Distress Tolerance and Opioid Misuse
Addiction Recovery Center

Distress Tolerance and Opioid Misuse

New research from Harvard Medical School sheds light on the relationship between distress tolerance and opioid misuse. The findings, published by researchers Dr. R. Kathryn McHugh and Dr. Roger D. Weiss, found “among patients with chronic pain, those who reported less ability to tolerate physical and emotional distress were more likely to misuse opioid analgesics.” This finding probably comes as a surprise to noone experiencing problematic opioid use and chronic pain or those working to treat it. What is interesting, however, was that “neither pain severity nor pain sensitivity was associated with the risk of opioid misuse.”

Distress Tolerance and Opioid Misuse

One would expect more pain and pain sensitivity to equal a greater likelihood of misusing opioids, but this study shows us that may not be the case. Our perceptions about how we can handle and tolerate things seem to play a greater role. Distress tolerance is one of the most important skills someone can learn in therapy or treatment. It’s a big focus for us at AToN. Why? Because we often cannot make things better immediately, so learning how to tolerate our distress and weather the storm until it passes (And it will pass!) is invaluable. Otherwise we are vulnerable to any upsetting or scary thing that comes our way, including pain.

The researchers administered the Distress Intolerance Index, which asks people to identify with statements which express “fear and anxiety at the prospect of physical or emotional distress.” The people who met criteria for opioid misuse scored higher on the measure overall. And the higher the score, the more severe the misuse. Dr. McHugh said the link “likely occurs because patients who are intensely apprehensive of distressing experiences may seek quick stress relief through behaviors such as substance use, risk taking, avoidance, and escapism.”

Dr. Mchugh also recommended that doctors assess distress intolerance in their chronic pain patients. This way, doctors can enhance the distress tolerance skills of people who need it and monitor their prescriptions closely. Dr. McHugh said “Enhancing tolerance of distress has great potential for mitigating the risk of opioid misuse and treating opioid use disorder.” She also highlighted the impacts of stress and co-occurring disorders, and she said she believes they “are the norms rather than the exceptions.” We at AToN would agree based on our work here.

At AToN, this will always be a focus of our treatment. In fact, we regularly administer the Distress Tolerance Outcome Scale in our outcome research. Our residents, on average, experienced a statistically significant increase in distress tolerance in the 30 days of treatment received. Specifically, our residents demonstrated on average a 32% increase in distress tolerance from admission to discharge, taking them from a mean score of 2.56 upon entry, to a 4.16 out of a maximum 5.0. An assessment of effect size demonstrated a very large effect size (eta squared .58). (Effect sizes over a .4 are statistical speak for “mathematically very significant!”) Call us to learn more about how we can help you learn and practice all of the tools needed to treat your problematic addictive behaviors.


Sarah Zucker, Psy.D.
AToN Center 888-535-1516