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Abstract

Loneliness has emerged as a pervasive, bidirectional driver of substance misuse among young adults in the United States. Drawing on current research, clinical observation, and a representative case example, this practice note examines the relational and structural dynamics underlying the intersection of loneliness and substance use during young adulthood. The authors argue that substance misuse in this population is increasingly rooted in chronic social disconnection and unaddressed attachment needs—the factors that are often overlooked in traditional treatment models. Guided by attachment theory and a micro–meso–macro framework, we propose a multi-level intervention strategy that emphasizes peer-based relational supports, developmentally attuned social skills training, and systemic reforms. We call on social workers and behavioral health professionals to integrate loneliness screening into clinical assessment, advocate for pro-connection infrastructure, and pursue attachment-informed care models. By reframing substance misuse as a relational issue, the field can more effectively disrupt loneliness-misuse cycles and foster long-term recovery and resilience in young adult populations.

Keywords

health disparities/social determinates of health substance misuse addiction/substance misuse addictions social isolation adolescents/young adulthood development across the lifespan

Introduction

Loneliness—defined as the subjective experience of social disconnection and unmet relational needs (Cacioppo et al., 2014; Hawkley & Cacioppo, 2010)—has become a defining feature of modern young adulthood. Although the COVID-19 pandemic exacerbated this issue through prolonged institutional closures and mandated social distancing, rising rates of loneliness among young adults (hereafter also referred to as emerging adults, young people, or YAs) predated the pandemic. According to the U.S. Surgeon General’s Advisory (2023), nearly half of U.S. adults report experiencing loneliness, with YAs consistently reporting the highest levels across age groups (Bruss, 2024). Loneliness has also been linked to increased vulnerability to substance misuse in YAs (Bonar et al., 2022; Copeland et al., 2018; Ingram et al., 2020; Savolainen et al., 2020). Substance use in YAs declined significantly in 2020, likely due to pandemic-related restrictions (Layman et al., 2022; Miech et al., 2023; Temple et al., 2022), and this trend has remained relatively stable in the years since (National Institutes of Health, n.d.). However, these declines should not lead to complacency among practitioners. Despite a return to relative normalcy in the post-pandemic context, it is still crucial to identify and sustain the protective factors that contributed to this reduction, especially for at-risk populations such as young adults. The urgency of this issue is underscored by the societal cost of substance misuse—over $232 billion in health care spending and $740 billion in total annual costs. This includes not only medical consequences but also premature death, lost productivity, and adverse social outcomes (National Institute on Drug Abuse, 2024).

This article adopts an attachment theory-informed lens to examine the intersection of loneliness and substance misuse among young adults. While other frameworks—such as behavioral, neurobiological, and sociocultural—offer valuable insights, attachment theory provides a developmentally grounded and relationally nuanced approach. It helps explain how unmet early social needs shape emotion regulation, coping strategies, and vulnerability to maladaptive behaviors. Crucially, attachment theory also informs evidence-based interventions in behavioral health and social work, offering practical applications that address both internal (psycho-emotional) and external (socio-environmental) risk factors. We argue for the development of effective, developmentally responsive interventions to move beyond individual-level explanations and consider how loneliness and substance misuse are co-produced by factors across interpersonal, institutional, and structural levels. To this end, we propose a practice model guided by attachment theory and a micro–meso–macro framework, one that targets the relational and environmental risk contexts shaping young adult experiences and advances systems of care focused on socialization.

Loneliness and Substance Misuse Among Young Adults: A Review of Emerging Evidence

Young adulthood is a critical developmental period marked by identity exploration, increased autonomy, and a greater reliance on peers and romantic partners for social support (Arnett, 2024; Scales et al., 2015; Wood et al., 2018). Yet these milestones are increasingly threatened by the growing prevalence of loneliness and social isolation. Social participation among such age groups has declined precipitously: time spent in person with friends has dropped by nearly 70% over the past two decades, while time spent alone has steadily increased (Kannan & Veazie, 2023). Nearly one in four young adults now report feeling lonely “a lot of the days” (Kirwan et al., 2025; Witters, 2023), and in a national study examining the intersection of loneliness, mental health, and substance misuse, nearly half (49%) reported experiencing significant loneliness (Horigian et al., 2021). In 2022, 13 million YAs in the United States reported engaging in substance use, with alcohol and cannabis being the most commonly used substances, with usage rates in 2021 of 82% and 42%, respectively (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2022). Critically, substance use among emerging adults translated to 29,600 overdose deaths in 2022 (Centers for Disease Control and Prevention, 2025).

Empirical evidence demonstrates a link between chronic loneliness and substance misuse among YAs, often operating in a self-reinforcing, bidirectional cycle; isolation and emotional pain may drive substance use not merely for recreation but as a strategy to cope with unmet social needs (Blanchard et al., 2019; Deep et al., 2024; National Academies of Sciences et al., 2020). Substance misuse can also lead to maladaptive behavioral patterns, such as difficulty adhering to role obligations and relational conflict, that further intensify the prevalence of social isolation (Pomrenze et al., 2022; Volkow & Blanco, 2023). Loneliness has been associated with a 1.75-fold increased risk of smoking, a 1.80-fold increased risk of alcohol use, and a 1.55-fold increased risk of habitual drug use among YAs compared to their less lonely peers (Kim et al., 2024). Savolainen and colleagues (2020) found similar associations across three national contexts (i.e., the United States, South Korea, and Finland), demonstrating the global significance of this dynamic. These patterns are especially concerning given the developmental sensitivity of young adulthood. When loneliness becomes chronic during this life stage, substance use can become an entrenched coping strategy, laying the groundwork for long-term biopsychosocial harm and chemical dependence (Matthews et al., 2023).

Emerging evidence also indicates that a secure attachment style serves as a protective factor against both loneliness and substance misuse (Jethava et al., 2022; Meulewaeter et al., 2019). Consistent peer attachment, specifically, has been shown to act as a buffer against loneliness and substance misuse among YAs, with strong peer bonds associated with reduced emotional difficulties and a lower likelihood of maladaptive behaviors (Sezer & Gürtepe, 2025). In contrast, anxious and avoidant attachment styles are positively associated with higher levels of loneliness and substance misuse in young adults, since they may lack the relational resources necessary for healthy coping (Fuchshuber et al., 2024; Golchha & Raj, 2024; Schindler, 2019; Sundqvist & Hemberg, 2021). The temporary relief that substances may offer can quickly give way to eroded social bonds, increased solitary use, and progressive withdrawal from an active social life. This reinforces a cycle in which loneliness and substance misuse become mutually sustaining, deepening distress and complicating recovery (Christiansen et al., 2021).

Observations From Clinical Practice

In practice settings, we are similarly observing social isolation-substance misuse trends among young people, and we are witnessing how substance misuse is now manifesting as both a derivative and reinforcer of loneliness. Whereas in the past, young adults often identified peer pressure and social gatherings as primary triggers for their misuse, we now observe how the social lubrication feature is being readily replaced, with misuse more frequently occurring in the confines of the home environment and without social interaction or supervision. As social workers in practice, we are noting that clients increasingly describe their substance of choice in markedly personal terms, likening it to a “lover” or a “friend” that they frequently rely on for emotional regulation and social fulfillment. This is not an entirely novel trend: Rúdólfsdóttir and Morgan (2009), in a qualitative study of young women in the United Kingdom, found that participants described alcohol as integral to their personal and social identities, framing it as a source of empowerment and confidence—functions often attributed to adaptive interpersonal relationships. Similarly, MacLean (2016) reported that Australian adults viewed alcohol as a kind of “social technology”—a trusted mediator that facilitated social connection, akin to the role of a dependable friend. However, far less is known about how American young adults—particularly in the post-pandemic context—romanticize substance use or employ anthropomorphic language to describe their attachment to substances, especially within practice-oriented literature. To further illustrate how these dynamics are manifesting in real-time, the following case example, “Michael,” is included as a clinical formulation.

Case Example: Michael the “Solo Drinker”

Michael is a 21-year-old mixed-race, heterosexual male in undergraduate studies. In therapy sessions, he disclosed that he has been a “solo drinker” for many years, and his ritual of binge drinking (i.e., consuming vodka straight from the bottle in a repetitive fashion and only when alone) stems from issues of persistent loneliness. In reference to his alcohol use, the client states:

Alcohol is like the girlfriend I could never find outside of my home. She is reliable and she gives me what I need. She never disappoints me either. I can’t wait to be with her soon as I get home from school. When I open that first bottle, I feel instant calmness and joy. The joy is felt all through my body. It doesn’t take much effort to sit with her on the couch and veg out. It’s so much easier to drink alone than to worry about walking to a bar and drinking socially, which to me, brings up a lot of fear. I would rather stay at home than make the effort to put myself out there, and the more I drink at night, the more I feel like the couch is where I belong.

As per his reporting and confirmed by a former medical provider, the client endorses a history of unsuccessfully cutting back on alcohol intake. He also presents with a history of withdrawal symptoms, and alcohol use negatively impacting his ability to fulfill obligations at school.

Our assessment indicates that Michael has developed an unhealthy attachment to alcohol, cognitively framing it as a “reliable companion” that provides emotional regulation and compensates for the absence of a stable community. In therapy, Michael affirmed this assessment, demonstrating insight into how alcohol has become a substitute for unmet social needs. He also identified intergenerational influences, noting that his father’s ritualized drinking in solitude, shaped his own coping mechanisms through learned behavior. Michael currently appears to be in the contemplative stage of change, expressing ambivalence about altering his routine. While he acknowledges the comfort and predictability alcohol provides, he is also beginning to recognize its limitations and costs (Prochaska & Velicer, 1997; Raihan & Cogburn, 2025). Together, this case and our broader clinical observations illustrate a growing trend: for many young adults, substances are becoming the more accessible alternative to human connection, a way to feel attached to “something,” when attachment to others feels out of reach. Michael’s case illustrates how chronic loneliness may drive internalized coping schemas that manifest in solitary substance use.

Existing Gaps in Treating Substance Misuse and Loneliness

The increasing epidemic of loneliness among young adults highlights critical gaps in current clinical interventions and public health policies. Despite the clear relational underpinnings of substance use in this population, current systems of care often fail to address social disconnection as an area of need. Historically rooted in a moral model that stigmatized substance use as a personal failing, these approaches to substance treatment continue to reflect punitive policies that prioritize surveillance and control over support and connection (Kehinde, 2024; Shah & Househ, 2023). Although the biopsychosocial model for substance misuse (positing that biological/genetic, psychological, and sociocultural factors contribute to substance use initiation and maintenance; Buckner et al., 2021; Duncan, 2020; Skewes & Gonzalez, 2013) has gained prominence, treatment systems remain siloed by profession and sector.

Through direct observation, we have seen the extent to which YAs are left to navigate these fragmented systems on their own. This dynamic heightens feelings of loneliness and disconnection. Structural barriers, including a lack of communication between agencies, digital systems that hinder interpersonal connections, and rigid institutional protocols, prevent providers from delivering attachment-informed, person-centered care (Brandt et al., 2022). Moreover, the relationship between loneliness and substance misuse is neither uniform nor random—it is shaped by broader systems of inequity. Young men, particularly Black men and those in rural communities, face distinct risks, including restrictive gender norms that discourage help-seeking, the cultural normalization of male solitude, and ongoing exposure to discrimination and mistrust in health care settings (Johnson et al., 2024; Smith et al., 2023). These disparities reveal that loneliness is not just an individual experience but one embedded in social, cultural, and economic systems. As a result, current treatment models inadvertently place the burden of recovery on individuals without addressing the social environments that perpetuate loneliness (Pettersen et al., 2019). These systems can reinforce stigma and fail to acknowledge the role of loneliness and structural disconnection in patterns of substance misuse among young people while discarding the strengths of this age group.

Attachment Theory-Informed Interventions: An Innovative Approach

To meaningfully address rising substance misuse among YAs experiencing loneliness, we must dismantle siloed systems of care and respond to the broader risk environments—micro, meso, and macro—that foster chronic social isolation. Drawing from the risk environment framework (Rhodes, 2002, 2009), attachment theory (Bowlby, 2007), and recent public health guidance, including the U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection (2023), this approach recognizes loneliness as an emotional state and a socio-ecological function shaped by structural disconnection, service fragmentation, and inadequate access to socially enabling settings.

At the micro and meso levels, fostering emotionally supportive environments where young adults can develop foundational interpersonal skills through consistent, stigma-free engagement is critical. Colleges, universities, and community health agencies are well-positioned to implement preventive infrastructures that promote social belonging. We propose a three-pronged strategy to address the intersection of loneliness and substance misuse in this population. First, institutional settings should integrate interpersonal process groups, skills-based workshops, and peer support groups while also providing social workers with training in attachment theory and social skills interventions tailored to substance use recovery. Second, attachment-informed group models should be implemented to help young people explore and reflect on their communication styles, relational schemas, and self-concepts—a direction supported by evidence on the effectiveness of attachment-based therapies in substance use treatment (Diamond et al., 2016; Schindler, 2019). Third, recovery programs should incorporate structured social opportunities, such as peer-led social exposure activities and community-based group events, positioning connection-building as a central feature of recovery. Recent research supports this integrated approach. Adaptations of the Adolescent Community Reinforcement Approach (A-CRA) for young adults have shown that substance use reduction is more effective when paired with strengthened social bonds (Godley et al., 2017; Welsh et al., 2019). Similarly, peer-led models like Young People in Recovery demonstrate how embedding community-building into recovery enhances engagement, belonging, and recovery capital (Broman et al., 2025; Meisel et al., 2024). These relationally grounded efforts also support young adults in examining how early attachment experiences shape social avoidance and relational vulnerability. Kristina, a 21-year-old woman participating in an attachment-informed virtual group, reflected:

I never really thought about how I talk to people until the group. I just assumed people would leave, so I kept my distance. But now I see that I push them away before they even get close—and that doing that makes me crave drugs even more.

This kind of insight is vital to recovery, especially for a generation raised in a digital landscape marked by inconsistent models of intimacy and disrupted peer connection.

At the macro level, systems can inform and support better practice by reorienting investments toward pro-connection policies. As recommended in the Surgeon General’s “Connection-in-All-Policies” framework (Office of the Surgeon General [OSG], 2023), public health systems must address the social determinants of connection by advancing adequate access to housing, transportation, green spaces, and education—key forms of social infrastructure that enable young adults to access peer groups and participate in civic life. When such infrastructure is inaccessible, particularly in rural areas, food deserts, or economically disadvantaged communities, the disconnection is both physical and psychosocial. Investments in these domains should prioritize populations at highest risk of social disconnection, ensuring that initiatives such as libraries, parks, volunteer programs, and public transit are designed inclusively and equitably.

Beyond a tri-leveled intervention, health professionals and social workers must be trained to routinely assess social disconnection as part of substance use evaluations for young adults. However, current loneliness measures often fail to capture the nuanced and evolving ways loneliness manifests during this life stage. Widely used tools such as the UCLA Loneliness Scale, including its three-item version (Hughes et al., 2004), were not specifically designed for young adults and lack validated thresholds for categorizing loneliness severity (Das et al., 2021; Gründahl et al., 2022). Although the UCLA-3 gained popularity during the COVID-19 pandemic for its brevity, telephone validation, and ease of administration (Lum et al., 2020), it does not differentiate between state (acute, situational) and trait (chronic, dispositional) loneliness, an increasingly relevant distinction for young adults in post-pandemic and digitally mediated contexts (McComb et al., 2020; Shah & Househ, 2023; Spata et al., 2024). This gap is especially salient for emerging adults, who may experience rapid shifts in social connection that are not adequately reflected in static assessments. Although both state and trait loneliness are associated with adverse mental health outcomes, including substance use, they likely influence behavior through different mechanisms (Gründahl et al., 2022; Spata et al., 2024; van Roekel et al., 2018).

Existing tools, such as the De Jong Gierveld Loneliness Scale and the Social and Emotional Loneliness Scale for Adults (SELSA; DiTommaso & Spinner, 1993), primarily assess trait loneliness but do not capture the kinds of moment-to-moment fluctuations that may be critical in identifying heightened risk among young adults (Alsubheen et al., 2025). This limitation is particularly concerning given evidence that previously well-connected young adults may suffer more intensely from sudden episodes of social isolation, with cascading effects on substance use and mental health (Spata et al., 2024). As such, there is a pressing need to refine loneliness assessments to ensure cultural sensitivity, developmental appropriateness, and predictive validity for substance use outcomes. Improving these tools will better equip providers to detect latent or context-specific disconnection, tailor interventions more effectively, and prevent the progression of loneliness becoming chronic (Ingram et al., 2020; Sundqvist & Hemberg, 2021).

Conclusion

Loneliness has emerged as a powerful and bidirectional driver of substance misuse among young adults—a phenomenon rooted not only in individual distress but also in broader relational and structural disconnection. Far from being a peripheral concern, loneliness now stands as a pressing public health issue with deep implications for behavioral health and recovery. As this practice note has shown, the intersection of social isolation and substance use in young adulthood reflects systemic conditions that disrupt pathways to connection, erode protective relationships, and compromise access to meaningful care. Drawing on clinical insight, empirical literature, and case examples such as Michael, we have illustrated how substance misuse increasingly operates as a maladaptive strategy for coping with unmet attachment needs. This dynamic underscores the urgent need for developmentally responsive, attachment-informed, and socially connected models of intervention. Social workers and behavioral health professionals must cultivate a sharper clinical lens for identifying loneliness as a core risk factor for substance use and respond by embedding opportunities for authentic connection into every stage of recovery work. If social work is to remain ethically grounded and clinically effective in addressing substance misuse, it must take seriously the relational voids that precede and perpetuate it. Treating loneliness not as an ancillary issue, but as a central feature of addiction risk and recovery, is no longer optional; it is essential to advancing healing, justice, and long-term well-being for young adults.

Implications for Practice

The intersection of loneliness and substance misuse among young adults presents a critical challenge, and opportunity, for social workers and allied practitioners. The findings in this practice note suggest several actionable implications:

Reframe Substance Misuse as a Relational and Structural Issue

Practitioners must expand their conceptualization of substance misuse beyond individual pathology to include the social, relational, and ecological conditions that perpetuate addiction. This shift supports a trauma- and attachment-informed lens that recognizes social disconnection as both a precursor to and consequence of substance use.

2. Integrate Loneliness Screening into Routine Clinical Assessment

Given the bidirectional relationship between loneliness and substance use, clinicians should incorporate validated tools to assess social disconnection in intake processes, treatment planning, and discharge procedures. Doing so can improve the detection of psychosocial risk factors and tailor interventions to address both emotional and relational needs.

3. Advocate for Pro-Connection Infrastructure at the Community Level

Social workers in policy and administrative roles should champion policies that invest in inclusive public infrastructure—such as libraries, youth centers, green spaces, and accessible transit—particularly in rural and underserved areas. These physical environments play a critical role in enabling relational environments and strengthening community-level protective factors.

4. Bridge Service Fragmentation Through Attachment-Informed Training

Agencies should prioritize training behavioral health providers in attachment theory and social connection–based models of care, particularly as they relate to the developmental needs of young adults. To institutionalize this shift, we recommend integrating such training into continuing education requirements for behavioral health licensure and incorporating related content into clinical licensure examinations, including those for Licensed Clinical Social Workers (LCSWs). In addition, we urge the Council on Social Work Education (CSWE) to evaluate how accredited programs are currently preparing students in the domains of attachment theory, social support theory, and connection-centered care. Embedding these frameworks into curricula and professional standards will strengthen providers’ capacity to identify, understand, and intervene in the relational dimensions of substance misuse among young adults.

5. Target Male Social Disconnection as a Risk Factor

Young men, especially those from marginalized backgrounds, are disproportionately impacted by social withdrawal and underutilize mental health resources (Gough & Novikova, 2020; Lereya et al., 2024). Gender-responsive interventions should be developed to normalize vulnerability, promote peer accountability, and create male-specific safe spaces to discuss loneliness and relational health without stigma.

6. Inform Future Research and Measure Development

More empirical work is needed to validate loneliness screening tools that reflect developmental realities of emerging adulthood. Researchers should also investigate intervention outcomes that combine substance use treatment with social skills training, particularly for those with avoidant or anxious attachment styles.

Footnotes

Disposition editor: Cristina Mogro-Wilson

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Funding

Some authors received financial support for research from the T32HL140290,“Post-doctoral Training in Promoting Health Equity in Cardiovascular Disease” at The University of Texas at Austin.

ORCID iDs

Jeffrey Alexander Morris

Obi Onyegesi

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Treating the Cycle of Social Isolation and Substance Misuse in Young Adults

Abstract

Keywords

Introduction

Loneliness and Substance Misuse Among Young Adults: A Review of Emerging Evidence

Observations From Clinical Practice

Case Example: Michael the “Solo Drinker”

Existing Gaps in Treating Substance Misuse and Loneliness

Attachment Theory-Informed Interventions: An Innovative Approach

Conclusion

Implications for Practice

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iDs

References