Social network mechanisms of behavior change in alcohol use disorder recovery: A longitudinal observational cohort study.

Social factors play a pivotal role in both the development of and recovery from alcohol use disorder (AUD), and social network analysis provides a rigorous framework to understand these influences. The current study applied social network analysis to understand recovery from AUD, with a secondary aim of examining sex differences in social network influences. A cohort of adults with AUD making a significant recovery attempt (N = 501) were followed over six waves during a 1-year period (83% retention) and completed assessments of egocentric networks (up to 20 closest alters) and drinking behaviors. Hierarchical models run within a Bayesian imputation framework examined social network characteristics in relation to three recovery outcomes: abstinence, reduction in World Health Organization (WHO) drinking levels, and reductions in drinks/week. Follow-up analyses were stratified by sex. Three social network characteristics predicted abstinence: number of family member alters, number of alters in mutual help organizations (MHOs), and interaction frequency with alters; the latter two factors were also predictive of WHO drinking level and drinks/week. Network heavy drinking days was specifically negatively associated with reductions in WHO drinking level. Sex differences revealed greater network heavy drinking selectively impeded WHO level reductions for female participants, whereas having more MHO program members in one's network selectively facilitated recovery for male participants. These findings reveal the importance of social networks, particularly involvement in MHOs and the family, in AUD recovery. (PsycInfo Database Record (c) 2026 APA, all rights reserved).