Study Finds Low Utilization of Specialty Treatment for Problem Alcohol Use; Differences Associated with Race, Ethnicity, and Health Risk Status

Only four percent of people who are screened and report heavy drinking go on to receive specialty treatment for their alcohol use, according to a study published in Alcohol: Clinical and Experimental Research. The study found race, ethnicity, and health risk profile to be associated with differences in the likelihood of receiving specialty treatment. These findings echo previous studies and highlight the need for more tailored approaches to screening and intervention to improve treatment for diverse groups of people with varying levels of alcohol use problems, from heavy drinking to alcohol use disorder.

To understand factors associated with the likelihood of receiving specialty treatment for problem drinking, researchers examined the electronic health records of over two hundred thousand Kaiser Permanente Northern California members, identified through a screening questionnaire as heavy drinkers. Individuals in the study were considered to have received specialty treatment if, within 60 days of the screening, they had an outpatient, inpatient, telephone, or video visit with an addiction medicine, psychiatry, or integrated behavioral health specialist or received medication for alcohol use disorder. Kaiser Permanente members can obtain specialty addiction and mental health treatment without a referral.

Based on distributions of patient characteristics, participants were grouped into five health risk profiles: a heavy daily drinking group with fewer health risks, a heavy weekly drinking group with fewer health risks, a heavy daily drinking group with more health risks, a heavy weekly drinking group with more health risks, and a group with substance use disorder and other mental health disorder. Health risks included smoking, obesity, a sedentary lifestyle, chronic diseases, and high blood pressure.

Overall, only 4 percent of participants with heavy drinking received specialty treatment. The heavy daily drinking group with fewer health risks was less likely to receive specialty treatment than people in all other health risk profiles. The group with substance use and other mental health disorders was most likely to receive specialty treatment. Latino/Hispanic and Asian/Pacific Islander drinkers had lower odds of receiving treatment compared to White patients. Black participants with substance use and mental health disorders and Hispanic/Latino participants with heavy daily drinking and more health risks were less likely to receive treatment than their White counterparts. Asian/Pacific Islander and Black participants in the weekly heavy drinking group and fewer health risks were more likely to receive specialty treatment than their White counterparts. Findings regarding differences by race and ethnicity have similarly been found in prior studies, nationally representative samples, and other healthcare systems.

Of those who did receive specialty treatment, more people used mental health treatment compared to addiction treatment, at a rate of three to one, which may be due to a higher prevalence of mental health disorders or other factors, such as stigma. Sixty thousand of the participants were considered to have, or be at risk for, alcohol use disorder. Still, only five percent of people in the higher-risk group received any specialty treatment.

These findings do not imply causality. Further exploration of factors such as socioeconomic status and other social determinants of health, such as employment status, might provide further insight into potential barriers to receiving specialty treatment.

Racial and ethnic disparities in receipt of specialty treatment across risk profiles of adults with heavy alcohol use. V. Palzes, F. Chi, C. Weisner, A. Kline-Simon, D. Satre, S. Sterling.

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