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The Unbear Able Heavin Ess of Lon Eliness 6/12/2020 THE UNBEARABLE HEAVINESS OF LONELINESS Presented by Cardwell “C.C.” Nuckols, PhD. 1 Welcome, your facilitator will be: Samson Teklemariam, LPC, CPTM • Director of Training and Professional Development for NAADAC • NAADAC, the Association for Addiction Professionals • www.naadac.org • [email protected] 2 1 6/12/2020 www.naadac.org/webinars 3 Behavioral Science. Made Mobile. 4 2 6/12/2020 Using GoToWebinar (Live Participants Only) Control Panel 02 Asking Questions Handouts Audio (phone preferred) Polling Questions 5 NAADAC Webinar Presenter Cardwell “CC” Nuckols, PhD. • One of the world’s leading experts on addiction and recovery. • Authored more than 65 journal articles and 30 books/workbooks. • Best seller: The EgoLess SELF • Email: [email protected] 6 3 6/12/2020 Webinar Learning Discuss various patient factors from Objectives psychosocial variables, to disorders, to personality variables associated with isolation and loneliness. Discuss current research on the impact of social isolation on individual (patients and staff) functioning and well-being. Consider a range of understandings and clinical approaches-as loneliness is multi-determined- helpful to the individual experiencing loneliness and isolation. 7 Loneliness is not the same as being a “private” person or what might be called a “loner”. Some people both desire, need and enjoy a lot of alone time. 8 4 6/12/2020 9 LONELINESS The Internet has transformed how Americans work, play, search, shop, study, communicate, and relate to one another. People are increasingly connected digitally, but the prevalence of loneliness (perceived social isolation) also appears to be rising. From a prevalence estimated to be 11–17% in the 1970s (Peplau, Russell, & Heim, 1979), loneliness has increased to over 40% in middle aged and older adults (Edmondson, 2010; Perissinotto, Cenzer, & Covinsky, 2012). 10 5 6/12/2020 DEFINING LONELINESS One may enjoy being alone (a pleasant state defined as solitude) at times in order to reach personal growth experiences or to simply take a temporary break from dealing with the demands of modern life. Loneliness corresponds to a discrepancy between an individual’s preferred and actual social relations (Peplau & Perlman, 1982). This discrepancy then leads to the negative experience of feeling alone and/or the distress and dysphoria of feeling socially isolated even when among family or friends (Weiss, 1973). One can feel lonely in a crowd or in a marriage. 11 DEFINING LONELINESS THE DIFFERENCE BETWEEN…. CURRENT AMOUNT OF SOCIAL CONTACT AND INTIMACY DEGREE OF ISOLATION DESIRED AMOUNT OF SOCIAL CONTACT 12 6 6/12/2020 DEFINING LONELINESS Loneliness emphasizes the fact that social species require the presence of others but also the presence of significant others whom they can trust, who give them a goal in life, with whom they can plan, interact, and work together to survive and prosper (J. T. Cacioppo & Patrick, 2008). One needs to feel connected to significant others to not feel lonely. One can be temporarily alone and not feel lonely as they feel highly connected with their spouse, family, and/or friends –evenatadistance.Subjectivity and perception of the friendly or hostile nature of one’s social environment is, thus, a characteristic of loneliness. 13 DEFINING LONELINESS-NEUROBIOLOGICAL Human beings are troop primates by nature. When we are faced with prolonged loneliness it goes against our primal impulses. The brain reacts to loneliness as an emergency situation. The hormones of our stress response- the glucocorticoids- are kept at an elevated level. On an unconscious level we essentially prepare our bodies to travel in search of other humans. 14 7 6/12/2020 DEFINING LONELINESS-SUBJECTIVE EXPERIENCE Lonely people self-describe in very negative ways that span a large range of self-deprecating characteristics. Examples of these are feeling worthless, empty inside, unacceptable, and separated from others. They also say they feel alone and lonely, vulnerable, relationally inadequate, and spiritually empty. They indicate that they feel pessimistic, disliked, and unappreciated. Anumberoflonelypeoplesaytheyfeelangryatothers because they perceive that these others are unwilling to rescue them from their loneliness (www.knowswhy.com/how-does-social-media- createisolation). 15 DEFINING LONELINESS-SUBJECTIVE EXPERIENCE This is a particularly interesting perception, since it assumes that other people possess the capacity but nonetheless refuse to "remove" the loneliness that is being experienced. This is another illustration of the unrealistic expectations that some lonely people have; we might also refer to it as "magical thinking." It is clear from these self-descriptions that lonely people are unhappy people and that, when their loneliness becomes chronic, depression is a likely correlate. Booth, R. Loneliness as a Component of Psychiatric Disorders. Medscape General Medicine. 2000;2(2) 16 8 6/12/2020 THE RELATIONSHIP BETWEEN LONELINESS AND DEPRESSION Many clinicians believed, for decades, that loneliness was simply an aspect of depression. (cf. Young, 1982). There is now considerable evidence showing that loneliness and depression are separable and that loneliness increases the risk for depression (J. T. Cacioppo et al., 2006; Heinrich & Gullone, 2006). Apotentialdifferencebetweenlonelinessanddepression is while both are filled with helplessness and pain, loneliness is characterized by the hope that all would be perfect if only the lonely person could be united with another longed for person. 17 LONLINESS, DEPRESSION AND SUBSTANCE USE DISORDER Feelings of isolation, depression or anxiety can lead to alcohol and drug use.Iftheyworkwell,abuseandaddictioncanfollow. Those struggling with loneliness often use substances as a substitute for interpersonal relationships. Alcoholics and those addicted to drugs are often lonely people. If you use these substances in an attempt to combat loneliness, they only exacerbate the feelings in the long run. As addiction progresses, many addicts find themselves losing the support of their family and friends. May lead to even deeper isolation. 18 9 6/12/2020 LONLINESS, DEPRESSION AND SUBSTANCE USE DISORDER Severe early life stress dramatically increases the risk of addiction and the risk increases with greater trauma exposure Swedish study where children who lost their parents, experienced a parent’s diagnosis of cancer or observed domestic violence had twice the risk of substance use disorder in life 19 LONLINESS, DEPRESSION AND SUBSTANCE USE DISORDER: WHY OPIATES? Relieves stress Action on mu receptors on amygdala Feeling of being warm, fed and cared for Dissociation from negative feeling states Cognitively intact Dopamine high and enhanced sense of well-being Dopamine signal from reward center to prefrontal cortex 20 10 6/12/2020 LONLINESS, DEPRESSION AND SUBSTANCE USE DISORDER According to a recent survey… Loneliness could have roughly the same impact on mortality that smoking 15 cigarettes a day has. This would mean loneliness is potentially more adverse to your health than obesity! The Z Generation (mid-1990s as starting birth years and the early 2010s as ending birth years) and Millennial Generation (early 1980s and 1990s) report feeling lonelier than any other generation in history. There was no major difference in responses between men and women or among racial demographics 21 THE RELATIONSHIP BETWEEN LONELINESS AND DEPRESSION Not all lonely people are depressed, nor are all depressed people lonely, but the 2 conditions share significant variance in many of the studies that have measured them both. Some people experience transient loneliness, others amorepermanenttypeofloneliness.Those suffering chronic forms of loneliness are more likely to also be depressed than those whose loneliness is more fleeting, reactive, and situational 22 11 6/12/2020 THE RELATIONSHIP BETWEEN LONELINESS AND DEPRESSION DIFFERENTIAL DIAGNOSIS It is important for clinicians to note that the conditions may be cooccurring. It should also be noted that these 4 suggested target areas should be considered minimal areas of exploration, that is, they should be considered the beginning exploratory domains of differential diagnosis. 23 THE RELATIONSHIP BETWEEN LONELINESS AND DEPRESSION First, if the major area of patient dissatisfaction is focused on interpersonal issues rather than more global concerns about his or her life, the clinician may well be dealing with loneliness. Lonely people, if they are not also depressed, tend to be primarily concerned with their interpersonal distress, which may be accompanied by anger, anxiety, or any number of other factors. Depressed people, on the other hand, tend to have more global concerns that span the breadth of their lives 24 12 6/12/2020 THE RELATIONSHIP BETWEEN LONELINESS AND DEPRESSION Second, clinicians will want to probe duration issues, that is, how long patients have felt sad, worthless, or whatever their presenting complaints might be. The longer those negative affects have been present, the greater the likelihood that depression is part of the clinical picture 25 THE RELATIONSHIP BETWEEN LONELINESS AND DEPRESSION Third, determine the type and degree of guilt the patient is experiencing, since guilt appears to be more typical of depression than loneliness -- although some lonely patients also complain about feeling guilty Finally, clinicians should explore the area of vegetative symptomatology,sincesomeresearchershave found many of these to be more descriptive of depression
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