Citation

Ferguson E, Zale E, Ditre J, Wesolowicz D, Stennett B, Robinson M, Boissoneault J. Ann. Behav. Med. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1093/abm/kaaa072

PMID

32914834

Abstract

BACKGROUND: Pain and substance use are frequently comorbid and have been shown to exert bidirectional effects. Self-medication of pain and distress via substance use is common and can be understood via negative reinforcement, ultimately strengthening the pathway between pain to substance use over time. As such, a testable model of the potentially modifiable candidate mechanisms that underlie the pain to substance use pathway is needed.

PURPOSE: This review proposes a testable model of pain as an antecedent to substance use to guide future research and inform clinical practice.

METHODS: An integrative review of current evidence regarding pain, substance use, and associated risk factors (i.e., negative affect, pain-related attitudes, negative urgency, and substance use outcome expectancies) was conducted.

RESULTS: The Catastrophizing, Anxiety, Negative Urgency, and Expectancy (CANUE) model highlights modifiable risk factors for self-medicating pain with substance use, including increased negative affect and maladaptive pain-related attitudes (i.e., pain catastrophizing, pain anxiety, and fear of pain), negative urgency, and substance-related outcome expectancies for pain relief and enhanced pain coping.

CONCLUSIONS: Targeted behavioral and psychological interventions that address these factors may facilitate more adaptive pain-coping responses, thereby reducing the impacts of pain on substance use. Systematic research is needed to evaluate the validity and clinical utility of this model.

Language: en

Keywords

Alcohol; Substance use; Cannabis; Pain; Nicotine; Opioid use