The effect of social investment on treatment outcome

Social support is associated with better response to treatment. Treatments focused on relationships, such as marital and family therapy, are directed in part at promoting this support. However, the strength of the relationship between support and abstinence is modest, as is the demonstrated incremental effectiveness of treatments focused on relationships. Treatment-matching research needs to determine under what set of conditions treatments focused on relationships will enhance abstinence. The primary aim of this study was to determine whether the relationship between alcohol involvement and alcohol-specific social support is moderated by a person's social investment. The second aim was to determine the set of circumstances under which extended individually focused cognitive behavioral (CB) treatment and a relationship enhancement (RE) of brief cognitive behavioral treatments would improve outcomes. Patients were randomly assigned to individual or relationship-enhanced outpatient treatment and followed for 12 months. Results indicated that a patient's social investment did moderate the strength of the relationship between support and posttreatment alcohol involvement: Among high investors, there was a strong positive relationship, while the association was weak for low investors. A hypothesized triple-order interaction between social investment, posttreatment support and treatment did not materialize. However, an interaction between support and treatment showed that those with high support did equally well in either treatment, while those posttreatment support was low benefited from CB, but experienced poor outcomes when treated in relationship enhancement of CB. Further analyses indicated that increasing alcohol-specific support for low investors was probably contraindicated. We suggest that patients with low investment should be treated in an extended cognitive behavioral modality, while relationally enhanced CB treatment should be limited to high investors who are likely to experience support for their abstinence following treatment.