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Ferguson E, Lewis B, Teitelbaum S, Reisfield G, Robinson M, Boissoneault J. Longitudinal associations between pain and substance use disorder treatment outcomes. J Subst Abuse Treat 2022; 143:108892. [PMID: 36228338 PMCID: PMC11025107 DOI: 10.1016/j.jsat.2022.108892] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Pain is commonly reported among those in treatment for substance use disorders (SUD) and is associated with poorer SUD treatment outcomes. The current study examined the trajectory of pain over the course of SUD treatment and associations with substance use outcomes. METHODS This observational study included adults seeking treatment for alcohol, cannabis, or opioid use disorders (N = 811). Participants completed a battery of assessments at treatment admission, 30 days post admission, and at discharge, including measures of demographics, pain, quality of life, abstinence self-efficacy, and craving. RESULTS Analyses indicated linear reductions in pain intensity and interference over time. Significant interactive effects were observed for opioid use disorder (OUD) and time, such that participants with OUD had greater reductions in pain intensity and interference over time compared to those without OUD. Elevated pain intensity was associated with negative treatment outcomes, including reduced quality of life and abstinence self-efficacy, and greater craving and negative affect. CONCLUSIONS Reductions in pain occur over the course of SUD treatment, particularly for those with OUD. Greater pain was also associated with adverse SUD treatment outcomes. Results suggest that treatment and associated abstinence may be beneficial for those with co-occurring pain and SUD, highlighting an additional benefit of improving access to SUD treatment for patients and health care systems. Future research should replicate these findings among diverse samples and further characterize the trajectory of pain during and after SUD treatment.
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Affiliation(s)
- Erin Ferguson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Scott Teitelbaum
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Gary Reisfield
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.
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Ferguson E, Vitus D, Williams M, Anderson M, LaRowe L, Ditre JW, Stennett B, Boissoneault J. Sex differences in associations between delay discounting and expectancies for alcohol analgesia. Exp Clin Psychopharmacol 2022; 30:862-872. [PMID: 34410797 PMCID: PMC8857303 DOI: 10.1037/pha0000517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Self-medication of pain with alcohol is prevalent, and expectancies for alcohol analgesia likely influence pain relief and alcohol consumption. Hazardous alcohol use has been associated with greater delay discounting rates; however, little is known about the relationship between delay discounting and expectancies for alcohol analgesia. Therefore, the present study examined sex differences in associations between delay discounting and expectancies for alcohol analgesia. Healthy drinkers without chronic pain (N = 53) completed measures of expectancies for alcohol analgesia, alcohol use, and alcohol outcome expectancies. A five-trial adjusting-delay discounting task (DDT) for monetary outcomes was also administered. Regression analyses revealed that sex moderated the relationship between delay discounting and expectancies for alcohol analgesia. Steeper delay discounting rates were associated with weaker expectancies for alcohol analgesia among men when adjusting for average alcohol consumption. Among women, nonsignificant associations between delay discounting rates and expectancies for alcohol analgesia were observed. These findings provide initial evidence of sex differences in associations between delay discounting and expectancies for alcohol analgesia. The directionality of these associations was unexpected and may have implications for patterns of self-medication with alcohol. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erin Ferguson
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Darya Vitus
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Michelle Williams
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Molly Anderson
- Department of Psychology, University of Florida,
Gainesville, FL, USA
| | - Lisa LaRowe
- Department of Psychology, Syracuse University, Syracuse,
NY, USA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse,
NY, USA
| | - Bethany Stennett
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
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3
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de Laat B, Nabulsi N, Huang Y, O'Malley SS, Morris ED, Krishnan-Sarin S. Differences in the association between kappa opioid receptors and pain among Black and White adults with alcohol use disorders. Alcohol Clin Exp Res 2022; 46:1348-1357. [PMID: 35633151 DOI: 10.1111/acer.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between alcohol and pain is complex. Associations between pain and alcohol use disorder (AUD) vary by race, but the underlying biological basis is not understood. We examined the association of the kappa opioid receptor (KOR) with responses to the cold-pressor test (CPT), before and after treatment with the opioid antagonist naltrexone, among individuals with AUD who self-identified as Black or White. METHODS Thirty-seven individuals (12 Black, 24 White, and 1 Multiracial) with AUD participated in two CPTs, separated by 1 week during which they received naltrexone 100 mg daily. During each CPT, pain reporting threshold (PRT), average pain increase rate (APIR), relative pain recovery (RPR), and alcohol craving were recorded. KOR availability was measured using [11 C]-LY2795050 positron emission tomography (PET) prior to treatment with naltrexone. RESULTS Black participants reported higher PRT and APIR than White participants during the CPT before, but not after, naltrexone treatment. Among Black participants, KOR availability was positively associated with PRT and APIR before, but not after naltrexone. Greater KOR availability was associated with faster RPR for White, but not Black, participants. The CPT induced more alcohol craving in Black than White participants, particularly in individuals with low KOR availability, an effect that was not attenuated by naltrexone. CONCLUSIONS KOR involvement and naltrexone effects on responses to the CPT were different between Black and White participants. These preliminary findings suggest that further exploration of the differences in the opioid system and pain among Black and White individuals with AUD and their relationship with naltrexone's effects is warranted.
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Affiliation(s)
- Bart de Laat
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Nabeel Nabulsi
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | | | - Evan D Morris
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA.,Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
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Wang J, Cheng Z, Kim Y, Yu F, Heffner KL, Quiñones-Cordero MM, Li Y. Pain and the Alzheimer's Disease and Related Dementia Spectrum in Community-Dwelling Older Americans: A Nationally Representative Study. J Pain Symptom Manage 2022; 63:654-664. [PMID: 35081442 PMCID: PMC9035327 DOI: 10.1016/j.jpainsymman.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD). OBJECTIVES Examine the association between cognitive impairment across the ADRD spectrum and pain assessment and treatment in community-dwelling older Americans. METHODS This cross-sectional, population-based study included 16,836 community-dwelling participants ≥ 50 years in the 2018 Health and Retirement Study. ADRD, assessed by validated cognitive measures, was categorized into "dementia," "cognitive impairment, no dementia (CIND)" and "intact cognition." Pain assessment included pain presence (often being troubled with pain), pain severity (degree of pain most of the time [mild/moderate/severe]), and pain interference (pain making it difficult to do usual activities). Pain treatment included recent use of over-the-counter pain medications and opioids (past 3 months), and regular intake of prescriptions for pain. RESULTS Dementia were associated with lower likelihood of reporting pain presence (Odds Ratio [OR]= 0.61, P = 0.01), pain interference (OR = 0.46, P < 0.001), reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.38, P < 0.001), and lower likelihood of receiving pain treatment, that is, recent use of over-the-counter pain medications (OR = 0.60, P = 0.02) and opioids (OR = 0.33, P < 0.001), and regular intake of prescriptions for pain (OR = 0.461, P = 0.002). CIND was associated with reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.75, P = 0.021), lower likelihood of reporting pain interference (OR = 0.79, P = 0.045) and recent over-the-counter pain medication use (OR = 0.74, P = 0.026). CONCLUSION CIND and dementia increased the risk of under-report and under-treatment of pain. Systematic efforts are needed to improve pain recognition and treatment among older adults with cognitive impairment, regardless of dementia diagnosis.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging (J.W., K.L.H., M.M.Q.), University of Rochester School of Nursing, Rochester, New York, USA.
| | - Zijing Cheng
- Department of Public Health Sciences (Z.C., Y.L.), University of Rochester Medical Center, Rochester, New York, USA
| | | | - Fang Yu
- Edson College of Nursing and Health Innovation (F.Y.), Arizona State University, Phoenix, Arizona, USA
| | - Kathi L Heffner
- Elaine Hubbard Center for Nursing Research on Aging (J.W., K.L.H., M.M.Q.), University of Rochester School of Nursing, Rochester, New York, USA; Division of Geriatrics & Aging, Department of Medicine (K.L.H.), University of Rochester Medical Center, Rochester, New York, USA; Department of Psychiatry (K.L.H.), University of Rochester Medical Center, Rochester, New York, USA
| | - Maria M Quiñones-Cordero
- Elaine Hubbard Center for Nursing Research on Aging (J.W., K.L.H., M.M.Q.), University of Rochester School of Nursing, Rochester, New York, USA
| | - Yue Li
- Department of Public Health Sciences (Z.C., Y.L.), University of Rochester Medical Center, Rochester, New York, USA
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Santora L, Byrne D, Klöckner C. Clusters of older adults with and without experience of alcohol-related harms based on affective motivations for drinking. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:379-405. [PMID: 36003125 PMCID: PMC9379293 DOI: 10.1177/14550725211073006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: This cross-sectional study explores profiles of community-residing Norwegian older adults (aged 62–95 years) in relation to their personally expressed motives for alcohol use. It specifically investigates drinking motives as they uniquely characterise alcohol consumers reporting problem and non-problem drinking assessed using the Drinking Problem Index (DPI). Methods: Two-step cluster analysis was used to delineate subgroups of alcohol consumers on seven drinking motivation variables, together with DPI score. The clusters were evaluated by gender, physical health and psychological health status. Results: Four clusters of alcohol consumers were identified in relation to drinking motives: Low motivated drinkers, Ambivalent drinkers, Enhancement drinkers, and Coping drinkers. For one subgroup, a strong reliance on alcohol to cope with negative feelings was most relevant to both non-problem and problem drinkers. For another subgroup, enjoying the effects of alcohol, but non-reliance on alcohol to cope with negative mood were associated with reporting drinking problems. Ambivalent drinkers reported overall low satisfaction with mental health. Very poor physical and mental health were more prevalent in men than in women characterised as Coping drinkers. Predominantly mental health status supported distinctiveness of delineated clusters. Conclusion: This study demonstrates that the classification approach to profiling of characteristics of alcohol consumers based on their motivations to drink may have a potential utility in human care settings to identify individuals who incur or may be at risk of developing alcohol-related problems in later life, and those who are not.
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Affiliation(s)
- Lidia Santora
- Norwegian University of Science and Technology, Trondheim, Norway; and Australian National University, Canberra, Australia
| | - Don Byrne
- Australian National University, Canberra, Australia
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Brennan PL, Holahan CJ, Moos RH, Schutte KK. History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND. BMC Public Health 2021; 21:2319. [PMID: 34949174 PMCID: PMC8705185 DOI: 10.1186/s12889-021-12358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later. METHOD A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later. RESULTS Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND. CONCLUSIONS For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.
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Affiliation(s)
- Penny L Brennan
- Institute for Health & Aging, University of California, San Francisco, Box 0646, 490 Illinois St., Floor 12, San Francisco, CA, 94143, USA.
| | - Charles J Holahan
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Rudolf H Moos
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
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7
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Behrendt S, Kuerbis A, Becker U, Mejldal A, Andersen K, Søgaard Nielsen A, Tolstrup J, Holm Eliasen M. Distinct health-related risk profiles among middle-aged and older adults with risky alcohol use from the Danish general population. Drug Alcohol Depend 2021; 226:108872. [PMID: 34246918 DOI: 10.1016/j.drugalcdep.2021.108872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Knowledge is lacking on distinct health-related risk profiles among the substantial group of middle-aged and older adults with risky alcohol use (AU). Such profiles could inform the planning of interventions and prevention. AIMS To 1) identify distinct health-related profiles based on different types of health-related functioning limitations and distress and 2) assess associations between these profiles and age, sex, and health-relevant behaviors (e.g., smoking). METHODS Cross-sectional nation-wide Danish health survey with n = 6630 adults aged 55-64 and n = 7605 aged 65-74 with at least risky AU (>84 g ethanol/week in women, >168 in men). Health-related risk profiles were identified with Latent Class Analysis (LCA). Multinomial regression was applied for the association between risk profiles and auxiliary variables. RESULTS A six-class LCA solution was found among 55-64 year-olds (classes: 'Normative' [61%], 'Distress' [6%], 'Mental health limitations [5%]', 'Pain-related distress [10%]', 'Broad limitations and pain distress [7%]', 'High overall burden' [11%]) and a five-class solution among 65-74 year-olds. Most classes were comparable across age groups. The 'Distress'-class characterized by pain-distress, tiredness-distress, and sleep-related distress (6%) only showed in the younger group. In both age groups, auxiliary covariates (high-risk AU, possible alcohol use disorder, weekly smoking) were positively associated with problematic profile membership (vs. normative class membership). CONCLUSION Middle-aged and older adults with risky AU have distinct health-related profiles relevant for the form and content of prevention and interventions. Despite their distinct features, almost all problematic health profiles warrant careful attention regarding high-risk AU and probable alcohol use disorder.
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Affiliation(s)
- Silke Behrendt
- Institute of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C, Denmark.
| | - Alexis Kuerbis
- Silberman School of Social Work at Hunter College, 2180 Third Avenue, New York, NY 10035, United States
| | - Ulrik Becker
- National Institute of Public Health, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C, Denmark
| | - Janne Tolstrup
- National Institute of Public Health, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Marie Holm Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
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Pengpid S, Peltzer K. Elder abuse and health outcomes among community-dwelling older adults in India: results of a national survey in 2017-2018. J Elder Abuse Negl 2021; 33:327-341. [PMID: 34433374 DOI: 10.1080/08946566.2021.1970683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study aimed to estimate the associations between elder abuse and poor physical health, poor mental health, and health risk behaviors in older adults in a national community-based survey in India. The study sample included 31,477 older adults (≥60 years) from a cross-sectional national community dwelling survey in India in 2017-2018. Results indicate that the prevalence of elder abuse in the past 12 months was 5.2%. In the adjusted logistic regression analysis, elder abuse was significantly positively associated with poor mental health and poor well-being (low life satisfaction, not happy, insomnia symptoms, depressive symptoms, loneliness, neurological or psychiatric problems, and lower self-rated health status), poor physical health (bone or joint disease, physical pain, gastrointestinal problems, incontinence, functional disability, underweight, and persistent headaches), fall and health care utilization. In addition, in unadjusted analysis, elder abuse was associated with poorer cognitive functioning, current tobacco use, and dizziness. Elder abuse among older adults in India is associated with poor physical health, poor mental health, and health care utilization, emphasizing the need to consider elder abuse in various physical and mental health contexts.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa.,College of Medical and Health Science, Asia University, Taichung, Taiwan
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Zale EL, Powers JM, Ditre JW. Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain. Alcohol Res 2021; 41:08. [PMID: 34306903 PMCID: PMC8289456 DOI: 10.35946/arcr.v41.1.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors-expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations-were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.
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Affiliation(s)
- Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York
| | - Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York
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10
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Sex moderates the effects of experimentally induced musculoskeletal pain on alcohol demand in healthy drinkers. Drug Alcohol Depend 2021; 219:108475. [PMID: 33385694 PMCID: PMC8911397 DOI: 10.1016/j.drugalcdep.2020.108475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/21/2020] [Accepted: 11/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pain may serve as an antecedent for alcohol use, increasing risk for hazardous drinking and associated consequences. Delayed onset muscle soreness (DOMS) induction produces clinically relevant but time-limited musculoskeletal pain. This study was conducted to determine whether DOMS induction on the dominant elbow flexors influenced alcohol demand using the Alcohol Purchase Task (APT). We hypothesized DOMS would increase alcohol demand relative to a sham control. Based on existing studies of pain self-medication, we expected DOMS-related increases in alcohol demand would be greatest in men. METHODS Participants (N = 53; 57 % women) were randomly assigned to a DOMS (eccentric exercise) or sham condition (concentric exercise). Participants completed the APT pre-exercise and 48 -hs post-exercise. Repeated measures GLM was used to characterize group by sex by time interactions on APT indices, including intensity, breakpoint, essential value (EV), Omax, and Pmax. RESULTS The DOMS procedure significantly increased pain ratings at the elbow flexors. Men had significantly higher demand intensity than women across groups and time points. Significant interactive effects were detected for breakpoint and EV. From pre- to post-test, breakpoint significantly increased in men in the DOMS group. However, breakpoint and EV significantly decreased in women in the DOMS group. CONCLUSIONS Increased alcohol demand in men in the DOMS group was consistent with epidemiological data suggesting men are at higher risk for self-medicating pain with alcohol than women. However, decreased demand in women was unexpected. Taken together, results indicate DOMS induction may be a useful means to characterize pain as an antecedent for alcohol use.
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Paulus DJ, Rogers AH, Asmundson GJG, Zvolensky MJ. Pain severity and anxiety sensitivity interact to predict drinking severity among hazardous drinking college students. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:795-804. [PMID: 32931714 DOI: 10.1080/00952990.2020.1804921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Hazardous alcohol use among college students is a growing problem. Alcohol is commonly used in the context of pain due to acute analgesic effects, although the role of pain among hazardous drinkers has not been examined. Little is known regarding factors that may moderate pain-alcohol relations. One factor is anxiety sensitivity, which reflects the fear of physiological sensations. Pain severity and anxiety sensitivity may interact such that those with high anxiety sensitivity may have stronger pain-alcohol relations.Objectives: The current study examined interactive associations of pain severity and anxiety sensitivity in relation to hazardous drinking severity, alcohol consumption, and alcohol problems among hazardous drinking college students (n = 370; 78.1% female).Methods: Self report measures of alcohol use, pain severity, and anxiety sensitivity were collected and moderation analyses were conducted.Results: There was a significant interaction of pain severity and anxiety sensitivity in relation to hazardous drinking severity (β = 0.25, p = .037); pain severity was significantly related to hazardous drinking for high (β = 0.28, p < .001) but not low (β = 0.09, p = .202) anxiety sensitivity. There was a similar interaction for alcohol consumption (β = 0.35, p = .008). For alcohol problems, there was no significant interaction, but there were unique main effects of both pain severity (β = 0.23, p < .001) and anxiety sensitivity (β = 0.34, p < .001).Conclusions: These findings suggest that drinkers with high anxiety sensitivity may use alcohol hazardously (and in greater quantities) in the context of pain. If replicated with longitudinal samples, the findings may inform clinical practice in terms of screening for and treatment of anxiety sensitivity.
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Affiliation(s)
- Daniel J Paulus
- Department of Neuroscience, Medical University of South Carolina , Charlestion, SC, USA.,Department of Psychology, University of Houston , Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston , Houston, TX, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston , Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, TX, USA.,Health Institute, University of Houston , Houston, TX, USA
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12
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Behrendt S. Research is needed to understand substance use disorders in old adulthood. Addiction 2020; 115:600-602. [PMID: 31502317 DOI: 10.1111/add.14811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Silke Behrendt
- Institute for Psychology, University of Southern Denmark, Odense, Denmark.,Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, and OPEN Patient Data Explorative Network, Odense University Hospital, and BRIDGE, BrainResearch, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Fernandez AC, Bush C, Bonar EE, Blow FC, Walton MA, Bohnert AA. Alcohol and Drug Overdose and the Influence of Pain Conditions in an Addiction Treatment Sample. J Addict Med 2020; 13:61-68. [PMID: 30161038 PMCID: PMC6533535 DOI: 10.1097/adm.0000000000000451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Overdose from alcohol and/or drugs kills tens of thousands of Americans annually, with a large number of deaths attributed to opioid pain medications. Addiction treatment patients are known to be at high risk for overdose; however, the relationship between pain and overdose history within this group is understudied, especially in relation to alcohol overdoses. In the present study, we evaluated whether nonfatal overdose history was more likely among addiction treatment patients with pain, and examined the characteristics of overdoses among those with and without pain. METHODS We analyzed cross-sectional data from 739 patients at a large residential addiction treatment center (median age 37, 25.7% female). We used 2-stepped binary regression models to evaluate whether demographics, pain type (chronic, acute, or both), depression symptoms, and opioid misuse were associated with lifetime history of nonfatal (1) alcohol and (2) drug overdose (lifetime yes/no), and conducted follow-up analyses examining overdose characteristics. RESULTS In adjusted analyses, history of chronic pain (odds ratio [OR] 2.60, 95% confidence interval [CI] 1.59, 4.27) and illicit drug use (OR 1.99, 95% CI 1.07, 3.68) were associated with an increased likelihood of nonfatal alcohol overdose. Opioid misuse (OR 3.11, 95% CI 2.51, 3.86), depression symptoms (OR 1.33, 95% CI 1.14, 1.55), and younger age (OR 0.96, 95% CI 0.94, 0.97) were associated with increased likelihood of drug overdose. Those with pain reported a higher number of lifetime alcohol overdoses and were more likely to combine numerous drugs with alcohol before overdose. CONCLUSIONS Pain conditions may play an under-recognized role in the overdose epidemic, particularly alcohol-related overdose. Addiction treatment and overdose prevention interventions should incorporate appropriate assessment and treatment of pain including education about the risks of polysubstance use, particularly combining alcohol with sedatives and prescription pain relievers.
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Affiliation(s)
- Anne C. Fernandez
- Department of Psychiatry & Addiction Center, Michigan Medicine, Ann Arbor, MI, 48109 USA
| | - Christopher Bush
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Erin E. Bonar
- Department of Psychiatry & Addiction Center, Michigan Medicine, Ann Arbor, MI, 48109 USA
- Injury Prevention Center, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Frederic C. Blow
- Department of Psychiatry & Addiction Center, Michigan Medicine, Ann Arbor, MI, 48109 USA
- VA Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
| | - Maureen A. Walton
- Department of Psychiatry & Addiction Center, Michigan Medicine, Ann Arbor, MI, 48109 USA
- Injury Prevention Center, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Amy A.S.B. Bohnert
- Department of Psychiatry & Addiction Center, Michigan Medicine, Ann Arbor, MI, 48109 USA
- VA Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
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14
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Yeung EW, Lee MR, McDowell Y, Sher KJ, Gizer IR. The Association Between Alcohol Consumption and Pain Interference in a Nationally Representative Sample: The Moderating Roles of Gender and Alcohol Use Disorder Symptomatology. Alcohol Clin Exp Res 2020; 44:645-659. [PMID: 31957038 DOI: 10.1111/acer.14282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prior research on alcohol consumption and pain has yielded inconsistent results regarding the directionality of effects for both consumption-to-pain and pain-to-consumption relations. The present study sought to examine directionality of these relations by testing bidirectional longitudinal associations between consumption and pain interference, a crucial aspect of pain that captures pain-related disability and has been regarded as a valuable measure of treatment outcome. In addition, this study explored possible moderation of these bidirectional longitudinal associations by gender and alcohol use disorder (AUD) symptomatology. METHODS Analyses included 29,989 current/former drinkers who were interviewed at both waves (2001 and 2004) of the U.S. National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Analyses used self-report data from both waves on past-year average daily volume of alcohol consumed and past-month pain interference (1 item from the Medical Outcomes Study 12-item Short-Form Health Survey [MOS-SF-12]). AUDADIS-IV data from Wave 1 were used to index baseline AUD symptomatology (i.e., symptom count). Cross-lagged panel modeling and multigroup analyses were employed. RESULTS Regarding the consumption-to-pain-interference relation, in general, higher baseline alcohol consumption was associated with lower subsequent pain interference at follow-up. However, among men with higher AUD-symptom counts, the opposite pattern emerged, with higher baseline alcohol consumption being significantly related to higher subsequent pain interference at follow-up. Regarding the pain-interference-to-consumption relation, higher baseline pain interference was significantly associated with lower subsequent alcohol consumption at follow-up, and no moderating effects were observed. CONCLUSIONS The distinctive patterns of the consumption-to-pain-interference relation observed among men with elevated AUD symptomatology suggest that this relation might be driven by different mechanisms across different groups of individuals. Specifically, the detrimental effect of alcohol on pain interference might emerge at relatively advanced stages of AUD among men, consistent with Koob's Dark Side of Alcohol Addiction theory in human research.
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Affiliation(s)
- Ellen W Yeung
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri.,Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, California.,Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia
| | - Matthew R Lee
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri.,Center of Alcohol and Substance Use Studies (CAS), Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Yoanna McDowell
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Ian R Gizer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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15
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Interactive Effects of Quality of Life and Related Factors on Alcohol Use Outcomes. Can J Aging 2020; 40:49-67. [PMID: 32029021 DOI: 10.1017/s0714980819000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This investigation derives its impetus from public health concerns around detecting, mitigating, and preventing the deleterious effects that alcohol use can cause particularly in advanced age. We aim to complement gerontological research by exploring the interactive effects of quality of life and related factors on alcohol use outcomes assessed by the Drinking Problem Index. The study is based on cross-sectional data collected from questionnaires mailed to a randomly drawn sample of 6,000 Norwegian adults aged 62 and older (participation rate: 32%). According to the Chi-square Automatic Interaction Detection (CHAID) analysis, constellations of interactive factors emerged differently for women and men, and, between non-problem and problem drinkers. For women, drinking outcomes were related to intra-psychic functioning, and for men, to physical health and social situation. An ongoing quality-of-life assessment may be very important in the comprehensive assistance provided to those older people who are vulnerable to undergoing alcohol-related harms.
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16
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Edwards S, Vendruscolo LF, Gilpin NW, Wojnar M, Witkiewitz K. Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies. Alcohol Clin Exp Res 2020; 44:368-383. [PMID: 31840821 PMCID: PMC11004915 DOI: 10.1111/acer.14260] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
Alcohol use disorder (AUD) and chronic pain are enduring and devastating conditions that share an intersecting epidemiology and neurobiology. Chronic alcohol use itself can produce a characteristic painful neuropathy, while the regular analgesic use of alcohol in the context of nociceptive sensitization and heightened affective pain sensitivity may promote negative reinforcement mechanisms that underlie AUD maintenance and progression. The goal of this review was to provide a broad translational framework that communicates research findings spanning preclinical and clinical studies, including a review of genetic, molecular, behavioral, and social mechanisms that facilitate interactions between persistent pain and alcohol use. We also consider recent evidence that will shape future investigations into novel treatment mechanisms for pain in individuals suffering from AUD.
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Affiliation(s)
- Scott Edwards
- Department of Physiology and Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA 70112
| | - Leandro F. Vendruscolo
- National Institute on Drug Abuse (NIDA), Intramural Research Program (IRP), Baltimore, MD 21224
| | - Nicholas W. Gilpin
- Department of Physiology and Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA 70112
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque NM 87131
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17
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C Evans M, Bazargan M, Cobb S, Assari S. Pain Intensity among Community-Dwelling African American Older Adults in an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3894. [PMID: 31615105 PMCID: PMC6843192 DOI: 10.3390/ijerph16203894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although social, behavioral, and health factors influence prevalence and intensity of pain, very few studies have investigated correlates of pain among economically disadvantaged older African American (AA) adults. OBJECTIVE This study explored social, behavioral, and health correlates of pain intensity among community-dwelling AA older adults in an economically disadvantaged area of Los Angeles. METHODS A cross-sectional study on 740 AA older adults (age ≥ 55 years) was conducted in South Los Angeles between 2015 and 2018. Exploratory variables were age, gender, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, pain-related chronic medical conditions (CMCs), and depressive symptoms. Dependent variable was pain intensity. Linear regression was used for data analysis. RESULTS Age, financial difficulties, living alone, smoking, pain-related chronic medical conditions, and depressive symptoms were associated with pain intensity. Individuals with lower age, higher financial difficulties, those who lived alone, those with a higher number of pain-related chronic medical conditions, more depressive symptoms, and nonsmokers reported more pain intensity. Gender, educational attainment, marital status, and drinking were not associated with pain intensity. CONCLUSION The results may help with the health promotion of economically disadvantaged AA older adults in urban areas.
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Affiliation(s)
- Meghan C Evans
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
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18
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Neddenriep B, Bagdas D, Contreras KM, Ditre JW, Wolstenholme JT, Miles MF, Damaj MI. Pharmacological mechanisms of alcohol analgesic-like properties in mouse models of acute and chronic pain. Neuropharmacology 2019; 160:107793. [PMID: 31562845 DOI: 10.1016/j.neuropharm.2019.107793] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/17/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022]
Abstract
Alcohol use and chronic pain are highly comorbid. Acute alcohol use typically produces an analgesic effect. However, chronic use can worsen the progression of chronic pain. In rodent models, acute models of pain have primarily been used to investigate the relationship between alcohol and pain analgesia. Here, we use two models of chronic pain, chronic inflammatory and peripheral neuropathic pain, to investigate acute alcohol's antinociceptive and analgesic properties. We hypothesize that acute ethanol is acting through opioid receptors to create an analgesic-like effect in both reflexive and affective dimensions of pain. Using male and female C57BL/6J mice, oral ethanol administration (0-1.25 g/kg) showed a dose-dependent reversal of mechanical hypersensitivity in both Complete Freund's Adjuvant (CFA) and chronic constriction injury (CCI) models of chronic inflammatory and neuropathic pain. No sex differences were observed. Using the conditioned place preference (CPP) task to assess the subjective responses to ethanol's anti-nociceptive properties, CCI-injured animals showed a preference for the ethanol-paired side, suggesting a reduction in an aversive and pain-like state produced by nerve injury. These effects are likely mediated through the kappa and possibly the mu opioid systems, since ethanol-induced anti-nociception following CCI was fully reversed by pretreatment with the kappa selective antagonist, nor-BNI, or high doses of naltrexone. These data show that ethanol possesses analgesic-like properties in chronic inflammatory and neuropathic pain models in mice and provide new insight into ethanol as it relates to chronic pain.
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Affiliation(s)
- Bradley Neddenriep
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA; Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - Deniz Bagdas
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA; Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - Katherine M Contreras
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA; Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jennifer T Wolstenholme
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA; VCU-Alcohol Research Center, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - Michael F Miles
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA; VCU-Alcohol Research Center, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA; Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA.
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19
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Zale EL, LaRowe LR, Boissoneault J, Maisto SA, Ditre JW. Gender differences in associations between pain-related anxiety and alcohol use among adults with chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:479-487. [PMID: 30864852 DOI: 10.1080/00952990.2019.1578968] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and consumption, and drinking for pain-coping predicts escalations in alcohol use over time. Pain-related anxiety is a transdiagnostic vulnerability factor that has been implicated in both pain and substance-related (i.e., tobacco, opioids, cannabis) outcomes, but has not yet been studied in relation to alcohol use. Objective: We sought to conduct the first test of cross-sectional associations between pain-related anxiety, gender, and alcohol use. Methods: Adults with chronic pain (N = 234; Mage = 29.54, 67% Female) self-reported pain-related anxiety, gender, and alcohol use (i.e., consumption frequency/quantity, alcohol-related consequences, and dependence symptoms measured with the Alcohol Use Disorders Identification Test; AUDIT). Hierarchical regression and conditional effects models were used to test associations between pain-related anxiety, gender, and alcohol use. Results: Pain-related anxiety was positively associated with alcohol-related consequences and alcohol dependence symptoms measured by the AUDIT among males, but not females. Pain-related anxiety was not associated with the frequency/quantity of alcohol consumption in our sample. Conclusions: These findings are consistent with prior research, which has demonstrated associations between pain-related anxiety and deleterious substance use outcomes. Results provide initial evidence that pain-related anxiety may be a relevant factor to consider in the context of alcohol research and treatment among male drinkers.
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Affiliation(s)
- Emily L Zale
- a Department of Psychology, Binghamton University , Binghamton , NY , USA
| | - Lisa R LaRowe
- b Department of Psychology, Syracuse University , Syracuse , NY , USA
| | - Jeff Boissoneault
- c Department of Clinical and Health Psychology, University of Florida , Gainsville , FL , USA
| | - Stephen A Maisto
- b Department of Psychology, Syracuse University , Syracuse , NY , USA
| | - Joseph W Ditre
- b Department of Psychology, Syracuse University , Syracuse , NY , USA
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20
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Powers JM, Zvolensky MJ, Ditre JW. An integrative review of personalized feedback interventions for pain and alcohol. Curr Opin Psychol 2019; 30:48-53. [PMID: 30825840 DOI: 10.1016/j.copsyc.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 01/12/2023]
Abstract
Interrelations between pain and alcohol consumption are considered to be bidirectional in nature, leading to greater pain and increased drinking over time. Personalized feedback interventions (PFIs), which typically aim to motivate behavior change via presentation of personalized and normative feedback, hold great promise for integrated treatment. There has been no previous review of PFIs for pain, and limited work has focused on examining the utility of PFIs for more established, adult drinkers. Our review of the literature revealed that brief, computer-based PFIs can improve pain outcomes and decrease problematic alcohol consumption. Future research would likely benefit from developing integrated, computer-based PFIs for pain and alcohol misuse. Such approaches offer potential for broad impact, while simultaneously reducing patient and healthcare provider burden.
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Affiliation(s)
| | | | - Joseph W Ditre
- Department of Psychology, Syracuse University, United States.
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21
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Ditre JW, Zale EL, LaRowe LR. A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions. Annu Rev Clin Psychol 2018; 15:503-528. [PMID: 30566371 DOI: 10.1146/annurev-clinpsy-050718-095440] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each confer acute analgesic effects, frequent or heavy use may contribute to the development and progression of chronic pain, and pain may be heightened during abstinence. Additionally, pain can be a potent motivator of substance self-administration, and it may contribute to escalating use and poorer substance-related treatment outcomes. We integrated converging lines of evidence to propose a reciprocal model in which pain and substance use are hypothesized to interact in the manner of a positive feedback loop, resulting in the exacerbation and maintenance of both conditions over time. Theoretical mechanisms in bidirectional pain-substance use relations are reviewed, including negative reinforcement, social cognitive processes, and allostatic load in overlapping neural circuitry. Finally, candidate transdiagnostic factors are identified, and we conclude with a discussion of clinical implications and future research directions.
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA; ,
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York 13902, USA;
| | - Lisa R LaRowe
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA; ,
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22
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Wranker LS, Elmståhl S, Ekström H. Pain and alcohol: a comparison of two cohorts of 60 year old women and men: findings from the Good Aging in Skåne study. Scand J Pain 2018; 18:611-620. [PMID: 29995637 DOI: 10.1515/sjpain-2018-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/16/2018] [Indexed: 11/15/2022]
Abstract
Background and aims Pain, use of painkillers and alcohol are highly prevalent in the general population. Aims of the study were to describe differences in pain, alcohol consumption and use of painkillers among two 60 year old birth cohorts stratified by gender. Methods Participants were recruited from the Skåne centre of The Swedish National study on Aging and Care, a multicentre, prospective, longitudinal study. The sample comprised 60 year old men and women born between 1941 and 1943 and recruited to the study between 2001 and 2004 (n=663) and 60 year old men and women born in the period 1952-1954 and recruited to the study between 2013 and 2015 (n=924). Specially trained research staff conducted the interviews. For descriptive statistics the variables were presented in total numbers, percentages, mean and standard deviation, and 1st and 3rd quartile are also shown. The sample was divided into four groups: men and women born in the period 1941-1943, men and women born in the period 1952-1954, respectively. Results No difference in alcohol intake was detected between the two birth cohorts. All participants, regardless of pain or not, reported alcohol use below the specified risk level for both sexes. Teetotallers were more common in the 1952-1954 male cohort, 128 (29%), p<0.029. Two hundred and eighty one Men born between 1952 and 1954 reported pain (59.0%), compared to 173 men born between 1941 and 1943 (51.6%), p<0.034. There was no difference between the male cohorts in use of painkillers, p<0.062. No difference was found between the two female cohorts in terms of pain, p<0.144. One hundred and ten women in the 1941-43 cohort used painkillers (53.1%) compared to 119 women born between 1952 and 1954 (40.1%), p<0.004. When comparing men and women with pain born between 1941 and 1942, men with moderate pain use more alcohol, 157 g/month (q1 10, q3 365) than women, 44 g/month (q1 0, q3 134), p<0.001. Men with severe pain also use more alcohol, 96 g/month (q1 17, q3 324) than women, 27 g/month (q1 0, q1 118), p<0.030, and when those with pain were merged into a group, men use more alcohol, 175 g/month (q1 31, q3 356), than women, 68 g/month (q1 1, q3 207), p<0.001. This also applies to the later cohort; men, 132 g/month (q1 22, q3 270), compared to women, 76 g/month (q1 8, q3 182), p<0.001. When merging all pain into one group women use more painkillers both in the 1941-43 cohort, men (39.9%) compared to women (53.1%), p<0.010 and in the 1952-54 cohort, men (18.5%) compared to women (26.6%), p<0.003. Use of analgesics and alcohol is common but the highest percentage is among women born between 1941 and 1943, 45 (48.9%). Conclusions Pain and alcohol use are common among 60 year old women and men. A gender difference is that women use more painkillers. In the 1941-43 cohort almost every second woman with moderate pain who took painkillers also consumed alcohol. Implications It is time to alert prescribers that a large section of the population uses alcohol combined with painkillers. More research is needed to better understand the long-term perspective on health when using both painkillers and alcohol.
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Affiliation(s)
- Lena Sandin Wranker
- Department of Health Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden
| | - Henrik Ekström
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden
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23
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Paolillo EW, Obermeit LC, Tang B, Depp CA, Vaida F, Moore DJ, Moore RC. Smartphone-based ecological momentary assessment (EMA) of alcohol and cannabis use in older adults with and without HIV infection. Addict Behav 2018; 83:102-108. [PMID: 29126667 DOI: 10.1016/j.addbeh.2017.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/22/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Ecological momentary assessment (EMA) has been used to characterize substance use among adult populations; however, little is known about the validity of EMA and the patterns and predictors of substance use among older adults with and without HIV infection. METHODS Thirty-five (22 HIV-positive, 13 HIV-negative) older adults aged 50-74 were assessed for 14days and completed up to four smartphone-based surveys per day. RESULTS Participants completed an average of 89.5% of possible EMA surveys. EMA self-reported alcohol and cannabis use were significantly positively correlated with laboratory-assessed, self-reported days of alcohol (r=0.52, p=0.002) and cannabis (r=0.61, p<0.001) used and quantity of alcohol (r=0.42, p=0.013) and cannabis (r=0.41, p=0.016) used in the 30days prior to baseline assessment. In a subset of 15 alcohol or cannabis users, preliminary analyses of the effects of mood and pain on alcohol or cannabis use showed: 1) greater anxious mood predicted substance use at the next EMA survey (OR=1.737, p=0.023), 2) greater happiness predicted substance use later in the day (OR=1.383, p<0.001), and 3) higher pain level predicted substance use earlier in the day (OR=0.901, p=0.005). CONCLUSIONS Findings demonstrate that EMA-measured alcohol and cannabis use has convergent validity among older adults with and without HIV infection. Preliminary results showing predictors of substance use highlight the importance of gathering EMA data to examine daily variability and time-dependent antecedents of substance use among this population.
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Miller MB, Chan WS, Boissoneault J, Robinson M, Staud R, Berry RB, McCrae CS. Dynamic daily associations between insomnia symptoms and alcohol use in adults with chronic pain. J Sleep Res 2018; 27:e12604. [PMID: 28940629 PMCID: PMC5862719 DOI: 10.1111/jsr.12604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/29/2017] [Indexed: 11/28/2022]
Abstract
Individuals with chronic pain are at risk for sleep disruption and heavy alcohol use, yet the daily associations between these behaviours are not well characterized. This study aimed to determine the extent to which alcohol use affects insomnia symptoms and vice versa in adults reporting symptoms of chronic pain. Participants were 73 individuals (93% women) reporting alcohol use in addition to symptoms of insomnia and chronic pain. They completed daily diaries assessing insomnia symptoms and alcohol use for 14 days. Multilevel modelling was used to evaluate the bidirectional associations between alcohol use and insomnia symptoms at the daily level. Consistent with laboratory-based research, alcohol use was associated with decreased sleep-onset latency the same night but increased sleep-onset latency 2 nights later. Specifically, for every alcoholic drink consumed, time to sleep onset decreased by 5.0 min in the same night but increased by 4.3 min 2 nights later. Alcohol use was not significantly associated with subsequent wake after sleep onset or total sleep time, and insomnia symptoms were not significantly associated with subsequent alcohol use. To our knowledge, these data provide the first evidence that alcohol use negatively affects insomnia symptoms up to 2 days post-consumption in patients reporting symptoms of insomnia and chronic pain. Findings suggest that one drink will have minimal impact on sleep, but heavier drinking (e.g. four-five drinks) may have a clinically significant impact (16-25-min increase in sleep-onset latency). Future studies may assess alcohol use as a point of intervention within this population.
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Affiliation(s)
| | - Wai Sze Chan
- Department of Psychiatry, University of Missouri, Columbia, MO
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL
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Koivula R, Tigerstedt C, Vilkko A, Kuussaari K, Pajala S. How does Older People's Drinking Appear in the Daily Work of Home Care Professionals? NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims In this article the authors ask how the alcohol use of elderly home care clients affects the daily work of home care professionals and how the professionals act to support the drinking client. Methods Semi-structured interviews with 10 home care professionals were conducted from December 2014 to February 2015 in the Helsinki metropolitan area of Finland. Everyday situations during home visits related to the clients' alcohol use were analysed according to modalities of agency of the home care professionals. Results The results focus on three themes raised in the interviews: supporting life management of the client, the lack of qualifications in tackling clients' drinking and the need for multi-professional collaboration. Intoxicated clients complicated the home care nurses' work and obstructed the implementation of recommendations set out to guide the professionals' operations. Care work with alcohol-using clients was particularly demanding, and the professionals were concerned about not having enough training in how to encounter elderly clients' drinking. Multi-professional collaboration with substance abuse services and emergency department personnel was called for to remedy this problem. Conclusions More extensive and detailed research is needed for a better picture of how clients' drinking influences home care nurses' working conditions and what kind of skills nurses need in different alcohol-related situations. Such research would have the potential to benefit clients and improve the well-being of the employees.
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Ahangari A, Stewart Williams J, Myléus A. Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 1. Trop Med Int Health 2016; 21:1282-1292. [PMID: 27443945 DOI: 10.1111/tmi.12757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). METHODS The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. RESULTS Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. CONCLUSION Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults.
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Affiliation(s)
- Alebtekin Ahangari
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jennifer Stewart Williams
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden. .,Research Centre for Generational, Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Anna Myléus
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Aguila E, Guerrero EG, Vega WA. Sociodemographic characteristics associated with alcohol use among low-income Mexican older adults. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:16. [PMID: 27129926 PMCID: PMC4850697 DOI: 10.1186/s13011-016-0061-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite increasing concern about the quality of life of older adults, little is known about characteristics associated with health risk behaviors among older adults in middle-income countries. This study relied on unique longitudinal data to examine the relationship between sociodemographic characteristics and alcohol use among low-income older adults, one of the fastest-growing populations worldwide. METHODS This multilevel longitudinal analysis involved three waves of data (2008-2010) from 2,351 adults aged 70 or older in Yucatán, Mexico. Multilevel regressions models were used to test interactions among gender, speaking Mayan (indigenous language), and socioeconomic status to understand conditions associated with the odds of current alcohol use and the frequency and amount of alcohol use. RESULTS Half of the participants in this study report consuming alcohol in their lifetime, 21.58 % of whom were current alcohol users. Older adults reported consuming alcohol 1.15 days a week and 1.60 drinks per day. Speaking Mayan was associated with lower odds of current alcohol use. However, men who spoke Mayan reported higher odds of drinking alcohol compared to women and non-Mayan (Spanish) speakers. The positive relationship between socioeconomic status and alcohol use was also moderated by gender (male). CONCLUSIONS Findings show that older and Mayan populations had lower odds of drinking in Yucatán, Mexico, whereas men were at highest risk of drinking alcohol, after adjusting for ethnic culture and socioeconomic status. Implications for health policy and epidemiological studies on substance use among older adults residing in low-income settings are discussed.
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Affiliation(s)
- Emma Aguila
- Sol Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA 90089, CA, USA.
| | - Erick G Guerrero
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - William A Vega
- Preventive Medicine and School of Social Work, University of Southern California, Los Angeles, CA, USA
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Holdsworth C, Mendonça M, Pikhart H, Frisher M, de Oliveira C, Shelton N. Is regular drinking in later life an indicator of good health? Evidence from the English Longitudinal Study of Ageing. J Epidemiol Community Health 2016; 70:764-70. [PMID: 26797821 PMCID: PMC4975801 DOI: 10.1136/jech-2015-206949] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/01/2016] [Indexed: 02/02/2023]
Abstract
Background Older people who drink have been shown to have better health than those who do not. This might suggest that moderate drinking is beneficial for health, or, as considered here, that older people modify their drinking as their health deteriorates. The relationship between how often older adults drink and their health is considered for two heath states: self-rated health (SRH) and depressive symptoms. Methods Data were analysed from the English Longitudinal Study of Ageing (ELSA), a prospective cohort study of older adults, using multilevel ordered logit analysis. The analysis involved 4741 participants present at wave 0, (1998/1999 and 2001), wave 4 (2008/2009) and wave 5 (2010/2011). The outcome measure was frequency of drinking in last year recorded at all three time points. Results Older adults with fair/poor SRH at the onset of the study drank less frequently compared with adults with good SRH (p<0.05). Drinking frequency declined over time for all health statuses, though respondents with both continual fair/poor SRH and declining SRH experienced a sharper reduction in the frequency of their drinking over time compared with older adults who remained in good SRH or whose health improved. The findings were similar for depression, though the association between depressive symptoms and drinking frequency at the baseline was not significant after adjusting for confounding variables. Conclusions The frequency of older adults’ drinking responds to changes in health status and drinking frequency in later life may be an indicator, rather than a cause, of health status.
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Affiliation(s)
- Clare Holdsworth
- School of Physical and Geographical Sciences, Keele University, Keele, UK
| | - Marina Mendonça
- School of Physical and Geographical Sciences, Keele University, Keele, UK
| | - Hynek Pikhart
- Department of Epidemiology & Public Health, University College London, London, UK
| | | | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Nicola Shelton
- Department of Epidemiology & Public Health, University College London, London, UK
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Choi NG, Marti CNN, DiNitto DM, Choi BY. Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis. West J Emerg Med 2015; 16:1146-58. [PMID: 26759670 PMCID: PMC4703192 DOI: 10.5811/westjem.2015.9.27704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Late middle-aged and older adults' share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. METHODS Data came from the 2013 National Health Interview Survey's Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators. RESULTS LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. CONCLUSION Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | | | - Diana M. DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Bryan Y. Choi
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
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Zale EL, Maisto SA, Ditre JW. Interrelations between pain and alcohol: An integrative review. Clin Psychol Rev 2015; 37:57-71. [PMID: 25766100 PMCID: PMC4385458 DOI: 10.1016/j.cpr.2015.02.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
Abstract
Pain and alcohol use are both highly prevalent in the general population, and pain-alcohol interrelations are of increasing empirical interest. Previous research has identified associations between pain and alcohol dependence, and the current review provides novel contributions to this emerging domain by incorporating studies that have tested relations between pain and low-to-moderate alcohol consumption, and by identifying potential psychosocial mechanisms of action. Specifically, we sought to integrate evidence of pain-alcohol relations derived from two directions of empirical inquiry (i.e., effects of alcohol on pain and effects of pain on alcohol use) across psychological, social, and biological literatures. We observed converging evidence that associations between alcohol consumption and pain may be curvilinear in nature. Whereas moderate alcohol use was observed to be associated with positive pain-related outcomes (e.g., greater quality of life), excessive drinking and alcohol use disorder appear to be associated with deleterious pain-related outcomes (e.g., greater pain severity). We also observed evidence that alcohol administration confers acute pain-inhibitory effects, and that situational pain may motivate alcohol consumption (e.g., drinking for pain-coping). Future research can inform theoretical and clinical applications through examination of temporal relations between pain and alcohol consumption, tests of hypothesized mechanisms, and the development of novel interventions.
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Affiliation(s)
- Emily L Zale
- Syracuse University, Syracuse, NY 13244, United States
| | - Stephen A Maisto
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States
| | - Joseph W Ditre
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States.
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Survival patterns in squamous cell carcinoma of the head and neck: pain as an independent prognostic factor for survival. THE JOURNAL OF PAIN 2014; 15:1015-22. [PMID: 25043982 DOI: 10.1016/j.jpain.2014.07.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED Survival outcomes in patients with squamous cell carcinoma of the head and neck (HNSCC) vary by extent of disease, behavioral factors, and socioeconomic factors. We assessed the extent to which pretreatment pain influences survival in 2,340 newly diagnosed patients with HNSCC, adjusting for disease stage, symptoms, pain medications, comorbidities, smoking, alcohol consumption, age, sex, and race/ethnicity. Patients rated their pain at presentation to the cancer center (0 = "no pain" and 10 = "pain as bad as you can imagine"). Survival time was calculated from the date of diagnosis to the date of death of any cause or last follow-up. Five-year overall survival was calculated for all the variables assessed in the study. Severe pain (≥7) was most prevalent among those with oral cancer (20.4%; pharynx = 18.8%; larynx = 16.1%) and significantly varied by tumor stage, fatigue severity, smoking status, comorbid lung disease, and race (all P < .05) across cancer diagnoses. Overall 5-year survival varied by pain for oral (severe pain = 31% vs nonsevere pain = 52%; P < .001) and pharyngeal cancer (severe pain = 33% vs nonsevere pain = 53%; P < .001). Multivariable analyses showed that pain persisted as an independent prognostic factor for survival. Pain reported prior to treatment should be considered in understanding survival outcomes in HNSCC patients. PERSPECTIVE Pretreatment pain was an independent predictor of survival in a large sample of HNSCC patients even after accounting for tumor node metastasis stage, fatigue, age, race/ethnicity, smoking, and alcohol intake. Therefore, symptoms at presentation and before cancer treatment are important factors to be considered in understanding survival outcomes in HNSCC patients.
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Kelley AS, Langa KM, Smith AK, Cagle J, Ornstein K, Silveira MJ, Nicholas L, Covinsky KE, Ritchie CS. Leveraging the health and retirement study to advance palliative care research. J Palliat Med 2014; 17:506-11. [PMID: 24694096 DOI: 10.1089/jpm.2013.0648] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine's series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject's death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care. SETTING While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas. CONCLUSION In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research.
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Affiliation(s)
- Amy S Kelley
- 1 Brookdale Depratment of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
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