Opioid overdose continues to produce a staggering number of deaths in the United States, but recent news gives hope that response efforts, supported by health psychology research, may be turning the tide.
In May 2024, the Center for Disease Control and Prevention released their provisional 2023 data showing a 3% decrease in year-to-year overdose deaths, the first decrease since 2018 (CDC, 2024). This trend has grown stronger in 2024, although it is uneven across states, and suggests that overdoses during this fourth wave of the crisis—characterized by the mixing of illicit substances, usually fentanyl and a stimulant—may finally be on the downturn. The cause for the decrease is not yet clear and likely attributable to multiple efforts, including improved treatment and care, expanded law enforcement, and increased access to harm reduction (Saunders et al., 2024).
Despite this good news, the total overdose count remains near record highs. The loss in 2023 of another 107,543 people (75% to opioids) means that the U.S. has lost nearly a half million people to drug overdoses in only five years (National Institute on Drug Abuse, 2024). Clearly, our nation faces a steep path to recovery. Health psychology research plays an important role in understanding and addressing the huge human toll from this ongoing crisis.
Health Psychology in Opioid Research
Health psychology is “the field of psychology that addresses the interactions of psychological, social, cultural, and biological factors as they relate to health and well-being across diverse populations and settings.”a There are many substantive ways that health psychology contributes to the fight against the opioid crisis. Examples include psychoeducation, community collaborations, provider functioning and health, biopsychosocial and disease-related factors (predisposing, precipitating, perpetuating, and limiting factors, social determinants of health, etc.), occupational exposure, and research on related issues such as comorbid conditions or stigma. Three prominent topics addressed here are Treatment of Pain, Treatment of Opioid Use Disorder, and Impact on People.
- Treatment of Pain
Health psychology fills a critical role in pain treatment. For decades, health psychologists have been important leaders in developing an understanding of the mechanisms of pain signaling, effective behavioral approaches to treating pain, and treatment evaluation and assessment. Clinical health psychologists have developed and provided alternative and adjunctive treatments for pain by focusing on cognitive, emotional, and behavioral elements, which can help to improve the effectiveness of treatment, promote self-management of pain, and, hopefully, prevent substance use disorders. Recently, the Society sponsored an update by Dr. Mark Lumley on “Novel Psychological Treatments for Chronic Pain” that surveyed the state of the research on treatments for chronic pain. Health psychologists have led important federally funded clinical trials of pain treatment that focus on acute, chronic, and recurrent pain due to headache, cancer, and back injury among many others. The Society’s Pain Psychology Interest Group comprises researchers and clinicians who “share a particular interest in advancing the science and practice of pain” and is a good resource for Society members who want to know more about pain treatment.
- Prevention, Treatment, and Recovery from Opioid Use Disorder
As clinicians and researchers in a wide range of integrated health settings, health psychologists provide critical contributions to prevention, treatment, and recovery from substance and opioid use disorders. As noted above, patient education, and self-management training are key ways that health psychologists promote prevention for opioid use disorders (e.g., Darnall et al., 2021). Health psychologists generate research to expand and refine treatment approaches, often pointing out considerations related to unique identities that enhance the effectiveness and tailoring of interventions (e.g., Preis et al., 2020 provide an example related to treating women with opioid use disorders). Health psychology researchers are engaged in work to extend recovery and decrease relapse. For example, health psychologists have developed interventions that directly promote health behaviors and facilitate management of multiple comorbid conditions (Wachholtz et al., 2022) and interventions that more obliquely promote recovery from opioid use disorders such as via stigma reduction among providers (Hooker et al., 2023).
- Impact on People
The opioid crisis represents a mammoth impact on the lives of people in the U.S. Since the rapid increase in overdoses due to fentanyl in 2013, over 780,000 Americans have died from an overdose. The burden of this crisis is felt throughout culture in every community, although the burden has not been borne equally. Health psychologists have helped to highlight the impact of the substance use crisis on populations and communities. As one example, my own work, in collaboration with the social work researcher Dr. Hee Lee and community partners, has documented the impact of opioids in several heavily affected counties in rural Alabama. The mixed methods project demonstrated the ways opioid use penetrated every part of those communities, influencing attitudes and perceptions in predicted and unexpected ways (Eyer et al., 2023; Lee et al., 2023). This work can then be used to advocate for patients, families, and communities affected by opioid use.
Future Efforts
The role of health psychology research in the opioid crisis is critical, and its description is as varied and diverse as the problem itself. Clearly, the field has taken up this challenge, and additional results are arriving every day. (In the writing of this, I ran across three different clinical trials with findings due soon!) While I focused here on the role of health psychology research on the Treatment of Pain, Treatment of Opioid Use Disorder, and Impact on People, many other critical areas of health psychology research accompany these, such as research on provider health and functioning and community engagement to promote outcomes. We extend Kudos to the health psychologists doing this great work. We look forward to seeing the results of this research continue to improve the lives and wellbeing of our neighbors, family, and friends.
Society Resources
- Mark Lumley on “Novel Psychological Treatments for Chronic Pain”: https://societyforhealthpsychology.org/articles-resources/pain-psychology/novel-psychological-treatments-for-chronic-pain/
- Society for Health Psychology’s Pain Psychology Interest Group: https://societyforhealthpsychology.org/get-involved/interest-groups/pain-psychology/
- Coming soon from the Society’s Health Research Council (HRC):
- a webinar to highlight this work to members
- a proposal for programming at the 2025 APA Convention
Note
a This formal definition was adopted by the Society’s Executive Board on 4/23/2014 as part of the work of the Task Force on Rebranding.
References
Centers for Disease Control and Prevention [CDC]. (2024, May 15). US overdose deaths decrease in 2023, first time since 2018. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm
Darnall, B. D., Roy, A., Chen, A. L., Ziadni, M. S., Keane, R. T., You, D. S., Slater, K., Poupore-King, H., Mackey, I., Kao, M. C., Cook, K. F., Lorig, K., Zhang, D., Hong, J., Tian, L., & Mackey, S. C. (2021). Comparison of a single-session pain management skills intervention with a single-session health education intervention and 8 sessions of Cognitive Behavioral Therapy in adults with chronic low back pain: A randomized clinical trial. JAMA Network Open, 4(8), e2113401. https://doi.org/10.1001/jamanetworkopen.2021.13401
Eyer, J. C., Won, C., Sawyer, M., Luo, Y., Wang, K., Chipalo, E., Thomas-LeBlanc, G., & Lee, H. (2023). A phenomenological study of barriers and needs related to opioid prevention, treatment, and recovery in rural Alabama. The Qualitative Report, 28(11), 3358-3378. https://doi.org/10.46743/2160-3715/2023.5915
Hooker, S. A., Crain, A. L., LaFrance, A. B., Kane, S., Fokuo, J. K., Bart, G., & Rossom, R. C. (2023). A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians. Addiction Science & Clinical Practice, 18(1), 10. https://doi.org/10.1186/s13722-023-00366-1
Lee, H. Y., Eyer, J. C., Luo, Y., Jeong, H., Chapman, S., & Hudnall, M. (2023). Opioid literacy among individuals living in rural Alabama: The role of social determinants of health. Journal of Psychosocial Nursing and Mental Health Services, 1-8. https://doi.org/10.3928/02793695-20230523-03
National Institute on Drug Abuse. (2024, August 21). Drug overdose deaths: Facts and figures. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
Preis, H., Inman, E.,* & Lobel, M. (2020). Contributions of psychology to research, treatment, and care of pregnant women with Opioid Use Disorder. American Psychologist, 75(6), 853-865. https://doi.org/10.1037/amp0000675
Saunders, H., Panchal, N., & Zitter, S. (2024, September 23). Opioid deaths fell in mid-2023, but progress is uneven and future trends are uncertain. Kaiser Family Foundation. https://www.kff.org/mental-health/issue-brief/opioid-deaths-fell-in-mid-2023-but-progress-is-uneven-and-future-trends-are-uncertain/
Wachholtz, A., Robinson, D., & Epstein, E. (2022). Developing a novel treatment for patients with chronic pain and Opioid User Disorder. Substance Abuse Treatment, Prevention, and Policy, 17(1), 35. https://doi.org/10.1186/s13011-022-00464-4