Importance of Connectedness

It may at first seem strange to focus on enhancing healthy connectedness as a solution to substance use problems. However, upon closer consideration, it becomes clear that social disconnection and unhealthy relationships are significant factors behind many of our most pressing social problems, including problems related to substance use.

How Social Relationships Influence Health

An American Psychologist, Sheldon Cohen and his colleagues have used clinical research to identify three social relationship variables that appear to influence health outcomes (Cohen, 2004).

Social Construct	Specific Processes
Social support: existence of a social network that provides material, informational and emotional resources to cope with stress	The actual provision of support, or even just the perception of the availability of support, reduces the effects of stressful experiences by promoting effective coping strategies or suggesting less threatening interpretations of adverse events.
Social integration: participation in a broad range of social relationships	Promotes positive psychological states (e.g., identity, purpose, self-worth, and positive affect) that induce health-promoting physiological responses. Provides information and may be a source of motivation and social pressure to care for oneself.
Negative interactions: serious, enduring social conflicts (e.g., problems with spouses, close family members or friends)	Increases risk for disease due to person's appraisal of social conditions as stressful and the consequential changes in health behaviours.

Cohen (2004) suggests that social interventions to improve health and wellness should not concentrate on constructed or artificial social interactions, but on creating and strengthening the diverse "natural social networks" around us and increasing the availability of social support within these networks.

A look into the research on the psycho-social factors associated with problematic substance use provides solid empirical evidence of the benefits of healthy connectedness. Researchers have identified sets of conditions that seem to reduce or enhance the likelihood of substance-use problems. These so-called "risk and protective factors" include both individual and societal influences across the lifespan.

Life Stage	Risk Factors	Protective Factors
Pre-natal	Maternal alcohol and tobacco use Genetic influences	Nutrition Social supports
Early childhood (0 to 5)	Extreme socio-economic disadvantage Childhood trauma	Easy temperament Social and emotional competence
Middle childhood (6 to 11)	Extreme socio-economic disadvantage Early school failur Favourable parental attitudes toward substance use Childhood behaviour problems (including mental health issues)	Social and emotional competence Shy and cautious temperament Parental harmony
Adolescence (12 to 18)	Community influences (including access to positive social activities, levels of substance use in the community ,availability of substances, and media portrayal of substance use) Conflict with parents, or parental substance use problem Low involvement with adults Peers engaging in problematic substance useSchool failure Mental health problems	Attachment to family, school, and community Involvement in faith community Parental harmony and good child-parent communication
Early adulthood (19 to 29)	Peers or partner who use substances Patterns of behaviour in social, educational, or employment setting Unemployment Mental health problems	Attachment to family, school, and community Faith community involvement Parental harmony and good child-parent communication
Later adulthood (30 to 64)	Mental health problems	Effective regulation of alcohol in the community Stable supportive relationships
Senior years (65 +)	Loss of a partner Social isolationReduced social support	Stable supportive relationships

A close examination of the known risk and protective factors reveals that connectedness and disconnectedness figure prominently in them. Of course, not all people who are disconnected experience problems with substance use, and not all that are connected in healthy ways remain problem free (bringing up the complex topic of personal resiliency). But the population-level evidence is clear: the likelihood of experiencing problems with substance use is significantly higher for those whose lives contain more risk factors (greater disconnection), and significantly lower for those whose lives contain more protective factors (greater healthy connection).

This perspective may help to explain why problematic substance use is becoming more common over time. Consider how our cultures have shifted in the modern era. Many of the changes that have taken place involve the breaking apart of what were once meaningful connections between people, places and things (Alexander, 2008). And it is not only disconnections between us but also within us. Psychologists and others have begun to recognize that disconnection with our emotional natures is a leading cause of stress and disease in society. Below, we explore the concept of connectedness as it relates to the individual, family, and the community at large.

Building Connection in Individuals

As a result of a variety of biological, psychological and social influences, many people learn to avoid or otherwise mismanage their emotions. Research has shown that the conscious or unconscious repression/suppression of emotions, or the unhealthy venting of emotions from the position of a victim, can lead to physiological changes. These changes can compromise important bodily functions, including those associated with the nervous, endocrine, and immune systems (Pennebaker & Traue, 1993). As well, people who have a difficult time acknowledging and productively expressing their emotions are prone to both psycho-somatic disorders and illness-related behaviours, including problematic substance use (Abbass, 2005).

There are a host of social and institutional factors that condition people to disregard or otherwise poorly regulate their emotions. For example, people are often chastised for being “emotional". In addition, significant emphasis is placed on mental understandings and rationality at the expense of honouring our human capacity to know and experience life through our feelings. It is necessary to change these social norms and patterns which condition people to disconnect from healthy emotional awareness and expression. This is a challenge to every one of us to become aware of how we consciously or unconsciously mismanage our own emotional responses, and how we contribute to the conditions which influence others to poorly regulate theirs. It is nothing less than a call for us to create genuine social space for all our humanness, including our emotional natures.

Building Connection in the Family

A growing body of knowledge across multiple disciplines is revealing that environmental and social influences are likely more important than genetic inheritance in explaining the disparate health and social outcomes found in society (Lipton, 2008). Furthermore, since genetic conditions are difficult (if not impossible) to change, environmental and social conditions are the appropriate focus of our efforts to improve health and social outcomes, at least for the foreseeable future.

Environmental and social influences appear to significantly affect human development across the entire life span. However, these factors are particularly important in the first few years of life, when many of our basic emotional, mental and physical processes and attributes are shaped. What is becoming clear from the research is that a lack of adequate bonding and nurturance, especially in the first few years of life, can have significant and lasting effects on the emotional, mental and even physical (i.e., neurological) development of individuals (Snelling & Greenberg, 2006). Unfortunately, in today’s fast-paced society, close bonding is not as common as it was in the past.

In addition to lack of adequate nurturing, the presence of stressful or harmful circumstances in childhood (e.g., physical, emotional or sexual abuse; substance use or mental health problems in the household; violence toward the mother; separation from a parent) greatly increases the risk of a host of negative health and social outcomes, including harmful substance use (Anda et al., 2007; Anda et al.,1999; Dube et al., 2006; Dube et al., 2003; Dube et al., 2002; Edwards, et al., 2007).

When discussing connectedness in familial environments, the twin issues of nurturance and childhood trauma stand out. Communities must start acting as communities in the normative sense of that word. That is, the well-being of ALL members of a community must become a real priority, and together people must find ways to support individuals and families so they can address issues of nurturance and childhood trauma in meaningful ways. This brings us to the third level of analysis.

Building Connections in Your Community

Building connections to manage substance-use problems has three main goals: (1) to address the exclusion and stigma of people who use substances in harmful ways, and meaningfully involve them in solutions; (2) to create the partnerships and collaborations required to address the complex societal factors that increase the likelihood of harmful substance use in society; and (3) to counteract unhealthy cultural trends that serve to reduce the health and resiliency of communities over time.

Social Inclusion. Social exclusion and isolation are both significant risk factors for poor health outcomes. There are a number of ways in which exclusion can affect health. For example, it can increase feelings of loneliness, depression and hopelessness in individuals, all of which are correlated with poor health outcomes. Social exclusion can also mean that a person does not have ready access to the formal and informal social supports they need to maintain their health. And finally, economic hardship, which is often associated with marginalization and social exclusion, may mean that people do not have the physical resources they need to achieve and maintain genuine wellness. Promoting broad inclusiveness in society can address these factors and others by enhancing social capital. Activities, resources and structures that encourage bonding, bridging or linking between individuals and/or institutions in society are examples of social capital (Putnam, 2000). Experience has shown that when given the chance to contribute , people who use substances in harmful ways can actively participate in the solution.

Community Partnerships. The causes of problematic substance use are both complex and poorly understood. This is a second major reason for promoting connectedness within community as a way to deal with substance use issues. Under general conditions of complexity and uncertainty, some observers suggest it is important to encourage diversity and experimentation in our response, and then develop effective ways of determining what is actually working on the ground to deal with the the problem (Homer-Dixon, 2000). The creation and maintenance of partnerships capable of facilitating decentralized and multi-faceted responses tailored to the needs of particular communities is obviously a key component to developing these types of innovation-promoting arrangements. More information on the theory and practice of creating effective community partnerships is available throughout this website.

Health Promoting Cultures. A third rationale for enhancing connectedness in communities to deal with substance use relates to the broader issue of culture. While we often point to the failure of individuals when trying to understand what causes people to engage in harmful substance use, we now know that human behaviours result from the complex interplay of societal factors (e.g., policy, mass media, social norms, etc.) and individual factors (e.g., biology, personality, etc.) (Adelman & Taylor, 2003). One of the most important structural factors influencing behaviour is the pervasive (yet largely informal) constellation of norms, customs, rules and influences that we know as "culture." Unfortunately, it is also one of the most difficult factors to identify.

When thinking about culture and harmful substance use we often focus on "subcultures" of individuals in society where risky drug and alcohol use is common. However, it may be just as important to recognize that there are aspects of mainstream culture that are actively promoting disconnectedness and ill health. In particular, Eckersley (2005) suggests two qualities that detract from our ability to create and maintain healthy connectedness in society, namely, extreme materialism and unhealthy forms of individualism.

The question then becomes, what can communities do to deal with this? Changing culture is difficult but not impossible. For example, consider how cultural norms around drinking and driving have changed in recent years. While this change took several decades and required millions of dollars of investment in public education and targeted enforcement, broadly speaking it is no longer socially acceptable to drink and drive. Part of what is needed is conscious recognition of the fact that aspects of our dominant, western culture are propagating unhealthy attitudes. Furthermore, we need to acknowledge that these attitudes are taking us in the opposite direction from where we need to be to create communities that promote lasting resiliency and wellness. Once this reality is consciously recognized, communities then need to devise creative ways to reduce the presence of unhealthy cultural influences that increase risk and develop innovative initiatives that promote healthy connectedness.

References

Abbass, A. (2005). "Somatization: Diagnosing it Sooner Through Emotion-focused Interviewing. Journal of Family Practice, 54(3):215-224.

Adelman, H. & Taylor, L. (2003). "Creating School and Community Partnerships for Substance Abuse Prevention Programs," The Journal of Primary Prevention, 23(3):329-369.

Alexander, B. (2008). The Globalization of Addiction: A Study in the Poverty of Spirit. New York: Oxford University Press.

Anda R., Brown D., Felitti V., Bremner J., Dube S., & Giles W. (2007). "Adverse childhood experiences and prescribed psychotropic medications in adults." American Journal of Preventative Medicine, 32(5):389–94.

Anda, R., Croft, J., Felitti, V., Nordenberg, D., Giles, W., Williamson, D. and Giovino, G. (1999). "Adverse Childhood Experiences and Smoking During Adolescence and Adulthood." Journal of the American Medical Association, 282(17):1652-1658.

Cohen, S. (2004). "Social Relationships and Health." American Psychologist, 59(8):676-684.

Dube, S., Anda, R., Felitti, V., Edwards, V. & Croft J. (2002). Adverse Childhood Experiences and Personal Alcohol Use as an Adult. Addctive Behaviours, 27(5):713-725.

Dube S., Felitti V., Dong M., Chapman D., Giles W., Anda R. (2003). "Childhood Abuse, Neglect and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experience Study. Pediatrics, 111(3):564–572.

Dube S., Miller J., Brown D., Giles W., Felitti V., Dong, M., Anda, R. (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of Adolescent Health 38(4):444.e1-444.e10.

Eckersley, R. (2005). "Cultural Fraud." Drug and Alcohol Review, 24(2):157-163.

Edwards, V., Anda R., Gu D., Dube, S . & Felitti, V. (2007). “Adverse Childhood Experiences and Smoking Persistence in Adults with Smoking-related Symptoms and Illness.” Permanente Journal 11:5–7.

Homer-Dixon, T. (2002). The Ingenuity Gap: Facing the Economic, Environmental, and Other Challenges of an Increasingly Complex and Unpredictable Future. Toronto: Vintage Canada.

Lipton, B. (2008). The Biology of Belief: Unleashing the Power of Consciousness, Matter and Miracles. New York: Hay House.

Loxley, W., Toumbourou, J., Stockwell, T.R., Haines, B., Scott, K., Godfrey, C., Waters, E., Patton, G., Fordham, R.J., Gray, D., Marshall, J., Ryder, D., Saggers, S., Williams, J. and Sanci, L. (2004). The Prevention of Substance Use, Risk and Harm in Australia: A Review of the Evidence. National Drug Research Institute and the Centre for Adolescent Health.

Putnam, R. (2000). Bowling Alone: The Collapse and Revival of American Community. New York: Simon & Schuster

Snelling, J. & Greenberg, T. (2006). “Brain Development and Emotional Development: The Role of Teaching in Organizing the Frontal Lobe.” Ch. 4 in P. Salovey & D. Sluyter (eds.), Emotional Development and Emotional Intelligence: Educational Implications. New York: Basic Books.