). Family attachment was related to household members and the ties

among members; more members and stronger ties were associated with lower alcohol problem

severity (Chung et al., 2014). In terms of treatment, participants yearned to re-establish, contin-

ue, and improve family relationships with an emphasis on a need for structure, boundaries, and

support (Green, Mitchell, & Bruun, 2013). Family support was an essential part of the bonding

network used in maintaining drug recovery but when it was the sole social network of the partic-

ipants they were more likely to relapse (Panebianco et al., 2015). Individuals who were drug free

former users were found to have larger support networks that consisted of both family and com-

munity domains (Panebianco et al., 2015).

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It was equally important to examine peer bonding networks in terms of substance use

(Best et al., 2015; Boeri et al., 2015; Chung et al., 2014; Flores et al, 2013; Green, Mitchell, &

Bruun, 2013; Mawson et al., 2015; Panebianco et al., 2015; Unlu & Sahin, 2015). Peer influ-

ences had a higher impact on males in regards to substance use when compared to women of the

same age (Unlu & Sahin, 2015). Results also indicated that “friends provided access to social

capital through new social networks [although] these were typically within the same drug-using

community” (Boeri et al., 2015). The greater number of peers who abstained from drug use with-

in a social network was associated with lower alcohol and marijuana problem usage (Boeri et al.,

2015; Chung et al., 2014). Individuals were many times able to both recognize negative influ-

ences within their social network and a need to break away from these networks but found it dif-

ficult to do so (Green, Mitchell, & Bruun, 2013).

Bonding networks were found amongst current drug users, drug users in treatment, and

former drug users where as bridging and linking networks were almost non-existent (Boeri, et

al., 2015). Young adults in recovery experienced difficulties in “psychological health, physical

health, relationships, and daily living conditions compared to same aged peers” which created a

barrier to social connectedness (Mawson et al., 2015). Recovery and treatment programs provid-

ed bonding and some bridging networks but did not create social opportunities for peer interac-

tion outside of recovery groups (Boeri, et al., 2015).

Discussion and ConclusionFindings from this literature review demonstrated the link that exists between social capi-

tal, social networks, and substance use. This link can now be used to provide recommendations

for the future when looking to improve treatment programs and fill gaps in relapse prevention.

Currently, pharmacological and psychosocial interventions are the standards of treatment

for drug use disorders (EMCDDA, 2016). Often times providers focus on drug use as an individ-

ual pathological problem, or the physiological effects those drugs have had on the client (Cloud

& Granfield, 2008). However, a young person’s drug use has been shown to be impacted by in-

fluencing factors such as: age, gender, ethnicity, income, mobility and social capital (Flores et al,

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2013; Unlu & Sahin, 2015). Often times, clients in treatment achieve the ability to abstain from

drug use due to the institutional environment, but fail to have the same results in a natural setting

(White, 2009). Many times, this is due to the fact that during treatment these influencing factors

become less evident. To maintain recovery after treatment these factors need to be addressed by

the provider. This is what makes building social capital in terms of long-term recovery mainte-

nance more effective than individual, repeated treatment episodes (White, 2009).

So instead of “focusing on a dependent person’s [drug] use independent of the social

context that surrounds [them],” treatment would be more successful if it considered opportunities

for clients to build actual social capital (Granfield & Cloud, 2001). Supportive social networks

are important in building positive social capital both during and after treatment. It is essential

that treatment programs develop ways for which young adults can “review and reflect on the im-

portance of heavy-using and non-using [individuals] and to increase engagement with non-using

[individuals] in their social networks” (Mawson et al., 2015). By reviewing their network struc-

ture and ties to using and non-using family and friends, individuals can recognize negative peer

influences and make changes to their personal network for positive outcomes after treatment. It

is also important to remember that not every individual will be able to break ties with negative

influences in their social network. Providers should also look to provide skills to manage these

types of relationships. This can be done by limiting time and type of contact with these specific

individuals (Brown et. al, 2015). Currently, family counseling is not as widely used young people

and adult populations in terms of treatment. This could perhaps be due to the nature of drug use

and the stress it places on interpersonal relationships. However, “practitioners might seek to

build the capacity of families and bonded social networks to provide effective mutual support

and to make changes together” when looking to build supportive social networks for individuals

in drug treatment programs (Green, Mitchell, & Bruun, 2013).

Intervention efforts should also be focused on improving the individuals environmental

quality of life after treatment and must take “the role of environment safety, opportunity for

leisure, and access to [ongoing] services” into account in order to prevent relapse (Laudet &

White, 2008). This can be done by addressing the lack of bridging networks during treatment and

by offering “accommodation support, linkage to employment and training opportunities, and

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providing opportunities for leisure activities that are congruent with recovery goals” (Mawson et

al., 2015). Opportunities like those mentioned offer integration into an individuals’ community

through a variety of social groups, thus creating bridging and linking networks. Both types of

networks help to control “deviancy and reinforce positive health norms” which could promote

relapse prevention post-treatment (Ferlander, 2007). By providing transportation to religious or

spiritual organizations, social clubs, and sports teams, treatment facilities could also create

bridges between non-drug using and recovering social groups. These bridging relationships

would provide opportunities for recovering users to make changes in their social networks with-

out leaving them isolated. Linking networking opportunities could be achieved during treatment

by providing and encouraging workplace and educational opportunities (Boeri et al., 2015).

Linking networks are essential to improving socioeconomic status within society, which is asso-

ciated with more social resources and a reduced chance of relapse (Cloud & Granfield, 2008).

Self-help and recovery groups are a foundational aspect to many drug treatment programs

today (EMCDDA, 2016). They have been shown to foster social connection via social support,

motivation, and inspiration among group members and help to create positive social capital

(Laudet & White, 2008). However, when recovery groups are the primary form of social net-

works individuals have “little incentive to engage in social networks outside recovery

groups” (Boeri et al., 2015). Thus creating a barrier to building bridging and linking networks

with non-using peers. Again, this is why during treatment, activities and opportunities for social

interaction need to be expanded beyond recovery groups so new social networks can be built to

foster more positive social capital.

Limitations

Some of the studies used in this literature review had small numbers of participants due

to their qualitative nature which makes it difficult to generalize the results to overall populations.

Participants in these studies were also users of various and sometimes multiple illicit drugs mak-

ing it difficult to generalize to a specific drug using population. The small number and specific

nature of which the rehabilitation centers where chosen for each study also makes the data less

representative of the whole area and country in which the studies were done. Each study re-

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viewed also took place in different higher income counties. This makes it challenging to apply

the findings to lower and middle income countries due to other influencing factors on substance

use in those settings.

Conclusion

Social capital, social networks, and their utilization during drug rehabilitation treatment

should be researched on a larger scale in order to provide more significant and generalizable in-

formation. However, based on the findings of this literature review current drug treatment pro-

grams should begin to implement ways for clients to evaluate and make changes to their personal

networks. As well as, create opportunities to form new social networks via positive bonding,

bridging, and linking relationships, within their societies. By creating these positive social net-

works individuals in treatment would be able to acquire more positive social capital lifting their

status in society and helping them maintain recovery post-treatment. Doing so could potentially

reduce the estimated 40% to 60% of drug users that relapse after treatment (NIDA, 2012).

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