1. Background
Addiction is one of the most important health problems in the world, specially in Iran (1), and many factors are related to onset and maintenance of this common disorder. Since the ancient times, philosophers and scientists have known loneliness as one of the most complex psychological phenomena. At that time loneliness was a positive concept (2), which meant withdrawal from daily routine events to achieve more important goals in life (thinking, meditation, and spiritual connection), but nowadays it is not considered as a positive experience in psychological literature and refers to social withdrawal and poor social interaction.
Feeling of loneliness is a psychologically destructive and terrifying experience (3) that makes severe psychological and physical problems (4, 5). In social interaction, satisfaction is very important and critical for health. Sense of loneliness could make problems in social interaction and decrease the self-protective behavior potentials as a social threatening factor (6). It is believed that loneliness is a pervasive and dysphoric experience, which is the outcome of the expectation of individual and his or her current status. Feeling of loneliness has a direct relationship with the emotional domain and individual cognitive function and causes lack of adaptation in cognition, experience, and social expectations (7).
Studies are in favor of high prevalence of the sense of loneliness. Dykstra (8), and Ditommaso et al. (4) reported the prevalence rate about 8% to 10% and the other studies showed that 15% to 30% of people experience loneliness continuously. Heinrich and Gullone (6) believed that one out of four people suffer from chronic loneliness. A recent review by Hawkley and Cacioppo (9) revealed that about 80% of people aged lower 18 and 40% of the over 65 years reported feeling of loneliness at least sometimes.
Baumeister and Laery (10) argued about the basic needs and the feeling of belonging as essential motivations in individual`s emotion, thinking, and behavior, which need at least a minimum of positive stable interpersonal relationship; therefore, an individual who develops problems in making and maintaining satisfactory relationship with the others will develop problems in satisfaction of the feeling of belonging, and this kind of deprivation leads to morbidity (10-13). Generally, drug abuse is a multifactorial disorder in which every factor has its specific and common effects on the development and maintenance of addiction (14). Thus, any intervention concerning the prevention and treatment of addicted individuals should consider these factors or variables (1). The current study assessed the status of loneliness as an individual psychological factor and compared it in individuals with and without substance dependence disorder.
2. Objectives
The current study aimed to assess emotional, social, romantic, and familial dimensions of loneliness in drug abuser and nondrug abuser individuals.
3. Patients and Methods
In the current cross sectional study, 118 drug users who were referred to Baharan Psychiatric Hospital (affiliated to Zahedan University of Medical Sciences, Iran) and diagnosed as a case of addiction by a psychiatrist, were enrolled through random sampling method, and 110 individuals, without history of using narcotic drugs, were selected through available sampling method from drug abusers` companions, students or staff of the hospital as non-drug abuser group.
To assess the loneliness, the Iranian short version of the social and emotional loneliness scale for adults (SELSA-S) (15) was employed. The SELSA-S was initially developed by Ditommso et al. (4). They have reported Cronbach alpha of 0.87 to 0.90 for this questionnaire. Iranian form of SELSA-S was prepared and validated by Jowkar and Salimi (15). They reported Cronbach alpha values of 0.92, 0.84 and 0.78 for romantic, social, and familial subscales, respectively. The scale used in the current study is a 14-item scale with three subscales including romantic (four items), social (five items), and familial (five items) loneliness. Each item has five degrees of Likert rating scale from zero (completely agree) to four (completely disagree). Getting higher scores in each subscale means higher feeling of loneliness.
4. Results
Hundred and fifty two participants were men (66.7%) and 76 were women (33.3%). In the drug abuser group, the age range was 16-55 (mean = 29.43, SD = 7.83), and in the drug non-abuser group the age range was 17-50 (mean = 27.99, SD = 8.54). Table 1 shows demographic characteristics of the participants. Results of the t-test indicate (Table 2) that individuals diagnosed with substance dependency scored higher on the romantic, family, social, and emotional subscales of SELSA than those of individuals without substance dependency. These differences were statistically significant (P < 0.001). Although there was no statistically significant difference between substance dependent men and women (Table 3) on loneliness scores , results of the t-test showed a significant difference between scores of non-dependent men and women on romantic subscale.
Table 1. Demographic Characteristics of Participants a
| Substance Dependent | Substance Non-Dependent | |
|---|---|---|
| Marital Status | ||
| Married | 62 (52.5) | 56 (50.9) |
| Single | 56 (47.5) | 54 (49.1) |
| Education level | ||
| Primary school | 7 (5.9) | 4 (3.6) |
| < High school | 40 (33.9) | 15 (13.6) |
| < High school | 56 (47.5) | 66 (60) |
| University | 15 (12.7) | 25 (22.7) |
| Total | 118 (100) | 110 (100) |
a Data are presented as No. (%).
Table 2.Comparing Individuals with and Without Substance Dependence Disorder Based on Subscales of SELSA-S a
| Substance Dependents | Substance Non-dependents | t-test | P Value | |
|---|---|---|---|---|
| Romantic | 11.22 ± 5.06 | 8.09 ± 3.62 | 5.33 | 0.00 |
| Family | 15.61 ± 4.62 | 10.79 ± 3.54 | 8.79 | 0.00 |
| Social | 12.5 ± 5.29 | 8.06 ± 2.78 | 7.83 | 0.00 |
| Emotional | 26.83 ± 8.27 | 18.88 ± 5.83 | 8.32 | 0.00 |
a Data are presented as Mean ± SD.
| Men | Women | t-test | P Value | |
|---|---|---|---|---|
| Romantic | 11.22 ± 5.11 | 11.19 ± 4.95 | 0.03 | 0.9 |
| Family | 15.8 ± 4.43 | 14.71 ± 5.46 | 0.97 | 0.3 |
| Social | 12.24 ± 5.16 | 13.66 ± 5.58 | 1.11 | 0.2 |
| Emotional | 27.03 ± 8.06 | 25.9 ± 9.33 | 0.56 | 0.5 |
a Data are presented as Mean ± SD.
b Number of men = 97, number of women = 21.
| Men | Women | t-test | P Value | |
|---|---|---|---|---|
| Romantic | 7.12 ± 3.06 | 9.05 ± 3.9 | 2.87 | 0.00 |
| Family | 10.65 ± 4.01 | 10.92 ± 3.02 | 0.4 | 0.68 |
| Social | 8.03 ± 3.05 | 8.09 ± 2.5 | 0.1 | 0.91 |
| Emotional | 17.78 ± 5.8 | 19.98 ± 5.71 | 2 | 0.04 |
a Data are presented as Mean ± SD.
b Number of men = 55, Number of women = 55.
5. Discussion
According to the results of the current study, the difference of mean scores on the four dimensions of loneliness were statistically significant between drug abusers and non-abusers , higher in drug abuser group in all domains of social and emotional loneliness scale. In addition, the difference of the mean score of emotional domain, which is the sum of romantic and familial domains, was statistically significant between two groups. Similar findings reported by some other researchers such as Page (16).
Heinrich and Gullone (6) indicated that feeling of loneliness is a cognitive variable related to worse physical and mental health and has direct relationship with depression and alcohol abuse (17, 18), low self-esteem, low self-confidence, assertiveness, shyness (6, 19), disinhibited, high risk behaviors, anxiety, and tension (20). According to the results of the current study, which indicate the higher score of loneliness, drug abuse and entertaining themselves could be a way out of a feeling of loneliness and acquiring a feeling of security, also drug abuse could be a way to satisfy the emotional and psychological needs (20).
Non drug abusers, who have real familial support system, do not need any compensation for their conflict by abusing drugs or taking high risk behaviors. Results of the current study indicated more sense of familial loneliness in drug abusers. In addition to the difference of the score rate of loneliness in the two groups, there was a more romantic feeling of loneliness in women rather than men in non-drug abusers, which is similar to the results of some other studies (such as Swami) (18). This negative feeling may cause individuals to develop different kinds of reactive compensations including passive withdrawal reactions such as walking, studying, doing exercise, watching movie, and playing music or passive depressive reactions, in this case individual is overwhelmed with feeling of loneliness and may develop crying, thoughtfulness, or abusing drugs (6).
In summary, social and emotional feeling of loneliness as a high risk factor may cause initiation of drug abuse and its maintenance, therefore it is suggested to consider this critical variable in prevention and treatment of addiction. However, it is necessary to conduct further studies to see what biological and environmental factors influence the development of social and emotional loneliness and how those factor can be incorporated in prevention and treatment protocols.
