(10) Individuals Diagnosed with an Alcohol Use Disorder: Who Receives What Healthcare Advice?

Background:  Alcohol use disorder (AUD) remains a significant public health issue that requires a continuum of treatment [1], and studies indicate that race and ethnicity-related and gender-related disparities persist in access to treatment [2,3]. Thorough assessment is necessary to provide comprehensive treatments [4], including asking about use and associated problems, advising individuals to cut back and providing information about accessing treatment. This study explored socio-demographic and substance-related correlates of advice given by healthcare providers to participants with AUDs.

Methods:  Data from the 2015-2019 National Surveys on Drug Use and Health were used to study adults (18+ years old) who had received a DSM-IV AUD diagnosis and had visited a primary care provider within the past 12-months. Those who had received treatment for alcohol use were excluded (n=15,052). Adjusted logistic regression models assessed the relationship between self-reported socio-demographic factors, substance-related factors (past 12-month use of tobacco, marijuana, cocaine, prescription pain relievers, sedative/tranquilizer (ST), and stimulants) and being a.) asked about frequency/quantity of alcohol used; and among those who were asked about frequency/quantity of alcohol used (n=7,714) being b.) asked about problems with alcohol, c.) advised to cut down on alcohol consumption, and d.) offered information about treatment.

Results:  Over half of the participants (52.5%) were asked about alcohol use, among them 22.3% were asked about associated problems, 15% were advised to reduce consumption and 7.5% were offered treatment information. Males were less likely to be asked about alcohol use than females (aOR= 0.73, 95%CI=0.64, 0.82) however, when asked they were more likely to be asked about associated problems (aOR= 1.54, 95%CI=1.30, 1.83), advised to cut down consumption (aOR= 1.80, 95%CI=1.35, 2.42) and offered information about treatment (aOR= 1.83, 95%CI=1.42, 2.34) than females. Participants self-identifying as non-Hispanic Black (aOR= 0.72, 95%CI=0.61, 0.86), Hispanic (aOR= 0.63, 95%CI=0.53, 0.75), or non-Hispanic Others (aOR= 0.67, 95%CI=0.57, 0.78) were less likely to be asked about alcohol use than those identifying as non-Hispanic White. Participants with insurance were more likely to be asked about the frequency or quantity of alcohol use than participants without insurance (aOR= 2.14, 95%CI=1.88, 2.43). Participants with tobacco dependence (aOR= 0.62, 95%CI=0.54, 0.70) and marijuana use disorder (aOR= 0.85, 95%CI=0.73, 0.99) were less likely to be asked and those with PPR use (aOR= 1.33, 95%CI=1.19, 1.48), ST use (aOR= 1.19, 95%CI=1.04, 1.36), ST misuse (aOR= 1.26, 95%CI=1.07, 1.50) and ST disorder (aOR= 1.66, 95%CI=1.17, 2.37) were more likely to be asked about use. Once asked, participants who had alcohol dependence were more likely (aOR= 1.44, 95%CI=1.25, 1.65) to be asked about problems, to cut (aOR= 2.67, 95%CI=2.16, 3.31); offered information about alcohol treatment (aOR= 1.48, 95%CI=1.10, 2.00).

Conclusions:  Being asked about frequency/quantity of alcohol used is the first step towards conversation around alcohol use disorder treatment. Results indicate that there might be significant gap in the treatment continuum, especially for those identifying as racial-ethnic or gender minority. Making health providers more aware of need to ask patients about alcohol use, particularly among those serving racial and ethnic minorities, might help reduce the individual and societal burden of alcohol.

References: 1. Ray LA, Bujarski S, Grodin E, Hartwell E, Green R, Venegas A, Lim AC, Gillis A, Miotto K. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. The American journal of drug and alcohol abuse. 2019 Mar 4;45(2):124-40.
2. Vaeth PA, Wang‐Schweig M, Caetano R. Drinking, alcohol use disorder, and treatment access and utilization among US racial/ethnic groups. Alcoholism: Clinical and Experimental Research. 2017 Jan;41(1):6-19.
3. Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, Huang B, Jung J, Zhang H, Fan A, Hasin DS. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA psychiatry. 2017 Sep 1;74(9):911-23.
4. Thomas CP, Ritter GA, Harris AH, Garnick DW, Freedman KI, Herbert B. Applying American Society of Addiction Medicine performance measures in commercial health insurance and services data. Journal of addiction medicine. 2018 Jul 1;12(4):287-94.

Diversity, Equity, and Inclusion: We assessed differences in rates of being asked by healthcare providers about alcohol use, problems of alcohol use, receiving advise to cut down on alcohol consumption and information about alcohol treatment based on self-reported race/ethnicity, gender and insurance status. The results indicated stark differences, indicating health disparities among participants with alcohol use disorder (AUD). Authors are aware of the socially constructed nature of variables used such as gender, race/ethnicity. The categories used in the analyses were based on the National Surveys on Drug Use and Health. We will address themes of healthcare disparities considering the strengths and limitations of the methods used and data available.