Use of Intervention Mapping to Develop a Group-Based Psychotherapy Intervention for Co-Occurring Chronic Pain and Substance Use

Pain and substance use (SU) frequently co-occur and can exacerbate one another; individuals with pain may have substance use reinforced through acute analgesic effects of substances, pain can be a barrier to cessation, and substances can worsen pain. Pain and SU are often addressed in isolation, leading to fragmentation or conflicting treatment goals. An integrated group psychotherapy protocol has the potential to improve management of co-occurring chronic pain and substance use. Using Intervention Mapping as a framework, we first conducted a needs assessment that included a literature review and qualitative interviews with key partners (mental health providers, peer specialists, and veterans with lived experience); through this, we selected the target population of veterans with chronic pain and risky substance use. Further, the inclusion of peer support was noted as a valuable component to improve participant engagement. In the next stage, we identified transdiagnostic factors of unhelpful pain attitudes (pain-related worry, anxiety, and fear), negative urgency, substance cravings, and expectations of pain relief from SU as targets for the intervention. In the third stage, components of DBT and ACT were chosen as methods by which the intervention will address the above factors; in particular, the 8-session protocol will incorporate mindfulness, identification of values, emotion regulation, distress tolerance, and interpersonal effectiveness skills. An upcoming single-arm pilot trial of the intervention will examine feasibility and acceptability of the intervention and provide data to inform iterative refinements to the intervention for future trials. Funding: VA Pain/Opioid Consortia for Research (Rapid Start Funds, grant #COR-19-489).