Quick answer
The 2023 Surgeon General advisory says family and close friends are where adults place meaning and purpose. In 2021, 49 percent reported three or fewer close friends, compared with 27 percent in 1990.
The 2023 advisory from the U.S. Surgeon General, "Our Epidemic of Loneliness and Isolation," says adults across the globe rate social relationships, particularly family and close friends, as the most important source of meaning, purpose, and motivation. That sentence is the spine of this page. The advisory does not define a special category called platonic intimacy. It does say that family and close friends are where adults place meaning.
A friend-minutes essay, built out of how many minutes a day people spend in the same room, is a different article. You will not get that diary here. You will get the rating about meaning, and two counts that are easy to mash into one count if you are not careful.
Close friends, 1990 and 2021
Put 1990 beside 2021. The share of Americans who said they had three or fewer close friends was 27 percent in the earlier year and 49 percent in the later one. The shift is large enough to feel like gossip, and it is still a specific claim about that phrase, "three or fewer close friends." It is not a claim about how many hours those friends got. It is not a claim that the missing friends were replaced by acquaintances at work. The advisory does not, in these notes, explain the whole cause. It reports the two percentages. You can sit with the gap without inventing the story that fills it.
"Close friends" is the phrase on that line. Keep it. If you swap in "people I could call in a crisis" or "people who really know me," you may be talking about confidants, and the advisory uses a separate figure for them.
Confidants, among people who are not lonely
Inside the group that is not reporting loneliness or isolation, nearly 90 percent have three or more confidants. Read the boundary. That nearly-90 figure is not a figure for Americans in general. It is about people who are not reporting loneliness or isolation. Inside that group, three or more confidants is the common pattern. The advisory does not say the reverse in a matching percent: it does not, in these notes, give you the share of lonely people who have fewer than three confidants. Do not write that missing number in yourself.
You might be thinking a close friend and a confidant are the same role with two outfits. The notes will not let you treat the 49 percent and the nearly 90 percent as one statistic. One is a year-to-year change in how many Americans say they have three or fewer close friends. The other is a snapshot of confidants among people who are not reporting loneliness or isolation. Both can be true. Neither is a quota for your life. A person with two extraordinary friends has not failed a test the advisory scored for them personally.
Less than 20 percent of people who often or always feel lonely or isolated recognize it as a major problem. That recognition gap sits next to the confidant figure for a reason. You can be thin on people who really hear you and still not call the thinness a major problem. The advisory is describing under-recognition, not scolding you. If you are unsure whether you are lonely, the absence of a label is not evidence that you are fine. It is part of the pattern the advisory reports.
Connection is wider than the friendship word
Social connection, in the advisory, is the structure, function, and quality of relationships with others. Family, friends, colleagues, and neighbors all count. Neighborhoods, digital environments, schools, and workplaces also inform connection. A close friend can be the main source of meaning and still not be the whole structure. A neighbor who checks on you, a colleague who tells the truth, a sibling you trust, can sit inside the same definition. This page keeps family and close friends at the center of the meaning sentence, because that is what adults rated. It does not shrink connection down to a single bond.
A 2022 study cited in the advisory found that only 39 percent of U.S. adults said they felt very connected to others. One study found a 16 percent decrease in network size from June 2019 to June 2020. Those two lines are about felt connection and about network size, not about the 1990-to-2021 friend count. Stacking them into "everyone is isolated now" is looser than the text. Use them as neighboring facts: many adults do not feel very connected, and at least one study saw networks shrink across that pandemic year.
What the advisory ties to thin connection
The advisory attaches serious health associations to loneliness: higher risk of heart disease, dementia, stroke, depression, anxiety, and dying sooner. It compares a lack of social connection with smoking as many as 15 cigarettes a day, and it says that risk outruns the risk tied to obesity and to physical inactivity. The premature-death increases it prints are 26 percent for loneliness and 29 percent for social isolation. Sixteen longitudinal studies, pooled, tied poor social relationships to a 29 percent higher heart-disease risk and a 32 percent higher stroke risk. Quoting the American Heart Association in 2022, the advisory calls isolation and loneliness common and still underrecognized as factors in cardiovascular health and in brain health.
Those lines are population associations. They are not a diagnosis hiding in your friend count. The advisory also estimates social isolation among older adults at 6.7 billion dollars in excess Medicare spending a year, and it attributes 154 billion dollars a year in U.S. stress-related absenteeism to loneliness. Money figures describe a public cost. They do not price your Friday night.
The individual suggestions in the advisory include looking for warning signs such as more time alone or limited interactions with friends, and seeking opportunities to help other people. Helping someone else is not a trick to collect confidants. It is one of the moves the advisory names. Meaning, in the opening sentence, is already tied to other people. Helping is a way of being one of those people for someone else.
Care, if the thinness is heavy
If loneliness is heavy, a primary care clinician can screen you and refer you, which is one route named by the National Institute of Mental Health. NIMH also says treatment is usually therapy, medication, or both, and that NIMH itself cannot give you medical advice or referrals. Do not stop a treatment you are already in without talking with a health care provider. This page is education about an advisory. It is not treatment, and it cannot tell you whether your friend count is the thing making you ill.
Anxiety about dating closeness is a different research question from the confidant count, and it is taken up in what a 35-item fear scale found. That scale is not a measure of how many close friends you had in 1990 or 2021.
Who are the people you would actually tell the truth to this month, and have you spoken to them, or only counted them?
Advisory and help pages cited
- Office of the Surgeon General, "Our Epidemic of Loneliness and Isolation," 2023. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
- National Institute of Mental Health, "Help for Mental Illnesses," last reviewed April 2026. https://www.nimh.nih.gov/health/find-help
Frequently Asked Questions
- Where do adults place meaning?
- In social relationships, and especially in family and close friends. The advisory says that rating also covers purpose and motivation, and that it shows up across the globe.
- How did the close-friend report move from 1990 to 2021?
- The portion of Americans saying they had three or fewer close friends went from 27 percent to 49 percent.
- What confidant figure belongs to people who are not lonely?
- Nearly nine in ten adults outside the group that reports loneliness or isolation have at least three confidants. Do not swap that figure for the close-friend percentages.
- Does a short friend list diagnose heart disease?
- No. The advisory ties loneliness and weak social ties, at population level, to higher heart and stroke risk and to earlier death. A clinician has to assess a person. A count is not a diagnosis.
- What does the advisory suggest a person actually do?
- Notice warning signs such as spending longer stretches alone or having thin contact with friends, and look for chances to help somebody else. If you need care, your doctor can check for a mental-health need and point you onward. NIMH itself will not make you a referral.