Your new prescription? It’s not medicine

By Jessica DuLong, CNN

(CNN) — Fewer nights out with friends, more take-out meals, less theatergoing. Americans are spending more time alone than ever before.

Whether this trend results from an epidemic of loneliness, which leaves people wanting for company, or a century of solitude, in which individuals prioritize solo time, the fact remains that more of us are on our own more often. But humans are social creatures whose well-being depends on belonging, and too much solitude comes with significant health consequences — for individuals and society.

At the same time, the US health care system is “expensive, complicated, dysfunctional” and possibly “broken,” experts say. Higher costs do not translate to better outcomes, and uneven access leads to avoidable disparities for people of color and other marginalized groups.

“Social prescribing,” which entails offering health care referrals for community activities, not just medications, can help on all fronts, argues solutions-focused journalist Julia Hotz. In her book, “The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging,” Hotz shares how nurturing interpersonal connections and encouraging community involvement can improve individuals’ physical and mental health, while also strengthening communities. Cost-effective, and already popular in the UK, the social prescribing movement is gaining traction in the US.

As evidence mounts that meaningful relationships are as crucial to our well-being as diet and exercise, Hotz explains the science of connection and gives practical suggestions to help combat our growing isolation.

This conversation has been edited and condensed for clarity.

CNN: What is a social prescription?

Julia Hotz: Social prescriptions are health care referrals for activities and resources in your community. Recognizing the significant role that our environment, relationships and community play in our health outcomes, these prescriptions typically involve movement, art, nature, service and some element of belonging. When people are struggling with issues like anxiety, depression or even chronic pain, sometimes the most effective intervention isn’t a just a pill but also reconnecting with community. Because social determinants account for 80% of our health, incorporating them as a healing modality just makes sense.

CNN: Are social prescriptions intended to replace conventional medicine?

Hotz: Not at all. This is about complementing traditional medications, therapies and other treatments with evidence-based social interventions. While I am concerned about overprescribing, I also have a lot of empathy for doctors who feel that medications, surgeries and other conventional treatments are their only options. Rather than replacing or taking away standard treatments, the goal of social prescribing is to invest in alternatives so we’re putting more, not fewer, options on the table. You can take your prescription antidepressant and take a walk with friends, and both can help with your depression.

CNN: Do social prescriptions work?

Hotz: The science supports the efficacy of prescriptions for movement, nature, art, service and belonging to ease symptoms of a range of diagnoses, including attention deficit hyperactivity disorder (ADHD), chronic pain, dementia and loneliness. Exercise, for example, helps treat depression disorders, stress, anxiety and type 2 diabetes. Treating symptoms only through conventional therapies and medication misses the powerful impact that interacting meaningfully with other people in our communities has on our health.

Here’s an example from someone I interviewed: When Akeela’s back injury developed into chronic pain she had to leave her job. Without her work as a caretaker, she lost her sense of purpose and became very depressed. She tried every therapy, pill and surgery that doctors prescribed for her pain. Some of it helped.

But what really made her feel better was an unconventional prescription: volunteering for a children’s health care charity. By turning the focus away from herself and her pain and toward care for others, the severity of her back pain lessened. In an era when so many people are suffering with chronic pain, it’s critical that we take advantage of all available remedies — even unexpected ones like volunteering in your community.

CNN: Do the same social prescriptions work for everyone?

Hotz: Social prescribing works because it’s personalized. It’s not about pushing everyone into the same activities but connecting individuals with activities that resonate with their particular values and interests.

When her patients are struggling, pain psychologist Dr. Rachel Zoffness suggests that they visualize pain as a dial. Just as experiencing negative emotions, like sadness and anger, can turn the pain dial up, other things can turn it down, including distraction. She asks her patients to think of an occasion when they got so caught up in what they were doing that they forgot about their pain. When health care providers ask these kinds of questions, they’re helping patients figure out the social prescriptions that might work best for them.

CNN: Do US health care providers issue social prescriptions?

Hotz: Although social prescribing is more mainstream in countries with nationalized health care systems, such as the UK, the movement is growing. An increasing number of providers are issuing social prescriptions around the 50 states. Social Prescribing USA, a nonprofit, tracks initiatives, pilots and research projects across the country in an interactive map.

Meanwhile, I recommend people begin by prescribing themselves spots in free or donation-based activities in their local communities. To find an ideal activity, people can ask questions like: What did I love doing as a child? If I had two extra hours in my day, what would I spend them on? What makes me lose track of time?

CNN: How does social prescribing help with loneliness?

Hotz: Loneliness has a profound effect on physical as well as mental health. If you’re lonely, you’re more likely to die prematurely; you’re more likely to be anxious or depressed or get dementia; you’re more likely to end up in the emergency room. The consequences of all that are equivalent to smoking 15 cigarettes a day.

Because they align with a patient’s interests and values, social prescriptions create meaningful connection — the kind of connection that seems more compelling than staying at home. This has tremendous health benefits. The goal is not “let’s all get in a kumbaya circle and hold hands and be best friends and hug a stranger.” Instead, social prescriptions reconnect you with what matters

CNN: Why is social connection so important?

Hotz: Humans have evolved so that social connections are a need just as vital as food and water. Yet, record numbers of us are choosing to spend time alone. Life is exhausting. We work hard. We’re burnt-out. Digital media might make us we feel like we’re constantly connected, but it leaves us so drained that we just want to retreat into our homes and not see anyone. We were not wired to live in the conditions that modern life demands.

CNN: How does online connection compare to in-person interaction?

Hotz: For some people — such as those with limited mobility or individuals who feel isolated because of differences between them and their local community — online connection can be a lifesaver. But most online interaction, particularly on social media, doesn’t provide the elements of connection that are truly restorative.

Quality connection provides feelings of inclusion, being seen and affirmed for who you are and a true sense of belonging. Forging a real connection leaves you feeling like you know yourself better after spending time with that person. And that may be more beneficial for your health than spending time with 10 people who you don’t know well.

CNN: How does creating a sense of belonging improve health?

Hotz: Solitude is important for some of us, some of the time. But when being alone becomes the norm, we can start to experience the health consequences of loneliness without even realizing it.

Science tells us that belonging is healing. The Harvard Study of Adult Development, which followed people for more than eight decades, names the strength of relationships as the No. 1 one predictor of health and longevity.

CNN: What are the societal costs of a lack of belonging?

Hotz: This has enormous consequences. People who lack a sense of belonging elsewhere can wind up becoming involved in sometimes very harmful and extreme political causes. Stories from former QAnoners, for example, often include discussion of depression, social isolation, loneliness and lack of belonging leading up to their getting sucked in.

People register social pain like physical pain, research shows. Even just witnessing social exclusion can activate our brain circuits. That can translate into a desperation that leads people to find belonging in places that do a lot of damage. Groups mobilizing to cause harm to people are growing in popularity because society is not provided something it once did.

We can counter this trend by investing in other spaces for connection — local opportunities for engaging in movement, nature, art, service and belonging — things that just happen to be really healthy for us, too.

CNN: You call those five options — movement, nature, art, service and belonging — the pillars of social prescribing. What’s their significance?

Hotz: These five pillars are not just nice add-ons; these are requirements for our life. We know this is true because of how our health improves when we engage in these activities.

Moving our bodies releases serotonin and endorphins and improves our hippocampus function. Spending time in nature restores our attention and focus. Some studies have shown effects on par with taking Ritalin. Engaging in art reduces anxiety and trauma symptoms, which makes sense given how humans have used storytelling and art to cope with tough emotions since the beginning of time.

Service and belonging are the biggest because we didn’t survive in the big, bad wild all on our own; we survived in a group. Just think about how, for generations, last names reflected our function within the community. Now, many of us are not engaging in communities but choosing artificial and often electronic sources of connection. That’s when our health begins to suffer.

CNN: What’s your sense of social prescribing’s future in the US?

Hotz: Investing in social prescribing bridges divides, offering a bipartisan solution to address issues important to people across the political spectrum. Folks on the left are concerned about health care access and affordability. On the right, the Make America Heathy Again (MAHA) movement is concerned about pharmaceutical safety and reducing chemicals in our food and medicines while fiscal conservatives are focused on cost-cutting.

Not only does social prescribing provide significant health benefits, but it also actually saves money over time while reducing pressure on an overburdened system. Think of the 92-year-old who goes to the hospital just because she doesn’t have anywhere else to go. Instead, prescribing her a weekly phone call with someone or a spot in a knitting group is going to save health care resources and ultimately save the taxpayer money.

If we want to invest in an approach that improves health outcomes, reduces health care costs and can appeal to people of all political persuasions, let’s recognize the way our environments affect our health and prioritize social prescribing.

Jessica DuLong is a Brooklyn, New York-based journalist, book collaborator, writing coach and the author of “Saved at the Seawall: Stories From the September 11 Boat Lift” and “My River Chronicles: Rediscovering the Work That Built America.”

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