A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

Ed Day,Deborah Bamber,Jennifer L Seddon,Carmel Bennett,Ilias Goranitis,Sanju George,Shabana Akhtar,Nick Freemantle,Charlotte Powell,Marilyn Christie,Andrew Ball,Alex Copello,Emma Frew

doi:10.1186/s12888-018-1600-7

Abstract

BackgroundApproximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST.MethodsA two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support).ResultsA total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence.No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall).ConclusionsPatients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement.Trial registrationISRCTN Trial Registration Number: ISRCTN22608399.Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.

Highlights

3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment
We report the findings of a pilot trial with the aim of implementing, observing and assessing the efficacy of a social-network intervention (Brief-Social Behaviour and Network Therapy – Brief Social Behaviour and Network Therapy (B-Social behaviour and network therapy (SBNT))) for both opiate substitution treatment patients and their social network members
This paper reports on three of the trial’s main objectives: 1. To test the feasibility of recruiting patients engaged in drug treatment services for at least a year but still reporting heroin use to a trial of B-SBNT, and following them up over 12 months

Summary

Introduction

3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Since there has been more focus on ‘recovery’, with a national strategy requiring treatment agencies to focus on increasing the number of patients leaving their service abstinent from all illicit and prescribed drugs, in good mental and physical health, and with improved quality of life [2] Supporters of this approach noted that this goal was rarely achieved, with only 3% of people reporting abstinence within three years of starting opiate substitution treatment (OST) in one study in Scotland [3]. One potential strategy to support abstinence from illicit drugs is to encourage patients of OST services to end all contact with drug-using peers This is unlikely to happen if no alternative social contact or support is available, and so psychosocial treatment approaches have begun to focus on building links to individuals and groups who provide competitive reinforcement for abstinence. When this is done successfully, the development of new positive social supports is associated with a reduced risk of relapse to heroin and other drug use and better overall outcomes [10,11,12,13,14]

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