# Understanding the Association Between Substance Use and Loneliness in Midlife and Older Adults

## TL;DR

This study finds a link between substance use and loneliness in adults aged 50 and older, highlighting the need for targeted public health strategies.

## Contribution

The study provides new evidence of a statistically significant association between substance use and increased loneliness in midlife and older adults.

## Key findings

- Substance users had a 17% higher risk of feeling lonely always/usually compared to non-users.
- The association remained significant after adjusting for covariates like age, sex, and health status.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Loneliness is a growing public health concern and is highly prevalent among adults aged ≥50 years.Substance use is a significant public health burden, as it places individuals at increased risk for morbidity and mortality.

Loneliness is a growing public health concern and is highly prevalent among adults aged ≥50 years.

Substance use is a significant public health burden, as it places individuals at increased risk for morbidity and mortality.

Public health significance—Why is this work of significance to public health?
Substance use and loneliness are increasing among adults aged ≥50 years, posing a growing public health burden.Understanding the link between substance use and loneliness can inform targeted prevention and early-intervention strategies for adults aged ≥50 years.

Substance use and loneliness are increasing among adults aged ≥50 years, posing a growing public health burden.

Understanding the link between substance use and loneliness can inform targeted prevention and early-intervention strategies for adults aged ≥50 years.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Healthcare providers should routinely screen for both substance use and loneliness in adults aged ≥50 years.Age-specific, targeted strategies are urgently needed to reduce the burden of substance use and loneliness among adult populations.

Healthcare providers should routinely screen for both substance use and loneliness in adults aged ≥50 years.

Age-specific, targeted strategies are urgently needed to reduce the burden of substance use and loneliness among adult populations.

Substance use, a significant public health concern, may be associated with worsening social connections and feelings of loneliness among adult populations. This study examined the associations between substance use (i.e., binge alcohol, e-cigarette, and traditional cigarette use) and loneliness among adults aged ≥50 years residing in the US. We conducted a secondary analysis of cross-sectional data from the 2023 Behavioral Risk Factor Surveillance System Social Determinant of Health Equity module. The sample included 138,614 adults aged ≥50 years, representing approximately 55.4 million individuals in this age group. Substance use was the key independent variable and categorized into two groups: no substance use and substance use—participants who reported current use of ≥1 of three substances (i.e., binge alcohol, e-cigarette, and traditional cigarette use). Overall, 19.0% of participants reported using ≥1 substance use, 21.0% reported feeling lonely sometimes, and 5.1% feeling lonely always/usually. Participants who reported using ≥1 substance had a 17.0% higher relative risk of feeling lonely always/usually (compared to feeling never/rarely lonely) than adults who did not report substance use, after adjusting for all covariates (RRR 1.17; 95% CI 1.10–1.35; p = 0.029). These findings underscore the strong link between substance use and loneliness among midlife and older adults.