Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic.

Alcohol use disorder (AUD) and chronic pain disorders are pervasive, multifaceted medical conditions that often co-occur. However, their comorbidity is often overlooked, despite its prevalence and clinical relevance. Individuals with AUD are more likely to experience chronic pain than the general population. Conversely, individuals with chronic pain commonly alleviate their pain with alcohol, which may escalate into AUD. This narrative review discusses the intricate relationship between AUD and chronic pain. Based on the literature available, the authors present a theoretical model explaining the reciprocal relationship between AUD and chronic pain across alcohol intoxication and withdrawal. They propose that the use of alcohol for analgesia rapidly gives way to acute tolerance, triggering the need for higher levels of alcohol consumption. Attempts at abstinence lead to alcohol withdrawal syndrome and hyperalgesia, increasing the risk of relapse. Chronic neurobiological changes lead to preoccupation with pain and cravings for alcohol, further entrenching both conditions. To stimulate research in this area, the authors review methodologies to improve the assessment of pain in AUD studies, including self-report and psychophysical methods. Further, they discuss pharmacotherapies and psychotherapies that may target both conditions, potentially improving both AUD and chronic pain outcomes simultaneously. Finally, the authors emphasize the need to manage both conditions concurrently, and encourage both the scientific community and clinicians to ensure that these intertwined conditions are not overlooked given their clinical significance.

Exploring the Relationship Between ADHD Symptoms and Daily Cannabis Consequences in Emerging Adulthood: The Role of Cannabis Motives.

OBJECTIVE: Research has documented the relationship between attention-deficit/hyperactivity disorder (ADHD) and increased cannabis use, but the studies largely rely on cross-sectional or longitudinal designs. Few studies have examined the impact of recent (i.e., past 6 months) ADHD symptoms on more proximal cannabis-related factors. The purpose of the current study was to examine the relationship between cannabis use motives (coping, boredom, and sleep) and consequences and the impact of ADHD symptoms on these relationships. METHOD: Participants were 62 emerging adults (ages 19-25 years; M = 22.12, SD = 2.07; 60% male) who used cannabis regularly (two or more times in the past 2 weeks) and completed a screener assessing past-6-months ADHD symptoms at baseline followed by 14 daily reports on cannabis use, consequences, and motives. RESULTS: Across the 14 days, cannabis consequences were higher for participants with greater past-6-months symptoms of ADHD. In addition, on days when participants used cannabis for boredom and on days when they used cannabis for sleep, cannabis consequences were higher. Although greater past-6-months ADHD symptoms were associated with more consequences on days when sleep motives were endorsed, contrary to hypotheses, the strength of this relationship was greater on days when sleep motives were not endorsed. Overall, greater daily consequences for those with higher ADHD symptoms may reflect exacerbation of these symptoms, and follow-up analyses revealed that the cannabis consequences associated with higher ADHD scores were indeed ones that overlap with ADHD symptoms. CONCLUSIONS: The results suggest that ADHD symptoms, along with sleep and boredom motives, contribute to increased daily cannabis consequences and should be considered in developing interventions for emerging adults.

Extraversion modulates cortisol responses to acute social stress in chronic major depression.

BACKGROUND: Chronic Major Depressive Disorder (CMDD) is a common, disabling illness that is often complicated by high reactivity to social stress. To further elucidate the nature of this reactivity, the current study evaluated whether the personality dimensions of neuroticism and extraversion influenced cortisol responses to a social challenge in CMDD patients vs. controls. METHODS: Fifty participants with CMDD and 58 healthy controls completed the Trier Social Stress Test (TSST) using a standard protocol. Neuroticism and extraversion were measured using the Revised NEO Personality Inventory. Hierarchical linear regressions assessed associations between independent variables neuroticism and extraversion and dependent variable cortisol area-under-the-curve increase (AUCi) in response to the TSST in the two study groups. RESULTS: The extraversion-by-group interaction was a significant predictor of cortisol AUCi, while no significant findings related to neuroticism were found. Simple slopes analysis revealed a significant negative association between extraversion and AUCi in the CMDD group, but not in healthy controls. Post-hoc analysis of the raw cortisol data over time found that CMDD participants with higher extraversion scores had significantly higher pre-challenge cortisol levels than did other study participants, however this did not explain or confound the AUCi results. CONCLUSIONS: In participants with CMDD but not in controls, higher levels of extraversion were associated with higher pre-challenge cortisol levels and decreased cortisol reactivity during the TSST, however these two findings were statistically independent. These findings underline the importance of considering personality factors when studying stress biology in CMDD patients. Extraversion may prove to be an important intermediate target for both research and clinical work in this complex, heterogenous and often treatment-resistant population.