Social Withdrawal and Prescription Opioid Misuse Among Older Adults in the United States

The literature indicates an association between social isolation and substance use. Though related, social withdrawal is a construct that has received less attention. Given that prescription drugs are commonly misused by older adults, this paper contributes to the literature by examining the association between social withdrawal and prescription opioid misuse.

We use data from 2009 to 2022 U.S. National Survey on Drug Use and Health, focusing on respondents 50+ (N = 111,386; 54.8% female; 74.1% non-Hispanic White). Social withdrawal is measured with 3 items from the WHO Disability Assessment Scale, individually and as a scale, capturing the level of social withdrawal severity experienced when going out of the home, dealing with strangers, and participating in social activities. Our outcome is past-year prescription opioid misuse. Logistic regression models consider the association between these 2 measures. Models account for underlying mental health alongside additional covariates.

Levels of social withdrawal and prescription opioid misuse remained relatively constant across observation years. A significant association exists between social withdrawal and past-year prescription opioid misuse. We find increasing odds of past-year prescription opioid misuse across social withdrawal severity levels. Severe social withdrawal across measures is associated with 1.59 (95% CI = 1.28, 1.98) to 2.1 (95% CI = 1.74, 2.48) times higher odds of past-year prescription opioid misuse relative to no social withdrawal. Predicted probabilities of misuse are 1% among those with no social withdrawal, but 6% among those experiencing severe social withdrawal. A nonsignificant interaction shows this relationship is consistent across years. These estimates are robust to numerous controls and alternative specifications.

Prescription opioid misuse is associated with social withdrawal. Social withdrawal is bound up with, and yet independent of, mental and physical health. Addressing the social causes of social withdrawal, as well as mental and physical health, could advance addressing opioid misuse among older adults.