Substance use disorder treatment: the role of comorbid chronic pain and post-traumatic stress in maintaining substance use

Patients in treatment for alcohol and substance use disorders often have other physical and mental health concerns that can contribute to the development of dependence, and make it more difficult to treat the dependence. Chronic pain and posttraumatic stress disorder (PTSD) are two conditions that are often underdiagnosed and undertreated among patients in substance use treatment. The NOR-APT study will focus on increasing knowledge of chronic pain and PTSD among patients in treatment for substance dependence. The NOR-APT project will 1) describe how many patients in substance use treatment who have chronic pain, and how the pain influences substance use, function and outcomes of the treatment, 2) explore the overlap between chronic pain and PTSD, and 3) explore how dependence, chronic pain and PTSD develop over time, in relation to each other. Up to 1 500 patients in treatment for substance dependence will be invited to complete a survey on alcohol, substance and medication use, pain (duration, location, intensity, impact on social, mental and physical day-to-day function), potentially traumatizing life-events and symptoms of post-traumatic stress. In addition, the patients can consent to the project linking their responses to national demographic and health registries, where information on previous physical and mental health diagnoses, treatments, work situation and more is available. We expect the results from the study to contribute to future research on interventions for patients with dependence, chronic pain and PTSD, and in the long term improve treatment for the patients.

Patients with substance use disorders (SUDs) are characterized by a wide range of comorbidities related to both physical and mental health. These comorbidities may contribute to both development and maintenance of the substance dependence and hinder positive outcomes of substance use treatment. This funding application for the Norwegian Addiction, Pain and Trauma study (NOR-APT) will focus on two comorbidities that are typically underdiagnosed and undertreated among patients with SUD; chronic pain conditions and post-traumatic stress disorder (PTSD). Despite knowledge of the high prevalence of chronic pain and PTSD among patients with substance use disorders, there are two large knowledge gaps related to pain and trauma among people with SUDs. 1) There is little knowledge of chronic pain characteristics among different types of substance dependence, chronic pain treatment history and impacts on substance use outcomes 2) There is no study of the overlap between chronic pain and PTSD among patients with different types of substance dependence, and the trajectories for development of comorbid SUD, chronic pain and post-traumatic stress. The ongoing NOR-APT study will contribute knowledge towards these gaps through a rarely utilized research design where self-reported patient survey data are combined with high quality, nearly complete, longitudinal registry data from the first and second line health care services and the prescription database. Data is collected from patients in inpatient, outpatient and detoxification treatment at four hospital sites. Over 800 patients have participated per march 2023, the goal of 1?500 participants is estimated to be reached by the end of 2023. This proposal will fund necessary expenses for achieving the research goals of the study. This includes salary for the PI (4 years, 50%), a 3-year fulltime phd candidate, and expenses for linkage to registry data, secure data storage and conferences/seminars.