Year

2020

Degree Name

Doctor of Philosophy

Department

School of Psychology

Abstract

Background: Loneliness is defined as a mismatch between the relationships one has and those they desire (Peplau & Perlman, 1982). It is well established that loneliness negatively affects health and wellbeing (Beutel et al., 2017; Holt-Lunstad et al., 2015), however loneliness is understudied amongst people with substance use disorders (SUD). Social and cognitive models suggest that loneliness is due to the way one perceives their social world and a loss or lack of identification with social groups. Using the Social Identity Approach (Tajfel & Turner, 1979; Turner et al., 1987) and cognitive theory (Cacioppo & Hawkley, 2005) as the foundation, this thesis comprises four studies which aim to explore loneliness amongst people with SUD.

Method: Study 1 consisted of a systematic review of 41 empirical studies that examined loneliness in people with SUD. Study 2 was cross-sectional and involved 316 participants completing a survey consisting of measures of demographics, substance use, loneliness, and physical and mental health. A multidimensional measure of loneliness, the Social and Emotional Loneliness Scale for Adults –Short Version (SELSA-S) was used in an effort to assess its validity in SUD populations. Study 3 consisted of qualitative interviews with 20 participants attending residential SUD treatment. Interviews were guided by cognitive theories of loneliness. In Study 4, 41 participants in SUD treatment programs completed a 6- session group-based loneliness intervention called Groups 4 Belonging (G4B). This intervention was developed based on findings from studies 1, 2 and 3 as well as cognitive theory and the Social Identity Approach to loneliness. Measures of loneliness, group membership, stress, wellbeing, and cravings were administered pre- and post-intervention.

Results: Study 1 found that loneliness was related to; poorer physical and mental health, substance use, quality of relationships, stigma and perception of ill treatment by others. Few studies used measures that had been validated for use with SUD samples, and only one loneliness intervention had ever been trialled with this population. Study 2 found that the SELSA-S measure of loneliness might be valid for use with a SUD population, but replication studies are required. Study 2 confirmed that loneliness is highly prevalent, and was correlated with poor physical and mental health for this sample. Study 3 found that cognitive theories of loneliness might help to explain the relationship between loneliness and substance use. A lack of authenticity in relationships, and the impact of problematic substance use on one’s relationships was found to contribute to loneliness for people with SUD. Additionally, Study 3 found that unhelpful cognitions, destructive interpersonal behaviours and substance use emerged as a result of feeling lonely. Finally, Study 4 found that the theoretically derived loneliness intervention, G4B, is likely to be feasible for delivery across residential SUD treatment settings.

Conclusions: The studies included in this thesis demonstrate that loneliness is likely to be a prevalent and problematic experience for people with SUD, and that loneliness is likely to have negative implications for the health and wellbeing of this population. Interventions that target social cognitions, such as mistrust and fear of negative evaluation, as well as promote identification with multiple social groups may be helpful for this population.

FoR codes (2008)

170106 Health, Clinical and Counselling Psychology, 170113 Social and Community Psychology

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.