Chronic pain acceptance may reduce link between pain intensity and alcohol use severity among veterans

by Research Society on Alcohol

edited by Gaby Clark, reviewed by Andrew Zinin

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Accepting chronic pain—being willing to experience pain while maintaining valued activities—may protect against higher alcohol use severity among veterans with chronic musculoskeletal pain, according to a preliminary study. More than 1 in 4 U.S. veterans report drinking at levels that increase the risk of alcohol-related harms, and 1 in 3 experiences chronic pain. The conditions commonly overlap among veterans, and possibly also in the brain, with some research pointing to shared neurobiological pathways affecting stress and reward signaling.

Research has linked more intense pain to heightened alcohol use as a means of self-medicating and avoidance. Rigid or habitual attempts to control pain are associated with pain-related distress and maladaptive coping, including substance use. Chronic pain acceptance, in contrast, is linked to reduced pain-related disability and lower dependence on pain medication, including opioids.

For the study in Alcohol: Clinical & Experimental Research, investigators at Syracuse University explored chronic pain acceptance and alcohol use patterns. They surveyed 429 veterans (76% male, 74% white) who reported chronic musculoskeletal pain and recent drinking, using scales measuring pain intensity and acceptance, alcohol use and other data.

Statistical analysis showed that among veterans with lower levels of pain acceptance, greater pain intensity was linked to higher alcohol use severity. But those with moderate or high levels of pain acceptance did not show the same link between pain intensity and alcohol use severity. The relationship between pain intensity and chronic pain acceptance accounted for 2.2% of the variance in alcohol use severity, a small effect size but typical of interaction effects in behavioral health research.

Higher drinking severity was linked to being younger, male, white or Hispanic, smoking, using opioids for pain and being early in the pain trajectory (versus familiar with long-term pain).

The study adds to a growing literature linking acceptance of chronic pain and substance use behavior. Veterans experiencing more intense pain and lower levels of chronic pain acceptance may be more likely to report higher alcohol use severity. The study suggests potential clinical value in screening for risk factors and could inform more personalized treatment strategies. Acceptance-based interventions, such as Acceptance and Commitment Therapy, may warrant further study in co-occurring chronic pain and drinking patterns that increase the risk of alcohol-related harms. Ongoing research is needed.

More information

Chronic Pain Acceptance Moderates the Association Between Pain Intensity and Alcohol Use Severity Among Veterans With Chronic Musculoskeletal Pain, Alcohol: Clinical and Experimental Research (2026). doi.org/10.1111/acer.70305Digital Object Identifier (DOI)

Key medical concepts

Acceptance and Commitment TherapyAnalgesics, Opioid

Clinical categories

PsychiatryPsychology & Mental health Provided by Research Society on Alcohol Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

Andrew Zinin

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