On Improving Recovery Engagement In the Context of Increased Social Isolation and Loneliness

I recently attended  a webinar on loneliness and the COVID-19 Pandemic by the Coalition to End Social Isolation and Loneliness. The physical health and mortality facets of social isolation are jaw dropping. We need to focus more of our resources on recognition of social isolation as a health determinant in respect to substance use conditions and more actively engaging people who are socially isolated into the recovery process. It is as an essential element of recovery, not as an ancillary process. Consider these facts:

• More than one third of adults over age 45 report being lonely (AARP – 2010)
• Less than a quarter of adults participate in a social club, community group, sports league, or other local group (Pew Research Center, 2009).
• Social isolation carries risk that in many cases, exceeds that of other well-accepted risk factors, including smoking up to 15 cigarettes per day, obesity, physical inactivity, and air pollution (Holt-Lunstad et al., 2010)
• Greater social connection is associated with a 50% reduced risk of early death (Holt-Lunstad et al., 2010)

Recovery happens in community. We need to consider what these trends in increased isolation (even pre COVID-19) mean for people with substance use conditions. We know that addiction thrives in isolation and recovery is a process of connection. People engaging in the recovery process spend time face to face, form tight social bonds and identify commonality. It is the core foundation of recovery for many of us.

How do societal trends over the last few decades towards more isolation, less civic engagement and fewer connections between people impact addiction recovery for people who have little experience with forming and maintain social connection?  As a society, we are becoming more isolative. Are there greater barriers for making the types of connections simply because people have less experience making them? How can the recovery community adapt to these societal changes in ways that support people obtaining and sustaining community?

People have clearly benefited from moving services and supports online during the COVID-19 pandemic. We have found immediate benefits and have raised some concerns raised about who gets left behind. Some people I talk to say that they may not go back to face to face meetings because the virtual meetings are more convenient. Others logged off after the first few weeks as the luster of newness wore off. They did not feel like they were getting the same connection as the face to face meetings. We need to study these dynamics over a long period of time to better understand how to effectively utilize virtual recovery tools.

Should we consider the growing body of research that suggest that the use of social media / on line engagement processes increase isolation and depression or that the medium can create barriers to engagement:

• A 2018 study from the University of Pennsylvania found that students who limited their use of Facebook, Instagram, and Snapchat to 30 minutes a day had reductions in loneliness and depression.
• A 2014 study published in the International Journal of Human-Computer Studies noted that delays on phone or conferencing systems shaped our views of people negatively: even delays of 1.2 seconds made people perceive the responder as less friendly or focused.
• A 2015 metanalysis of telepsychiatry published in the World Journal of Psychiatry indicated the telepsychiatry medium can interfere with the therapeutic alliance as there are difficulties in detecting non-verbal cues barriers from the lack of physical proximity and physical presence.

Connection is very much in our blood. The recovery community movement has rightly focused on developing recovery community centers that bring people together, recognizing that connection is fundamental to the recovery experience for many of us. We are seeing the ways we connect adapt over time. Recovery community groups like The Phoenix on the national level and Sync Recovery Community here in Pennsylvania are focusing on bringing people together for active recovery events. These are exciting innovations!

We may want to consider using online services in ways that engage people who are isolated and support them in more systematic ways in increasing strong connections in a more methodical way by developing recovery capital.  This is a post not to present answers – it is intended to frame questions for consideration:

• Are there groups already focusing on this?
• If social isolation has a profound negative health indicator for all of our society, what are we doing about it?
• Should we be methodically be screening for social isolation in the engagement process so we can more effectively address it in the recovery process?
• How do we address the fact that many of the people who need to access recovery are isolated so profoundly that they may not know how to form close connections to others?

I do not pretend to know the answers, but I suspect that we will need to focus on developing answers to these questions moving forward. I do think that we have an opportunity to innovate care in ways that more effectively address the needs of our community.

What do you as a reader think?