Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment Trial
Open accessAbstract
Aims: To test the association between pain and heavy drinking lapses during and following treatment for alcohol use disorders (AUD). Design: Secondary data analysis of data from two clinical trials for AUD. Setting and participants: Participants included 1383 individuals from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study in the United States [69.0% male, 76.8% non‐Hispanic White average age = 44.4, standard deviation (SD) = 10.2] and 742 individuals from the UK Alcohol Treatment Trial (UKATT) in the United Kingdom [74.1% male, 95.6% White, average age = 41.6 (SD = 10.1)]. Measurements: Form‐90 (a structured assessment interview) was used to assess the primary outcome: time to first heavy drinking day. The Short Form Health Survey and Quality of Life measures were used to assess pain interference and pain intensity. Findings: Pain was a significant predictor of heavy drinking lapses during treatment in UKATT [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.08, 1.32, P = 0.0003] and COMBINE (OR = 1.12, 95% CI = 1.03, 1.21, P = 0.009), and was a significant predictor of heavy drinking lapses following treatment in COMBINE (OR = 1.163, 95% CI = 1.15, 1.17, P < 0.00001). After controlling for other relapse risk factors (e.g. dependence severity, self‐efficacy, temptation, psychiatric distress), pain remained a significant predictor of heavy drinking lapses during treatment in UKATT (OR = 1.19, 95% CI = 1.06, 1.34, P = 0.004) and following treatment in COMBINE (OR = 1.44, 95% CI = 1.07, 1.92, P = 0.01). Conclusions: Among people treated for alcohol use disorder, being in physical pain appears to predict heavy drinking lapses during or after treatment.
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Physical pain is a significant predictor of alcohol use, heavy alcohol use, and relapse to drinking after a period of abstinence.
“Perhaps more compelling, physical pain appears to be a significant predictor of alcohol use and heavy alcohol use and relapse to drinking after a period of abstinence (Larson et al., 2007;Caldeiro et al., 2008;Witkiewitz et al., 2015).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Witkiewitz et al., 2015
The Results report that pain significantly predicted heavy-drinking lapses in both trials and any-drinking lapses following treatment in COMBINE. But the Introduction defines a lapse as drinking beyond a limit after either abstinence or a moderate-drinking goal, so the study does not establish that these lapses followed abstinence. Its findings also concern people treated for alcohol use disorder, rather than alcohol use generally. (LLM, conf=0.84)
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- Authors
- Witkiewitz, K., Vowles, K. E., McCallion, E., Frohe, T., Kirouac, M., & Maisto, S. A.
- Affiliations
- University of New Mexico (US)
- Syracuse University (US)
- Corresponding author
- Witkiewitz, Katie
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2015-06-03
- Volume
- 110
- Issue
- 8
- Pages
- 1262-1271
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC4503502
- OpenAlex
- W1535542142
- Cited by
- 99
- References
- 70
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 13 · 2023: 7 · 2022: 5 · 2021: 12 · 2020: 9 · 2019: 11 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 2
- FWCI
- 6.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R01AA022328, K05AA016928, T32AA0018108)
- National Center for Complementary and Alternative Medicine (R34AT008398)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- pain, heavy drinking, relapse, alcoholism, alcohol treatment, pain interference, pain intensity, predictors of relapse, COMBINE study
- MeSH terms
- Acamprosate, Adult, Alcohol Deterrents, Alcohol Drinking, Behavior Therapy, Combined Modality Therapy, Female, Humans, Male, Naltrexone, Pain Measurement, Recurrence, Taurine, Treatment Outcome, Alcohol-Related Disorders, Chronic Pain
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