Papers of the Week

Alcohol consumption in the setting of chronic HCV is associated with accelerated progression towards cirrhosis, increased risk of hepatocellular carcinoma, and higher mortality. This analysis contextualizes how sociodemographic factors, chronic pain, and depression relate to the motivations of individuals with chronic HCV to consume alcohol. We conducted a secondary analysis of baseline data from the Hep ART trial of behavioral interventions on alcohol use among patients with HCV. Alcohol consumption was measured using the Drinking Motives Questionnaire and a novel 6-item measure of pain-related drinking motives. Statistical analyses performed included ANOVA for bivariate analyses and multivariable ordinary least squares linear regression. At study baseline, 181 participants had an average age of 55 years; the majority (66.7%) reported beyond-minor pain and a third (37%) met criteria for depression; drinking motives were higher for individuals with beyond-minor pain (means 9.9 vs 4.6, p<.001) and who met criteria for depression (means 10.9 vs 6.4, p<.001) when using the pain-related drinking motives items. Average pain(coef=1.0410067141<.001) was significantly associated with increased motives to drink to relieve pain in the full baseline model specification controlling for all covariates using ordinary at least squares; depression (coef=7.06; 95% CI 1.32, 12.81; p=.016) was significantly associated with increased non-pain-related motives to drink. From baseline to 3 months follow up, compared to participants who had mean average pain scores among the sample, motives to drink to relieve pain decreased in participants who had higher average pain scores (coef=-0.30; 95% CI -0.59, -0.01; p=.40). Physical pain and depression are associated with increased motives to consume alcohol. Patients with chronic liver disease should be screened for chronic pain and depression, and if present, referred to pain specialists or co-managed in partnership with pain specialists in hepatology clinics.