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. Author manuscript; available in PMC: 2022 Mar 1.
Published in final edited form as: Pain. 2021 Mar 1;162(3):787–793. doi: 10.1097/j.pain.0000000000002077

Table 1.

Relationship between chronic pain and substance use

Causal Path Illustrative quote
Independent Onset of Chronic Pain and SUD
SUD Prior to Pain “I mean I drank all my life…one way or another, off and on…but I’d say the last 15, 20 years it’s gotten progressively worse due to stress and depression… I just started drinking more and more. And with the pain… it was just another excuse. I felt like I had to drink to kill the pain.”
Pain Recognized in Sobriety “When I first started using the meth and coke, I just started doing it because I liked it…And then I got clean in 1984…And I relapsed in ‘92. When I relapsed that’s right around the time…I got diagnosed with the back problems. During my sobriety is when I was really feeling that pain. I went through a divorce and I ended up relapsing… That’s when I realized that if I started getting high on meth, I wasn’t suffering the pain nearly as much.”
Self-Medication of Physical and Emotional Pain
Substance Used to Treat Pain “I mean my only thing I really knew to do, and I basically developed my own thing, is I just basically drink a lot of alcohol. Daily. I became a daily drinker…That’s how I managed pain, how I managed to get to sleep, and also other stuff. Just being a post-deployment person.”
Opioid Medication for Pain Catalyzes Substance Use
Brief Exposure to Opioids “…[it] was just like a one or two-time thing… but, I realized how it made me feel. And [in] the military I got pain medication a couple times when I was in Iraq. But not for long periods of time… I would always tell the doctors, I don’t want to get on this stuff but I’ll use it temporarily… And then after I came back from Iraq… that’s when I started self-medicating. And honestly, I used my back as an excuse… I personally don’t think that pain medication helped my back at all. But it helped me not care. And I liked pain medication.”
Rapid Opioid Taper Reveals SUD … the guy was an idiot. But he gave me what I wanted [opioids] And it was easy for me to agree with him and justify it, “Oh he’s a doctor, he knows better than I do”…and then of course they [VA staff] were all happy to tell me… that he no longer works here. There was no, “well we’re gonna cut you down slowly.” So two days later I was buying heroin.