Impact of the Epidemic of Loneliness and Isolation

Recently a Surgeon General Advisory called attention to the public health crisis of loneliness, isolation, and lack of connection in our country. U.S. Surgeon General Dr. Vivek Murthy stated, “Given the significant health consequences of loneliness and isolation, we must prioritize building social connections the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders.” He goes on to cite the health consequences of poor or insufficient connection as an increased risk of heart disease, stroke, dementia, and premature death.

I think he missed at least one health consequence of loneliness; an increased risk of substance use disorder in the lonely.  A bit odd it was missed since that was one of the “other critical public health issues” mentioned. 

Loneliness is considered a risk factor for the development of substance use disorder (SUD). When individuals experience loneliness, they are more susceptible to turning to substances such as alcohol, drugs, or other addictive behaviors. This occurs as a coping mechanism for emotional distress and fills the void they feel.

Loneliness can contribute to substance use disorder in several ways:

1. Coping Mechanism: People may use substances as a way to self-medicate and temporarily alleviate feelings of loneliness and isolation.
2. Peer Pressure: Loneliness can make individuals more vulnerable to peer pressure. This may lead to seeking acceptance from social groups that engage in substance use.
3. Increased Risk-Taking: Loneliness can lead to increased risk-taking behaviors. This includes experimenting with substances, due to a lack of social support or a sense of belonging.
4. Escapism: Individuals may use substances to escape from their feelings of loneliness and emotional pain.
5. Neurobiological Factors: Loneliness can affect brain chemistry and the reward system. This makes individuals more susceptible to the pleasurable effects of substances. 

It’s important to note that loneliness is just one of many potential risk factors for substance use disorder. It often interacts with other factors such as genetics, environmental influences, mental health issues, and socioeconomic factors. Addressing loneliness through social support, meaningful connections, and healthy coping mechanisms can play a significant role in preventing or mitigating the risk of substance use disorder. 

How can a healthcare professional be lonely when they are surrounded by people all day? 

Being physically surrounded by people doesn’t necessarily guarantee social or emotional connection, and there are several factors that can contribute to loneliness even in such a context:

1. Lack of Meaningful Connections: Meaningful relationships involve sharing emotions, thoughts, and experiences beyond the scope of work. This may not occur when interacting with colleagues and we would not expect them to occur when interacting with patients. 
2. Isolation: Healthcare professionals who work long or odd hours might not have much opportunity to engage in social activities outside of work. 
3. High Stress and Emotional Toll: Dealing with illnesses, suffering, and difficult situations take a toll on the healthcare professionals’ emotional well-being. Constant exposure to these things can lead to emotional exhaustion and a sense of isolation.
4. Emotional Regulation: Healthcare professionals need to maintain a certain level of emotional detachment to provide the best care. This can create a barrier to forming deeper emotional connections with colleagues.
5.  Workplace Dynamics: Conflicts, competition, or a lack of support within the workplace can contribute to a feeling of isolation and loneliness, even when surrounded by people.
6. Burnout: Overworking and burnout can lead to social withdrawal and decreased interest in social interactions, even if the job involves being around people all day.

Moving Forward

It is important that healthcare professionals, and those who employ them, are aware of the risks and prioritize well-being and mental health. 

1. Make an effort to build meaningful relationships outside of work.
2. Seek support if needed. Especially with those who understand the challenges of working in the healthcare field.
3. Practice self-care which involves establishing boundaries between work and personal life to ensure time for self-care.
4. Advocate for or participate in workplace initiatives that promote a supportive and collaborative environment. 

Mitigating drug diversion in a facility does not start with the handling of a controlled substance. Diversion mitigation starts long before that when we work to advance the health and well-being of our staff.