Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect

Katie Witkiewitz, Elizabeth McCallion, Kevin E. Vowles, Megan Kirouac, Tessa Frohe, Stephen A. Maisto, Ray Hodgson, Nick Heather

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of 2 clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. Method: Participants included 1,383 individuals from the COMBINE Study (COMBINE Pharmacotherapies and Behavioral Interventions for Alcohol Dependence; COMBINE Study Research Group, 2003; 31% female, 23% ethnic minorities, average age = 44.4 [SD = 10.2]), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age = 41.6 [SD = 10.1]) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). Results: Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. Conclusion: Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse.

Original languageEnglish (US)
Pages (from-to)1044-1057
Number of pages14
JournalJournal of Consulting and Clinical Psychology
Issue number6
StatePublished - Dec 1 2015


  • Alcohol relapse
  • Alcohol use disorder (AUD) treatment
  • Negative affect
  • Pain intensity
  • Pain interference

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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