Date of Award

8-22-2025

Date Published

September 2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Advisor(s)

Joseph Ditre

Keywords

alcohol;chronic pain acceptance;pain;veterans

Subject Categories

Clinical Psychology | Psychology | Social and Behavioral Sciences

Abstract

The co-occurrence of chronic pain and unhealthy alcohol use is common among veterans and associated with worse treatment outcomes and greater functional impairment relative to either condition alone. Accordingly, the U.S. Department of Veterans Affairs (VA) has underscored the importance of addressing co-occurring medical conditions in their clinical practice guidelines for substance-related disorders. Recent legislation has also oriented the VA towards complementary and integrative health therapies to minimize opioid prescriptions for chronic pain. Thus, identifying malleable psychological factors linking pain to alcohol use is a vital step in the development of tailored interventions for veterans. The goal of the current study was to examine the moderating role of chronic pain acceptance in pain-alcohol relations among veterans with chronic musculoskeletal pain. Veterans (N = 429; Mage = 56.6) were recruited via Qualtrics Panels for an online survey and completed validated measures of pain intensity, chronic pain acceptance, alcohol use severity, and perceptions of alcohol-assisted pain coping. Hierarchical linear regression and conditional effects models were used to test associations between pain intensity, chronic pain acceptance, and alcohol outcomes. Results indicated that chronic pain acceptance moderated the relationship between pain intensity and alcohol use severity, with a significant positive association observed at low, but not moderate or high, levels of acceptance. In addition, pain intensity and chronic pain acceptance were independently associated with perceptions of alcohol-assisted pain coping. Extending previous research linking chronic pain acceptance to opioid-related outcomes, the current findings suggest greater pain acceptance may buffer the impact of pain on alcohol use. Chronic pain acceptance may represent a promising treatment target for veterans with co-occurring pain and alcohol use.

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Open Access

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