Take a hike! ‘Social prescriptions’ offer a medication alternative

It’s well known that activities such as hiking and enrolling in creative arts classes have been found to provide significant mental and physical health benefits to some patients.

Many physicians around the world have embraced this practice of “social” prescribing, a concept that connects patients with a range of non-clinical services within their community, to improve mental health by promoting physical activity.

A more holistic approach to healthcare

Although the practice of social prescriptions is being used in countries including Australia, Canada, England, Ireland, Japan, and Scotland, the US has been slower to adopt the concept.^[] Alan Siegel, MD, a family physician with Contra Costa Health Services in California, hopes to change this.

As co-founder of the advocacy group, Social Prescribing USA, Dr. Siegel's goal is to see social prescriptions available to every American by the year 2035. He tells MDLinx that while medications can treat symptoms, social prescriptions add meaning to a patient’s life.

In 2010, Dr. Siegel founded a program to engage patients in expressive arts, such as dance, writing, and music, to reduce anxiety, depression, and stress. He has also been working nationally to bring the arts to healthcare workers to address HCP burnout, anxiety, and depression.

“We’ve had great results with patients and providers reporting how these simple interventions have significantly improved their health,” Dr. Siegel says.

A 2023 study confirmed the benefit of adding arts and culture assets into healthcare.^[]

Many of the other countries that have adopted social prescribing utilize link workers who curate community resources that physicians can “prescribe” to their patients. While the US doesn’t have link workers, Dr. Siegel says social workers and community health workers are taking on these roles in some centers. According to Dr. Siegel, there are also many resources available to doctors, including the University of Florida’s Arts on Prescription: A Field Guide for U.S. Communities.

A prescription for loneliness

Ashwin Kotwal, MD, a geriatrician and assistant professor at the University of California, San Francisco (UCSF) School of Medicine, knows how prevalent loneliness is in our society, and he makes a point to inquire about his patients’ social well-being during exams.

“I ask my patients how often they feel lonely, because it’s hard to know if you don’t ask,” he tells MDLinx. “Even patients who have families may still feel lonely.”

US Surgeon General Dr. Vivek Murthy believes that loneliness and social isolation have become an underappreciated public health crisis. In May 2023, he released a report noting that loneliness and isolation have become an epidemic.^[]

While the pandemic helped to de-stigmatize loneliness, Dr. Kotwal would like to see systemic changes within our healthcare system that could reduce medicalizing patients and accelerate social prescriptions.

“As clinicians, we’re skilled at picking up on subtle cues that a patient is in pain, but we rarely consider how social components such as isolation can amplify pain in a patient’s brain,” he says. “It’s important that we look at how we can improve our patients without medication.” 

Dr. Kotwal has conducted several studies on the benefits of social prescriptions and has found that in some cases, they can reduce the need for opioids, antidepressants, and sleep medications. This is significant, as his research also showed that lonely older adults are twice as likely to use opioids to ease pain, and more than twice as likely to use sedatives and anti-anxiety medication.^[]

“Interventions such as social prescriptions avoid overprescribing medications that can lead to drug dependency, impaired attention, and falls in older adults,” Dr. Kotwal says. “I think as doctors we need to advocate for spending more on social care. Sadly, the US is far behind other countries in terms of implementing social prescriptions.”

While older adults are at a higher risk of experiencing adverse health outcomes as the result of ongoing loneliness, it’s important for people of all ages to maintain social connections. Studies have shown that people who are lonelier reported poorer sleep quality and more chronic diseases, and were more likely to develop coronary heart disease than those who maintained strong social connections.^[]

“Organizations including the Foundation for Social Connection offer resources for physicians who want to learn more about social prescriptions and who want to become involved in expanding these efforts,” Dr. Kotwal says.