Only four percent of people who are examined and report heavy drinking subsequently receive special treatment for their alcohol consumption, according to a study published in Alcohol: Clinical and experimental research. The study found that race, ethnicity, and health risk profile were associated with differences in the likelihood of receiving specialty care. These findings are consistent with previous studies and highlight the need for tailored screening and intervention approaches to improve treatment for different groups of people with varying degrees of alcohol problems, from heavy drinking to alcohol use disorder.
To understand the factors associated with the likelihood of receiving specialty treatment for alcohol problems, researchers examined the electronic health records of over two hundred thousand Kaiser Permanente Northern California members who were identified as heavy drinkers through a screening questionnaire. Individuals in the study were considered recipients of specialty treatment if they had an outpatient, inpatient, telephone or video appointment with an addiction medicine, psychiatry or integrated behavioral health specialist within 60 days of screening or were receiving medication for alcohol abuse. Kaiser Permanente members can receive specialty treatment for addiction and mental health without a referral.
Based on the distribution of patient characteristics, participants were divided into five health risk profiles: a group with heavy daily alcohol consumption and fewer health risks, a group with heavy weekly alcohol consumption and fewer health risks, a group with heavy daily alcohol consumption and more health risks, a group with heavy weekly alcohol consumption and more health risks, and a group with substance use disorders and other mental disorders. Health risks included smoking, obesity, physical inactivity, chronic diseases, and high blood pressure.
Overall, only 4 percent of participants with heavy drinking received specialty treatment. The daily heavy drinker group with fewer health risks was less likely to receive specialty treatment than those with all other health risk profiles. The group with substance use and other mental disorders was most likely to receive specialty treatment. Latino/Hispanic and Asian/Pacific Islander drinkers had lower odds of receiving treatment than white patients. Black participants with substance use and mental disorders and Hispanic/Latino participants with heavy daily drinking and higher health risks were less likely to receive treatment than their white counterparts. Asian/Pacific Islander and Black participants in the weekly heavy drinking group with fewer health risks were more likely to receive specialty treatment than their white counterparts. Findings on differences by race and ethnicity have been obtained in previous studies, nationally representative samples, and other health systems.
Of those who received specialized treatment, more people sought psychiatric treatment than addiction treatment (by a ratio of three to one), which may reflect a higher prevalence of mental disorders or other factors such as stigma. 60,000 of the participants had alcohol abuse or were at risk of it. Yet only five percent of people in the at-risk group received specialized treatment.
These findings do not allow for a causal relationship. Further investigation of factors such as socioeconomic status and other social determinants of health, such as employment status, may provide further insight into potential barriers to seeking specialty care.
Racial and ethnic disparities in receipt of specialty care among high-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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