CCSAD | Therapeutic Approaches Address Growing Issue of Loneliness

Although it is a frequently misunderstood concept and there exists no DSM-5 criteria to formally diagnosis it, loneliness is a condition that is plaguing an increasing number of individuals, and it is exacerbating other harmful health conditions, Cardwell Nuckols, PhD, told Cape Cod Symposium on Addictive Disorders attendees on Sunday.

In the 1970s, 11-17% reported of adults surveyed reported loneliness, Nuckols said. As of 2012, that rate has increased to over 40% in middle aged and older adults. In 2006, 25% of individuals polled by researchers at Purdue University could not name a single person they felt close to. Moreover, in April 2020, 13.8% of U.S. adults reported that they always or often felt lonely, an increase from 11% just 2 years prior that was likely fueled by the onset of the COVID-19 pandemic, Nuckols said.

Those struggling with loneliness often describe themselves in very negative ways, using self-depreciating traits, Nuckols said. Such individuals feel pessimistic, disliked and unappreciated. Some feel angry because they perceive others as unwilling to rescue them from their feeling of loneliness. Nuckols said this belief in many instances is a case of unrealistic expectations because it assumes others have the capacity to remove someone from feelings of loneliness and simply choose not to, when this isn’t necessarily the case.

Individuals with substance use disorders often are lonely people, Nuckols said, and feelings of isolation, depression and/or anxiety can sustain alcohol and drug use, creating a destructive cycle. Substances become viewed as a substitute for interpersonal relationships, but when those substances are used to combat loneliness, they only exacerbate those feelings in the long run.

“The more we drink and use, the lonelier we get,” Nuckols said.

Severe early life stress and greater trauma exposure dramatically increase risk of addiction, said Nuckols.

Having the right thought, however, can activate behavioral changes in patients that eventually lead to accomplishing desired goals. The key step is mustering the right outlook to set this reaction in motion, and this is where patients can get stuck if they start with a negative worldview.

“What happens that I find interesting is that as one starts to work a personal spiritual program, like a 12-Step program, your worldview will change,” Nuckols said. “As your worldview changes, character defects drop away because they don’t have utility anymore.”

Nuckols then shared 4 primary interventions for reducing loneliness that have been studied:

Increasing opportunities for social interaction. The problem with this intervention, Nuckols said, is that a large number of contacts is not equivalent to quality relationships. Even if patients want to connect, their unconscious hypervigilance for social threat can lead them to be negative with or withdraw from others.

Programs that enhance social support, such as mentoring or buddy-care programs. Loneliness is not only about giving support, but also giving back support. Giving promotes a sense of wellbeing. Still, Nuckols said, data on this intervention has shown little impact.

Focusing on the development of social skills. This includes speaking on phone, giving/receiving compliments, enhancing nonverbal social skills. Ultimately, this has also shown to produce limited returns, as people are lonely for many reasons besides poor social skills. Experimental research has shown most adults have at least minimal social skills, but these adults are more likely to call upon these skills when they feel low levels of loneliness rather than high.

Addressing maladaptive social cognition. Of the interventions discussed, therapies that address maladaptive social cognition, such as cognitive behavior therapy, have demonstrated the most improvement, Nuckols said. Such therapy can be expensive and time-consuming, and client’s lack of openness to changing their thoughts about and interactions with others can be obstacle to effective treatment. It is possible this intervention may be more effective if augmented initially by appropriate pharmacologic treatment, Nuckols said.