When pain becomes a constant companion, many veterans turn to alcohol to escape it—a coping pattern that researchers at Syracuse University have begun to understand in a new light. A groundbreaking study reveals that how veterans think about their chronic pain may be just as important as how much pain they actually feel when it comes to preventing harmful drinking.
The overlap between chronic pain and alcohol misuse is stark among U.S. veterans: more than 1 in 4 report drinking at levels that increase the risk of alcohol-related harms, while 1 in 3 experiences chronic pain. These conditions often occur together, and emerging research suggests they may share common pathways in the brain, both affecting stress and reward signaling in ways that can trap veterans in a cycle of escalating substance use.
The conventional understanding has long held that intense pain drives people to drink more—self-medicating to numb both physical suffering and emotional distress. But the Syracuse researchers discovered something more nuanced. They surveyed 429 veterans with chronic musculoskeletal pain and recent drinking histories, measuring both pain intensity and their psychological acceptance of that pain. The key distinction lies in acceptance: being willing to experience pain while continuing to engage in valued activities, rather than rigidly fighting against pain or avoiding situations that might trigger it.
Their findings, published in Alcohol: Clinical & Experimental Research, point to a protective mechanism. Among veterans with lower levels of pain acceptance, the relationship held true—greater pain intensity correlated with higher alcohol use severity. But veterans with moderate or high levels of pain acceptance broke the pattern. Regardless of how intensely they experienced pain, those who had learned to accept it showed no elevated link between pain intensity and alcohol use severity.
This interaction accounted for 2.2% of the variance in alcohol use severity—a small but meaningful effect size typical of behavioral health research. The implications are significant: a psychological shift toward acceptance may genuinely interrupt the path from pain to harmful drinking.
The research also identified other risk factors associated with more severe drinking among this group: being younger, male, white or Hispanic, smoking, using opioids for pain, and being early in the chronic pain journey rather than having learned to live with long-term conditions. These patterns suggest that veterans newer to chronic pain may be especially vulnerable to alcohol misuse as a coping mechanism.
The findings point toward a promising direction for clinical intervention. Rather than accepting increased drinking as an inevitable consequence of chronic pain, treatment approaches like Acceptance and Commitment Therapy—which teach people to acknowledge pain while pursuing meaningful activities—may help veterans break the cycle. By screening for those at highest risk—particularly younger veterans with intense pain and low acceptance—clinicians could offer more personalized, prevention-focused care.
The study adds to growing evidence that psychological acceptance of chronic pain is linked to reduced disability, lower opioid dependence, and potentially, fewer substance-related harms. For veterans caught between two overlapping struggles, this research suggests that the path forward may not require eliminating pain—an often impossible goal—but rather transforming one's relationship with it.