Social prescriptions offer patients solutions beyond traditional medicine

Photo Cred: Helena Lopes/Pexels

By Linda Childers

Integrative practitioners looking for additional ways to help their clients cope with loneliness and depression may find that offering social prescriptions helps to improve health and wellbeing.

In an August 2022 scientific statement released by the American Heart Association and published in the Journal of the American Heart Association,  social isolation and loneliness were associated with a 30 percent increased risk of stroke or heart attack, or death from either.

Although social prescribing is still a fairly new concept in the United States it’s been used as a treatment modality over the past two decades in the United Kingdom, Canada, and other European Union countries. The practice of social prescribing encourages healthcare providers, including integrative practitioners, to write a prescription for a wide range of community services, ranging from dance classes to volunteering, that help to improve a patient’s mental health and wellbeing.

Social prescriptions benefit patients of all ages and in some cases, can also reduce the need for opioids, antidepressants, and sleep medications. One study, published in JAMA Internal Medicine, recommended that clinicians should consider offering their patients who were over 60, and suffering from isolation and loneliness, a social prescription rather than medication that doesn’t treat the underlying social experience of loneliness.

The study noted that “loneliness was associated with higher pain medication use and more than twice the frequency of use of antidepressants, sleep medications, and benzodiazepines. In addition to being addictive, these medications are associated with adverse consequences among older adults, including opioid dependence, gastrointestinal bleeds, falls, fractures, delirium or cognitive impairment, new functional disability, and death.”

Yet loneliness doesn’t just affect older Americans. A 2021 report from Harvard University, found that loneliness impacts all ages, and has become more prevalent since the pandemic, with 36 percent of all Americans, including 61 percent of young adults, and 51 percent of mothers with young children, reporting feelings of “serious loneliness.”

As the psychology program director for City of Hope’s Department of Supportive Care Medicine, in Duarte, California, Jeanelle Folbrecht, PhD, has found social prescriptions to be helpful for many cancer patients experiencing social isolation and loneliness; health problems that have been exacerbated during the pandemic.

“It’s so important for patients to stay engaged and connected with others,” Folbrecht said. “Our psychology team at City of Hope utilizes several forms of therapy and social prescriptions, that encourage behavioral activation or engagement in meaningful activities as part of emotional or physical recovery.”

“It’s important to look at a patient’s interests and values and to align those with a social prescription,” Folbrecht said. “If it’s a younger patient, I’ll often suggest an age-appropriate activity with their peers that’s both easy and doable.”

With social isolation, economic instability, and health uncertainty taking a toll on Americans, Folbrecht noted that many patients need treatments that go beyond medical intervention.

“With the pandemic, there’s a shortage of mental health providers,” Folbrecht said. “But not all patients need a prescription for an antidepressant or ongoing therapy. If they’re feeling lonely or isolated, a social prescription can be offered by a variety of practitioners and complement any medical treatment they’re receiving.”

Kien Vuu, MD, a concierge doctor and founder of VuuMD Performance and Longevity in Los Angeles remembers watching one of his patients struggle as they tried to lose weight and manage their diabetes. He knew they were stressed, and that their unhealthy diet, sedentary lifestyle, and poor sleep were contributing to their unhealthy weight and their diabetes. Wanting to help his patient achieve their health and wellbeing, Vuu offered his patient a social prescription, encouraging them to take a class in breathwork.

“Once they implemented a regular practice of breathwork, they were able to make better choices in all areas of their life,” said Vuu.“They recognized the triggers that lead to emotional eating as well as prior disempowering beliefs about the ability to lose weight and were then able to make better lifestyle choices, lose 45 pounds, and reverse their diabetes.”

According to Vuu, social prescriptions, or lifestyle prescriptions as he likes to call them, offer integrative practitioners an additional tool as they work to improve their client’s mental and physical health.

“Lifestyle choices play a big role in the course of disease, and appropriate lifestyle interventions can dramatically improve symptomatology and sometimes even reverse some conditions,” Vuu said. “As integrated practitioners, we need to take a look at the patient holistically and determine the activities that bring joy to the patient, and that are also appropriate for the patient’s physical abilities.”

Vuu also recommends looking at several major lifestyle considerations for each patient including sleep, movement, nutrition, stress and emotional mastery, thoughts in mindset, relationships, and a sense of purpose.

“Social or lifestyle prescriptions can used in conjunction with conventional medical treatments,” he said. “For example, a diabetic patient requiring insulin can adhere to a glycemic index diet, while being given a social prescription for activities such as meditation, dancing, and tai chi to help with stress levels.”

With social isolation and loneliness on the rise, Vuu said social prescriptions offer a powerful remedy.

“Many research studies support the fact that loneliness is an inflammatory state, causing elevation in the stress hormone cortisol, while weakening the immune system,” Vuu said. “Prescribing social connection is very important in bringing down the stress and inflammatory markers, which help improve the symptomatology in any condition.”