Chronic Pain Acceptance Moderates the Association Between Pain Intensity and Alcohol Use Severity Among Veterans With Chronic Musculoskeletal Pain

Alcohol Clin Exp Res (Hoboken). 2026 Jun;50(6):e70305. doi: 10.1111/acer.70305.

ABSTRACT

BACKGROUND: Chronic pain and hazardous alcohol use are prevalent and commonly co-occur among US veterans. A growing literature highlights pain as a motivator of alcohol consumption, with evidence suggesting more intense pain is associated with an increased likelihood of drinking for pain management. Although chronic pain acceptance (i.e., willingness to experience chronic pain and its sequelae while maintaining engagement in valued life activities) has emerged as a protective factor in the context of opioid-related behavior, its role in shaping pain-alcohol relations has not been examined. The goal of this cross-sectional study was to test chronic pain acceptance as a moderator of the association between pain intensity and alcohol use severity among veterans with chronic musculoskeletal pain.

METHODS: Veterans (N = 429; M_age = 56.6) were recruited via Qualtrics Panels for an online survey. Measures included the Graded Chronic Pain Scale, Chronic Pain Acceptance Questionnaire, and Alcohol Use Disorders Identification Test. Hierarchical linear regression and conditional effects models were used to test associations between pain intensity, chronic pain acceptance, and alcohol use severity.

RESULTS: Chronic pain acceptance moderated the relationship between pain intensity and alcohol use severity, with a positive association observed at low but not moderate or high levels of acceptance. Exploratory subgroup analyses among veterans scoring above threshold for hazardous drinking also revealed an interaction, though none of the conditional effects were statistically significant.

CONCLUSIONS: The current findings suggest that higher levels of chronic pain acceptance may buffer the impact of pain on alcohol use. Additional research is needed to evaluate the utility of acceptance-based interventions for veterans with co-occurring chronic pain and hazardous drinking.

PMID:42283800 | DOI:10.1111/acer.70305