The following article is a part of conference coverage from the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurses in psychiatry. Check back for more from APNA 2020.


A systematic review of 31 studies showed evidence supporting the psychoneuroimmunology (PNI) paradigm, a methodology that indicates simultaneous social isolation/loneliness and substance abuse negatively impacts coping patterns, leading to continued substance abuse and relapse. Because of this association, patients with substance use disorder (SUD) should be thoroughly assessed for loneliness and social isolation in order to improve outcomes, according to results presented at the American Psychiatric Nurses Association 34th Annual Conference, held online from September 30 to October 4, 2020.

The investigators, led by Laurie A. Theeke, PhD, conducted a literature search for quantitative studies that included a measure of social isolation or loneliness and had samples of adults with SUD. Critiques were made for 31 quantitative studies, and study findings were synthesized. Evidence for the PNI paradigm was present in all studies.

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Adults endorsing loneliness who had SUD also showed increased social anxiety, relational aggression, and depressive symptoms. Adults with SUD and social isolation reported lower self-regulation and control; these patients also had worse outcomes for rates of both compulsory and voluntary hospitalization. One of the studies identified loneliness as the reason for relapse among 31% of respondents. Avoiding social isolation and having emotional support were identified as protective factors for SUD.

Study investigators concluded that in practice, “It is important for nurses to assess for social isolation and loneliness in people with substance use disorder as these concepts may contribute to relapse.” Regarding future research, investigators stated, “Studies of social connectedness, loneliness, and social isolation are needed in people with substance use disorder. It is important to differentiate responses to loneliness and social isolation so that interventions could be developed based on precise response targets.”

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Theeke L, Mallow J, Zullig K, Garland, M, Tuscano M. Loneliness, social isolation, and substance use in adults: findings from a systematic review. Presented at: APNA 34th Annual Conference; September 30-October 4, 2020. Poster 173.