Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect

Abstract

Objective: Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of 2 clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes.

Method: Participants included 1,383 individuals from the COMBINE Study (COMBINE Pharmacotherapies and Behavioral Interventions for Alcohol Dependence; COMBINE Study Research Group, 2003; 31% female, 23% ethnic minorities, average age = 44.4 [SD = 10.2]), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age = 41.6 [SD = 10.1]) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT).

Results: Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking.

Conclusion: Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse.

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Figures

Figure 1a

Parallel process growth mediation model in COMBINE. BSI = Brief Symptom Inventory; WHO-QOL = World Health Organization Quality of Life measure of pain interference; SF-12 = Short Form 12 measure of pain interference.

Figure 1b

Parallel process growth mediation model in UKATT. GHQ = General Health Questionnaire; EQ-5D = European Quality of Life measure of pain intensity; SF-36 = Short Form 36 Health Survey measure of pain intensity and pain interference.

Figure 2

Association between pain scores at the end of treatment and percent heavy drinking days by treatment condition in UKATT. MET = Motivation enhancement therapy; SBNT = Social behavior and network therapy