Reducing Drinking Among US Veterans with Unhealthy Alcohol Use Might Improve Chronic Pain Symptoms and Reduce Other Substance Use

US veterans with unhealthy alcohol use who reduce their drinking may gain some improvement in chronic pain symptoms and use of other substances, according to a study in Alcoholism: Clinical and Experimental Research. Hazardous drinking is common in the US, and frequently co-occurs with chronic pain, depression and anxiety, and with tobacco, cannabis or cocaine use.  Many people use alcohol and other substances to mask or self-manage pain and psychiatric symptoms, although there is little evidence to support such use. If, conversely, a reduction in drinking (or use of treatment for alcohol misuse) were to benefit co-occurring conditions or substance use, this could support an integrated approach to screening or treatment. The new analysis assessed the impact of drinking reduction on improvement of chronic pain, psychiatric symptoms, and other substance use among US veterans with unhealthy alcohol use – a population with high rates of these co-occurring conditions.

Researchers used data from the Veterans Aging Cohort Study (VACS), which follows ~7000 US veterans (half of them HIV-positive) receiving healthcare in 9 centers. From 2003/04, participants completed annual surveys, including questions on past-year alcohol and substance use and on co-occurring symptoms and conditions – such as interference of pain with work, and self-reported symptoms of depression and anxiety. The current analysis focused on the ~1500 participants who reported unhealthy alcohol use – defined as scoring 8+ on the ‘AUDIT’ questionnaire – in at least one annual survey. Researchers identified those who had reduced (score of <8) and not reduced (score of 8+) their drinking at the next year’s survey, and compared the two groups for improvement of co-occurring conditions another year later.

Co-occurring conditions at baseline were common; almost half had moderate/severe symptoms of pain interference, more than two-thirds were smokers, a third reported past-year cannabis-use, and a third cocaine-use. Over half reported anxiety symptoms, and a third depression. At the next survey, 31% had reduced their drinking, while 37% had not (with data unavailable for 32%). Statistical analysis showed that, compared with not cutting down, reduced drinking at 1 year was associated with higher odds of improved pain symptoms at 2 years, and higher odds of stopping smoking, cannabis, or cocaine use. However, there was wide uncertainty in the estimates, and little evidence for improvement in depression and anxiety symptoms. Findings were similar in those with and without HIV, although the association of drinking reduction with stopping smoking and cocaine use was stronger in HIV-positive participants.

The findings provide some evidence for improvement in chronic pain symptoms and substance use with drinking reduction among veterans. However, because the timing of alcohol reduction relative to improvement in other conditions (or substance use) was often unknown, it cannot be concluded that the drinking reduction caused the improvement. The analysis also did not control for other factors that may affect these outcomes – such as receiving treatment, or changes in social or economic circumstances. Further studies with more precise data on the timing and reasons for changes in alcohol use and co-occurring conditions will be needed to fully evaluate the impact of drinking reduction, and the potential value of integrated treatment and screening strategies to address these. For now, the findings support continued efforts to reduce drinking in veterans with unhealthy alcohol use, and provide reassurance that drinking reduction is unlikely to worsen pain symptoms or hinder efforts to reduce other substance use.

Does reducing drinking in patients with unhealthy alcohol use improve pain interference, use of other substances, and psychiatric symptoms?

E.C. Caniglia, E.R. Stevens, M. Khan, K.E. Young, K. Ban, B.D.L. Marshall, N.E. Chichetto, J.R. Gaither, S. Crystal, E.J. Edelman, D.A. Fiellin, A.J. Gordon, K.J. Bryant, J. Tate, A.C. Justice, R.S. Braithwaite (pages xxx).

ACER-20-4461.R1