Gender differences in associations between pain-related anxiety and alcohol use among adults with chronic pain

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; M_age = 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.