Loneliness and Isolation in Recovery

The house is quiet, the old friends are still using, and the night feels like a reason to go back. Loneliness shows up in SAMHSA's Matrix client handbook as a feeling with a practical risk attached. The handbook, written for people in intensive outpatient treatment for stimulant use disorders, uses the shorthand HALT: hungry, angry, lonely, or tired. On lonely, it says recovery is often a lonely process. People lose relationships because of substance use. Staying abstinent may mean giving up friends who still use. The feelings of loneliness are real and painful. They make people more vulnerable to relapse. Who can stand with you is the support-network guide. The seasonal version of the same problem is the holiday guide. Friendships as a recovery dimension are the friendships guide.

If you might act on thoughts of suicide, call or text 988. If someone is being hurt, will not wake, or cannot breathe, call 911. Do not use alcohol, a benzodiazepine, or another drug to get through a lonely night. After a long run of heavy drinking, quitting all at once can threaten your life, and an abrupt benzodiazepine stop can cause seizures. That limit is the withdrawal guide.

What the handbook means by lonely

In the section on emotional triggers, loneliness is one of three red flags, with anger and feeling deprived. The handbook says it is hard to give up friends and activities that were part of a substance-using life. Separation from friends and family leaves people lonely. Friends and family who do not use are often not ready to risk a relationship that failed before. The person in recovery is stranded between groups. That feeling, the handbook says, can drive a person back toward using.

The same handbook lists isolating, staying by yourself much of the time, among behaviors tied to substance use. A section on staying busy asks whether you isolated while using, how that affected use, and whether being alone now reminds you of it. It also says being around people can feel uncomfortable and annoying, and that being alone can mean fewer hassles. The point of the question is recognition. A wish for a quiet evening is not the same pattern.

The handbook is frank that a substance-free life can feel tame, and that people have to work at making abstinence interesting. Beginning to reconnect, or to build a life around activities and people that do not involve use, is called critical. If the empty hours are the louder problem, structure is the boredom guide. If the hard part is a partner or a new relationship, the dating guide covers that without inventing a waiting period.

Connection as a recovery dimension

SAMHSA's working definition names four dimensions that support a life in recovery. Community is relationships and social networks that provide support, friendship, love, and hope. The principle on relationships says an important factor is people who believe recovery is possible, who offer hope and encouragement, and who suggest strategies and resources. Family, peers, providers, faith groups, community members, and other allies are listed as that network. Through those relationships, the definition says, people leave unhealthy or unfulfilling roles and take up new ones, such as partner, caregiver, friend, student, or employee.

The peer principle in the same document says mutual support and mutual aid, including shared experience, play an invaluable role. Peers can offer belonging and valued roles. It also says professionals provide clinical treatment and other services that support the path the person chooses. Company from people who understand is not a replacement for clinical care. Clinical care is not a replacement for a human afternoon. The peer specialist role is the peer support guide. A referral conversation is not that role.

Creating a Healthier Life says talking with someone who has been through similar things, including addiction, makes people feel less alone. Seeing that others have moved forward can make the next step feel possible. A support group, in that handbook, can offer input from people with similar experience, a chance to support someone else, and ideas about services you had not considered. Social wellness is defined as healthy relationships with friends, family, and the community, and an interest in the needs of other people.

The practical questions in the social section are ordinary. Have you found a support group on an issue that matters to you? Have you made a plan to see a friend? Are you keeping in touch, including by phone when people live far away? The handbook says even a phone call can lift your spirits. It also asks whether you set aside time with family and friends, and whether you go where new people are. Volunteer work and groups built around an interest are examples. They are questions, not a social prescription. A person who is not safe in a particular group should not treat the question as an order to attend.

When the quiet is an emergency, and when it is a referral

A painful evening can still be an evening you get through with a call to someone who is not using. The handbook's red-flag language is about feelings that flood you and point back toward use. If the feeling includes a plan to die, or you cannot stay safe, use the crisis line above. If someone is overdosing or being hurt, use the emergency number above. A referral conversation is the wrong first call in those moments.

An organization built to offer connection has a federal name of its own. SAMHSA's definition is the recovery community organization guide. When you are safe enough to look for ongoing care, FindTreatment.gov lists treatment providers. Call or text (800) 653-9376 if you want a referral conversation about what kind of program fits, including whether you want a group, individual care, or both. The person on the phone is not assigned to be your friend.

Some company is costly. A room that includes people who are using is not the community dimension just because it is crowded. That limit is the boundaries guide. The separate pain of ruptured relationships is the forgiveness guide. Neither one is a reason to wait out a crisis alone.

Additional Resources

Sources cited on this page:

• SAMHSA: Client's Handbook, Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders (SMA 15-4154)
• SAMHSA: Working Definition of Recovery (PEP12-RECDEF)
• SAMHSA: Creating a Healthier Life, A Step-by-Step Guide to Wellness (SMA-16-4958)
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions