Misuse Behaviors Research Articles

Patient race and opioid misuse history influence provider risk perceptions for future opioid-related problems.

In response to the dual public health crises of chronic pain and opioid use, providers have become more vigilant about assessing patients for risk of opioid-related problems. Little is known about how providers are making these risk assessments. Given previous studies indicating that Black patients are at increased risk for suboptimal pain care, which may be related to stereotypes about drug abuse, the current study examined how patient race and previous opioid misuse behaviors impact providers' risk assessments for future prescription opioid-related problems. Physician residents and fellows (N = 135) viewed videos and read vignettes about 8 virtual patients with chronic pain who varied by race (Black/White) and history of prescription opioid misuse (absent/present). Providers rated patients' risk for future prescription opioid-related adverse events, misuse/abuse, addiction, and diversion, and also completed measures of implicit racial attitudes and explicit beliefs about race differences in pain. Two significant interactions emerged indicating that Black patients were perceived to be at greater risk for future adverse events (when previous misuse was absent) and diversion (when previous misuse was present). Significant main effects indicated that Black patients and patients with previous misuse were perceived to be at greater risk for future misuse/abuse of prescription opioids, and that patients with previous misuse were perceived to be at greater risk of addiction. These findings suggest that racial minorities and patients with a history of prescription opioid misuse are particularly vulnerable to any unintended consequences of efforts to stem the dual public health crises of chronic pain and opioid use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The relative contribution of pain and psychological factors to opioid misuse: A 6-month observational study.

There is a pressing need to better understand the factors contributing to prescription opioid misuse among patients with chronic pain. Cross-sectional studies have been conducted in this area, but longitudinal studies examining the determinants of prescription opioid misuse repeatedly over the course of opioid therapy have yet to be conducted. The main objective of this study was to examine the relative contribution of pain and psychological factors to the occurrence of opioid misuse among patients with chronic pain prescribed opioids. Of particular interest was to examine whether pain intensity and psychological factors were more strongly associated with certain types of opioid misuse behaviors. Patients with chronic pain (n = 194) prescribed long-term opioid therapy enrolled in this longitudinal observational cohort study. Patients completed baseline measures and were then followed for 6 months. Opioid misuse was assessed once a month using self-report measures, and urine toxicology screens complemented patients' reports of opioid misuse. Heightened pain intensity levels were associated with a greater likelihood of opioid misuse (p = .014). However, pain intensity was no longer significantly associated with opioid misuse when controlling for psychological factors (i.e., negative affect, catastrophizing). Subsequent analyses revealed that higher levels of catastrophizing were associated with a greater likelihood of running out of opioid medication early, even after controlling for patients' levels of pain intensity and negative affect (p = .016). Our findings provide new insights into the determinants of prescription opioid misuse and have implications for the nature of interventions that may be used to reduce specific types of opioid misuse behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Development and Evaluation of an Antiviral Agent Medication Adherence Education Program for Patients with Chronic Hepatitis C.

This study aimed to develop and evaluate a goal attainment theory-based antiviral agent medication adherence education program (AMAEP) for patients with chronic hepatitis C. A nonequivalent control group pretest-posttest design was used. Data were collected from December 2019 to March 2020 from a control group of 35 outpatients and an experimental group of 28 outpatients older than 20 years old who had been diagnosed with chronic hepatitis C. The data analysis included an independent t-test, a χ2-test or Fisher’s exact test, a Kolmogorov–Smirnov test, an analysis of covariance, and a Mann–Whitney U test. The results showed the effectiveness of the education program for patients with chronic hepatitis C. There were significant differences between the control group and experimental group in patients’ knowledge of chronic hepatitis C (Z = −5.91, p < 0.001), medication self-efficacy (Z = −5.02, p < 0.001), medication adherence rate (t = −3.88, p < 0.001), medication misuse behavior (Z = −5.00, p < 0.001), and patients’ satisfaction with their interaction with healthcare practitioners (Z = −6.61, p < 0.001). Therefore, we hope that the education program developed in this study will be utilized as an intervention for patients with chronic hepatitis C and be further developed for other patients with viral hepatitis.

Pain rehabilitation's dual power: Treatment for chronic pain and prevention of opioid-related risks.

The purpose of this article is to provide a data-driven exploration of an interdisciplinary pain rehabilitation program (PRP) as a viable option for addressing the dual crises of chronic pain and opioid use. Psychologists are crucial providers in the PRP, in both intervention and leadership roles. There is well-established literature supporting pain rehabilitation as an effective treatment for chronic pain and functioning, but there are few studies examining the effects of pain rehabilitation on opioid misuse risk. We evaluated data from 60 patients with diverse chronic pain conditions who completed an interdisciplinary PRP to evaluate changes in pain, functioning (self-report and objective physical measure), psychological symptoms, and health-related quality of life. To evaluate the effect of pain rehabilitation on opioid-related risks, we examined opioid use and opioid misuse behaviors (measured by the Current Opioid Misuse Measure; COMM) pre- and posttreatment. Results demonstrated statistically significant improvements in all outcomes, with medium effect sizes for pain severity and large effect sizes for functioning, psychological symptoms, and emotional quality of life. Fifty-eight percent of patients were on opioid medications at entry compared with 15% at discharge. Among patients who entered on opioids, mean COMM scores were significantly reduced from above the cutoff for misuse risk (M = 13.57) to below the cutoff (M = 5.86). Overall, this study provided strong support for pain rehabilitation as an effective treatment for chronic pain and related suffering, while also providing a prevention-based opportunity for reducing opioid-related risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychology's role in addressing the dual crises of chronic pain and opioid-related harms: Introduction to the special issue.

Chronic pain is considered a public health crisis due to its high prevalence, impact, costs, and disparities in pain prevalence and treatment. In parallel, drug overdose, particularly due to opioids, has become an epidemic in the United States, prompting a public health crisis concerning harms associated with both prescribed opioid therapy for chronic pain and illicit opioid use. The purpose of this special issue is to highlight state-of-the-art psychological research that addresses the combined issues of chronic pain and harms associated with opioids. Articles included in this special issue focus on 2 related areas. The 1st set of innovative articles focuses on risk factors for chronic pain, characterization of patterns of opioid use and misuse, assessment of opioid risk, and identification of moderating factors in populations ranging from adolescents to older adults. The 2nd set of articles includes exemplary research on psychological approaches for management of chronic pain and opioid risk mitigation; integration of psychological approaches in patient-centered, evidence-based, multimodal and interdisciplinary plans of pain care; and treatment of co-occurring chronic pain and opioid use disorder. Last, the issue includes a guest editorial highlighting psychological research and the participation of psychologists in the National Institutes of Health's Helping to End Addiction Long-Term (HEAL) initiative. In this introduction, the guest editors highlight the objectives in this special issue are to stimulate additional research to develop psychological approaches to reduce opioid misuse behaviors, to help educate providers on opioid prescribing that is equitable and minimizes risk of harms, and to address co-occurring chronic pain and opioid use disorder in vulnerable populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Decisions to use antibiotics for upper respiratory tract infections across China: a large-scale cross-sectional survey among university students

ObjectivesTo investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs).DesignA cross-sectional questionnaire study.SettingThe participants recruited from six universities across all...

Association of knowledge and beliefs with the misuse of antibiotics in parents: A study in Beirut (Lebanon).

BackgroundAntibiotic resistance is a major public health concern. It has been associated with factors such as uncontrolled consumption, lack of knowledge, beliefs, and sociodemographic characteristics. Lebanon is characterized by high levels of antibiotic misuse, as almost half of the population self-medicates with antibiotics and over 30% of the antibiotics are dispensed without prescription. To-date, no studies determined adequately the association between knowledge, beliefs and antibiotic misuse in Lebanon.ObjectiveTo assess the association between level of knowledge and beliefs about antibiotics, and antibiotic misuse in Lebanon.MethodsWe conducted a cross-sectional study among 1,421 parents of schoolchildren using an anonymous self-administered Knowledge, Attitude and Practices questionnaire. The participants´ level of agreement with each item of knowledge and beliefs was measured using a Likert-type (0–10) scale. Misuse practices in the last month were detected through a series of questions aimed at determining the level of compliance with physicians´ instructions in terms of dosage and duration. Data were analyzed using logistic regression.Results277 participants (16%) acknowledged using antibiotics in the previous month, 41% of whom showed at least one misuse behavior. Misconceptions and beliefs about antibiotics substantially increased the odds of their misuse. For instance, participants who believed that antibiotics were effective in treating viruses, cold, or sore throat infections were twice as likely to misuse antibiotics [Adjusted Interquartile Odds Ratio (aIqOR): 2.08 (95%CI: 1.32, 3.19), aIqOR: 1.81 (95%CI: 1.41, 2.29), aIqOR: 2.19 (95%CI: 1.61, 2.93), respectively]. Parents who usually keep antibiotics at home antibiotics for future use were more likely to misuse antibiotics [aIqOR: 2.44 (95%CI: 1.68, 3.46)].ConclusionsOur findings indicate that the low level of knowledge and the existence of erroneous beliefs about antibiotics are associated with increased odds of antibiotic misuse. Key elements including rationale prescription and control of dispensing should be addressed when designing educational campaigns against antibiotic misuse.

Factorial Support and Measurement Invariance of the College Eating and Drinking Behavior Scale

Systematic measurement of simultaneous disordered eating patterns and alcohol consumption enables practitioners to identify harmful behaviors and evaluate behavior change. Despite instruments existing which measure these behaviors, few are tested for gender/ethnicity invariance or against measures for disordered eating behaviors and harmful alcohol consumption, rendering limited empirical support for utility. The College Eating and Drinking Behaviors Scale (CEDBS) is a three-factor, self-report measure. The purpose of this study was to conduct a confirmatory factor analysis, invariance testing, and evaluation of predictive validity. Participants included 583 traditional college students from two Southern universities who reported past 30-day alcohol consumption. Results supported the three-factor structure, and evidence of predictive validity indicates that the CEDBS measures disordered eating and alcohol misuse behaviors within the context of food and alcohol disturbance. Findings suggested the CEDBS performs similarly across genders and some ethnicities.

A Path Analysis Investigating the Relationships between Family Violence, Addictive Behaviors, and Trauma among Adolescents in China

Family violence is a public health concern in China. Exposure to family violence, including witnessing intimate partner violence (IPV) between parents and/or experiencing child abuse, has numerous deleterious effects on adolescent’s mental and behavioral health. This study examined specific mental and behavioral health outcomes of family violence exposure including trauma symptoms and addictive behaviors using a nationally representative sample of adolescents in China. Cross-sectional, self-report data were collected from 16,254 adolescents (M = 15.89 years of age, 47.69% female) using a self-administered survey. More than two-thirds of the sample reported having been exposed to child abuse or IPV at home. Adolescents who were exposed to child abuse and/or IPV were significantly more likely to misuse substances, engage in gambling activities and exhibited more trauma symptoms than their non-exposed peers. A multivariate path analysis revealed that child abuse had an indirect effect on severity of trauma symptoms through problem drinking, cigarette smoking, and gambling behavior. Witnessing IPV between parents had an indirect effect on trauma symptoms through problem drinking and cigarette smoking. An alternative pathway model suggested that child abuse and witnessing IPV between parents had indirect effects on a variety of substance misuse and gambling behavior through PTSD. Findings offer a unique insight into the effects of family violence exposure on adolescents in Greater China. Family violence awareness and intervention could be a meaningful intervention strategy to address substance use and behavioral health problems among adolescents in China.

Association of parental substance misuse with offspring substance misuse and criminality: a genetically informed register-based study.

Genetically informed studies have provided mixed findings as to what extent parental substance misuse is associated with offspring substance misuse and antisocial behavior due to shared environmental and genetic factors. We linked data from nationwide registries for a cohort of 2 476 198 offspring born in Sweden 1958-1995 and their parents. Substance misuse was defined as International Classification of Diseases diagnoses of alcohol/drug use disorders or alcohol/drug-related criminal convictions. Quantitative genetic offspring-of-siblings analyses in offspring of monozygotic and dizygotic twin, full-sibling, and half-sibling parents were conducted. Both maternal and paternal substance misuse were robustly associated with offspring substance misuse [maternal adjusted hazard ratio (aHR) = 1.83 (95% confidence interval (CI) 1.80-1.87); paternal aHR = 1.96 (1.94-1.98)] and criminal convictions [maternal aHR = 1.56 (1.54-1.58); paternal aHR = 1.66 (1.64-1.67)]. Additive genetic effects explained 42% (95% CI 25-56%) and 46% (36-55%) of the variance in maternal and paternal substance misuse, respectively, and between 36 and 44% of the variance in substance misuse and criminality in offspring. The associations between parental substance misuse and offspring outcomes were mostly due to additive genetic effects, which explained 54-85% of the parent-offspring covariance. However, both nuclear and extended family environmental factors also contributed to the associations, especially with offspring substance misuse. Our findings from a large offspring-of-siblings study indicate that shared genetic influences mostly explain the associations between parental substance misuse and both offspring substance misuse and criminality, but we also found evidence for the contribution of environmental factors shared by members of nuclear and extended families.

Toward security monitoring of industrial Cyber-Physical systems via hierarchically distributed intrusion detection

Industrial Cyber-physical systems (ICPSs), integrating communication, computation and control of industrial processes are referred to as a core technology to approach the Industry 4.0. Ensuring the ICPS security is of paramount importance in smart manufacturing. Considering the characteristics of large-scale, geographically-dispersed and multi-dimensional heterogeneous, federated and life-critical natures of ICPSs, this paper investigates a hierarchically distributed intrusion detection scheme that seeks to achieve the all-round safety protection of ICPSs according to the system structure and attacking types of each ICPS layer. For physical system-relevant perceptual executive layer, potential and covert attacks are detected by the clustered sensory system state residual anomaly monitoring based on a process noise and measurement noise-adaptive Kalman filter (PNMN-AKF). PNMN-AKF can perform a joint recursive estimation of dynamic system states, time-varying process and measurement noise covariance matrices by the variational Bayes approximation framework. In cyberspace, potential cyber-attacks are detected by the anomaly monitoring of the statistical distribution of the network transmission characteristics of data transmission layer by introducing a forgetting factor-induced recursive Gaussian mixture model (FF-RGMM). In the application control layer, a regularized sparse deep belief network model is introduced to characterize the misuse behavior for detecting potential attacks. Extensive validation and comparative experiments have been conducted on a numerical simulation system and a comprehensive ICPS simulation platform by using OPNET and a commonly-used benchmark simplified Tennessee Eastman process (STEP) based on Matlab/Simulink. Experimental results demonstrate that the proposed hierarchically distributed intrusion detection method can efficiently recognize potential and covert cyber-attacks in each ICPSs link with low false alarm rate and missing detection rate, which lays a foundation for the overall security monitoring of ICPSs.

A structural brain network of genetic vulnerability to psychiatric illness

Psychiatry is undergoing a paradigm shift from the acceptance of distinct diagnoses to a representation of psychiatric illness that crosses diagnostic boundaries. How this transition is supported by a shared neurobiology remains largely unknown. In this study, we first identify single nucleotide polymorphisms (SNPs) associated with psychiatric disorders based on 136 genome-wide association studies. We then conduct a joint analysis of these SNPs and brain structural connectomes in 678 healthy children in the PING study. We discovered a strong, robust, and transdiagnostic mode of genome–connectome covariation which is positively and specifically correlated with genetic risk for psychiatric illness at the level of individual SNPs. Similarly, this mode is also significantly positively correlated with polygenic risk scores for schizophrenia, alcohol use disorder, major depressive disorder, a combined bipolar disorder-schizophrenia phenotype, and a broader cross-disorder phenotype, and significantly negatively correlated with a polygenic risk score for educational attainment. The resulting “vulnerability network” is shown to mediate the influence of genetic risks onto behaviors related to psychiatric vulnerability (e.g., marijuana, alcohol, and caffeine misuse, perceived stress, and impulsive behavior). Its anatomy overlaps with the default-mode network, with a network of cognitive control, and with the occipital cortex. These findings suggest that the brain vulnerability network represents an endophenotype funneling genetic risks for various psychiatric illnesses through a common neurobiological root. It may form part of the neural underpinning of the well-recognized but poorly explained overlap and comorbidity between psychiatric disorders.

A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial.

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.

Substance use among transgender and cisgender high school students

Using data from a regional census survey of high school students, we compared substance use patterns between transgender and cisgender students, and students who did not know if they are transgender (DKT). Data from more than 23,000 youth from 26 high schools were used to compare alcohol-related behaviors, marijuana use, and non-medical use of prescription drugs (NMUPD) between these three groups. We also examined differences in substance use behaviors between these groups by grade. Results show that transgender students have significantly higher odds of engaging in most types of substance misuse behaviors including problem drinking, current marijuana use, and NMUPD, compared to cisgender students. DKT students have significantly higher odds of engaging in problem drinking, and NMUPD compared to cisgender students. Furthermore, differences in some substance use behaviors between transgender and cisgender students are greater among students in earlier grades compared to later grades; though this was not the case when comparing cisgender students to DKT students. Results highlight the elevated risk of substance use among transgender youth—especially during early high school years, and students who are not sure about their gender identity. Implications about the need for targeted and early prevention efforts for this vulnerable population are discussed.

Opioid Misuse and Risky Behaviors in Adolescents

Misuse of prescription pain medications is on the rise, especially among adolescents. Understanding risky behaviors that are associated with misuse

Historical Trauma and American Indian/Alaska Native Youth Mental Health Development and Delinquency.

Health disparities in American Indian/Alaska Native (AI/AN) youth are well documented in the literature, as AI/AN youth appear to be more likely to experience trauma and engage in high-risk behavior, such as substance misuse and risky sexual behavior. These youth also appear disproportionally affected by the criminal justice system. Scholars contend that much of these disparities can be traced back to the history of colonization of Indigenous peoples and the transgenerational effects of forced suppression of cultural ideology. This paper reviews the relevant literature on AI/AN youth mental and behavioral health, and this author highlights studies which examine the plausible relation between historical trauma and contemporary AI/AN youth mental health and delinquency. This author proposes that future research should target the high number of AI/AN youths in juvenile justice settings given that these youths appear neglected in current research.

Detection of Spectrum Misuse Behavior in Satellite-Terrestrial Spectrum Sensing Based on Multi-Hypothesis Tests

As the increasing of both users’ demand and the number of communication satellites, spectrum resource is becoming increasingly scarce. Cognitive radio (CR) can effectively alleviate the scarcity of spectrum resource. By using CR technology in the satellite and terrestrial integrated network, the satellite can share the spectrum resource with the terrestrial communication equipment to improve the spectrum utilization. However, due to the satellite communication’s inherent openness and the increasing intelligent level of devices, it makes the satellite communication vulnerable to spectrum misuse, which seriously threatens the reliability and efficiency of the satellite communication system. This paper studies the detection of spectrum misuse in the satellite-terrestrial spectrum sharing system. First, we model the problem as a ternary hypothesis test problem by using generalized multi-hypothesis Neyman-Pearson (GMNP). Then, we utilize a two-step method to solve the complex formula problem in the multiple authorized users scenario. Reasonable decision thresholds are derived by means of the generalized likelihood ratio test (GLRT) and maximum a posterior (MAP) criterion, respectively. Finally, the performance of detection is evaluated and analyzed comprehensively to verify the feasibility of the study.

Psychiatric comorbidity and co-occurring opioid misuse: Depression mediates the relationship between post-traumatic stress disorder and opioid misuse in community pharmacy settings

sBackground: Individuals who misuse opioids frequently have comorbid psychiatric issues, including post-traumatic stress disorder (PTSD) and depression. However, little is known about the mechanisms by which these disorders are associated with opioid misuse and specifically in community pharmacy settings. The current study examined whether depression mediated the relationship between PTSD and opioid misuse in patients filling opioid prescriptions. Methods: We administered a health survey in four community pharmacies among patients filling opioid medications in southwestern Pennsylvania. Univariate statistics were used to assess relationships among demographic and clinical characteristics of PTSD, depression, and opioid misuse behaviors. We then examined whether depression mediated the relationship between PTSD and opioid misuse using ordinary least squares path analysis with bootstrapping. Results: A total of 333 participants completed the health survey. Opioid misuse was reported among 15.9% of all participants, 33.3% among those with a positive PTSD screen, and 29.3% of those who screened positive for depression. Depression significantly mediated the relationship between PTSD and opioid misuse. Specifically, there was a statistically significant indirect effect (ab) of PTSD on opioid misuse through a pathway mediated by depression (ab = .06, SEab = .02, 95% CI = .02–.10). The direct effect (c’) of PTSD on opioid misuse was also significant (c’ = .12, SEc’ = .05, P = .01, 95% CI = .03–.22), suggesting partial mediation. Conclusions: Results suggest an indirect pathway by which clinical intervention may help ameliorate outcomes in patients with PTSD. Further, there is an increased need for screening, assessment, and intervention protocols for this patient population in which community pharmacy is a novel setting to expand future efforts within the patient population.

Health Literacy, Drug Knowledge, and Drug Misuse Behaviors Among North Korean Refugees.

This study measured levels of health literacy, drug knowledge, and drug misuse behavior and analyzed the relationship among major variables related to 137 North Korean refugees who could only receive limited medical benefits owing to cultural and linguistic barriers. The data were analyzed using descriptive statistics, t test, and the Pearson correlation coefficient using SPSS. The subjects' health literacy and drug knowledge levels were low; however, drug misuse behavior was not high. The drug dosage was significant considering the health literacy of the subjects; notably, the functional health literacy of women was high. However, many drug misuse cases were identified among women in their 40s. Health literacy and drug knowledge levels showed a significant relationship. It is necessary to provide community-based information to vulnerable groups to ensure safe use of medications and to develop a level-based and tailored educational program considering North Korean refugees' literacy levels and cultural characteristics.

Integrated Behavioral Treatment for Veterans With Co-Morbid Chronic Pain and Hazardous Opioid Use: A Randomized Controlled Pilot Trial

Opioid prescription in the treatment of chronic pain is frequent and carries a risk of increased morbidity and mortality in a clinically significant number of patients, particularly those who are using opioids in a hazardous manner. Few treatment options are available that target both pain-related interference and hazardous opioid use among patients with chronic pain. In military Veterans, this issue is of particular importance as numerous reports indicate continued high rates of opioid prescription for chronic pain, as well as significant opioid-related problems. The overall aim of the present study was to determine the feasibility of an integrated psychosocial treatment in Veterans with chronic pain, who also have evidence of hazardous opioid use. To examine this aim, a random design was used to assess the feasibility and initial efficacy of integrating 2 empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for opioid misuse. Half of participants were randomized to the integrated treatment group and all participants received usual care through a Veteran's Administration co-occurring disorders medical clinic to treat chronic pain and opioid misuse. In total, 37 participants were randomized and included in intent-to-treat analyses and 32 individuals were included in per protocol analyses with 6-month follow-up serving as the primary study endpoint. Feasibility indicators included recruitment, retention, and treatment completion rates. Recruitment fell short of targeted enrollment, although retention and completion were excellent. Primary outcome measures were opioid misuse, pain interference, and pain behavior. Simultaneous multiple regression analyses controlled for pain duration, baseline opioid dose, and baseline value for outcome measures. Results of both the intent-to-treat and per protocol indicated a significant effect in favor of the integrated intervention for opioid misuse, pain interference, and pain behavior. Results support the feasibility of providing an integrated treatment for both opioid risk and pain interference. PerspectiveOpioid misuse occurs in some opioid-prescribed individuals with chronic pain. Few treatment options exist that target both pain interference and opioid misuse. This study examined feasibility and initial efficacy of an integrated behavioral treatment for Veterans. Feasibility was supported, except recruitment. Efficacy was supported compared to usual care.