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Articles   |    
Disparities in the Use and Quality of Alcohol Treatment Services and Some Proposed Solutions to Narrow the Gap
Nina Mulia, Dr.P.H.; Tammy W. Tam, Ph.D.; Laura A. Schmidt, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300188
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Dr. Mulia and Dr. Tam are with the Alcohol Research Group, Public Health Institute, Emeryville, California (e-mail: nmulia@arg.org). Dr. Schmidt is with the Phillip R. Lee Institute for Health Policy Studies and the Department of Anthropology, History and Social Medicine, University of California, San Francisco, School of Medicine. An earlier version of this article was presented at the Summit on the Science of Eliminating Health Disparities, December 17–19, 2012, National Harbor, Maryland.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  This study assessed racial-ethnic disparities in access to high-quality treatment for at-risk drinking and alcohol abuse in the United States and simulated strategies to narrow the gap.

Methods  Longitudinal data collected in 2001–2002 and 2004–2005 from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed to examine racial-ethnic disparities in receipt of alcohol interventions that were provided in primary care and specialty treatment settings and that met published clinical guidelines. The sample consisted of 9,116 respondents who met criteria for at-risk drinking or alcohol abuse in 2001–2002. Simulation analyses projected how disparities in treatment services utilization might change if clinical guidelines promoted access to care in more varied health and human service settings.

Results  Compared with whites, members of racial-ethnic minority groups had less than two-thirds the odds of receiving an alcohol intervention over the roughly four-year study period (odds ratio [OR]=.62, p<.05). This disparity increased after adjustment for socioeconomic confounders and frequency of heavy drinking (adjusted OR=.47, p=.003). The most pronounced disparities were between whites and U.S.-born and foreign-born Hispanics. Simulation analyses suggested that these disparities could be partially mitigated by extending care into nonmedical service venues.

Conclusions  Current efforts to extend evidence-based alcohol interventions into medical settings address an important need but are likely to increase racial-ethnic disparities in access to high-quality treatment. Partial solutions may be found in expanding the range and quality of alcohol-related services provided in alternative delivery sites, including faith-based and social service institutions.

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Figure 1 Odds of receiving an alcohol intervention during a four-year period, by racial-ethnic groupa

a Whites are the reference group. Ns are unweighted.

*p<.05

Figure 2 Receipt of counseling from nonmedical providers among whites and members of racial-ethnic minority groups who used any alcohol services

*p<.05

Anchor for Jump
Table 1Characteristics of survey respondents, by racial-ethnic group, in percentagesa
Table Footer Note

a Data are from Wave 1 (2001–2002) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Percentages are weighted.

Table Footer Note

c Includes interpersonal or legal problems and failure to fulfill roles and obligations. Hazardous drinking is excluded.

Table Footer Note

d Intervention from specialty, medical, and nonmedical providers received prior to 12 months prior to baseline

Table Footer Note

e Intervention received in the 12 months prior to baseline and during the three-year follow-up period between baseline and Wave 2 (2004–2005) of NESARC

Anchor for Jump
Table 2Disparities between racial-ethnic minority groups and whites in the odds of receiving an alcohol interventiona
Table Footer Note

a Whites are the reference group..Data are from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions and refer to intervention received in the 12 months prior to baseline and during the three-year follow-up period between baseline and Wave 2.

Table Footer Note

b Base model: adjusted for sex, age, education, income, and health insurance

Table Footer Note

c Base model plus adjustment for weekly heavy drinking

Table Footer Note

d Base model plus adjustment for negative consequences of drinking

Table Footer Note

e Base model plus adjustment for prior lifetime alcohol intervention (received prior to 12 months prior to baseline)

Table Footer Note

f Fully adjusted model: adjusted for sex, age, education, income, health insurance, severity of need (weekly heavy drinking and negative drinking consequences), and prior lifetime alcohol intervention

Anchor for Jump
Table 3Estimated racial-ethnic disparities in the receipt of an alcohol intervention before and after a simulated policy change allowing use of nonmedical providersa
Table Footer Note

a According to current clinical guidelines, evidence-based alcohol interventions are understood to be services from general medical and specialty providers.

Table Footer Note

b Whites are the reference group.

Table Footer Note

c Calculated as (ORwithout–ORwith)/ORwithout

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