Interventions to reduce anxiety and depression may help prevent relapse in individuals with chronic pain who are recovering from alcohol use disorder (AUD). This conclusion comes from a recent study in which investigators reanalyzed data collected from people with chronic pain who participated in one of two major clinical trials on alcohol treatment, one in the United States and one in the United Kingdom. Both trials included the collection of data that allowed the authors of the present study to look at the links between pain, negative affect, and relapse. In the present study, the researchers conducted a separate reanalysis for each of the two original studies.
People in recovery from AUD commonly have relapses to heavy drinking following a stretch of abstinence or cutting back. Previous research has shown that risk factors for relapse include stress, craving, and the “negative affect” states of anxiety and depression. Pain has not been widely studied as a risk factor, even though chronic pain is common and often self-managed with alcohol.
Based on their new analyses, the authors report that people with higher pain levels in both studies tended to have higher levels of negative affect and increased rates of relapse. The key finding, however, was that the participants’ levels of anxiety or depression in both studies predicted relapse better than their particular pain levels.
It is important to note that in the U.K. clinical trial, a high-intensity behavioral intervention called social behavior network therapy (SBNT) appeared to reduce the effects of pain on negative affect and relapse. Participants in that trial were randomly assigned to receive either SBNT, which helped build social networks that supported abstinence or reduced drinking, or a lower-intensity motivational enhancement therapy (MET). In the MET group, participants with greater pain scores at the end of treatment tended to have more heavy-drinking days 12 months later. In contrast, those in the SBNT group with greater pain scores at the end of treatment did not drink significantly more a year later, than those with lower pain scores. The authors suggest that the healthy social support system built by the SBNT group may have reduced the participants’ tendencies to drink heavily in response to pain or negative affect.
The analysis was designed to show associations among pain, negative affect, and alcohol use, but not whether one factor came before or caused another. The authors concluded that the findings lend support for the SBNT intervention as well as future research into the potential benefits of negative- affect treatments for people with AUD and chronic pain.
Witkiewitz, K.; McCallion, E.; Vowles, K.E.; Kirouac, M.; Frohe, T.; Maisto, S.A.; Hodgson, R.; Heather, N. Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. Journal of Consulting and Clinical Psychology 83(6)1044–1057, 2015. PMID: 2609837
Reprinted from the NIAAA Spectrum, Volume 8, Issue 2, June 2016.