Department of Psychology, University of New Mexico, Albuquerque, NM.
Alcohol Clin Exp Res. 2018 Mar;42(3):478-488. doi: 10.1111/acer.13594. Epub 2018 Feb 6.
The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid-related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder (AUD) are a highly prevalent public health problem associated with considerable individual and societal costs. This study provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on AUD and OUD treatment outcomes, respectively, the role of pain in the co-use of alcohol and opioids, and treatment of comorbid OUD and AUD. Heavy drinking, opioid misuse, and chronic pain individually represent significant public health problems. Few studies have examined co-use of alcohol and opioids, but available data suggest that co-use is common and likely contributes to opioid overdose-related morbidity and mortality. Co-use of opioids and alcohol is related to worse outcomes in treatment for either substance. Finally, chronic pain frequently co-occurs with use (and co-use) of alcohol and opioids. Opioid use and alcohol use are also likely to complicate the treatment of chronic pain. Research on the interactions between alcohol and opioids, as well as treatment of the comorbid disorders is lacking. Currently, most alcohol research excludes patients with OUD and there is lack of measurement in both AUD and OUD research in relation to pain-related functioning. Research in those with chronic pain often assesses opioid use, but rarely assesses alcohol use or AUD. New research to examine the nexus of alcohol, opioids, and pain, as well as their treatment, is critically needed.
在美国，阿片类药物滥用、阿片类药物使用障碍（OUD）和阿片类药物相关的过量死亡急剧增加，导致了公众的强烈抗议、政策声明和资金倡议。与此同时，酒精滥用和酒精使用障碍（AUD）是一个高度普遍的公共卫生问题，与相当大的个人和社会成本有关。本研究对酒精和阿片类药物滥用进行了批判性审查，包括流行率、发病率和社会成本等问题。我们还回顾了酒精和阿片类药物使用之间相互作用的研究，阿片类药物和酒精对 AUD 和 OUD 治疗结果的影响，以及疼痛在酒精和阿片类药物共同使用中的作用，以及共病 OUD 和 AUD 的治疗。大量饮酒、阿片类药物滥用和慢性疼痛单独代表了重大的公共卫生问题。很少有研究检查酒精和阿片类药物的共同使用，但现有数据表明，共同使用很常见，可能导致阿片类药物过量相关发病率和死亡率。阿片类药物和酒精的共同使用与任何一种物质治疗的结果较差有关。最后，慢性疼痛经常与酒精和阿片类药物的使用（和共同使用）同时发生。阿片类药物的使用和酒精的使用也可能使慢性疼痛的治疗变得复杂。关于酒精和阿片类药物相互作用的研究以及共病的治疗研究不足。目前，大多数酒精研究都排除了 OUD 患者，在 AUD 和 OUD 研究中，与疼痛相关的功能缺乏测量。在慢性疼痛患者中的研究通常评估阿片类药物的使用，但很少评估酒精的使用或 AUD。迫切需要新的研究来检查酒精、阿片类药物和疼痛的关系及其治疗。
