Psychological, behavioral, cognitive and social factors associated with single vs dual alcohol and cannabis use in adolescents with chronic pain.

PURPOSE: Alcohol and cannabis are psychotropic substances most used by adolescents. Psychological, behavioral, social, and cognitive factors linked to substance use in adolescents with chronic pain (ACP) are unclear. We examined these factors among four groups: those reporting Only Alcohol Use (AU), Only Cannabis Use (CU), Co-use of Alcohol and Cannabis (CAM), and No Substance Use (No-SU).

METHODS

From September 2021 to May 2024, we surveyed 243 patients from a pediatric pain clinic in the Northeastern U.S. Kruskal Wallis, Mann-Whitney U, and Monte Carlo Chi-Square tests assessed group differences.

RESULTS

Among 243 (Mage = 16.9, SD = 1.42 years, 68% female), 12.3% reported AU, 5.3% CU, 19.8% CAM, and 62.6% No-SU in their lifetime. Groups differed by age, functional disability, depressive symptoms, and behavior avoidance in drive and fun-seeking domains (ps < 0.05). CAM group was older (p < 0.001), more depressed (p = 0.003), stressed (p = 0.03), and had more school-related anxious anticipation (p = 0.03) than No-SU, reporting more drinking and drunkenness (ps < 0.05) than AU. CU group reported greater pain interference (p = 0.04) and functional disability (p = 0.01) than AU, with 100% using for symptom relief and 85.6% for pain. Increased drunkenness past-year was positively associated with stricter curfew times and increased parental supervision in the CAM group (p < 0.006).

DISCUSSION: CAM group reported more stress, depression, and alcohol consumption, complicating pain management. CU is frequently used for pain relief and is associated with greater functional disability. Interventions targeting substance use and mental, physical, and social wellbeing in ACP are limited, underscoring the need for multidisciplinary strategies addressing pain and substance use in parallel.