How does loneliness affect people with substance use disorders?

Having someone to rely on in times of trouble is the top driver of high wellbeing nations.  Relationships and positive social connections are essential for us to thrive – the quality of our relationships and friendships at home, at work and in our communities matter. If we have a substance use disorder, we may make and maintain relationships that meet our needs while we are actively using substances. But once we begin the process to stop or reduce our substance use, our social needs are likely to change. This includes for example, making connections with non-users. 

There is evidence to suggest that when people with substance use disorders engage with people who are supportive of their treatment, it can lead to better outcomes. This means that as part of the treatment process and beyond, there may be a need to avoid situations and relationships that perpetuate substance use and to connect with people who support abstinence or reduction goals. 

But while the rationale behind ideas like this is often for better treatment outcomes, this process can increase the risk of loneliness for people with substance use disorders, particularly for those who are in the early stages of treatment.

We conducted an evidence review that sheds light on who might be most vulnerable to feeling lonely, as well as ways to help alleviate this loneliness.

Key findings

• Loneliness is likely to be related to more problematic substance use

Some of the studies included in the review found that greater severity of substance dependence correlates with greater loneliness, and that substances may even be used to avoid distressing feelings such as loneliness. 

No research has clarified the causal direction or dynamic of this relationship, but it is possible that those who use substances to a greater extent are also those who are more likely to have difficulty maintaining relationships and/or be stigmatised in society, and ultimately become lonelier as a result of social isolation and stigma. Our team has recently published a qualitative study that explores this relationship in a bit more depth . 

• Relationship expectations can contribute to  loneliness

The quality or quantity of interpersonal relationships influences the way people evaluate those relationships, and in turn, how they feel about them. It may be important for treatment providers to consider perceived as well as actual relationships that exist.

• Interventions to alleviate loneliness are scarce for people with substance use disorders

We found that there were no effective loneliness interventions that had been developed for people with substance use disorders. One study trialled an intervention, however it wasn’t found to reduce feelings of loneliness. Based on this finding, our team has developed and piloted a loneliness intervention, Groups for Belonging, for people accessing residential treatment.

Tips for treatment providers

• People with substance use disorders may feel lonelier than non-clinical populations, and loneliness might be most pronounced when people first enter into treatment.
• Clinicians might also need to keep an eye out for people who experience quite severe substance dependence and try to open up conversations about loneliness. Helping people with substance use disorders to overcome mistrust, fear of negative evaluation and stigma might also be helpful in reducing loneliness.