Alcohol use in adolescent chronic pain: Prevalence rates, perceptions of risk, and predictors of use

Alcohol use (AU) in pediatric chronic pain may exacerbate pain and impact adult substance use behavior. This study characterizes prevalence rates and biopsychosocial correlates of AU in adolescents with chronic pain. Cross-sectional survey study comprising adolescents aged 14-19 with chronic pain from a tertiary pediatric pain clinic. Among 243 adolescents, (68.70% female, Mage=16.9 [1.42] years), lifetime AU prevalence was 32.1% (78/243); past-year and past-month AU were 30.45% (74/243) and 16.46% (40/243), respectively. Adolescents endorsing AU were older, with higher depressive symptoms (ps<0.05). Age (OR=1.73, 95%CI [1.36-2.21], p < 0.001), depression (OR=2.18, 95%CI [1.28-3.74], p = 0.004), and behavioral approach (OR=1.18, 95%CI [1.02-1.37], p = 0.03) were significant predictors of lifetime AU. Adolescents who endorsed AU as less risky had higher odds of more frequent past-year AU compared to those who endorsed AU as more risky (OR ranged from 7.13 to 91.60, ps<0.02). Lifetime cannabis use (OR 5.71, 95%CI [2.17, 15.07], p < 0.001) and older age (OR 1.65, 95%CI [1.15, 2.38], p = 0.007) were associated with higher past-year AU frequencies. Findings highlight depressed mood and low risk perception as potential intervention targets to reduce alcohol-related harm in adolescents with chronic pain.