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The study found that hospitalized adults with social isolation had higher prevalence of multiple substance use disorders than patients without social isolation. In Figure 1, smoking was present in 49.3% of patients with social isolation versus 36.1% without social isolation, alcohol abuse in 14.4% versus 4.9%, and cannabis use disorder in 14.6% versus 1.4%. The authors also reported higher prevalence of stimulant-related and opioid-related disorders among patients with social isolation.

Among socially isolated hospitalized patients, the most prevalent substance-related conditions were smoking, alcohol use disorder, cannabis use disorder, stimulant use disorder, and opioid-related disorders. The article reports smoking in 49.3% of patients with social isolation, alcohol abuse in 14.4%, and cannabis use disorder in 14.6%, with stimulant-related and opioid-related disorders also occurring at elevated rates in this group.

Yes. Within the 2,050 patients coded for social isolation, substance use was more common in younger adults, males, and black patients. Patients aged 19 to 44 years made up 57.4% of the substance use group versus 41.8% of the non-substance-use group, prevalence was higher among males (64.7% vs 53.8%), and prevalence was higher in the black race (25.8% vs 13.1%). Regionally, substance use was also higher among socially isolated patients in the southern and western United States.

Among socially isolated patients, every substance category examined was more prevalent in males than females. Smoking was 56.6% in males versus 40.1% in females, alcohol use disorder 16.7% versus 11.5%, cannabis use disorder 19.3% versus 8.8%, stimulant use disorder 19.7% versus 12.1%, and opioid-related disorders 18.0% versus 14.8%.

Among socially isolated patients, black patients had higher prevalence than white and Hispanic patients for several substance categories. Smoking was 48.1% in white patients, 63.9% in black patients, and 33.3% in Hispanic patients; cannabis use disorder was 13.5%, 27.9%, and less than 1%, respectively; stimulant use disorder was 15.5%, 24.6%, and 12.5%; and opioid-related disorder was 17.2%, 16.4%, and less than 1%. Alcohol abuse showed no major racial differences, at 15.2% in white patients, 14.8% in black patients, and 12.5% in Hispanic patients.

Among socially isolated patients, substance abuse was associated with higher prevalence of anxiety disorder and bipolar disorder. Anxiety disorder was present in 55.9% versus 45.3%, and bipolar disorder in 23.5% versus 16.4% among those with versus without substance abuse. The authors also noted a lower prevalence of depression and psychosis among those with substance use.

In this study, length of stay was similar among socially isolated patients by substance use status, but hospitalization cost was higher among socially isolated patients with substance use. The authors did not report a difference in days hospitalized for smoking, alcohol use disorder, cannabis use disorder, stimulant-related disorder, or opioid-related disorder, but they did report greater cost burden in the substance use group.

This was a cross-sectional analysis of the 2018 National Inpatient Sample, a large US hospital dataset representing about 35 million yearly in-hospital interactions from more than 1,000 nonfederal acute care hospitals in 45 states. The study identified adult hospitalizations with social isolation using ICD-10-CM code Z60.4 and identified substance abuse using revised Clinical Classifications Software Refined codes. The final sample included 2,050 patients with social isolation diagnostic codes.

The main limitation is that the study was cross-sectional, so it provides only a single snapshot of association and cannot establish causation. The authors also note possible incomplete capture of variables in the dataset, the possibility of duplicate counting because visits rather than individual patients were recorded, inability to verify individual ICD codes, and lack of information on current medication use or duration of illness.

The authors conclude that social isolation should be addressed as a public health issue and that clinicians should integrate interventions that promote social connections into clinical practice. Based on the higher prevalence of smoking, alcohol use disorder, cannabis use disorder, stimulant-related disorders, and opioid-related disorders in socially isolated patients, the findings support active substance use assessment when social isolation is documented. The authors also suggest community-based programs and other strategies that address social isolation as part of prevention and management of substance use disorder.