Elsevier

Drug and Alcohol Dependence

Volume 158, 1 January 2016, Pages 167-171
Drug and Alcohol Dependence

Short communication
Reductions in physical pain predict lower risk of relapse following alcohol treatment

https://doi.org/10.1016/j.drugalcdep.2015.11.020Get rights and content

Highlights

  • Relationship between pain and relapse in alcohol-dependent patients was explored.

  • Decrease in pain level after treatment was associated with lower risk of relapse.

  • Managing pain may be useful in improving treatment outcomes of alcohol dependence.

Abstract

Objective

Physical pain is considered a potential predictor of relapse in alcohol-dependent individuals after treatment. The aim of this study was to evaluate whether reductions in pain level during the follow-up period after treatment were associated with lower relapse risk.

Method

A sample of 366 participants was recruited from alcohol treatment centers in Warsaw, Poland. At baseline, information was obtained about pain level, demographics, childhood abuse, impulsivity, depressive symptoms, severity of alcohol and sleep problems. After finishing the alcohol treatment program, patients were followed for 12 months and alcohol drinking (relapse) as well as pain severity were evaluated.

Results

In the followed-up group, 29.5% of patients confirmed that they drank any alcohol during past 4 weeks. Comparing follow-up to baseline pain, 48.6% of subjects reported an increased severity of pain, 28.8% reported the same level of pain, 22.6% reported decreased level of pain. There was a significant association between the decrease in level of pain and the lower risk of relapse. Other factors associated with relapse during 4 weeks prior to the follow-up were baseline severity of depressive symptoms, low baseline social support and number of drinking days during 4 weeks prior to entering treatment. In multivariate analysis, a decrease in pain level was associated with a lower likelihood of relapse (OR = 0.159; 95%CI:0.04–0.62; p = 0.008) even when controlled for other factors associated with relapse.

Conclusions

Decreases in pain level following treatment for alcohol dependence are associated with, and may contribute to, a lower risk of alcohol relapse.

Introduction

Heavy alcohol use is a major contributor to social and economic harm. In Poland, about 3% of the Polish general population meets criteria for alcohol dependence and another 5–7% of the population drinks alcohol in a harmful way (PARPA, 2008). Alcohol use disorder (AUD) treatment (Connors et al., 1996) is generally associated with improved longer-term outcomes relative to no treatment, but post-treatment relapse remains a significant problem (MATCH, 1997, Moos and Moos, 2006).

One potential factor that could relate to alcohol relapse is physical pain. Population studies, as well as data from clinical settings, indicate that pain and alcohol dependence commonly co-occur (Jakubczyk et al., 2015, Subramaniam et al., 2013, Von Korff et al., 2005). In addition, in adults entering inpatient AUD treatment, physical pain is associated with sleep problems, general psychopathology and severity of alcohol dependence (Jakubczyk et al., 2015), all of which are considered important risk factors for relapse (Boschloo et al., 2012, Bottlender and Soyka, 2005, Brower, 2003, Loree et al., 2014). Therefore, it is possible that physical pain could be associated with the risk of alcohol relapse. Prior studies of adults treated for a mixture of drug and alcohol problems found that higher pain predicts greater use of substances following treatment (Caldeiro et al., 2008). However, it is unclear if these results would generalize to AUD samples. In addition, Witkiewitz and colleagues (2015) utilized data from two large clinical trials and found that greater physical pain at baseline was associated with increases in heavy drinking, as well as drinking lapses, during and following alcohol use disorder treatment.

The present study extends Witkiewitz's work by studying the association between pain and AUD outcomes under real-world (non-experimental) treatment conditions. Specifically, we evaluated whether reductions in pain level during the follow-up period were associated with lower relapse risk after controlling for other potential predictors of relapse (Boschloo et al., 2012, Bottlender and Soyka, 2005, Brower, 2003, Loree et al., 2014).

Section snippets

Participants

The study received approval from the Bioethics Committee at the Medical University of Warsaw and the Medical School Institutional Review Board at the University of Michigan.

For this study, a group of 366 alcohol-dependent individuals entering abstinence-based, inpatient treatment programes in Warsaw, Poland, was recruited. The inclusion criteria were age more than 18 and a current diagnosis of alcohol dependence according to the DSM-IV criteria (A.P.A., 2000). The exclusion criteria were a

Relapse

Follow-up data were available for 50% of individuals (n = 183) who completed the baseline assessment. In the followed group, 29.5% of patients confirmed that they drank any alcohol during last 4 weeks; 94.2% of patients reported heavy drinking during the relapse.

Discussion

In this study, decreases in physical pain from baseline (at the start of treatment) to follow-up 1 year later were significantly correlated with lower likelihood of relapse even after controlling for other, well-recognized predictors of drinking. To the best of our knowledge, this is the second study, after the work of Witkiewitz and colleagues (2015), to report the association between pain and relapse in a group of alcohol-dependent patients and the first study to report this association using

Contributors

All authors contributed to the conceptualization and design of the analyses. MW, KB, MI and FB designed the study and wrote the protocol. AJ, MK, Anna K, Aleksandra K contributed to the data collection. AJ, KB, AB, MI took responsibility for conducting analyses. AJ, Aleksandra K, Anna K and MK managed the literature search. AJ and MI wrote the first draft of the manuscript. FB, MW and KB provided substantive and conceptual feedback on all drafts. All authors contributed to and have approved the

Conflict of interest

No conflict declared.

Role of funding source

This study was supported by the National Science Center grant [2012/07/B/HS6/02370; PI: Wojnar], the Polish Ministry of Science and Higher Education grant [2P05D 004 29; PI: Wojnar] the Fogarty International Center/NIDA International Substance Abuse Research Program grant [D43-TW05818; PI: Zucker], the Fogarty International Center /NIAAA International Collaborative Alcohol & Injury Research Training Program grant [D43-TW007569; PI: Blow], National Institute on Alcohol Abuse and Alcoholism grant

Acknowledgments

We thank all members of the research team in Poland (especially Anna Wnorowska, MD; Katarzyna Kositorna, MS; JuliaPupek, MD; Piotr Serafin, MD; Izabela Nowosad, MD) as well as the medical staff and patients at Kolska Addiction Treatment Center in Warsaw for their support of this research.

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