Gender moderates the association between distress tolerance and alcohol use among individuals with opioid use disorder

Highlights

• Alcohol use is common among individuals with opioid use disorder (OUD).

• Distress tolerance (DT) was related to alcohol use among women with OUD.

• DT was not related to alcohol use among men with OUD.

• Improving DT may be a mechanism to reduce alcohol use in women with OUD.

Abstract

Background

Alcohol use among individuals with opioid use disorder (OUD) can be dangerous, and understanding factors contributing to alcohol use in this population is important. The current study examined alcohol use among individuals with prescription OUD based on distress tolerance. It was hypothesized that individuals with greater distress tolerance abilities would have a lower frequency and quantity of alcohol use compared to individuals with less distress tolerance. It was also hypothesized that this association would differ based on gender.

Methods

A total of 122 individuals with prescription OUD participated in the current study. Participants completed questionnaires regarding demographics, distress tolerance, mental health symptoms, and frequency and quantity of alcohol in the past 30 days. A regression model was conducted using the alcohol-related variables as outcomes.

Results

There was a significant interaction between gender and distress tolerance on alcohol use frequency. Greater distress tolerance was associated with fewer alcohol use days in women, but there was no association between distress tolerance and alcohol use days in men.

Conclusions

The findings suggest that distress tolerance skills may be key to reducing alcohol use in women with prescription OUD.

Introduction

Opioid use is a significant public health problem in the United States (Brady et al., 2015; Gostin et al., 2017). During 2016, 18 million Americans misused prescription drugs, and 2.7 million met criteria for opioid use disorder (OUD; Center for Behavioral Health Statistics and Quality, 2016; Hughes et al., 2016). A meta-analysis of US clinical trials found that 38%–45% of patients seeking treatment for OUD met criteria for an alcohol use disorder (Hartzler et al., 2010, 2011). In high doses, both opioids and alcohol independently induce respiratory depression, and concurrent abuse of these substances increases the risk of fatal overdose (Ferri et al., 2014; Sebanjo et al., 2007; Spanagel and Vengeliene, 2013). While extensive prior studies examine opioid and alcohol use individually, significantly less literature characterizes the prevalence, impact, and treatment of co-occurring opioid and alcohol use (Soyka, 2015). Understanding factors influencing alcohol use patterns in the opioid-dependent population is of grave importance.

Distress tolerance is the ability to withstand negative emotional states (Simons and Gaher, 2005) and is associated with alcohol use problems (Gorka et al., 2012; Holzhauer et al., 2017) and drinking to cope with negative emotions (Howell et al., 2010; Vujanovic et al., 2011). Low distress tolerance predicts opioid misuse among patients with chronic pain (McHugh et al., 2016), and opioid relapse is more likely among people with low distress tolerance (Strong et al., 2012). Further, brief treatment targeting distress tolerance can result in decreases in opioid relapse among individuals with OUD (Stein et al., 2015).

Individual differences in distress tolerance may be especially relevant to understanding alcohol use among individuals with OUD. Individuals with OUD report cravings when experiencing withdrawal symptoms, exposure to opioid drug cues, and emotional distress (Back et al., 2015; Hyman et al., 2007), therefore, individuals with OUD and a low threshold for tolerating distress may be at greater risk of consuming alcohol. Among individuals with OUD, women were more likely than men to use additional medications to enhance the effects of pain medication (Back et al., 2009) and reported greater opioid cravings (Back et al., 2011). Further, among individuals engaged in substance use treatment, depressive symptoms were associated with substance use problems among women low in distress tolerance, but this association was not significant for men (Ali et al., 2015).

The current study examined the association between distress tolerance and alcohol use among individuals who met criteria for prescription OUD. It was hypothesized that greater distress tolerance abilities would be associated with less alcohol use. Because several reports suggest that men with prescription OUD are more likely to use alcohol than women (Back et al., 2011; Hartzler et al., 2011), it was hypothesized that men would use more alcohol than women and that the association between distress tolerance and alcohol use would be moderated by gender.