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Different Kinds of Lonely: Dimensions of Isolation and Substance Use in Adolescence

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Abstract

Social isolation is broadly associated with poor mental health and risky behaviors in adolescence, a time when peers are critical for healthy development. However, expectations for isolates’ substance use remain unclear. Isolation in adolescence may signal deviant attitudes or spur self-medication, resulting in higher substance use. Conversely, isolates may lack access to substances, leading to lower use. Although treated as a homogeneous social condition for teens in much research, isolation represents a multifaceted experience with structurally distinct network components that present different risks for substance use. This study decomposes isolation into conceptually distinct dimensions that are then interacted to create a systematic typology of isolation subtypes representing different positions in the social space of the school. Each isolated position’s association with cigarette, alcohol, and marijuana use is tested among 9th grade students (n = 10,310, 59% female, 83% white) using cross-sectional data from the PROSPER study. Different dimensions of isolation relate to substance use in distinct ways: unliked isolation is associated with lower alcohol use, whereas disengagement and outside orientation are linked to higher use of all three substances. Specifically, disengagement presents risks for cigarette and marijuana use among boys, and outside orientation is associated with cigarette use for girls. Overall, the adolescents disengaged from their school network who also identify close friends outside their grade are at greatest risk for substance use. This study indicates the importance of considering the distinct social positions of isolation to understand risks for both substance use and social isolation in adolescence.

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Acknowledgements

The authors thank the members of working groups at PSU and Duke University for their helpful comments. We gratefully acknowledge the contributions of study participants and families and the PROSPER staff to the success of this project.

Authors’ Contributions

M.C. wrote the manuscript and contributed to the study design; J.F. conducted analyses and participated in data interpretation and drafting; JM generated the networks; J.M. and M.E.F. conceived of the study and participated in design and revision. All authors read and approved the final manuscript.

Funding

Grants from the W.T. Grant Foundation (8316), National Institute on Drug Abuse (R01-DA018225), National Science Foundation (1535370), the National Institutes of Health (UL1-TR002240), and National Institute of Child Health and Development (R24-HD041025) supported this research. The analyses used data from PROSPER, a project directed by R. L. Spoth, funded by the National Institute on Drug Abuse (RO1-DA013709) and the National Institute on Alcohol Abuse and Alcoholism (AA14702).

Author information

Authors and Affiliations

  1. Duke University, Durham, NC, USA

    Molly Copeland, Jacob C. Fisher & James Moody

  2. King Abdulaziz University, Jeddah, Saudi Arabia

    James Moody

  3. The Pennsylvania State University, University Park, PA, 16801, USA

    Mark E. Feinberg

Authors
  1. Molly Copeland
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  2. Jacob C. Fisher
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  3. James Moody
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  4. Mark E. Feinberg
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Corresponding author

Correspondence to Molly Copeland.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The procurement of the data required for this study was approved by the Iowa State University and Pennsylvania State University institutional review boards

Informed Consent

All youth and families were informed about and consented to participate in this project.

Appendices

Appendix A: Family Relations Scale Items

The scale was constructed by taking the mean of each of the standardized measures, using the grand composite of the four affective quality subscales with one-fourth weight.

Affective quality: 1 = Always or almost always, 2 = Often, 3 = About half the time, 4 = Not very often, 5 = Never or almost never, for “During the past month, how often did…”

  • Your MOM let you know she really cares about you?

  • Your MOM act loving and affectionate toward you?

  • Your MOM let you know that she appreciates you, your ideas, or the things you do?

  • YOU let your mom know you really care about her?

  • YOU act loving and affectionate toward your mom?

  • YOU let your mom know what you appreciate her, her ideas, or the things she does?

  • Your DAD let you know he really cares about you?

  • Your DAD act loving and affectionate toward you?

  • Your DAD let you know that he appreciates you, your ideas, or the things you do?

  • YOU let your dad know you really care about him?

  • YOU act loving and affectionate toward your dad?

  • YOU let your dad know what you appreciate him, his ideas, or the things he does?

Activities with child: 1 = Everyday, 2 = A few times a week, 3 = About once a week, 4 = Two or three times during the past month, 5 = Once during the past month, 6 = Not during the past month, for “During the past month, how often did you…”

  • Work on homework or a school project together with your Mom or Dad?

  • Do something active together with your Mom or Dad?

  • Talk about what’s going on at school with your Mom or Dad?

  • Work on something together around the house with your Mom or Dad?

  • Discuss what you want to do in the future with your Mom or Dad?

  • Do some other fun activity that you both enjoy with your Mom or Dad?

Inductive reasoning: 1 = Always, 2 = Almost always, 3 = Almost half the time, 4 = Almost never, 5 = Never, for “How often?…”

  • My parents give me reasons for their decisions.

  • My parents ask me what I think before making a decision that affects me.

  • When I don’t understand why my parents make a rule for me, they explain the reason.

Appendix B: Robustness Checks and Sensitivity Analyses

Robustness checks in this appendix include models that introduce control variables for the treatment condition in the overall PROSPER intervention, a measure of school adjustment and bonding (scale items shown in conjunction with Table 7 below), and stepwise regression to test whether findings are sensitive to the introduction and order of the sociodemographic control variables used in the main analyses.

Treatment in the PROSPER intervention included randomly selected schools and families participating in a community-university program targeting teen resilience against peer influence to use drugs. Further information about the design and efficacy of the intervention can be found in Osgood et al. (2013) and Spoth et al. (2004). Table 6 shows that including controls for treatment and interacting treatment with the isolation dimensions does not significantly alter any of the findings described in this study.

Table 6 Logistic regression of dimensions of isolation predicting past-month drug use in PROSPER, including treatment condition and interactions between treatment and isolation dimensionsa
Full size table

Table 7 shows models including school adjustment and bonding. Including this variable significantly changes only one association, attenuating the association between disengagement and alcohol use. This change aligns with the conceptual role of disengaged isolation; for these self-excluding isolates, who do not see themselves as part of the school peer network, detachment from the school environment overall attenuates the observed relationship between alcohol use and disengagement from school peers. This measure is included in a model in these robustness analyses because such measures of affective qualities toward school are traditionally used as controls in tandem with structural peer network measures. However, given the conceptual collinearity of this school bonding measure with one of the isolation dimensions, the structural network focus of models in this study, and our aim of keeping models with several new definitional components reasonably simple, this measure is not included in main analyses.

Table 7 Logistic regression of dimensions of isolation predicting past-month drug use in PROSPER, including school adjustment and bonding
Full size table

Finally, Tables 8–10 show stepwise regressions for each substance and the isolation dimensions, where sociodemographic controls used in the models are successively added individually. This process shows that results are robust to the independent introduction of control variables.

Table 8 Stepwise logistic regression of dimensions of isolation predicting past-month cigarette use in PROSPER
Full size table
Table 9 Stepwise logistic regression of dimensions of isolation predicting past-month marijuana use in PROSPER
Full size table
Table 10 Stepwise logistic regression of dimensions of isolation predicting past-month alcohol use in PROSPER
Full size table

School Adjustment and Bonding Scale Items

The school adjustment and bonding scale is the mean of eight items of a validated school bonding scale (Oelsner et al. 2011; Simons et al. 1991), with α = 0.76. Potential responses include 1 = Never true, 2 = Seldom true, 3 = Sometimes true, 4 = Usually true, 5 = Always true, to “True?…”

  • I like school a lot.

  • I try hard at school.

  • Grades are very important to me.

  • School bores me.*

  • I don’t feel like I really belong at school.*

  • I feel very close to at least one of my teachers.

  • I get along well with my teachers.

  • I feel that teachers are picking on me.*

* Indicates items that are reverse-coded.

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Copeland, M., Fisher, J.C., Moody, J. et al. Different Kinds of Lonely: Dimensions of Isolation and Substance Use in Adolescence. J Youth Adolescence 47, 1755–1770 (2018). https://doi.org/10.1007/s10964-018-0860-3

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  • DOI: https://doi.org/10.1007/s10964-018-0860-3

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