An Examination of Chronic Pain and Opioid Use Among Veterans with and without Alcohol Use Disorder

Chronic pain is devastating and highly prevalent among Veterans in the United States (Johnson, Levesque, Broderick, Bailey & Kerns, 2017). While there are various treatment options for chronic pain, opioids remain high in popularity. Although opioids are fast-acting and effective, potential consequences range from unpleasant side effects to dependence and fatal overdose (Baldini, Korff & Lin, 2012; Park et al., 2015; Kaur, 2007). The effects of opioid treatment can be further complicated by a history of alcohol abuse. Past alcohol abuse is a risk factor for opioid misuse (McCabe et al., 2008). One alternative to opioid medication is Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). CBT-CP has shown small to moderate effects on chronic pain after the end of treatment (Naylor, Keefe, Brigidi, Naud & Helzer, 2008). The current study examined the effect of CBT-CP on opioid prescriptions, as well as the role of past alcohol abuse in CBT-CP efficacy, through an archival data analysis of Veterans Affairs patient charts. In order to determine the effect of CBT-CP on opioid prescriptions, an opioid change score was calculated from treatment start date to twelve months post-treatment. An analysis of 106 patient charts demonstrated no statistically significant difference in opioid prescriptions between Veterans who were referred and attended treatment (n = 24) and those who were referred but did not attend (n = 82). Veterans from both groups showed a reduction in prescribed opioids during a 12-month period. Furthermore, there was no statistically significant difference between Veterans with versus without a history of alcohol abuse in terms of the change in opioid prescriptions over a 12-month period (both groups showed reductions). This research suggests that opioid prescriptions may decrease over time among Veterans referred for CBT-CP, even among those who do not participate in the groups. More work is needed to understand the relationship between opioid prescriptions and actual opioid use over time among Veterans who do and do not choose to participate in CBT-CP. Continuing to address poly-substance use in chronic pain patients also is critical to ensure that Veterans suffering from chronic pain receive appropriate intervention.