The role of social isolation in opioid addiction

Abstract

Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain's opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.

Keywords: BOTSA; addiction; opioid; social capital; social isolation.

Fig. 1.

An image from CDC indicating the death rate per 100 000 people in the USA from unique classes of opioid drugs as well as cocaine and methamphetamine for comparison.

Fig. 2.

A conceptual model of the cyclical nature of opioid use and social connection.

Fig. 3.

A linear model depicting the correlation between drug overdose mortality rates and social capital among 35 counties in West Virginia.