Intervention Summary

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Network Therapy

Network Therapy is a substance-abuse treatment approach that engages members of the patient's social support network to support abstinence. Key elements of the approach are: (1) a cognitive-behavioral approach to relapse prevention in which patients learn about cues that can trigger relapse and behavioral strategies for avoiding relapse; (2) support from the patient's natural social network; and (3) community reinforcement techniques engaging resources in the social environment to support abstinence. Network Therapy patients typically participate in outpatient treatment twice per week for 12 to 24 weeks. The patient participates in weekly individual therapy sessions and weekly sessions attended by network members approved by the therapist. Patients agree to contingency contracts agreeing to aversive consequences if they use targeted drugs. Some practitioners ask patients to submit urine samples for testing.

Descriptive Information

Areas of Interest	Substance abuse treatment
Outcomes	Review Date: February 2007 1: Opiate use 2: Cocaine use
Outcome Categories	Drugs
Ages	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)
Genders	Male Female
Races/Ethnicities	Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Outpatient Other community settings
Geographic Locations	No geographic locations were identified by the developer.
Implementation History	The intervention has been implemented in multiple clinical settings since 1993. Information on the exact number of sites and clients is not available. In 1999 the intervention developer conducted a study on the feasibility of training.
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: February 2007

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.

Supplementary Materials

Galanter, M. (1993). Network therapy for addiction: A model for office practice. American Journal of Psychiatry, 150, 28-36.

Galanter, M., & Brook, D. (2001). Network therapy for addiction: Bringing family and peer support into office practice. International Journal of Group Psychotherapy, 51, 101-122.

Galanter, M., Keller, D. S., & Dermatis, H. (1997). Network therapy for addiction: Assessment of the clinical outcome of training. American Journal of Drug and Alcohol Abuse, 23, 355-367.

Galanter, M., Keller, D. S., & Dermatis, H. (1997). Using the Internet for clinical training: A course on network therapy for substance use. Psychiatric Services, 48, 999-1008.

Glazer, S. S., Galanter, M., Megwinoff, O., Dermatis, H., & Keller, D. S. (2003). The role of therapeutic alliance in network therapy: A family and peer support-based treatment for cocaine abuse. Substance Abuse, 24, 93-100.

Keller, D. S., Galanter, M., & Weinberg, S. (1997). Validation of a scale for network therapy: A technique for systematic use of peer and family support in addiction treatment. American Journal of Drug and Alcohol Abuse, 23, 115-127.

Outcomes

Outcome 1: Opiate use
Description of Measures	Opiate use was assessed by urinalysis. According to the program developer, urine samples were collected weekly and analyzed by a State-accredited laboratory.
Key Findings	A randomized controlled trial compared 33 Network Therapy clients who also received buprenorphine maintenance with 33 clients who only received buprenorphine maintenance and individual therapy. All clients submitted weekly urine samples. Among Network Therapy clients, 64.5% of all samples submitted were negative for opioids, compared with 45.3% of all samples submitted by medication maintenance clients (p < .05). The number of opiate-free urine samples correlated significantly with the number of Network Therapy sessions (p < .05). Network Therapy clients also were more likely than control clients to submit negative urine samples at their last three sessions (50% vs. 23%, p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.1 (0.0-4.0 scale)

Outcome 2: Cocaine use
Description of Measures	Cocaine use was measured by urinalysis. Urine samples were collected weekly and analyzed by a State-accredited laboratory.
Key Findings	One study compared Network Therapy with treatment as usual over 6-12 months of treatment. Among Network Therapy clients, 88% of 107 urine samples were negative for cocaine, compared with 66% of 82 urine samples collected from 20 treatment-as-usual clients (p < .0003). In a pretest-posttest study, over 6 months of treatment, 73% of urine samples provided by 47 Network Therapy clients were negative for cocaine. The last three weekly urine samples were negative for cocaine for 20 clients (43%).
Studies Measuring Outcome	Study 2, Study 3
Study Designs	Quasi-experimental, Preexperimental
Quality of Research Rating	1.3 (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	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)	75.8% Male 24.2% Female	59.1% White 24.2% Hispanic or Latino 12.1% Black or African American 4.5% Race/ethnicity unspecified
Study 2	26-55 (Adult)	85.1% Male 14.9% Female	61.7% White 21.3% Black or African American 17% Hispanic or Latino
Study 3	26-55 (Adult)	73.3% Male 26.7% Female	50% Black or African American 36.7% White 13.3% Hispanic or Latino

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: Opiate use	3.0	3.5	0.0	1.5	2.5	2.0	2.1
2: Cocaine use	3.0	2.3	0.5	0.5	0.0	1.5	1.3

Study Strengths

Urinalysis provides an objective measure of drug use.

Study Weaknesses

Although authors reference a fidelity instrument, they do not state how intervention fidelity was assessed. It is unclear how many data were missing and how missing data were handled. It is unclear whether Network Therapy participants were self-selected. In one study sample sizes were different without explanation. Groups differed in amount of data provided. Only those who completed treatment were included in analyses.

Readiness for Dissemination

Review Date: February 2007

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.

Galanter, M. (2003). Network Therapy for alcohol and drug abuse: Effective office-based treatment. Arlington, VA: American Psychiatric Publishing, Inc.

Galanter, M. (n.d.). Network Therapy for alcohol and drug abuse: Effective office-based treatment [VHS Tape]. New York: New York University.

Galanter, M., & Keller, D. (1994). Network Therapy for substance abuse: A therapist's manual. New York: New York University.

Galanter, M., Keller, D., & Dermatis, H. (1997a). Using the Internet for clinical training: A course on Network Therapy for substance abuse. Psychiatric Services, 48(8), 999-1008.

Galanter, M., Keller, D. S., & Dermatis, H. (1997b). Network Therapy for addiction: Assessment of the clinical outcome of training. American Journal of Drug and Alcohol Abuse, 23(3), 355-367.

Keller, D. S., Galanter, M., & Weinberg, S. (1997). Validation of a scale for Network Therapy: A technique for systematic use of peer and family support in addiction treatment. American Journal of Drug and Alcohol Abuse, 23(1), 115-127.

Network Therapy online training course, http://www.med.nyu.edu/substanceabuse/course

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
2.5	1.5	1.0	1.7

Dissemination Strengths

The brochure, therapist's manual, and videotape provide excellent written and visual descriptions of the goals and methods of this intervention. Engaging family and significant others in the treatment recovery process is a strength of this approach. The therapist manual and video also could, with some tailoring, double for training use. The Network Therapy Rating Scale (NTRS) may be used to measure fidelity to the network therapy methods.

Dissemination Weaknesses

The materials provide little information that might help providers make good use of them. The materials also do not address privacy issues in working with family and significant others, and some of the older psychodynamic materials cited in the manual may be viewed as objectionable by some practitioners and patients in light of the extensive research of the past decade regarding the neurobiology of addiction. There is no description of the content and style of therapist training or any description of the source, qualifications, and preparation of trainers. A well-developed competency-based training and manual is needed, as well as specific protocol for adoption in office-based or other practice models. Clinical supervision is not discussed in any of the materials. Though an online training course is cited, the Web site does not appear to be active. No information is provided on the uses of the NTRS in any practical application of this intervention. The materials provide no information on how, when, where, or by whom reliability is assessed or how assessors are selected, trained, supervised, and evaluated. There is also no description of how reliability information is reported to and used by therapists, supervisors, or others as a way to improve treatment outcomes.

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
Training VHS	$54	No
Other implementation materials, training, technical assistance/consultation, and quality assurance materials	Contact the developer	Contact the developer

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Galanter, M., Dermatis, H., Keller, D., & Trujillo, M. (2002). Network therapy for cocaine abuse: Use of family and peer supports. American Journal on Addictions, 11, 161-166.

Contact Information

To learn more about implementation or research, contact:
Marc Galanter, M.D.
(212) 263-6960
marcgalanter@nyu.edu

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