Date of Award

Winter 12-22-2021

Degree Type


Degree Name

Master of Science (MS)




Ditre, Joseph W.


behavioral health, benzodiazepines, chronic pain, prescription drug misuse, substance use

Subject Categories

Clinical Psychology | Psychology | Social and Behavioral Sciences


Benzodiazepines (BZDs), a class of sedative-hypnotic drugs, are at the center of an emerging prescription drug crisis. From approximately 1995-2015, overdose deaths involving BZDs quadrupled and average dose equivalents more than tripled. Specific concern has centered on elevated rates of BZD use among individuals with chronic pain, given that BZDs are generally not indicated for pain management. Consistent with negative reinforcement and motivational models of substance use, desire for pain alleviation may be a salient motivator of BZD use, particularly as individuals commonly report using BZDs for negative affect alleviation. The present study tested cross-sectional associations between pain intensity and clinically relevant BZD use patterns among individuals with chronic pain. We also examined the role of pain catastrophizing, a malleable transdiagnostic factor reflecting negative cognitive-affective pain responses. Participants were 306 adults (Mage = 38.7, 38.9% female) with chronic musculoskeletal pain and a current BZD prescription who completed an online survey study via Amazon Mechanical Turk. Hierarchical linear regression results indicated that pain intensity was positively associated with past-month BZD use frequency and BZD dependence severity. Logistic regression results indicated that greater pain intensity was associated with a 1.2 times greater likelihood of endorsing BZD misuse behaviors. Pain catastrophizing was positively associated with BZD dependence severity and likelihood of BZD misuse, after accounting for pain intensity. Initial findings implicate pain/pain-related cognitive-affective processes in higher-risk BZD use, and suggest pain relief is a common, yet underrecognized, self-reported motivation for taking BZDs. Future research should examine mechanisms underlying pain-BZD covariation and co-use behaviors.


Open Access



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