Does treating pain with alcohol affect drinking reduction among women with HIV enrolled in a clinical trial of naltrexone?

Christina E Parisi; Hannah R Gracy; Nicholas J Bush; Robert L Cook; Yan Wang; Natalie Chichetto

doi:10.1111/acer.15165

Does treating pain with alcohol affect drinking reduction among women with HIV enrolled in a clinical trial of naltrexone?

Alcohol Clin Exp Res (Hoboken). 2023 Oct;47(10):1917-1925. doi: 10.1111/acer.15165. Epub 2023 Aug 28.

Authors

Christina E Parisi^{1

2}, Hannah R Gracy², Nicholas J Bush^{2

3

4}, Robert L Cook^{1

2}, Yan Wang^{1

2}, Natalie Chichetto^{1

2}

Affiliations

¹ Department of Epidemiology, University of Florida, Gainesville, Florida, USA.
² Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA.
³ Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA.
⁴ Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USA.

PMID: 37864537
PMCID: PMC10662960 (available on 2024-10-01)
DOI: 10.1111/acer.15165

Abstract

Background: Many women living with HIV (WLWH) experience pain. Alcohol use with the intent to treat pain could lead to hazardous drinking and difficulty in reducing drinking. Naltrexone acts on opioid receptors important for pain regulation and is an approved treatment for alcohol use disorder. In this secondary analysis of a randomized double-blind placebo-controlled naltrexone clinical trial, the goals were to (1) compare alcohol reduction between women who drank to treat pain and those who did not and (2) examine differences in alcohol reduction by both drinking intention and treatment arm.

Methods: Women living with HIV (N = 194, mean age 48.3 years, 83% non-Hispanic Black, 11% Hispanic) with hazardous drinking (>7 drinks/week) were randomized to receive daily treatment with naltrexone 50 mg or placebo for 4 months. Study visits occurred at baseline and 2, 4, and 7 months (posttreatment). The number of drinks/week was measured using the Timeline Follow Back. Use of alcohol to treat pain was self-reported. Participants were categorized as using alcohol to treat pain or not and in the naltrexone or placebo group. Chi-square, t-test, MANOVA, and sequential mixed effects models were used to determine group differences in demographic factors, mean/drinks per week, and percent change in mean drinks/week at baseline and each follow-up visit.

Results: There was a consistent decrease in drinking throughout the study. There was not a significant difference in mean drinks/week at any point in the study between women who used alcohol to treat pain and those who did not. When considering treatment arm, at 2 months only those who did not use alcohol to treat pain in the naltrexone group had a significantly lower mean drinks/week than the other groups (p = 0.007); all groups had similar decreases in drinking from 4 months onward.

Conclusion: In the naltrexone group, WLWH who drank to treat pain reduced their alcohol consumption more slowly than WLWH who did not drink to treat pain. Replication of these findings would suggest that alcohol treatment guidelines should address pain as a factor in drinking outcomes.

Keywords: HIV; alcohol; naltrexone; pain; women.

Abstract

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