In 2023 the U.S. Surgeon General issued an advisory called Our Epidemic of Loneliness and Isolation. This guide walks through what it says and what it does not, with help from the National Institute on Aging (NIA). It is general education, not medical advice.
By the Exsura Team · October 25, 2026
The advisory lists reaching out to a family member, friend, counselor, health care provider, or the 988 crisis line among ways to “Seek help during times of struggle with loneliness or isolation.” The 988 Suicide & Crisis Lifeline says it is “available 24/7/365” and that conversations are “free and confidential.” You can call or text 988 or chat at 988lifeline.org.
NIMH says: “In life-threatening situations, call 911.” For help choosing, see 988 vs 911: when to call which.
The advisory says: “Social isolation and loneliness are related, but they are not the same.” It defines social isolation as objectively having few social relationships, social roles, group memberships, and infrequent social interaction. Loneliness, it says, “is a subjective internal state” that results from perceived isolation or an unmet need between the connection you want and the connection you have.
NIA puts it simply: “You can live alone and not feel lonely or socially isolated, and you can feel lonely while being with other people.” The advisory also defines solitude as a state of aloneness by choice that does not involve feeling lonely.
The advisory says: “Recent surveys have found that approximately half of U.S. adults report experiencing loneliness, with some of the highest rates among young adults.”
U.S. adults report experiencing loneliness, according to recent surveys cited in the Surgeon General advisory
For young adults, the advisory reports they are “almost twice as likely to report feeling lonely than those over 65.” It also cites time-use data showing that for ages 15 to 24, time spent in person with friends fell by nearly 70% over almost two decades, from roughly 150 minutes per day in 2003 to 40 minutes per day in 2020. That is a measure of time spent, not of loneliness itself, and the advisory does not name a single cause.
One more finding from the advisory: despite how common it is, less than 20% of people who often or always feel lonely or isolated recognize it as a major problem.
The advisory says loneliness “is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.” Some of the numbers it cites from the research it reviews:
These are group averages across studies, not a prediction for any one person. The advisory also says the link with depression runs both ways: depression and anxiety often involve social withdrawal, which raises the risk of isolation and loneliness.
“More broadly, lacking social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day.”U.S. Surgeon General advisory, 2023
That comparison is about lacking social connection in general, not loneliness alone, and it is a comparison of mortality impact, not a claim that the two are the same.
The advisory is direct about this. It says: “evidence supports a potential causal association,” and that the body of evidence suggests “a likely causal association between social isolation and a variety of poor health outcomes, including death.” It also says: “Despite the strength of the evidence linking social connection to various health outcomes, certain gaps and limitations in research still exist.”
NIA adds a sensible note that the arrow can run both ways: “If you are in poor health, you may be more likely to be socially isolated or lonely.” So treat the figures above as strong signals, not as proof that loneliness alone causes any one condition.
The advisory’s list of what individuals can do is practical and small. It is a set of recommendations drawn from the research, not a tested treatment:
NIA, writing for older adults, suggests similar steps, including scheduling time each day to stay in touch with family, friends and neighbors, finding an activity you enjoy, staying physically active with others, introducing yourself to your neighbors, and joining a cause. It also says: “If you are feeling isolated or lonely a lot of the time, you may want to tell your doctor or another health care professional.”
If loneliness is tangled up with low mood, anxiety or worry, a provider can help. See how to find a mental health provider or low-cost mental health care in Dallas County. If it feels hard to bring up with the people close to you, see talking to your family about mental health.
The Surgeon General advisory says social isolation is objectively having few social relationships and infrequent social interaction, while loneliness is a subjective internal state, the distressing feeling of a gap between the connection you want and the connection you have. They are related but not the same.
The advisory says recent surveys found that approximately half of U.S. adults report experiencing loneliness, with some of the highest rates among young adults. That is based on self-reports in surveys.
The advisory says loneliness is associated with a greater risk of conditions including cardiovascular disease, dementia, stroke, depression, anxiety and premature death. It describes the evidence for social isolation and poor outcomes as suggesting a likely causal association, and says gaps in research remain.
The advisory recommends reaching out to a friend or family member each day, minimizing phone distraction during conversations, serving others, joining groups, and seeking help from a family member, friend, counselor, health care provider or the 988 crisis line during times of struggle. NIMH says that in life-threatening situations, call 911.
Sources last checked October 25, 2026. This article is general education, not financial, legal or medical advice. Rules, fees and programs change, so confirm details with the organization before you act.
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