Sot Scr Med Vol 34, No 4. pp 405-414.

1992 0277-9536192 $5 00 + 0 00
Pnnled m Great Bntam All nghts reserved Copynght Q 1992 Pergamon Press plc

LONELINESS AND ALCOHOL ABUSE: A REVIEW OF

EVIDENCES OF AN INTERPLAY
INGEMARAKERLIND and JAN OLOF HORNQUIST
Department of Commuruty Medtane, Faculty of Health Sciences, Lmkopmg Umverslty,
S-581 85 LmkBpmg, Sweden

Abstract-This report contams a review of the hterature about the Interplay between lonehness and the
abuse of alcohol A theoretIca dIscussIon based on chmcal observations can be dated back to the 1950’s
Systematic empmcal studies, however, appear sparsely and have mamly been performed dunng the last
decade Thus, knowledge IS sttll mcomplete, but the review mdlcates that lonehness may be slgmficant at
all stages m the course of alcohohsm as a contnbutmg and mamtammg factor m the growth of abuse
and as an encumbrance m attempts to gve It up Concordant reports demonstrate that alcohohcs do feel
more lonely than members of most other groups do In advanced abusers, lonehness IS obviously
connected wth a number of negative charactenstlcs and, together with several of those, directly linked
to a poor prognosis. There are, however, no obvious relations to the external social sltuatlon (I e network)
or amount of dnnkmg Instead, the feehng of loneliness appears to be more connected wrth a general
negative perception about oneself and one’s relations to other people and also with a general
dlssatlsfaction wth most thmgs m hfe The lonely abuser seems hkewlse resigned and unable to bnng
himself to change his/her sltuatlon There are also assoclatlons with a broad array of psychopathology
In comparison to people with other health problems, the supportive value of the social network of
alcohohcs appears to be more wavenng

Keywords-lonehness, social network, alcohol abuse, hterature review

INTRODUCTION It is also a common opinion in clinical settings,

among theraplsts and clients as well, that loneliness
Man 1s a ‘social creature’, totally dependent on the and deficiencies m social relatlonships are detnmental
group for his or her development and survival as a factors m the course of alcohol problems They may
human being [I]. Expulsion from the community was have determmmg and reinforcing influences when
formerly a deadly menace, now hngenng symbohcally abuse 1s growing as well as becoming a hindrance in
at an emotlonal level Close relatlonshlps are still attempts to reduce the abuse by rehablhtatlon efforts
important for a sense of secunty and well-bemg Alcoholism has even been described as ‘the lonely
Feelings of loneliness stand out as the dreary antl- disease’ [6] The preludice comes, however, not only
pole Consequently, these fundamental affihatlve m the lacking sense of community but also often in
needs are basic elements m most different directions a superabundance of the ‘wrong’ type of contacts
of alcohol research, such as the psychodynamic (dnnkmg buddies) It 1s not unusual for abusers m
theones of frustrated dependency needs [2,3] and rehablhtatlon to get along more easily with the
social learning theones of deficient social skills [4,5]. absence of alcohol than the loss of social contacts
The threatening zero of the social attachment dlmen- associated with drinking Accordmgly, loneliness and
slon-lonehness-is, however, seldom exphcltly con- the establishment of non-dnnkmg contacts are re-
ceptualized m this context curnng themes m therapy and social planning at
In public opmlon, there are clear ideas about use discharge
and abuse of alcohol, allowmg one to cope with What IS the sclentdic evidence for these beliefs
emotlonal reactions m social intercourse. Alcohol as about the part lonehness plays m the course of
a social facilitator within traditional party forms 1s alcohol abuse? Firstly, m the matenal below, a bnef
commonly accepted To brace oneself with a dnnk or onentatlon 1s outhned concernmg research on social
two m approaching the opposite sex IS commonly relatlonshlps m general and m relation to alcohol
recognized, but not quite accepted. Dnnkmg as a abuse Then a closer review of studies on loneliness
solace after failure to establish contact or after?e- and alcohol abuse 1s presented
latlonshlps are broken is, together with solitary
dnnkmg, Just as familiar, but less accepted and often
considered hazardous To sum up, the use of alcohol SOCIAL NETWORK, LONELINESS AND HEALTH
as an effort to establish contact and cope with
lonehness 1s widely recognized and sometimes re- In the research on social relatlonshlps, mamfest
garded as a gateway to drinking problems. hnks to health and well-being have been established

405
406 IVGEMAR~ERLIND and JAMOLOF HORNQUIST

dunng the last decade [7] There are two mam lines ALCOHOL ABUSE AND SOClAL RELATIONSHIPS
m the development Social network research empha-
sizes external characteristics and the availabthty of As Schiht and Gomberg [26] have concluded,
social support [8,9] Research on lonehness [lO-121 “Research indicates that social support affects a
begins wtth the inner feelings of affimty and looks for person’s mental health posmvely by filhng needs for
antecendents and consequences m the overall hfe of affiliation, belongmg, respect, social recogmtion,
the mdtvidual Accordingly, there are two different affection, and nurturance, and by buffenng the effects
perspecttves on the ‘outward-Inward’ dimension of of stress” They mean that analyses of “well-being
the social exchange between the mdrvtdual and the and the absence of relatronshrps as represented by
environment [ 131 lonelmess, isolation, and loss” has as yet been incom-
The two research traditions have evolved m- pletely apphed m the field of alcohol research In this
dependently of each other, despite their common review of the theme, research on external features of
core and there have been notably few attempts at the social network are firstly outlmed, then a more
mtegration and cross-fertihzation [ 14-161 There thorough review of studies on the mner feeling of
are, however, some points m common According lonelmess 1s presented
to Rook [16], lonelmess researchers stress the satis-
faction of inherent needs for compamonshtp and Social network, social support and alcohol abuse
mttmacy, whereas social support theorists emphasize Despite their dtstmctive features of maladjustment,
the importance of different types of help from alcohol abusers rarely occur m research lmkmg social
others m stressful situattons The multidtmensional network and support to health, well-being and adap-
defimtions of social support often mclude an tation to life stress In the field of alcohol research,
emotional component [17] which corresponds to however, the issue of social relations has been dealt
essential parts of the mner feeling of lonehness with to some extent. Blane [3], for example, has
Moreover, many researchers have emphasized discussed the angry alcohohc m terms of ahenatmg
the perceived or subjective aspects of social support others and provokmg rgectton from ones he cares
[17] In her later research, Rook [18] demonstrated about Data m a study of Tokar et al [27] indicate
that compamonship plays a more far-reachmg that the alcoholic has a greater tendency than the
role than social support m sustammg well-being m non-alcoholic to withdraw from others m posttive as
general well as negative emotional states They emphasize the
In the growing research on lonelmess, there have improvement of interpersonal social relations as an
been a vanety of definitions of the concept [19] important treatment rmphcation In later studies,
However, most researchers agree on that lonelmess IS social network variables have been associated with
m its nature an unpleasant and distressmg experience wtllmgness to enter rehabilitation programmes [28]
[I91 that is not directly dependent on the degree of and with a positive outcome m rehabihtation [29-311
soctal tsolatton m an external sense, but depends The varying supportive value of the alcohohc’s social
more on perceived deficits m the quality of one’s contacts has also been noticed m some reports
social relations [l l] or a perceived lack of soctal 132,331
support [7] Accordmgly, social network effects on In a study by Schiht et al [26], alcohohc women
subjective feelings of loneliness are dependent on reported less social support than nonalcoholics when
‘cogmtive factors such as an mdividual’s expectatrons growing up and at present The authors find the data
or values’ [7] In classifymg lonelmess, two dimen- mdtcates that difficulties m social support may ante-
sions have proved useful to distmguish [20] One is date as well as result from alcohol problems Bi-
the distmction between transient states of loneliness directionahty m causal relations has also been
(‘state’ or acute) and more chronic dispositional pointed out by Brllmgs et al [29] While some re-
forms of lonelmess (‘trait’ or chronic) [21,22] The searchers [34, 351 have demonstrated how relapse can
other 1s based on the specific social deficit involved lead to impaired social resources, their own studies
[20], e g Weiss’s distmction between absence of an parttcularly emphasize the positive effect of current
mtlmate attachment (emotional lonelmess) and lack social resources on recovery [36, 371
of contacts m the social life more m general (social Other studies have dealt more exclusively wtth
lonehness) [23] family aspects of the alcoholic’s social relationshtps
In conformity with the extensive research on social Earlier reports on the detrimental effects of alco-
network and health [8,9], lonelmess has also been holism m the family have recently been supplemented
focused on as an important component ua critical life by studies of the family’s effect on the course of
situations (see Ref [24] for a review) Lo~ehness can alcohohsm [38] Many of the later studies have
be related to health m several different ways [25] (1) focused on family processes that might evoke, sup-
as an ‘illness’ m itself, (2) as an addition to tllness, port, and mamtam abuse as a stabihzmg factor or
e g symptoms m depressron, (3) as a cause of un- coping mechanism m dealmg with family dysfunc-
healthy behavior, e g alcohol consumptron, (4) as a tions [3841] However, there are also mdices of
consequence of illness (isolation), (5) as a cause of family changes m connection wtth treatment that may
illness sustam improvements m rehabihtation [38] Other
 Loneliness and alcohol abuse 407

studies indicate that the more cohesive and support- literature on lonehness [49,50] and on alcohol
ive the famtly, the better the patient’s prognosis [42]. [51-531 Segal [54], for instance, states that dnnkmg
The vrew of a umtary ‘alcohohc mamage’ has been is “one of the means of coping with feelings of
abandoned m favour of more flexible and multtvan- isolatton, creating an allusion of fnendsmp and to-
ate concepttons based on social leammg and general getherness”. It gives “social support for infirrmties
systems theory [43]. According to Pearlman (401, the and allows the expression of feelmgs”.
patterns of interaction m famihes with alcohol prob- In a study on alcohohsm and self-concept, Vander-
lems do not seem to differ from famthes experiencing pool [55] has drawn some conclusions about lonelr-
other forms of distress Jacob et al [39], on the other ness based on results from various self-concept scales.
hand, point out that such drfferences have been He found results mdicatmg that an alcoholic is
demonstrated m recent controlled experiments In basically lonely and feels “estranged, unworthy and
any case, the incidence of family dysfunction m unable to sustain mtimate relationships, dissatisfied
connectton with alcohol abuse is high Regardless of not only with himself . but also as a family member
the direction of causality, the supportive potential and m close relationships in general”. There were also
m these families with long-term abuse is probably results suggesting that alcoholics “may dnnk m order
reduced to escape lonehness and estrangement”
The first empirical study specifically on loneliness
Lonehness and alcohol abuse and alcohol abuse was made by Nerviano and Gross
The hnk between lonelmess and alcohol abuse has (561 Their motive was the common chnical obser-
been discussed m cluucal and psychological literature vation of the high degree of lonehness felt by many
srnce the 1950’s The discussion has, however, mainly chronic alcohohcs They point out two different plaus-
concerned theoretical reflections, anecdotal obser- ible reasons. feelmgs of lonehness as “an integral part
vations or, as Loucks [44] pomts out, references “in of the social detenoration that accompames alcoholic
a phenomenologmal sense” Systematic empirical chromcity” or as “a part of long-term affective prob-
studies are, however, sparsely appearing [45] and lems that contnbute to continued mebnatron” They
have marnly been performed during the last decade consider that an accurate assessment of lonehness
In a proneenng article, Bell (461 brought up the could hold important imphcations for the treatment
mam themes recurnng m later works [47,48]- He of alcohohcs as regards prediction and evaluation of
declares exphcitly that he does not rely on systematic response to therapy In their article, Nervtano et al
research data but rather presents “impressions of the [56] touch upon most of the principal themes m
relationship between social health and alcohol dts- subsequent research, even though their own results
ease” He apprehends man basically as a social being, concern Just one of them (see part (5) below). The
dependmg on others for survival The absence of research can be reviewed along the followmg paths
lonelmess IS, accordmgly, an essential critenon of
(1) Is lonelmess a contnbutory factor m the emer-
mental and social well-being As a consequence of
gence of alcohol abuse?
failures m child reanng, a large proportion of the
(2) Do alcohohcs feel more lonely than members of
populatton grow up to be ‘lone wolves’, with an
other groups?
mabrhty to trust m other people Basically, however,
(3) Are lonely dnnkers more vulnerable to the
they have the same needs of dependence and mtrmacy
problematic consequences of then alcohol con-
as others, but they have denied the sense of security
sumption?
and the satisfaction provided by close relationships
(4) Is lonelmess a hindrance m alcohol rehabthta-
In times of stress they can not rely on the protective
tion?
and supportive functions of the soctal network In-
(5) Which connections are found between loneh-
stead, they may turn to a dependence on chemicals to
ness and other soctal, psychological and medi-
make themselves msensmve to the discomfort of the
cal vanables, 1 e what are the charactenstics of
situatton [46] and to escape from their awareness of
the lonely alcohol&
separateness and aloneness [47] Dependence on
(6) What is the cause and effect m the mterplay
drugs IS, accordmgly, an actual substitute for depen-
between lonelmess and dnnkmg?
dence on others In conformity with Gaev 1471and
(7) Is lonehness an appropriate target m the treat-
MiJuskovic [48], Bell even regards loneliness or alone-
ment of alcohol abuse?
ness as the most important single factor m the
development of drug addiction
Gaev [47] has also pointed out that lonelmess tjoes (I) Lonehness as a precursor to akohol problems
not presuppose aloneness or social isolation It is The notion of lonehness as a determmmg factor in
rather a tendency to keep one’s pnvate feelings and the etiology of alcohohsm is a salient feature of the
thoughts to oneself, an mabihty to share one’s per- chmcal and theoretical reasonmg referred to above.
sonal life with others, that gradually engenders the Much m this hne of argumentation IScharactenstic of
state of tension which alcohol may relieve the smgle-factor way of thmkmg that was previously
Brief statements about lonelmess as a precursor to prevalent, mter alla m psychological theones of
alcohohsm likewise appear more mcidentally m the alcohohsm [57, 581
408 INGEMAR AKERLIND and JAN OLOF HORNQUIST

In current prospective longtudmal studies on demonstrate more feelmgs of loneliness than most
psychologrcal nsk factors, tmpulstveness, overacttv- other groups do Regardless of whether the feelings of
tty, aggressiveness and novelty-seeking m combr- lonelmess are precursors to or consequences of the
nation with an extroverted and soctable dtsposttton abuse, thts condttion IS a reminder m the management
have been recurrent findmgs [59] Thts pattern has of alcohohc treatment
been most charactensttc of early onset male alcohohcs
rdenttfied by the authonttes Cursonly regarded, lone- (3) Lone/mess and uu/“erabz/rry to a/coho/ problems
liness does not appear to be a sahent feature of thts The reviews above have dealt wtth group differences
group It should be noted, however, that the data between alcohohcs and other people Naturally, there
conststed solely of ratmgs by others (teachers etc) ts also a vanatton m loneliness wtthm the group of
Self-rated loneliness has, so far, not been mcluded m alcohohcs that may be related to differences m dnnk-
this type of studies At late onset, passive-dependent mg charactensttcs, overall functtonmg and prognoses
traits, such as pessimism, macttvtty and guilt feelmgs In a Swedtsh study [71] of chronic alcoholics, corre-
have turned out to be nsk factors [59] This 1sa pattern lattons between loneliness and, on the other hand,
more closely kindred to lonelmess chmcal signs of alcohohsm and health care utthzatton
An extroverted attttude does not necessanly ensure were presented No evident correlation between lone-
sattsfymg soctal functionmg, as appears from a liness and various vat-tables on the duratton of abuse
prospective study of women by Jones [60] Although appeared, though The latter notatton mdtcates that
bemg more other-directed, future problem drinkers the alcoholic’s feelmgs of lonelmess cannot be viewed
exhibited more obstacles to mterpersonal assoctattons only as a secondary effect of other detenoratton,
as adolescents Jones regards excessive drmkmg as a which usually follows the progresston of the abuse
way of copmg wtth feelmgs of despondency and Nor was lonelmess related to the amount of alcohol
madequacy consumed at the mtttal exammatton The results are
To some extent, the current issue may hkewtse be dtscussed m terms of the more lonely alcohohcs being
tllustrated by cross-sectional studies of reactions to more vulnerable and help-seeking as well as bemg
lonelmess m the general populatton In a Swedtsh more mchned to admit their own weaknesses
study [61], the resort to alcohol was comparattvely In a study of a non-chmcal group of relatively
frequently reported as a reactton to lonelmess That heavy drmkers, Sadava et al have reported that
was espectally charactenstlc of males wtth a htgh lonehness was stgmficantly related to alcohol prob-
degree of lonehness Moreover, drmkmg (and the use lems but not to quantitative aspects of alcohol con-
of tranquthzers) was a part of ‘sad passtvtty’, the most sumption [45] . Smce lonelmess, m then opmion,
important type of reaction to loneliness in a factor represents defictent soctal skulls, an absence of
analyttc study m the U S [62] It has also been supportive soctal relattonshtps, and negattvtsttc mtro-
reported that lonely people may drmk as a response to specttve tendencies, tt may be a source of vulner-
personal problems and feelings of stress, whereas ability to alcohol problems, 1 e it may lead to more
non-lonely people drmk more often m order to par- serious consequences of the drmkmg at the same
ttctpate in group social acttvittes [19] consumptton level It is possible that lonely people
pay attention more selectively to negative personal
(2) Are alcohoks more lonely? effects of drmkmg and regard them as mdtcattve of
Several reports from vartous cultures Indicate that personal problems
alcoholics feel more lonely than most other studied
groups (4) The lonely akohohc
One of these studtes [63] concerned Swedtsh alco- In the study of Nervrano et al, the lonely alcoholic
hohcs rmmedtately pnor to dtsabthty pension m com- stands out as bemg socrally mhtbtted, highly anxtous
parison with matched group of somattc patients m and havmg relattvely poor orgamzatton of tmpulse
the same sttuatton Studies m the U S and Japan expresston There was also a general tendency to
[26,64] compared female alcoholics wtth controls In deptct oneself m a negative way [56]
other studies of various populattons m the latter In a study of hospttahzed alcohol abusers [72],
countries, alcohohcs were respecttvely the most and lonehness was strongly correlated wtth shyness, de-
the second most lonely group [65,66] On the other pression and lack of purpose m hfe
hand, there was no difference m lonelmess between Akerlmd and Homqutst have presented a broader
people seeking treatment for alcoholism and people survey of overall life adJustment m chronic alcoholics
seeking treatment for other reasons at a _commumty [7 I, 731,compnsmg an array of socral, psychological
mental health clmtc [67] i and medical vanables The more lonely alcohohcs
In a study of a non-clmtcal sample of the general turned out wtth poorer psychologtcal well-being,
populatton, more lonelmess was found among people more discontent and dtssatrsfaction wtth hfe along
who had been treated for alcohol abuse 1681 Problem with a vanety of psychtatnc symptomatology Feel-
drmkmg has also been related to feelmgs of tsolatton mgs of indolence and msecunty as well as mfenonty
and non-mvolvement m soctal roles and relatronshtps and perceived negattve treatment from others were
[69, 701 People wrth alcohol problems obvtously the most pronounced charactenstlcs of the lonely
 Loneliness and alcohol abuse 409

abusers However, m agreement with studies on other classtcal forms of psychopathology vs loneliness that
groups (students, elderly people etc ) [I 11, there were is more circumscribed”” [13]
no sample nor obvtous connections to external
charactenstics of the social network (frequency of (5) Lonehness and the prognoses m rehabrhtatlon
contacts, etc ) Feelings of loneliness appeared more Regardless of the question of ettological sigmfi-
closely associated with dtssattsfactton wtth the quality cance at the ongm of alcohol problems, loneliness
of existmg relationships, independent of quantity m may be an important factor in attempts to give up
accordance with studies on other groups [II]. abuse Soctal contacts have often been narrowed to
Furthermore, low but agmficant correlations wtth heavy dnnkmg companions [77] . In many cases, a
chmcal symptoms of alcohol abuse emerged, while lasting improvement m dnnkmg habits presupposes
quantitative aspects such as duration and level of the the power to break away from such contacts The
alcohol consumption were unrelated at the first as- greater the disposttton to feelings of loneliness, the
sessment, which was refernng to past hfe as a whole harder tt would be to abandon the habitual envtron-
Achievements on the mtellectual tests were unrelated ment and exrstmg relattonships, even tf they are
to lonehness, as were most of the biochemical labora- imperfect
tory test results Accordmgly, the negative character- There are several studies on prognosis m rehabihta-
istics of the lonely abuser could not be explained by non (see Refs [78-811 for reviews). Only a few
a higher level of alcohol consumption or mtellectual however, have included the assessment of lonehness-
deficiencies (congenrtal or aqutred) related parameters
The pattern of general dissattsfaction and ducon- In a study of alcoholics at different stages of
tent m combmatton wtth Indolence and passtvity IS recovery [82], those having at least 1 year of sobnety
also noted m some studies on loneliness m other exhtbited less loneliness than alcoholics m an acute
groups Accordmg to Stokes, lonehness IS associated stage of detoxification The cross-sectional design
with a general tendency to perceive sttuations in a with different study groups does not, however, admit
negative way [74] Rubenstem et al [62] point out that the conclusion that feelmgs of loneliness were reduced
‘sad passivity’ IS charactenstic of the most lonely tf rehabthtatton was successful The difference may
ones There are also correspondences with some rather be explained by the fact that the mittally less
charactenzattons (“the hopelessly lonely who are lonely were more successful and, accordmgly, more
very dissatisfied with their relationships”, “the re- often mcluded m the recovered group The latter
signed, hopelessly lonely”) m de Jong-Gierveld and interpretation 1s m lure with results reported by
Raadschelders’s classtficatton of different types of Akerhnd et al, mdtcatmg that changes m loneliness
loneliness [75] were unrelated to changes m dnnkmg and workmg
In order to focus the often neglected longttudmal capacity [83]
dimension of lonelmess [I 1, 15,201, Akerhnd and One prospective prognostic study mcludmg loneh-
Homquist [76] have analysed the association between ness [84], covered a broad set of social, psychologtcal
change m lonehness and changes m other life areas and medical vanables Lonehness and mtercourse
over a 2-year period m the group of advanced alcohol with other abusers were found to be the most sigmfi-
abusers mentioned above [71,73] Increasmg loneh- cant negative predictors of successful rehabthtation
ness was prtmarily linked to deteriorated psychologi- Neither was the availabihty of other types of social
cal well-bemg and some aspects of hfe satisfactton network related to a posmve outcome, but rather the
This was also true for mood-related psychiatnc van- reverse This 1s in contrast to the findings m several
ables However, changes m satisfactton with one’s studies on social support m other groups [8] It IS
social relations together with a number of psychtatnc posstble that even these contacts, after years of
symptoms (not pnmanly mood-related) were nonre- dnnkmg, had been too interlaced with abuse and
lated This was the case m spite of the fact that these because of that had become a hindrance to tmprove-
variables correlated cross-sectionally with lonehness ment Alcohol abuse as a potentially stabthzmg factor
both at the begmnmg and end of the 2-year study m dealing with family dysfunctions has also been
penod Accordmgly, the latter components are only pointed out previously [85]
related to the permanent level of lonehness, while the The results suggest that the most favourable pre-
first cluster of vanables also appears to be related to requtsites for rehabihtation are at hand if the abuser
alterations m loneliness during the 2-year penod can relmquish the accustomed types of contacts m the
This discrepancy between cross-sectional and longt- usual environment where the abuse goes on, without
tudmal correlation patterns may indicate that feelings at the same time being restrained by feelings of
of lonehness could be comprised of different for& of lonehness Or to put it m other words, it is a matter
lonehness m regard to temporal stability A consider- of being able to be alone without feeling lonely
able part of the expenence of loneliness m alcoholics A further analysts of the data demonstrates that
seems to be more associated with their current state lonelmess can be brought together with the kindred
of mood and self-concept than with their social vanables of mfenority and perceived negative treat-
relationshtps The results illummate the drstmctton ment from others mto one group of negative prognos-
between “lonehness embedded m the context of the tic factors [81] Another equally stgmficant cluster of
410 IXGEMAR &ERLI\D and JAU OLOF HOR\QCIST

negattve predictors mcludes mdectston, lassttude and between changes m feelings of lonelmess and change
indolence Obvtously, the two clusters combmed m dnnkmg or working capactty were found [83]
provtde a parttcularly poor personal basis for the Moreover, a change m feelmgs of lonelmess was
mobthzatton required by successful rehabthtatlon merely weakly and amblgously connected wtth quan-
The thud stgmficant prognosttc factor, mteractlon tltatrve changes m the social network and not at all
with other abusers, also fits mto this pattern Feelings wtth change m satisfaction with one’s social contacts
of lonelmess imply a desire for commumcatron [76] To conclude, certam Improvements m the soctal
Whereas the more lonely abusers are also more network seem to occur concomttant with a favour-
unsure about then own worth and expect negative able course m rehabrhtatton, but there 1s no evidence
treatment from others, more cursory and nonde- of reductton m feehngs of lonelmess
mandmg intercourse with drmkmg companions may
be conceived of as a shortcut to commumon More- (7) Lonelrness and treatment of alcohol abuse
over, thts mteractton does not requtre active personal Systemattc treatment studies with the mam empha-
mvolvement, but fits a passtve, mdectstve and hstless sts on lonehness are rare Johnson [72] has evaluated
way of being It IS easily understood that there are the effect of two weeks of logoanalysts group treat-
considerable hindrances agamst change m the way of ment,* but without finding any change m lonelmess
hvmg when these ctrcumstances comctde A trial by Akerlmd and Homqmst to focus on
lonelmess m the therapy of alcohol abusers m varymg
(6) The mterplay between drmkmg and loneltness forms of rehabthtatton programmes ytelded prehmt-
What are the underlying causal mechanisms behmd nartly no dtfference m outcome m compartson with
the greater lonelmess seen m alcohol& The posse- standard treatment t However, another evaluatton of
bthty that more lonely people are more prone to group counsellmg with emphases on lonehness for a
developmg alcohol problems has already been dts- non-clmtcal group wtth early mamfestattons of heavy
cussed Another explanatton according to Nervtano dnnkmg, disclosed certain postttve treatment effects
et al [56] may be that lonelmess IS part of the general [94
detertoratton that accompames progression of the Allen et al [82] claim that understanding of the
abuse stgmficance of lonelmess should pervade the treat-
Accordmg to data from Schtht [86], the usually ment process m, for Instance, group acttvities, role
reported social tsolatton m female alcohohcs IS not play and plans for recreatton and letsure acttvtttes In
merely the effect of reJectton by those around them, addition, the mstttuttonal personnel should be
but the process can be reciprocal Increasing tsolatton trained to anttclpate possrble lonelmess problems and
and lonelmess IS also related to the women’s own also be able to meet the abusers wtth warmth, support
behavtoral choice to cut themselves off from friends and encouragement The community can play a key
who do not dnnk heavily, Inter aha m order to avoid role by creating meetmg spots m, for instance, day
crtttctsm This narrowmg of the social contacts has treatment centers and by supporting layman engage-
also been noted by other authors [87-891 It leads, ment, as m AA Medora, Woodward and Florell [93]
accordmg to Gomberg et al, to mcreasmg feelings also emphastze that lonelmess should be paid atten-
of lonelmess and lsolatton [77] Such feelmgs become tion to m group acttvtttes, discusstons, etc The aim
the mottve for addtttonal drmkmg whtch, m turn, should be to help the pattents cope with the problem
‘trtggers more reJection’ and provtde them with alternative strategies, and
If feelmgs of lonelmess are hterally an Integrated also, to a certam extent, to accept then loneliness
part of the social detertoratton [56] that accompanies
chrome alcohol problems, the process ought to be CONCLUSIONS
reversible The social network would then Improve
and feelings of lonelmess would dlmnnsh, along with The revtew evmces several mdtces of loneliness as
a regress m abuse Certam mdtcatlons of an Improved bemg a stgmficant factor m the use and abuse of
soctal network accompanymg reduced drinking have alcohol There are chmcal and theorettcal [46-541 as
Indeed been reported by Kammetr [90] Favazza and well as some emptrtcal (19, 55, 61,62, 691 mdtcattons
Thompson [91] found that successful therapy of of lonelmess as a precursor to alcohol problems
alcohohcs at least arrested the dlsmtegratton process Concordant reports demonstrate that alcohohcs do
of the social network In studies by Akerlmd and feel more lonely than members of most other groups
Homqulst, a more favourable course in rehabthtatton [26,63-701 In advanced abusers, lonehness IS obvt-
was connected wtth a reduction of abuser contacts ously connected wtth a number of negattve character-
and increased sattsfactton with social mtekourse, but istics [56,71-731 and, together with several of those,
there were only slight tendenctes of an increase m dtrectly lurked to a poor prognosis [8 1, 841 There are,
‘posttlve’ soctal contacts [83] However, no bonds however, no obvious relations to the external social
sttuatton (I e network) or amount of drmkmg The
lFaclhtatlon of the development of a sense of hfe purpose feeling of loneltness appears to be more connected
tAn evaluation m progress encompassmg 80 alcohol with a general negative perception about oneself and
abusers m rehablhtatlon one’s relattons to other people and also with a general
 Lonelmess and alcohol abuse 411

dissatisfaction with most thmgs m hfe [55, 71,731 social network is often restncted to dnnkmg compan-
The lonely abuser seems hkewtse restgned and unable tons [77] and the remammg non-dnnkmg contacts
to bnng himself to change the situation [71] There may be enervated by attntion of the abuse Neverthe-
are also associations with a broad array of psycho- less, basic needs for compamonshtp and commumon
pathology [71] Depressive symptoms constitute one ought to be of unabated stgmficance even m this
part of the picture but are not more sahent than other group Accordmg to Sulhvan and Poertner [96], the
symptoms, except for the longitudmal hnk to changes mdividual’s subjecttve way of evaluatmg his bonds to
m loneliness [76] other people may be Just as important a factor for
The expenence of lonehness, and the connected present and future overall hfe adjustment. Thts sug-
wtdespread negative attitude toward hfe, IS probably gestion was confirmed m the present review of studies
quite profound and enduring It appears to be on alcohohcs The results emphasize the sigmficance
difficult to change by means of ordmary supportive of the SubJecttve appraisal of these bonds whtle, m the
treatment methods, even though feehngs of lonelmess mterpersonal field, only contacts wrth other abusers
are especially focused on Of course, external social were stgmficant [8 1,841 The sense of compamonshtp
changes are often necessary for recovery, but tt accordmgly seems to be more important than the
cannot be taken for granted that they are suffictent to actual social resources provtded, m line with the
fill up the mtnnstc vacuity of the lonely one with findrngs of Rook (181
anythmg else but hts devotion to alcohol The estab- The feeling of lonehness was hkewise more linked
hshment of new social contacts is often an Important to the valuation of oneself and one’s total hfe sttu-
goal m the treatment of the smgle alcohohc, whose ation [7 1,731 Accordmg to Kaplan [97], “the process
network has been restncted to only dnnkmg buddies of becommg alcoholic mvolves an mcreasmg reliance
But the chances of a more lastmg Improvement are on alcohol to manage negative feelmgs about the
probably more favourable if such external changes self” [98] Indivrdual differences m self-esteem should
comcrde with emotional changes, as, for Instance, then be important for the capacity to face the ‘serious
findmg a strong commumon m a matter that requtres dilemma m recovery’ with less support from alcohol
a profound personal mvolvement or ‘conversion’, Accordmg to Bennett [98], this proposition has not
such as love affairs, AA or spiritual activtties Lay- yet been corroborated m a longrtudmal study of
man engagement during and after treatment may be relapse In the present review, however, alcoholics
an Important step on the path to communion wtth with greater confidence m themselves and thetr re-
nondnnkmg contacts outside the mstitution. lations to others were obviously more successful m
The search for nsk-factors and deleterious rehabihtatton [81]
consequences of hazardous dnnkmg IS the prevaihng Loneliness is a fundamental human expenence
paradigm m alcohol research Even though the per- which ranges from “fleetmg twinges of discomfort to
spective has been widened from specific alcohol- severe and persistent feehngs of Intense misery” [20]
related aspects (e g symptoms and diagnostic issues) There are clues m the research literature that loneh-
to a broader multivariate view [80,94], pathological ness may lead to alcohohsm, drug abuse and other
and deviant aspects are still often m the forefront behavioral disorders The causal pathways are, how-
Soctal and psychological factors have been studied ever, stall not clear Abuse may not only represent an
mamly from that perspective It is easy to overlook attempt to alleviate the pam connected wtth loneh-
the fact that the advanced alcohol abuser IS not ness, but it may also be a means of gettmg m touch
merely an ‘alcohohc’ but also an mdtvidual m a with other people or copmg with social anxiety [15]
cntical hfe sttuation The well-known social and Loneliness IS certamly not Just a pnvate problem for
occupational impairment is often regarded as Just a the mdividual, but IS also a burden for society. Both
secondary effect of the abuse and not a source of circumstances are motives for enhanced attention to
reactions m itself Even wtthout the mvolvement of lonelmess m research as well as m treatment
alcohol, the genera1 detenoration of their hfe situ-
ation would imply a crisis in which a spectrum of Acknowledgemenr-This study was supported by a grant
different reactions, attitudes and efforts to adapt from the Swedish Muustry of Health and Social Affairs,
could be expected The review suggests that the scope CornmIssIon for Social Research (DSF)
of mdividual reactions vanes from listless resignation
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c