Scand J SOCMed 15: 175-183, 1987
Loneliness Correlates in Advanced Alcohol Abusers
I. Social F a c t o r s arid N e e d s
Ingemar Akerlind, Jan Olof Hornquist and Birgit Hansson
From the Deparinteni of Preventive and Social hledicine,
Universiiy Hospiial, Linkoping, Sueden
Loneliness correlaies in advanced alcohol abusers. I . So-
cial factors and needs. Akerlind, I. and Homquist, J. 0.
(Department of Preventive and Social hledicine, Universi-
ty Hospital, Linkoping, Sweden).
Scand J Soc died 1987, 3 (175-183).
A previous report on 34 alcohol abusers undergoing reha-
bilitation revealed that, among 86 medical, social and
psychological variables, “feelings of loneliness” were
most important for the prognosis. The current analysis
was performed in order to illuminate the less satisfactory
prerequisites regarding external social factors and needs
of the lonely alcohol abuser. Ninety-five abusers, the
previously mentioned sample included, were examined
twice with an approximate interval of two years. The
results indicated that there were no simple or obvious
correlations to the external social situation (the amount of
contacts, social network, etc). Feelings of loneliness were
more closely associated with dissatisfaction with the qual-
ity of existing relationships, independent of quantity. Fur-
thermore, even in relation to work and activities, the
lonely abusers showed a general dissatisfaction with the
existing situation, independent of its nature. In addition,
the lonely abusers felt dissatisfied in a number of need
domains, although they were only inclined to stress the
priority of some social needs. To sum up, the lonely
abuser showed a recurrent pattern characterized by dis-
contentment and dissatisfaction, in combination with
some traces of passivity in essential life-spheres.
Key words: loneliness, alcoholism, quality of life, wellbe-
ing.
In spite of its fundamental import to man as a social
being, loneliness has long been a neglected research
area. However, during the last decade, a promising
development has begun (1). Apart from the broadly
human significance loneliness has, it also seems to
play an important role in critical life situations. It is
applicable to somatic (2) and psychiatric (3) illness-
es as well as to life crises such as divorce, bereave-
ment and aging (1, 4).
It is a common clinical opinion that loneliness is
an important factor in the rehabilitation of alcohol-
ics. It may have a deteriorating effect both when
alcoholic abuse begins and when efforts are made
to alleviate it. It is, for example, usual that an
abuser can withstand withdrawal of alcohol, but not
a complete loss of the social contacts associated
with it. Research literature contains some anecdo-
tal and observational data on alcoholism and loneli-
ness (5, 6 , 7). According to Loucks ( S ) , loneliness
has remained an amorphous construct, most often
mentioned in a phenomenological sense in discus-
sions of ititer uliu alcoholism. There are in fact very
few systematic studies on the subject. According to
a study on alcoholism and alienation by Calicchia &
Baressi (9), abusers exhibited significantly stronger
feelings of social isolation than is normal. Nervi-
ano & Gross (10) have applied a revised form of
Bradley’s Loneliness Scale to a group of alcohol
abusers and demonstrated its validity by a number
of correlations on an intermediate level in relation
to personality variables. They state that loneliness
scales “might serve as valuable predictors of an
alcoholic’s response to therapy” and “they show
potentially strong future utility for psychotherapy
research”. Allen et al. (1 1) have demonstrated that
abusers in the final stages of a rehabilitation pro-
cess express less loneliness than do abusers in ini-
tial stages. In a Japanese study (12), chronic alco-
holics showed higher loneliness scores than other
groups. Johnson (13) found that loneliness in a
group of alcoholics was highly correlated with shy-
ness and depression and inversely related to pur-
pose in life. Therapy designed to facilitate the de-
velopment of a sense of life purpose had no signifi-
cant effect on loneliness, shyness, depression or
purpose in life. In a previous study of abusers in
rehabilitation (14), we found that among 86 medi-
cal, social and psychological variables, “feelings of
loneliness” were most significant for a less satisfy-
ing prognosis.
Scand J SOCAfed IS
176 I . Akerlirid and J . 0.Hortiqitist
15
r
p 1c
s common drop outs, of the data tested for correlations with
2
nn
Y
Loneliness score
Fig. 1. The distribution of loneliness score at initial exami-
nation and at re-examination 2 years later.
The aim of the present study is to carry out a
more extensive survey of the lonely alcoholic. The
investigation was based upon a quality-of-life con-
cept that comprises six life domains: structural,
material, activity, social, psychological and physi-
cal (15). Intercorrelations between loneliness and
external social circumstances together with need
satisfaction are presented in this report while rela-
tionships to psychological and clinical variables are
reported in a following one.
METHOD
Subjects
In order to get a broad sample of advanced alcoholics, the
study group of 95 individuals was composed of two differ-
ent subgroups. The first one, also described by Elton &
Hornquist (16), comprised 54 males and 7 females, on the
threshold of disability pension when initially examined.
They represented, together with 17 drop-outs, the total
population of first-time applicants for disability pension
with an alcohol abuse during an 18-month period, in a
geographically defined region in the county of Ostergot-
land in Sweden. The drop-out was due to ethical contrain-
dications (8 cases), administrative errors (5 cases), geo-
graphical obstacles (3 cases) and in one case, refusal to
participate. The second subgroups of 34 males, also de-
scribed elsewhere (14, 16). was a matched sample of 30
individuals together with 4 additional ones. Th-e abuse was
approximately just as advanced as in the first group, but
they were still in rehabilitation at the initial examination.
Fourteen of them were inpatients at an institution for the
treatment of alcoholic's, 8 persons were undergoing outpa-
tients treatment at a socio-medical clinic, 6 were outpa-
tients at a psychiatric clinic and the remaining 7 abusers
were undergoing vocational rehabilitation.
The quality-of-life, loneliness included, of the partici-
Scnnd J Sac hled IS
pating alcohol abusers was examined twice with an ap-
proximate interval of two years. Four deaths and 2 drop-
outs reduced the study population by six during the inter-
val. Of the whole study group of 95 subjects, two partici-
pants did not complete their loneliness ratings at the initial
examination, but at reassessment. Another 15 individuals
self-rated their loneliness on the first instance but did not
complete the ratings at reassessment. Similar natural and
loneliness, occurred, and therefore the number of obser-
vations vaned from case to case. In order to get the
broadest possible basis, the correlations were calculated
out of the maximum of 93 and 80 observations on the
respective occasions. This somewhat shifting sample does
not imply any disadvantage in this context, but rather
increase the generality.
The study population ranged in age from 24 to 60 years
with a mean of 44.5 years (std 10.2) at the initial examina-
tion. The 7 females had about the same range in age (25 to
58 years) and were somewhat older (mean 48.9 years).
The alcohol abuse of the participants was quite extensive
and was accompanied by severe physical, psychological
and social damage. A majority (82%) had been using
alcohol regularly for more than 10 years (mean 20 years).
Several (40%) had started the abuse before the age of 20
years. Most of them (76439%) had records of trigger-
mechanism, black-outs and need for pick-me-ups. Almost
every third subject had had attacks of grand ma1 form
(27%) and delirium tremens (32%). Half of them (53%)
had elevated gamma-GT laboratory findings. The current
mean maximal daily consumption was 226 g alcohol. A
majority had been classified as moderately (52%) or se-
verely (32%) psychiatrically ill. Half of them had been
staying in special institutes for treatment of alcohol abuse
and 92% were known to the social authorities. A majority
(71 %) had less than 9 years basic education but 58% had
some kind of practical vocational training. Skilled (50%)
and manual (33 %) workers were the predominant occupa-
tional groups. The majority (77%) were living alone and
every second one was divorced. Only 10% were currently
married and cohabiting. More detailed accounts of the
alcohol abusers' comprehensive social, psychological and
medical characteristics have been given previously (16,
17, 18).
Procedure
The alcoholics were initially contacted and examined on
separate occasions during 1978 and 1979. They were re-
examined after two years in order to evaluate the effects
of disability pension, which is reported elsewhere (17).
Data from both examinations were included in this study
in order to counteract the problem with mass-significance
and make it possible to find the most stable and pervading
patterns. As expected, there were both individual and
group changes of several variables over the two years
(17). Interrelations with loneliness that recur despite these
changes and despite the somewhat shifting sample ought
to be especially reliable.
Each abuser self-rated hisher loneliness by judging
whether or not nine separate items were applicable to
hisher situation or feelings. This loneliness scale was part
of a questionnaire with ten other scales covering certain
 Lotieliness correlates in advanced alcohol abusers. I 177

' Table I. Correlations between lotielitzess and different aspects of the social network
Correlations
First Second
Social network variable assessment assessment

Quality in relations toward parents

Mother -.I6 -
Father -.07 -
Family
Availability -.33*** - .08
Number -.26** -.I1
Desired additional contact" (n=20) - - .48*
Close friends
Availability .os - .01
Number -.08 -.07
Contact frequency" - .05 .02
Desired additional contact" (n=71,60) .23* .20
Drinking buddies
Availability .14 .II
Number .07 .05
Contact frequency" (n=48,24) -.22 -.46*
Desired additional contact" (n=49,24) -.04 -.11
Cursory friends and acquaintances
Availability -.22* -.37***
Number -.23* -.26**
Contact frequency" (n=38,46) .26 -.Ol
Desired additional contact" (n=38,46) .2 1 -.17
Cohabiting -.25** .03
Experience of group involvement
Designating a reference group .I4 -
Feeling of affinity to outsiders .22* -
Computed for those who declared availability.
- Not measured.
* p<0.05, ** p<O.OI, *** p<O.OOl.

aspects of the person's social interaction, ego-conception
and life-satisfaction (19). The scale covered the following
conditions: longing for social contacts, companionship,
someone to talk to or someone who cares; feeling lonely,
isolated, cut off or left out of things; a wish for more
friends. As is illustrated in Fig. I , the abusers were rela-
tively evenly distributed over the whole range. There was
some predominance at the lowest levels, but much weaker
than in another somatically disabled group (20). At both
examinations, a great minority (45-35%) was scoring at
the upper half of the scale, indicating salient feelings of
loneliness. The internal consistency of the loneliness scale
m s 0.86 on the first assessment and 0.85 on re-examina-
tion (Cronbach's alpha).
The correlations between loneliness score and various
aspects of the abusers' social background (12 parame-
ters), external social network (20 parameters), work and
activities (27 parameters), societal position (9 parame-
ters), life-priorities (29 parameters) and life-satisfaction
(25 parameters) were calculated. These parameters were
assessed by means of a structured interview by a social
worker. More detailed information about the content of
the parameters is provided in the result section. Most of
the examination procedures and most of the parameters
have also been closely described in other papers (16, 18).
The relationships between loneliness score and the oth-
er variables were calculated both as Pearson's and as
Spearman's rank correlation coefficients according to
SPSS standard programmes (21). In addition to the coeffi-
cients calculated, most of the bivariate relationships were
plotted.
RESULTS
The plottings disclosed no specific nonlinear rela-
tionships in any instance. As expected there were
major similarities between the Pearson's and the
Spearman's correlation coefficients. Therefore only
the Pearson's coefficients are given. The main pat-
tern under the various headings below is usually the
following. First the most impressive and stable in-
terrelationships are given. Secondly, the weaker
and the less stable correlates are pointed out. Final-
ly the nonrelated parameters are enumerated. In
the last instance; no correlation coefficients are
reported. The strength of the interrelationships is

Scand J Soc hled IS

178 I . herlitid and J . 0 . Hornqiiist

Table 11. Correlations between loneliness and ad- Work and activities
aptation to work and lion-work sitiiation The alcoholic's work history was recorded in terms
Correlations of duration of inactivity (unemployed, sick-listed,
etc.) and frequency of previous work changes. Atti-
First Second tudes to future work were discovered by assessing
Work variable assessment assessment
wish for pension, the ability to designate a possible
Duration of inactivity .26** - future job and the ability to designate some desir-
Work changes .23** - able features of it. Adaptation to a non-work situa-
Wish for pension .27** .oo tion was illuminated by recording their feelings of
Designating a job -.15 -
Desirable job-features .03 - being meaningfully occupied, wishes for less spare
hleaningfully occupied -.36*** -.35*** time and feelings of lack of time. The results in
Wish for less spare time -.16 .34***
Lack of time .16 -.I2 Table I1 indicate that the lonely abuser had a some-
what poorer adaptation to work in the past as well
- Not measured. as to the current non-work situation. Reported esti-
* p<o.os, ** p<O.Ol, *** p<O.Ool.
mated time spent daily on different types of activi-
ties (extravert but not primarily social, more inti-
mate social, introvert non-social and passivity) are
described by the magnitude of the correlation coef- presented in Table 111. The lonely abuser spent
ficients and level of significance. Stability is indi- relatively more time on introvert non-social activi-
cated by recurring significant correlation coeffi- ties and less time on social intercourse in primary
cients at the two assessments. groups and on some extravert activities.

Social backgrorrnd Strzrctiirnl circirnislances

Of the background variables, residence in an urban Experienced insecurity (0.43, p<O.OOl; 0.39,
area was related to loneliness (0.32, p<O.OOl; 0.22, p<O.OOl) and inferiority (0.31, pcO.01; 0.26,
p<0.05). Sex was ambiguously related, females ex-
pressed a greater degree of loneliness (0.15, NS;
0.23, p<0.05). Reported difficulties in the current Table 111. Correlations between loneliness and time
administration of one's economy were ambiguously spent daily on different types of activities
related (0.02, NS; 0.24, p<0.05). Taxable mean in-
come was nonrelated. Duration of current resi- Correlations
dence, previous main residence, level of theoretical First Second
and practical education, type of occupation as well Activity variable assessment assessment
as current possession of certain selected capital
goods were uncorrelated. Age yielded very weak Extravert" -06 -.11
Work .M -.27**
negative correlation coefficients (-0.15, p=0.07; Studies .I6 -.01
-0.14, p=O.lO). Organizational .01 -.14
Shopping -.19* -.21*
Social netowrk
Domestic work -.04 .15
Religious -.09 -.04
The alcoholics' perceived quality of the relations to Sports and recreation -.25** -.24**
Contacts with authorities .18* .I1
their parents while growing up were registered. The
actual social intercourse was assessed in relation to Social" -.26** -.05
Parties and amusements .I4 .02
four primary groups of different degrees of intima- Family life -.34*** .06
cy. The network variables were: availability (to Intercourse with friends - .04 -.23*
have or lack), quantity, contact frequency and de- Introvert" .17* .21*
Books and newspapers .I2 .27**
sired change in the interaction. Moreover, the cur- TV and radio .I5 .05
rent living situation (cohabiting or living alone) was Passivity" .08 .09
recorded. Finally, the abusers' experiences of Resting .03 .04
group involvement were assessed by designation of Doing nothing in particular .lI - .14
reference groups and statements of affinity. The Composite score.
results are presented in Table I. * p<o.os, ** p<O.Ol, *** p<O.ool.
Scand J Soc hied IS
 Loneliness correlates in advanced alcohol abusers. I 179

‘ Table IV. Correlations between Ioneliness and personal dissatisfaction (“desire to change or improve
satisfied”) within various life-spheres
Correlations

First Second
Life-sphere item assessment assessment

Background
Education -0.04 0.27**
Material circumstances
Income 0.00 0.03
Possessions. 0.01 0.27**
Residential area 0.00 0.10
Residential standard 0.02 0.19*
Structural circumstances
Possibilities to participate in and influence society 0.10 0.30**
Personal support from society and authorities 0.15 0,24*
Activities
Work situation -0.03 0.28**
Capability to do various things 0.26** 0.50***
Possibilities to be active 0.22* 0.52***
Amount of time at own disposal . 0.12 0.14
Possibilities to be meaningfully occupied 0.11 0.38***
Social circumstances
Social interaction with other people 0.37*** 0.63***
Communion with others 0.47** * 0.55***
Family communion 0.35*** 0.49** *
Own importance for other people 0.25** 0.33**
Psychological circumstances
Intellectual ability 0.20* 0.20*
Own security 0.30** 0.49***
Possibilities to form one’s life according to one’s own will 0.27** 0.49***
Possibilities to enjoy life 0.33*** 0.40***
Independence 0.26** 0.38***
Feelings of freedom from external pressure 0.37*** 0.34***
Health
Bodily health 0.17 0.21*
Smoking and alcohol habits 0.38*** 0.10
Current overall situation 0.27** 0.39***
* p<0.05, ** ~ ~ 0 . 0 1***
, p<O.OOl.

p<O.O5) vis-A-vis institutes and authorities were
moderately and stably linked to loneliness. Per-
ceived limited influence on the decisions of authori-
ties (0.25, p<O.OI; 0.02, NS), limited participation
in political elections (0.07, NS; 0.19, pcO.05) to-
gether with lack of membership in trade unions
(-0.03, NS; 0.22, p<O.OS) were vaguely related.
Non-correlated were: experiencing the authorities
as acting in a superior or an antipathetic way and
opinions of injustices by society. The same applied
to participation in organizational activities.
Life priority and life satisfaction
The abusers’ ascriptions of importance or nonim-
portance to 29 specific conditions in life (life-prior-
ity) were unrelated to their loneliness ratings, with
a few exceptions. Some human-relation factors
were rated as being more important to the lonely
alcoholic: meaning something for somebody (0.17,
p=O.OS; 0.23, p<O.OS), having a family (0.02, NS;
0.24, (0.05) and not being alone (0.00, NS; 0.21,
p<O.OS). Some material assets were rated as being
more unimportant to the lonely alcoholic: owning a
car (0.22, p<O.OS; 0.27, p<O.OI), support and help
from society (0.14, NS; 0.26, ~ ~ 0 . 0 and
1 ) having
necessities such as food and clothing (0.07, NS;
0.20, p<O.O5).
Ascribed life-satisfaction (contentment as op-
posed to desired change or improvement) regarding
25 specific conditions in life was most obviously
intimately related io loneliness. As shown in Table
IVYall 13 evident and all nine ambiguous correla-

Scond J Soc Aled I S

180 I . h e r l i t i d and J . 0. Hornqirist
tions pointed in the same direction. Accordingly,
the lonelier the subject felt, the stronger was his
discontentment and inclination to change or im-
prove his life situation. Only residential area, time
at his own disposal and income were completely
unrelated.
DISCUSSION
The great number of correlation coefftcients entail a
risk of some false significant results, Therefore the
conclusions are only based on recurrent and more
encompassing patterns of correlations.
Social backgroirrid .
Contrary to the results of a Swedish survey on the
general population in the age interval from 16 to 74
years (22), a higher degree of rrrbariizatiorz was
moderately related to loneliness among alcohol
abusers. In the survey, loneliness was assessed
from the answer given to a single question. Conse-
quently the differing results may be attributable to
the various study groups and/or technique differ-
ences. Nevertheless the present finding may indi-
cate that urban settings are especially conducive to
loneliness as Hartog (23) has speculatively dis-
cussed. The divergent results may naturally also be
due to the fact that alcoholics constitute a subgroup
which is more vulnerable to the negative effects of
urbanization.
The few female alcoholics tended to express a
greater degree of loneliness than did the males. This
gender difference seems to appear also in the gener-
al population in Sweden (22) and is indicated in
several international studies (4). However, accord-
ing to Anderson (4), a closer examination reveals
that this result is valid only for studies where loneli-
ness is assessed by a single-item question. Where
loneliness scales are applied, most studies show no
gender differences. Accordingly, the results in this
study indicate relatively more loneliness among the
females than was expected from the general popula-
tion.
The lack of positive correlation between.age and
loneliness is in good accordance with the findings of
Nerviano et .al. (10) for alcoholics in the United
States._The observed.weak negative correlation for
the age interval in this study (young adult to mid-
dle-age) is also consistent with the U-shaped inter-
relation for the whole life-span found in the general
population in both Sweden (22) and the US (24).
Scand J Soc Afed I5
There were no interrelations between loneliness
and socio-ecorioaiic characteristics (income, edu-
cation and type of occupation). The range of these
variables was, however, limited in this group.
Nonetheless, this finding is consistent with the re-
sults of Nerviano et al. (10) for alcoholics where
education is concerned. Research covering the gen-
eral population seems to indicate a greater degree
of loneliness among the poor (25, 26).
Social network
There was no simple or obvious connection be-
tween loneliness and the external social situation.
The correlations in regard to most confidants (family,
close friends) were ambiguous or nonexistent. Only
the number of cursory friends and acquaintances was
moderately correlated to loneliness. Although these
results are in contrast with the common opinion,
they harmonize with previous research. The dis-
tinction between social isolation and loneliness has
been emphasized in research literature for quite
some time (27, 28). Falmouth (29) distinguishes
between loneliness caused by external circum-
stances and loneliness that originates in one’s own
personality. Weiss (30) similarly states that there
are two kinds of loneliness: 1) emotional isolation,
i.e. lack of close and intimate relations and 2) social
isolation, i.e. lack of meaningful friendship or ties
to other people. Later studies (31, 32) indicate that
feelings of loneliness are more related to dissatis-
faction with the quality of the relationships than to
the quantitative availability (frequency of contacts,
number of friends). This conclusion may also ex-
plain the apparently paradoxical result that the
lonely individual wanted a reduction in the interac-
tion with hidher own family. This desire is more
understandable in the case of the lonely abuser
being dissatisfied with that relationship.
Work arid activities
The stable and relatively strongest, though nomi-
nally quite moderate correlate “not being meaning-
fully occupied”, indicates dissatisfaction in relation
to work and activities. This discontentment may
also have influenced the fact that although the lone-
ly abuser on the first examination ranked pension
higher than work, on the second occasion, when
most of the abusers were pensioned, most wanted a
reduction of the time at hisher own disposal.
The habits and attitudes which emerged concern-
ing work and activities depicted the lonely abuser
 Lonelitiess correlates in advanced alcohol abusers. I
as being generally somewhat more socially intro-
vert. Moreover, most lonely individuals had been
excluded from the labour market during a longer
period of time in the past, which may explain the
more articulated wish for disability pension. The
latter correlate has a certain correspondence with
previous findings on the lack of future-orientation
among lonely drug addicts (33). In a study on uni-
versity undergraduates, Sermat (34) has also docu-
mented the link between loneliness and negative
future-orientation.
Motivation affects behaviour and level of activi-
ty. The relation between loneliness and motivation
has been discussed. Increase as well as decrease or
fluctuation in motivation are possible effects of
loneliness. Different authors have stressed various
parts of these bonds (30, 35, 36). Because of the
theoretical complexity, it is probably very difficult
to capture specific behavioural correlates of loneli-
ness, at least by simple linear measures. Thus, the
found lack of pronounced and stable relations be-
tween loneliness scores and the activity-time para-
meters are explicable. To a certain degree, the di-
rections of these found relationships accord the
conclusion of Nerviano et al. (10) that the lonely
alcoholic has less motivation or feels less need to
be active in social situations.
Striictiiral circiirnstances
The lonely abuser perceived insecurity and inferior-
ity vis-A-vis authorities. To some extent he also
experienced little possibility to influence their deci-
sions. Even in civic actions there was a greater
tendency to passivity and less to integration in soci-
ety. That is in conformity with the results of Jones
et al. (37), demonstrating the lonely student as be-
ing more alienated than others. However, contrary
to Jones et al., our study found opinions of injus-
tices to be nonrelated to loneliness. Accordingly,
lonely abusers appeared to be more subdued, hum-
ble and passive than lonely students. That is in
agreement with Calicchia’s et. al. (9) finding that
alcoholics in general are more alienated than non-
alcoholics.
Life priority and life satisfaction
Most of the assessed life-domain priorities proved
not to be related to loneliness. However, the few
positive correlates (“meaning something to some-
body”, “having a family” and “not being alone”)
-
13 8 7 W 3
181
all revolved around the individual’s need to relate
and correspond to various definitions of the loneli-
ness experience (23). It is also notable that the few
negative correlates all concerned material condi-
tions. Apparently, the lonely abuser tends to give
priority to human relations over tangible assets.
The results support the validity of the loneliness-
measuring technique used here.
As regards need satisfaction, the situation was
almost reversed when compared to need priority.
Most of the 25 variables (from education, residen-
tial standard, communion, alcohol and smoking
habits to the abuser’s overall situation) were more
or less moderately related to loneliness. The most
stable and strongest correlates were obtained for
dissatisfaction with the subject’s possibility to be
active, social intercourse, feeling of security and
possibility to be autonomous and to enjoy life.
Loneliness was always associated with a n inclina-
tion to change or improve one’s circumstances. The
lonely alcoholic was accordingly dissatisfied in
most of the life-domains, not only in the social
sphere, given particular priority. The salient dis-
satisfaction in that domain corroborates however,
that feelings of loneliness are more related to expe-
rience of quality of the social network than to quan-
titative aspects of it.
As in the case of need priorities, the life-satisfac-
tion correlates tend to support the validity of the
loneliness parameter used in this study. The inter-
relationships have quite an interesting content even
beyond the issue of validation. Notable is the im-
pressive range of completely different life-sphere
dissatisfactions, linked to the loneliness experi-
ence. Even if some similar findings have been re-
ported (38, 39), this chart has not been given earli-
er. In the words of Sadler & Johnson (40), “the
loneliness experience is total or global in its nature,
affecting one’s whole situation”.
General concliisions
The current analysis of the covariation between
“loneliness feelings” and the other variables as-
sessed, was performed in order to illuminate the
more unsatisfactory prerequisites of the lonely al-
cohol abuser. The results are mostly in harmony
with findings previously reported in other studies.
Since these have mainly referred to study groups
other than alcohol abusers, the results indicate a
generality among subgroups of individuals as well
as a crosscultural coverage. Moreover, it is of spe-
Scand J Soc hled 15
182 I . Akerlind arid J . 0 . Hortiqiiist
cia1 interest to reveal the correlates of loneliness in
such an assumed alienated and homogeneous group
as advanced alcoholics.
The present results demonstrate that quantitative
aspects of the social network do not determine the
feelings of loneliness in an unequivocal way. That is
in harmony with previous research on the topic (27,
28) It is also apparent that dissatisfaction with the
quality of existing relationships are of a more vital
importance for the feelings of loneliness, in accord-
ance with some other late reports (31,32). Still, this
is not a call for complete negligence of the external
situation. There is certainly some kind of recipro-
city between inner feelings and outer social condi-
tions. However, it is probably much more complex
than simply a question of degree.
Loneliness was originally included in the study,
together with other variables, in order to assess
quality of life (IS). Paloutzian & Ellison (41) give
prominence to loneliness as a key variable in estab-
lishing an index of quality-of-life since a person’s
sense of this is “intimately linked to satisfaction
with his or her social relations”. However, the
most lonely individuals’ more pronouced dissatis-
faction in this study is not restricted to social life
but includes work activities and needs in other life
domains. Accordingly, loneliness seems to be an
even more general indicator of quality of life than
Paloutzian et al. supposed. As a matter of fact,
their own data supports this conclusion. In a group
of females, loneliness was at least as highly associ-
ated with dissatisfaction in living situation as with
more socially oriented dissatisfaction in marriage.
Furthermore, our results indicate that the lonely
abuser’s life dissatisfaction may be combined with
some traces of passivity. This expanded irnpor-
tance of loneliness experiences for a person’s life-
quality is in perfect accordance with one compo-
nent in Sadler & Johnson’s (40) definition proposal,
in which loneliness is seen particularly as a total
feeling. Loneliness seems to interfere with or per-
tain to nearly all domains of life. It seems therefore
relevant to consider loneliness as being a lack in the
most basic human need of community in the man-
ner of Sullivan (42).
._
ACKNOWLEDGEMENTS
This work was supported by a grant from The Swedish
Ministry of Health and Social Affairs, Commission for
Social Research (DSF).
Scand J SOCAfed I5
REFERENCES
1. Peplau LA, Perlman D, eds. Loneliness: A source-
book of current theory, research and therapy. New
York: John Wiley, 1982.
2. Lynch JJ. The broken heart: The medical conse-
quences of loneliness in America. New York: Basic
Books, 1976.
3. Weeks DG, hlichela JL, Peplau LA, Bragg hlE. The
relation between loneliness and depression: A struc-
tural equation analysis. J Pers SOC Psycho 1980;
39: 123844.
4. Anderson L. Aging and loneliness: Interventional
study of a group of elderly women. Doctoral disserta-
tion. Karolinska Institutet, Stockholm, 1984.
5. Bell RG. Alcohol and loneliness. J SOC Therapy,
1956; 2: 171-81.
6. Milt H. Alcoholism: Its causes and cure. New York:
Scribner, 1976.
7. Rook KS, Peplau LA. Perspectives on helping the
lonely. In: Peplau LA, Perlman D, eds. Loneliness: A
sourcebook of current theory, research and therapy.
New York: John Wiley, 1982.
8. Loucks S. Loneliness, affect and self-concept: Con-
struct validity of the Bradley Loneliness Scale. J Pers
Assess 1980; 44,142-47.
9. Calicchia JP, Baressi RM. Alcoholism and alienation.
J Clin Psycho 1975; 31:770-75.
10. Nerviano VJ, Gross WF. Loneliness and locus of
control for alcoholic males: Validity against Murray
Need and Cattell trait dimensions. J Clin Psycho
1976; 32: 479-84.
11. Allen HA, Peterson JS, Whipple S . Loneliness and
alcoholism: A study of three groups of male alcohol-
ics. Int J Addictions 1981; 16: 1255-58.
12. Kudoh T, Nishikawa M. A study of the feelings of
loneliness. I. The reliability and validity of the revised
UCLA Loneliness Scale. Jpn J Exp SOC Psycho1
1983; 22: 99-108.
13. Johnson RA. Loneliness among hospitalized alcohol
abusers: Exploration and treatment. Doctoral disser-
tation, Oklahoma State University, 1984.
14. Hornquist JO, Akerlind I, Hansson B. The working
capacity of the alcohol abuser: Prognostic multiple
regression analysis.
15. Hornquist JO. The concept of quality of life. Scand J
SOCMed 1982; 10:57-61.
16. Elton M, Homquist JO. Abusers of alcohol immedi-
ately prior to pension. Acta Psychiat Scand 1983;
68: 44-54.
17. Hornquist JO. Elton M. A prospective longitudinal
study of abusers of alcohol granted disability pension.
Scand J SOCMed 1983; 11:91-96.
18. Elton M, Homquist. JO. Abusers of alcohol granted
disability pension: Prospective longitudinal and multi-
disciplinary studies. Doctoral dissertation, Linkoping
University, 1983.
19. Elton M, Hornquist JO. Grounds for disability pen-
sion: Younger abusers of alcohol as compared with
older ones. Scand J SOC Med 1983; 11:53-58.
20. Hornquist JO, Akerlind I, Bjurulf P. Quality of life
versus liver function, blood status and the immuno-
logical system in somatically disabled persons: An
 Loneliness correlates in advanced alcohol abusers. Z
explorative correlational analysis of the dynamic in-
terplay of loneliness and indolence. hlanuscript, 1986.
21. Nie NH, Hull CH, Jenkins JG, Steinbrenner K, Bent
DH. Statistical package for the social sciences. New
York: McGraw-Hill, 1975.
22. Andersson L. Interdisciplinary study of loneli-
ness-with evaluation of social contacts as a means
tomrds improving competence in old age. Acta SO-
ciol 1982; 25: 75-80.
23. Hartog J. The Anatomization. In: Hartog J, Audy JR,
Cohen YA, eds. The anatomy of loneliness. New
York: International Universities Press, 1980.
24. Peplau LA, Bikson TK, Rook KS, Goodchilds JD.
Being old and living alone. In: Peplau LA, Perlman D,
eds. Loneliness: A sourcebook of current theory, re-
search and therapy. New York: John Wiley, 1982.
25. Russel D. The measurement of loneliness. In: Peplau
LA, Perlman D, eds. Loneliness: A sourcebook of
current theory, research and therapy. New York:
John Wiley, 1982.
26. Weiss RS. Issues in the study of loneliness. In: Peplau
LA, Perlman D, eds. Loneliness: A sourcebook of
current theory, research and therapy. New York:
John Wiley, 1982.
27. Townsend P. The family life of old people. London:
Routledge & Kegan Paul, 1957.
28. Shanas E, Townsend P, Wedderburn D, Friis H, hlil-
hoj P, Stehouwer J. Old people in three industrial
societies. New York: Atherton, 1968.
29. Falmouth M. (Chm.) Woman’s Group on Public Web
fare, ‘Social Aspects of Loneliness’ Working Group.
In: Loneliness. National Council of Social Service,
London, 1964.
30. Weiss RS. Loneliness: The experience of emotional
and social isolation. Cambridge, Mass.: hlIT Press,
1973.
31. Cutrona CE, Peplau LA. A longitudinal study of lone-
liness. Paper presented at the annual meeting of the
Western Psychological Association, San Diego, Cali-
fornia, April 1979.
32. Cutrona CE. Transition to college: Loneliness and the
process of social adjustment. In: Peplau LA, Perlman
183
D, eds. Loneliness: A sourcebook of current theory,
research and therapy. New York: John Wiley, 1982.
33. Ben-Yehuda N. Success and failure in rehabilitation:
The case of methadone maintenance. Am J Communi-
ty Psycho1 1981; 9:83-107.
34. Sermat V. Some situational and personality correlates
of loneliness. In: Hartog J, Augy JR, Cohen YA, eds.
The anatomy of loneliness. New York: International
Universities Press, 1980.
35. Fromm-Reichmann F. Loneliness: Psychiatry 1959;
22: 1-15.
36. Peplau LA, Perlman D. Perspectives on Loneliness.
In: Peplau LA, Perlman D, eds. Loneliness: A sour-
cebook of current theory, research and therapy. New
York: John Wiley, 1982.
37. Jones WH, Freemon JA, Goswick RA. The persis-
tence of loneliness: Self and other determinants. J
Personality 1981; 49: 2 7 4 8 .
38. Russel D, Peplau LA, Ferguson hl. Developing a
measure of loneliness. J Pers Assess 1978; 42: 290-94.
39. Russel D, Peplau LA, Cutrona CE. The revised
UCLA Loneliness Scale: Concurrent and discrimi-
nant validity evidence. J Pers SOC Psycho1 1980;
39:472-80.
40. Sadler WA, Johnson TB. From loneliness to anomia.
In: Hartog J, Audy JR, Cohen YA, eds. The anatomy
of loneliness. New York: International Universities
Press, 1980.
41. Paloutzian RF, Ellison CW. Loneliness, spiritual well-
being and the quality of life. In: Peplau LA, Perlman
D, eds. Loneliness: A sourcebook of current theory,
research and therapy. New York: John Wiley, 1982.
42. Sullivan HS. The interpersonal theory of psychiatry.
New York: Norton, 1953.
Address for offprints:
Ingemar Akerlind
Department of Social Medicine
Health University
581 05 Link8ping
Sweden
Scand J Soc Med I S