Treatment for substance use and maintaining sobriety are often tied to supportive social networks, but what happens when the trusted confidants are also drug use partners?

A new study from the University of Nebraska–Lincoln’s Rural Drug Addiction Research Center examined how substance users are affected when their social support networks and drug use networks collide. The researchers found that these relationships commonly intersect, and lead to riskier behaviors by people who use drugs.

The study included 120 rural substance users, who reported on average, 2.64 co-drug use ties; 1.75 confidant ties, and 1.45 intersected, or multiplex, ties — ties that were both co-drug users and confidants. Ten percent of respondents reported that all of their social network ties were co-drug use partners. The study also found a relationship between the number of multiplex ties and the number of substances used. With each additional multiplex tie, the expected number of substances used increased 8.9%.

Kelly Markowski, a postdoctoral researcher with RDAR and co-author on the study, said most previous research hasn’t parsed out how social relationships like these affect substance users.

“We tend to think of drug use in a very individualized way, as an individual phenomenon, but it doesn’t happen in a vacuum,” Markowski said. “It happens in these complex social webs. If someone starts to develop trust or become friends with the people they are using drugs with, those ties become much more difficult to break and they take on a different meaning. In our study, we wanted to understand how those kinds of ties relate to individuals’ drug use.”

Using drugs with others raises risk factors, Markowski added, so it’s important to understand how social relationships affect substance use.

“It’s problematic because it increases the likelihood that individuals are going to use different substances and engage in riskier practices,” Markowski said. “For example, people who interact with others who also use substances are more likely to engage in risky injection practices, like sharing needles, and it can expose someone to new norms surrounding different kinds of drugs, which partially leads to this problem of polysubstance use.”

The research is novel in that it examined social networks among rural substance users. Most substance user research tends to focus on urban areas, but Markowski explained that there are important distinctions between urban and rural substance users.

“For people in rural areas, the amount of people you interact with is going to be smaller, with fewer options, so you’re more likely to have complex, multi-dimensional types of relationships, and it’s more difficult to break those ties,” she said. “You’re more isolated when you do break those ties, and it’s a problem more pronounced in rural areas. And it’s especially likely to impact the way treatment and recovery efforts unfold.”

The overlapping of these relationships and the rural-urban divide are both important factors for treatment providers to understand, Markowski said.

“The study calls attention to the fact that drug use is a social phenomenon, and it happens within social relationships and so we need efforts and treatment that address these social components and do not just focus on the individual’s behavior,” she said. “It’s a more complex problem that requires more complex solutions than, I think, current approaches are taking into account.”

The study was published in the journal, Addictive Behaviors, and was co-authored by Robin Gauthier, assistant professor of sociology; Jeffrey Smith, associate professor of sociology; and Sela Harcey, an alumna who received her doctorate from Nebraska in 2021. All are affiliated with the Rural Drug Addiction Research Center.