But what is surprising is that loneliness can have devastating consequences on mental and physical health. Evidence shows that loneliness can increase the risk of developing heart disease, stroke, depression, anxiety, dementia, and more.
It’s no surprise then that loneliness is one of the main factors that drive substance use. In my years of working as a therapist (and now as a coach at ALAViDA), I see loneliness come up again and again with clients, even more since the pandemic. So much of my work is helping clients work through loneliness, which in turn is key in reducing their substance use.
The first question I often ask clients is why they believe they use substances in the first place. At first blush, this question often strikes clients as odd. “What do you mean, why do I use substances? I love the taste of a good Cabernet Sauvignon.” Or “I like getting high with my friends at parties on the weekends.” And oftentimes, “I need to unwind at the end of a long day.”
Although those things may be true, I tell them they will likely find out that those are not their only or even primary reasons for using substances if they dig deep enough. Rather, I explain that if a person continues to use substances despite their damaging effects, it is likely they are doing so because the substances satisfy natural, understanding, and important needs within them. Changing their relationship with substances begins with understanding the needs they’re trying to meet through drinking or drug use, and then finding healthier ways to meet those needs.
After having this discussion, most clients acknowledge that there are in fact larger and deeper reasons why they use substances. These reasons are diverse and varied. Some people are using substances to try to feel something that they otherwise typically don’t, like self-confidence, a sense of calm, or a feeling of happiness. Some are using substances to not feel something that they otherwise typically do, like depression, anxiety and stress. However, in the last few years, the biggest reason that’s emerged as a main driver behind my clients’ substance use is loneliness.
In some ways, that shouldn’t be a surprise. In the last several years, loneliness has exploded as a major public health issue. As mentioned earlier, studies show that 30% to 40% of the population feels chronically lonely. That’s not lonely every once in a while; that’s feeling lonely frequently or almost all of the time. Loneliness is even more prevalent in certain populations such as young people, single mothers, members of the LGBTQIA community, immigrants, and older adults. In Great Britain, the issue of loneliness became such a national concern that the government appointed a cabinet-level minister of loneliness. And when Vivek Murthy was appointed the Surgeon General of the United States, the single public health issue he chose to most focus on was not cancer or diabetes or heart disease, as had his predecessors, but loneliness, something he later expanded on in Together: The Healing Power of Human Connection in a Sometimes Lonely World. He explains how technology has increased loneliness while appearing to do the opposite:
~ Vivek H. Murthy, 19th and 21st Surgeon General of the United States in Together: The Healing Power of Human Connection in a Sometimes Lonely World.
There are several reasons why my clients feel lonely, based on my observations. Some are physically isolated and cut off from other people, a problem that has only grown worse during the pandemic. Some don’t prioritize their relationships, believing that greater happiness in life lies elsewhere, in such things as money, success, and status. Some lack confidence in their self-worth, and struggle to believe that others would want much to do with them, and thus isolate themselves. Some, particularly those who have been hurt or traumatized in childhood, have difficulty trusting and opening up to others. (We recently touched on this in The Link Between Substance Use and Trauma.) And finally, some have never really learned the skills to develop intimacy with others, resulting in relationships that are often superficial and unsatisfying.
Whatever its causes, loneliness is one of the most painful aspects of the human experience. A Swedish proverb states that sharing a joy with another person doubles it and sharing sorrow halves it. Loneliness both robs a person of happiness and of the ability to reduce unhappiness. It’s a problem that makes all the other problems in life worse. Perhaps that’s why Mother Teresa, who worked with some of the poorest of the poor, at least economically, made the famous statement: “Loneliness is the worst form of poverty.”
Given the pain of loneliness, it is understandable why people who struggle with it would turn to substances. Some do so to anesthetize the pain of being alone. Some do so because the feeling produced by certain substances, such as opiates, mimics the feeling of being connected and loved. Others use substances as a means to connect with other people, either through increased self-confidence or decreased social anxiety. As journalist Johann Hari said in his TED Talk, Everything You Thought You Knew About Addiction is Wrong: “Human beings have a natural and innate need to bond, and when we’re happy and healthy, we will bond and connect with each other. But if you can’t do that, because you’re isolated or traumatized or beaten down by life, you will bond with anything [aka substances] that gives you some sense of relief.”
In situations where my clients use substances to cope with loneliness, one of my chief goals is to help them to feel more connected. In some cases, I strive to help clients to prioritize their relationships by realizing that things like money, success, and status rarely bring the long-term satisfaction we imagine. In other cases, I work to help clients to realize that the feelings of unworthiness that cause them to self-isolate, may have less to do with anything they are lacking, and more to do with what they needed but did not get as children. And at times, I work to help clients to be able to increasingly trust and open up to others, realizing that intimacy rests on a foundation of transparency and vulnerability. But in every one of these cases, the goal is the same: to help clients to substitute and perhaps even replace their relationship with substances with something even more satisfying: close, meaningful and fulfilling relationships with other people.
In his essay Why We Eat Too Much, philosopher Allain de Botton states: “When we overeat, it’s not food that we’re hungry for. We eat too much because what we’re really hungry for isn’t available.” I believe that a similar phenomenon applies to drinking and using substances. If we overdrink, it’s not alcohol that we’re thirsty for. It’s something else. Alcohol is just a substitute. And from my experience working with clients, I believe the thing that many of us are thirsty for is closeness and intimacy, and love. When we change our relationship with substances or begin to better understand why we use them in the first place, we have a better chance of finding what we were searching for all along.
~ Allain de Botton, Why We Eat Too Much
Overall, we need to address what is a core pain for many of us: loneliness, in order to improve health and our relationship to substances. Perhaps that’s why, as Johann Hari said in his TED talk: “The opposite of addiction is not sobriety. The opposite of addiction is connection.”
If you’d like to change your relationship with alcohol, cannabis, or other mood-altering substances, ALAViDA provides a wide range of support options. Connect with our care team for a personalized program proven to reduce substance use or use our self-guided approach to go at your own pace. Support is accessed through our TRAiL platform and includes a wide range of resources to help you reach your goals, including iCBT modules (internet-based Cognitive Behavioral Therapy), notifications and tracking tools, and more. Access the ALAViDA TRAiL.