Does social media have the capacity to change behavior?
In an effort to “find creative ways to help people beyond their acute treatment episode”, Warren Bickel, a professor at the Virginia Tech Carilion Research Institute (VTCRI), has been awarded a $1.7 million grant from the National Institutes of Health to study how social media can help people in recovery.
The main question we hope that they can answer is: “How do social interactions influence specific behaviors?”
Today, we speak with Warren K. Bickel, Ph.D. from Virginia Tech Carilion Research Institute about using social media in addiction recovery. We’re also interested in how they are measuring the impact of social media for people in recovery, as well as the scalability and replicability of successful programs. More here, with a section at the end for your questions.
SPECIAL NOTE: If you’re interested in participating, check out quitandrecovery.org for more.
ADDICTION BLOG: Let’s jump right into it! What gave you the idea to study the impact of social media relations on addiction recovery?
VIRGINA TECH CARILION: When I joined VTCRI in 2011, I founded the International Quit & Recovery Registry (quitandrecovery.org) to identify the characteristics of people in recovery from addiction, modeled after Brown University’s National Weight Control Registry, and engage them in online interactions with others in recovery.
A variety of studies using large observational data sets have supported the importance of social interactions for spreading a variety of behaviors such as alcohol consumption, depression, happiness, obesity, and cessation of cigarette smoking. These and other similar observations have increased the recognition of the importance of social networks in human behavior and helped frame an emerging scientific perspective.
Recently, I read a book on this perspective called “Social physics: How good ideas are spread- The lessons from a new science” by Alex Pentland that inspired my exploration of social physics. The overall goal of this quantitative approach is to describe the dynamics of information and social learning, and characterize the resulting behavior change of humans.
A funding opportunity to investigate social learning came available at just the right time. Our project is intended to carefully observe behavior and information spread in a constrained social network to ascertain whether these observations will promote continued recovery.
ADDICTION BLOG: You plan to study 1,500 volunteers and measure the impact of “connectedness” and “behavior changes” as a result of engagement on a social media platform. First, how and why do people in recovery feel connected to strangers when interactions on the internet can be anonymous and/or isolated experiences?
VIRGINA TECH CARILION: We hypothesize that individuals in recovery will feel connected to people in their social network because of their shared roles and experiences in the recovery process.
Moreover, basic studies investigating social contagion of pro-health behaviors found that when individuals were alerted that a randomly assigned health buddy engaged in a pro-health behavior, their behavior was affected despite no real world connection between the individuals. Furthermore, anonymity is an important component of 12-step recovery programs, where support and connectedness are certainly contributing factors to success.
ADDICTION BLOG: Further, why do you hypothesize that people grouped together according to their addictive substance may feel more connected to one another?
VIRGINA TECH CARILION: Participants recovering from similar addictive substances may have other experiences and/or environmental similarities in which they could relate to one another. As such, grouping those individuals together is hypothesized to generate commonalities to enhance communication, connectedness, and support.
ADDICTION BLOG: In the study, what kinds of positive behaviors are you looking for?
VIRGINA TECH CARILION: We are looking for engagement of network use, communication between peers through the interactive meetings and webinars, and completion of therapeutic education modules (modules that teach pro-health behaviors described below). We will also assess drug abstinence and recovery maintenance through weekly self-report assessments about drug use. Another set of assessments that measure quality of life and participation in recovery-related activities will be completed at three time points during the study.
ADDICTION BLOG: Can these positive behaviors be scaled or replicated in real life?
VIRGINA TECH CARILION: We think these pro-health behaviors could be replicated in real life, but that is part of our experimental question.
The social media platform we are using to initiate these experiments is based on the functionality of Facebook in order to best mimic familiar social media behaviors. If adoption of the positive behaviors is successful in our first model, which restricts communication to a small group, the recovery modules may be expanded for use in similar platforms. Furthermore, at the conclusion of examining our first model, the constraints will be released to examine the flow of information through a free network, which more closely resembles real life.
ADDICTION BLOG: Let’s talk more about hypotheses. One principle hypothesis of the project is that people who receive multiple notices that connected neighbors are engaged in pro-recovery actions are more likely to do the same. What is the scientific explanation behind this assumption?
VIRGINA TECH CARILION: An article in Science by Dr. Damon Centola, a consultant on our project, indicated that participants who received multiple social signals in a highly redundant lattice network topology were more likely to join a health forum. Another paper by Dr. Centola reported increased likelihood of engaging in pro-health behaviors after notifications that multiple network neighbors engaged in pro-health behaviors.
Collectively, these data demonstrate the importance of social network topology and frequency of notifications in engagement and adoption of positive behaviors. We intend to replicate and expand these findings by comparing two network typologies (i.e., lattice and small world) to examine the adoption of recovery specific behaviors.
ADDICTION BLOG: What would you say is your goal? How do you expect this study to impact people in recovery or people who need to get treatment?
VIRGINA TECH CARILION: Drug addiction interventions are often acute treatments that improve early recovery but do not sustain prolonged abstinence. In order to reduce the high relapse rates that are present in drug treatment, addiction should be treated as a chronic disorder.
The goal of these investigations is to teach individuals to manage their chronic disease condition so that, once taught, outcomes will improve and the outside cost for managing these conditions will be lower in the long-term.
In addition to teaching chronic management skills, we aim to determine the network topology and grouping characteristics that render individuals in recovery more likely to engage in pro-health behaviors. This has significance for adoption of modern treatment regimes that are likely to include remote, inexpensive therapeutic techniques.
ADDICTION BLOG: Who can participate in the study?
VIRGINA TECH CARILION: In each of two experiments, 768 registrants from our International Quit & Recovery Registry (quitandrecovery.org) will be enrolled into one of 6 networks of 128 registrants each. Individuals who are in recovery from a substance, for any length of time, who complete an initial questionnaire and setup a profile on quitandrecovery.org may be eligible to participate in these experiments.
ADDICTION BLOG: Can you tell us more about the interactive Therapeutic Education System that supports the social media interaction?
VIRGINA TECH CARILION: The Therapeutic Education System (TES) is a web-based interactive multi-module (comprised of 66 modules) education system based on cognitive behavior therapy concepts. The diversity of the modules ranges from “Learning to Use a Computer” to “Detox and Treatment Termination” or “Awareness of Negative Thinking”. This system has been validated as an effective intervention in substance-dependent individuals in three different studies, including a multi-site clinical trial network conducted by the National Institute on Drug Abuse.
ADDICTION BLOG: Do you see a day when an interactive Therapeutic Education System for addiction treatment or recovery may be automated?
VIRGINA TECH CARILION: These modules are currently web-based and fully automated and are commercially available. As mentioned earlier, three studies have shown the effectiveness of the TES in substance-dependent individuals and as more research is conducted and disseminated, we predict use of TES as a therapeutic intervention will increase.
ADDICTION BLOG: In the real world, what kinds of precautions should people in recovery take when interacting with others online?
VIRGINA TECH CARILION: As with any study there are a few potential risks to the participants. Participants might feel uncomfortable disclosing personal information such as drug use history and illegal behavior. While our network activity will be closely monitored by the researchers, there is a risk that participants may be exposed to materials posted by other network users perceived as inappropriate or offensive.
Along with implied consent upon enrollment, participants will agree to engage in appropriate behavior and language use on the social forums. While we will have a better idea of those behaviors to be most cautious of in this specific social media platform setting after our project begins, in general, as with any online interaction, recovering participants should be wary of sharing personal identifying information and those asserting offensive messages.
ADDICTION BLOG: Is there anything else you would like to add?
VIRGINA TECH CARILION: We would like to add that our International Quit & Recovery Registry is taking new registrants at quitandrecovery.org and that we have other opportunities, including recruitment for our new social media study, on our website for you to help others! Thank you, Addiction Blog, for taking the time to interview me. Our team is looking forward to future communication with you.