Treatment Barriers and Preferences Among Veterans With Chronic Musculoskeletal Pain and Alcohol Use in Primary Care

Buckheit, Katherine A.
Scharer, Jacob
Loughran, Travis A.
Beehler, Gregory P.
Moskal, Dezarie
Funderburk, Jennifer S.

VA Center for Integrated Healthcare, Syracuse VA Medical Center
VA Center for Integrated Healthcare, VA Western New York Healthcare System
School of Public Health and Health Professions, University at Buffalo
Department of Psychology, Syracuse University
Department of Psychiatry, University of Rochester

Stacy Ogbeide served as action editor.

Data will be made available upon written request to the corresponding author, Katherine A. Buckheit. This study was approved by the VA Western New York Institutional Review Board. This study was deemed exempt by the VA Western New York Institutional Review Board and granted a waiver of informed consent documentation. Participants received information about the study, its risks and benefits, and instructions on how to participate or opt out in an informational letter sent with the survey.

The views expressed in this article are those of the authors and do not represent the position or policy of the Department of Veterans Affairs or the U.S. government. The authors have no conflicts of interest. This study was supported by pilot funds from the Center for Integrated Healthcare, U.S. Department of Veterans Affairs, awarded to Travis A. Loughran. Article preparation was supported in part by the VA Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, VA Center for Integrated Healthcare, and VA Western New York Healthcare System (Katherine A. Buckheit, Travis A. Loughran, Dezarie Moskal, and Jacob Scharer).

Katherine A. Buckheit played a lead role in formal analysis, visualization, writing–original draft, and writing–review and editing and an equal role in conceptualization. Jacob Scharer played a supporting role in conceptualization, data curation, formal analysis, methodology, project administration, and writing–review and editing. Travis A. Loughran played a lead role in conceptualization, data curation, funding acquisition, investigation, methodology, and project administration and a supporting role in writing–review and editing. Gregory P. Beehler played a supporting role in conceptualization, funding acquisition, and writing–review and editing and an equal role in supervision. Dezarie Moskal played a supporting role in writing–review and editing. Jennifer S. Funderburk played a supporting role in conceptualization, funding acquisition, and writing–review and editing and an equal role in supervision.

Katherine A. Buckheit, VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210, United States [email protected]

Received August 21, 2024

revised November 8, 2024

Accepted November 23, 2024

Psychological Services Publish Ahead of Print, April 7, 2025. | DOI: 10.1037/ser0000938

Chronic pain and alcohol use commonly co-occur and are associated with considerable functional impairment. Many patients with chronic pain present to primary care, and integrated primary care may be well-suited to provide brief, behaviorally focused treatment. Little is known about behavioral health treatment barriers and preferences among primary care patients with chronic pain and alcohol use. Veterans enrolled in Veterans Health Administration primary care with a chronic musculoskeletal pain diagnosis and past-year alcohol use were identified via electronic medical record review and mailed a survey with measures of alcohol use, pain severity/interference, treatment preferences, and treatment barriers. Chi-square tests were used to identify statistically significant treatment preferences. Generalized linear models tested for differences in treatment barriers based on alcohol risk, and pain severity was tested as a moderator using the PROCESS macro in SPSS. Patients expressed preferences for individual, face-to-face treatment in primary care. Participants reported they were overall receptive to behavioral health treatment, with the exception of treatment for alcohol, tobacco, or other drug use. Differences based on alcohol risk were observed for readiness to change alcohol use and beliefs about the relationship between pain and alcohol. Pain severity was a significant moderator of the relationships between alcohol risk and pain readiness, beliefs about pain and alcohol, and overall alcohol treatment barriers. Treatment preferences were largely aligned with models of integrated primary care. The impact of barriers on treatment engagement may vary by a patient’s degree of alcohol-related risk, and thus a range of treatment options should be considered.