Substance use and misuse patterns and disability status in the 2020 US National Alcohol Survey: A contributing role for chronic pain

Background Evidence about substance use and misuse among adults with disabilities is still emerging, despite increased risk of chronic pain and mental health problems, which are in turn risk factors for substance use and misuse. Objective We examined substance use and misuse among adults with selected self-reported disability (versus without), controlling for sociodemographics, depression/anxiety, physical health, and chronic pain, and assessed whether associations could be attributed to chronic pain. Methods Data are from the nationally representative 2020 US National Alcohol Survey. Disability indicators included sensory or mobility impairment, receiving Medicare before age 65, and/or unemployment due to disability. Regression analyses determined associations of disability with past-year substance use and misuse. Mediation analyses examined the role of chronic pain. Results Approximately 18% met 1+ disability criterion, representing 42.8 million adults. Disability was associated with reduced odds of current drinking (OR = 0.77, p < 0.01), but greater odds of daily nicotine use (OR = 1.43, p < 0.01), any drug use (OR = 1.32 p < 0.01), prescription drug misuse (OR = 1.99, p < 0.001), and other drug use (OR = 2.02, p < 0.001). Disability was not associated with high-intensity drinking or marijuana use. Chronic pain accounted for 17–38% of the association between disability and nicotine use, any drug use, prescription drug misuse, and other drug use. Conclusions Findings indicated higher rates of substance use and misuse among people with disabilities, accounting for depression/anxiety, physical health, and chronic pain, with pain being a significant mediator. Substance use screening, brief intervention, and treatment should include appropriate accommodations for disabilities, inclusive of comprehensive pain management options.