Loneliness in the pandemic: risky times

Loneliness and isolation are bedfellows of addiction. Anything that intensifies loneliness will come with increased risks in tow. Of course, it’s not just those with substance use disorders who suffer from loneliness. In 2014, Professor John Cacioppo presented at a conference in Chicago, pointing out that that the impact of loneliness on premature death ‘is nearly as strong as the impact of disadvantaged socioeconomic status’. Disadvantaged socioeconomic status alone increases risk by 19%.

An Office for National Statistics report last year estimated that, during the coronavirus pandemic, more than 7M people in the UK felt lonely to the point that it affected their wellbeing. It’s a perfect storm for growth in substance use disorders in the population. Loneliness also holds risks for those in recovery.

When Julianne Holt-Lunstad and colleagues published their gargantuan meta-analysis of mortality risks in 2010 they found a ‘50% increased likelihood of survival for participants with stronger social relationships.’ From their research it looked like this was as strong a predictor of long healthy life as stopping smoking was and we know that smoking-related disease kills half of smokers.

So, having plenty of quality social connections is good for us generally, but it also has a lot to offer for those trying to recover from substance use disorders.

We have all known the long loneliness, and we have found that the answer is community

Dorothy Day

Mark Litt and colleagues from the University of Connecticut conducted a randomised trial of those with alcohol use disorder in treatment. These patients either had case management, contingency management AND social network, or simply social network connection interventions. 

The ones connected to sober social networks did better than the other groups. One mind-blowing statistic coming out of this was that ‘the addition of just abstinent person to a social network increased the probability of abstinence for the next year by 27%.’ If this was a consistent, repeated effect, think of the impact we could have on treatment populations.

What’s the best way to improve the social networks of those seeking recovery (and tackle loneliness in the process)? Answer: Introduce them to other recovering people. Where are recovering people to be found? In mutual aid groups and lived experience recovery organisations. In the UK and elsewhere we are thankfully rich with such resources.

There are many pathways to recovery, but one of the catalysts that is most evidenced is participation in Alcoholics Anonymous. A 2012 study found that the better outcomes associated with AA engagement were explained primarily by adaptive social network changes and increases in social abstinence self-efficacy (the belief that you can do it). 

The Cochrane Review on AA and 12-step facilitation found it to be at least as effective than other evidence-based approaches. Evidence is emerging though for other mutual aid groups, such as SMART Recovery and LifeRing, whose main mechanisms of action are likely to be similar.

Many people in recovery rely on this protective effect of connection to other human beings for recovery maintenance. In lockdown physical contact is very limited – in most cases to online meetings. Will return to substance use (the term formerly known as relapse) increase due to disconnection or will linking up on digital platforms like Zoom have a significant protective effect?

Getting clients/patients in treatment along to recovery mutual aid groups (online at the moment) and other lived experience recovery organisations is not rocket science, but it is less likely to happen if you are juggling a caseload of 50 clients. I hope that some of the resource going into treatment over the next few years will create systems where professionals both understand the salience of this and have time to do the key psychosocial work.

In 2021 with the welcome increase in funding for treatment in both Scotland and England, we have an opportunity to build in such systems and introduce training to ensure that at every point of contact we actively connect service users to others in recovery. I’m firmly of the belief that this should be at every client/patient contact, regardless of stage of recovery. Such connections can introduce and raise hope. Hope is an essential ingredient for recovery.

Public Health England have a great resource in the form of a Mutual Aid Toolkit and FAVOR UK have a helpful myth-busting guide, both of which I recommend. The PHE toolkit has a simple take:

  • involvement with mutual aid can significantly improve recovery outcomes 
  • more active or frequent involvement, such as becoming a sponsor, is associated with greater improvement in outcomes 
  • substance misuse treatment providers can improve sustained recovery outcomes (including abstinence) by actively encouraging service users to engage with mutual aid 

Loneliness needs to be pushed out of the bed. The solution to loneliness is connection. We can reduce the risks associated with loneliness for those with substance use disorders through active connection even if this is only on digital platforms at the moment. This is almost certainly a cost-effective way to improve outcomes. What’s to hold us back?

Twitter: @DocDavidM

Picture credit: http://www.istockphoto.com/gdefilip