Substance use and misuse patterns and disability status in the 2020 US National Alcohol Survey: A contributing role for chronic pain.
Sharon Reif, Katherine J Karriker-Jaffe, Anne Valentine and 4 others
PMID 35341718WHAT IT FOUND
Adults with disabilities were less likely to drink but more likely to misuse prescription drugs and use nicotine daily.
Chronic pain accounted for 17–38% of the link between disability and substance use, suggesting unmanaged pain drives self-medication rather than disability itself.
Key findings
01People with disabilities had significantly higher odds of daily nicotine use, any drug use, and prescription drug misuse compared to those without, even after adjusting for demographics and mental health.
02Chronic pain acted as a mediator, explaining 17–38% of the association between disability status and substance use, particularly for drug misuse and nicotine.
03Among those who drank, people with disabilities reported significantly more days of high-intensity drinking (8+ drinks) than those without disabilities.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study is cross-sectional, so it cannot determine if substance use caused disability or if disability led to substance use. Disability was defined by self-report and only four indicators, potentially underestimating the true prevalence or missing specific types of impairment. The survey excluded institutionalized populations, who often have higher rates of disability and substance use. Substance use measures were dichotomous (yes/no) for most outcomes, so the study could not assess the severity or frequency of use beyond the binary category. Self-reported data may be subject to underreporting of substance use.
Declared interests
Funding was provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA). The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that disability itself directly causes substance misuse. The findings suggest that chronic pain is a major driver, mediating up to 38% of the link, so addressing pain management is likely more critical than focusing solely on disability status.