The Power of Social Reinforcers in Addiction

Want to know one of the biggest factors in addiction? You may be thinking its access to drugs, or childhood trauma, or low self-esteem. And you’d be right: All of these factors do contribute to addiction and create barriers to recovery. However, there’s another less-talked-about factor that is just as important.

Social relationships.

Or, more accurately, social isolation.

We are born into this world with the need to connect with others. As infants this connection is aimed at our primary caregiver — our mother — and later it is our peers, colleagues, and intimate partners. When we are socially disconnected, or lonely, then the chances of self-medication increase substantially. A recent animal study (no, this is not the original Rat Park study you've read about) examining social interactions and addiction, has shown that rats choose to be around other rats in preference to substances.

Spotlight on loneliness

Former Surgeon General Dr. Vivek Murthy believes the rising number of lonely people in America is a growing threat to our health and well-being. According to his essay in the Harvard Business Review, 40% of U.S. adults report feeling lonely. “The culture around masculinity may actually be putting men at a higher risk of loneliness than women,” Murthy said. "We think that masculinity is tied to being self-sufficient and not expressing your emotions and certainly not admitting to feelings of loneliness. But many men do feel lonely – especially after they get married or have children where their social circles narrow."

Murthy equates loneliness to being just as dangerous to our health as smoking 15 cigarettes a day — that’s almost a pack per day.

And it’s not just in the United States where we are reflecting on the incredible number of people feeling lonely — the UK actually appointed the world's first Loneliness Minister. This sends people a powerful message: You are not alone.

"We evolve to be social creatures and thousands of years ago if you were connected to other people you were more likely to have a stable food supply and to be protected from predators. So when you're disconnected, you're in a stress state. When that happens chronically, it can have a profound impact on your health." —Former Surgeon General Dr. Vivek Murthy.

Loneliness and addiction

A recent animal study conducted by members of NIDA’s Intramural Research Program and NIDA’s Dr. Marco Venniro, a scientist in Italy, revealed that social reinforcement can be just as potent as heroin and meth. Rats were required to choose between social interaction with another rat or access to a drug (heroin or methamphetamine).

The result: The rats (some of which had been taking drugs for several weeks) consistently chose social interaction regardless of whether they were newbies or veteran drug users. Even when the rats were accustomed to living with other rats and having a social environment, they consistently chose further social contact over the option to self-administer the drug. Addicted rats were only likely to press the lever to receive more drugs instead of social interaction (i.e., relapse) when access to other rats was sufficiently delayed or punished.

Though other experiments have manipulated the social housing of rats and manipulated the "reward" given to the rat (such as offering tasty food), this is the first experiment in which the animal test subjects were given a choice between the two; social interaction or self-administration of the drug.

A summary of the findings:

• Rats chose social interactions over drugs
• Social interactions prevented intensification of drug seeking over time
• Rats that were forced into abstinence showed an increased risk of relapse.

This last point mimics the withdrawal and relapse process that people who struggle with addiction face. Rats who became voluntarily abstinent by seeking social interaction instead, however, did not see an increase in drug craving. It suggests that the point I've been making for a long time—my book The Abstinence Myth is based on it—is that forcing abstinence as the only outcome on those who struggle with addiction is actually counterproductive and leads to more problems.

Addiction Essential Reads

Methamphetamine Is a Major Drug Threat in the U.S.

Problematic Substance Use Is on the Rise Among Seniors

It’s important to note (in case this is not obvious): Humans are far more complicated than rats and simple social interactions are not always enough to ward off drug cravings, especially in light of trauma, biological dysregulation and life stress. In addition, we also need meaningful participation in our community and a sense of belonging, and drug-user communities provide that as well (which equates to social reinforcement of drug use, unlike in this rat study)

In support of these findings, a new report funded by the National Institutes of Health's National Institute on Alcohol Abuse and Alcoholism (NIAAA), concluded that individuals with substance abuse problems who are living in a collaborative housing setting would have their addiction treated more effectively than abusers not residing in a community-based facility.

What addiction treatments incorporate social connectedness into recovery?

While we can’t entirely generalize the results of this study to people, it does suggest that recovery programs that include a social element are far more likely to help individuals overcome drug problems than those that do not.

Programs that already do this include:

• Community Reinforcement Approach (CRA). This is a structured approach to alcohol addiction treatment that has two main goals: to eliminate positive reinforcers for drug use and to enhance positive reinforcers for sobriety. One of the major components of treatment involves significant others in the recovery process. CRA and Family Training (CRAFT) has been successfully incorporated into other therapeutic approaches such as motivational interviewing and family therapy.
• Cognitive Behavior Therapy (CBT). This is a psychological intervention that aims to increase immediate social rewards when patients are faced with the immediate temptations of drug use.
• Self-Help Programs. These include SMART Recovery, SOS, Life-Ring, Moderation Management and AA — recovery groups for people with alcohol or drug addictions. The benefit of these groups largely depends on building a new social structure in which the person can function. Though I'm not a huge fan of the 12-step program because I believe it can perpetuate shame and stigma, the sense of belonging or community they bring has the potential to help. Other self-help groups like SMART and SOS also have social interactions as do our IGNTD weekly online chats (but without the shame!).

How does social interaction work?

Social interaction can change the activity of specific neuronal circuits that control drug craving and relapse. It helps release oxytocin and reduce cortisol release. Overall, social interaction can provide a sense of purpose and offer opportunities for additional coping strategies as well as boredom and loneliness resolution.

How to get socially connected in your recovery

Though you can't replicate the study exactly in humans, there are some key takeaways: Feelings of connectedness to society can protect some people against Substance Use Disorders.

I started drinking because I wanted to "fit in," and it worked. When I began to identify my purpose—to break the stigma surrounding addiction and mental health, uphold the core values of the Harm Reduction community and help others find their purpose and live more authentic lives—I no longer felt the urge to drink or use drugs. I’ve found social reinforcement powerful in many areas of my life. My wife Sophie and I still rely quite heavily on our weekly couple's support group which we joined when we were healing from infidelity and dishonesty. We still meet with the group today and have forged lasting friendships.

While technology can bridge gaps for people who live in rural communities and enable them to find online peer groups, it can also isolate folks, especially when they use digital interaction to replace physical interaction entirely. But, when access or distance is a barrier, then online support is a fantastic resource. I know we’re having a LOT of success in our online groups.
We regularly see participants report that, knowing their weekly group chat was coming up allowed them to stay abstinent when they usually would have drunk or used. Additionally, we’ve had participants in our closed online support group reach out to others in the middle of a difficult emotional time and receive support that allowed them to stay away from danger and take constructive action.

Technology can be a powerful tool.

Here’s what you can do to prevent or treat loneliness:

• Get involved in your community. The choices are unlimited! You can act in a community play, volunteer at a local shelter, sign up for the community garden, or enroll in a class at your community college. The website Meetup.com offers a slew of options for joining others for essentially ANY activity (they literally have groups for bingo, hiking, real-estate buying an everything in between). If you are an employer, consider providing structured settings for employees to get to know one another on a personal level.
• If you are struggling with drugs or alcohol, choose a recovery program that has a social element to it as well as educational and inspirational components (like the IGNTD Recovery Hero Program).
• Reach out for help. Struggling with addiction on your own is not only a huge challenge, but also completely isolating. Reach out and connect with other people who are experiencing the same challenges as you, and seek a recovery approach that is the best fit for you. Don’t concern yourself too much with what everyone else thinks – find an approach that speaks to you and move forward.

“The fundamental thing is this: We have for years thought about ourselves as an individualistic society that champions individual achievement but what the data around loneliness tells us more and more is we're truly interdependent creatures and ultimately we need each other." —Former Surgeon General Dr. Vivek Murthy

To get connected with me and my tribe of recovery heroes, check out the IGNTD podcast and our Free online IGNTD Recovery workshop. Our online group support and weekly chats form the basis of many of our participants’ core recovery support. Find out more here.