Development of a Personalized Feedback Intervention Targeting Pain-Related Anxiety for Hazardous Drinkers with Chronic Pain

Objective: Hazardous alcohol use contributes to mental and physical health problems, disability, and may lead to an increased risk of premature death. Among individuals with chronic pain, the rate of hazardous alcohol use is elevated compared to the general population, yet, hazardous alcohol users with chronic pain remain an underserved group. There is a critical need to test alternative and complementary approaches to the implementation of effective interventions to reduce hazardous alcohol use among this high-risk segment of the general population; doing so in an integrated fashion may provide a more efficient and targeted intervention approach. Targeting pain-related anxiety, a transdiagnostic vulnerability factor that is prospectively associated with both hazardous drinking and chronic pain, may be beneficial. Thus, more work is needed to evaluate the benefit of targeting elevated pain-related anxiety among hazardous drinkers with chronic pain. Method: Our approach followed a staged model (1a/1b) consistent with NIH guidelines for developing and standardizing behavioral interventions. Phase IA involved collecting qualitative feedback from hazardous drinkers with chronic pain (N = 9; 77.8% female, Mage = 33.86, sd = 8.75) to refine intervention content and evaluate treatment acceptability and feasibility. For phase 1b, hazardous drinkers with chronic pain (N=118; 57.3% male, Mage = 35.24, sd = 11.90) participated in a pilot randomized clinical trial designed to compare pain-related anxiety/alcohol PFI (PA-PFI) to a health information control condition. assessment only among a sample of 130 hazardous drinkers with chronic pain. The primary aims focused on examining the effects of the PA-PFI on alcohol use, intention/motivation to reduce drinking, pain-related anxiety, and expectancies for alcohol analgesia/pain coping. Results: Results indicated that participants reduced drinking and primary outcomes changed in the expected directions. However, there was no effect of treatment condition on the changes in outcomes. Mean differences were in the expected directions, but did not reach statistical significance. Conclusion: Current data provide preliminary evidence for the utility of computer-based brief interventions to encourage behavior change, and targeting pain-related anxiety in the context of chronic pain may impact drinking behavior. However, the effects were limited in magnitude, and future work in this domain is warranted.