Researchers in the Psychology Department recently published articles exploring how pain in young adults can lead to cannabis use.

Callon Williams MS ‘21, Ph.D. ‘24, a postdoctoral fellow at Toronto General Hospital, pursued this research for her doctoral dissertation with adviser Emily L. Zale, an assistant professor of psychology and director of the Substance Use, Pain, and Health Research Lab at BU.

The first study was titled, “Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study” and was recently published in the Journal of Behavioral Medicine. The second, “Pain Predicts Past-Month Co-Use of Alcohol and Cannabis Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study,” was featured in the journal Alcohol.

Williams and Zale credited Nadine R. Mastroleo and Mark F. Lenzenweger, respectively an associate and a distinguished professor of psychology, for supporting their research. Mastroleo and Lenzenweger are listed as co-authors of both articles.

“We are particularly interested in emerging adults because they are a population at risk of engaging in substance use and pain is also highly prevalent in this group,” Williams and Zale wrote to Pipe Dream. “While past research examined how pain is associated to ongoing substance use — such as how frequently or heavily individuals use — at the time of these studies, there were no prior studies that examined pain as a predictor of initiating substance use among emerging adults.”

“That research gap sparked us to examine whether pain predicts the initiation of cannabis use and co-use of cannabis and alcohol among a nationally representative sample of emerging adults,” they continued.

The first study examined pain as a predictor of cannabis initiation “across five annual waves,” specifically analyzing groups of emerging adults between 18 and 24 years old who had never used cannabis previously. They asked a sample group how much pain they experienced in the prior week and found that those who had moderate to severe pain at baseline “were more likely to initiate cannabis use — and did so earlier — compared to those with little or no pain,” according to Williams and Zale. They used a zero to 10 scale, with moderate to severe pain registering as a four or higher.

The second study also focused on people who had never used cannabis before and investigated if pain was a predictive factor in engaging in the “co-use of alcohol and cannabis during emerging adulthood.” The study found that those with moderate to severe baseline pain were more likely to initiate riskier substance use patterns.

The Population Assessment of Tobacco and Health survey is a “nationally representative, longitudinal study of tobacco use, its determinants, and its impacts” and is funded by the Food and Drug Administration and the Center for Tobacco Products, according to a program fact sheet. Nearly 46,000 individuals were included in the survey’s first wave, which ran from September 2013 through December 2014.

Williams said that they study interactions between pain and substance use at the University’s Substance Use, Pain, and Health Research Lab. The lab, located in Clearview Hall, uses research investigations, outcome surveys and intervention development to determine the relationship between pain, substance use and mental illness.

“Emerging adulthood is a salient developmental period in which experimental and risky substance use behaviors are common,” Williams and Zale wrote. “Additionally, while emerging adults are often seen as a ‘healthy’ group, many experience significant levels of pain. We think this is an interesting developmental period to study because emerging adults are still developing coping skills and self-regulation strategies.”

Looking forward, Zale is examining connections between pain and nicotine vaping — especially in emerging adults experiencing menstrual pain — and “developing novel technology-driven interventions for substance use and pain.” Williams is working on an integrated pain and substance use treatment plan for surgical patients, aiming to reduce “the use of substances to cope and improving surgical outcomes.”

The University offers several health resources for its students, like the Decker Student Health Services Center and the University Counseling Center. Williams and Zale said providing psychoeducation through resources like these could be a step forward to support those who use substances as coping mechanisms.

“Students may not be aware of the associations between their pain and substance use behaviors or recognize when their coping patterns may be maladaptive and unhealthy,” Williams and Zale wrote. “Providing psychoeducation on alternative, adaptive coping strategies and connecting students to other services (e.g., community pain clinics) may be helpful for students who use alcohol or cannabis as a coping strategy.”