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Abstract

Objective:

The authors examined racial/ethnic and socioeconomic disparities in receiving treatment for alcohol use disorder (AUD).

Methods:

A retrospective cohort study was conducted that included adults (≥18 years) with AUD from the All of Us Controlled Tier database v7. Outcomes were lifetime receipt of FDA-approved medications (disulfiram, acamprosate, and naltrexone), psychotherapy (individual, family, and group-based session), and combination treatment (medication and psychotherapy). The study examined treatment receipt by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), insurance (private, Medicare, Medicare and Medicaid, Medicaid, Veteran Affairs [VA], none), income (<$10K, $10-<$50K, $50-$100K, >$100K), and area deprivation index (ADI) quintiles. Multivariable logistic and multinomial logistic regressions were used to assess the association between patient characteristics and treatment receipt.

Results:

The cohort consisted of 18,692 patients (mean age=57.1 years; 60.7% were male; 47.1% were non-Hispanic White). Almost 70% received no treatment, 11.4% received medication, 24.0% received psychotherapy, and 4.9% received combination treatment. In adjusted analysis, non-Hispanic Black (aOR=0.78, 95% CI=0.69–0.89) and Hispanic (aOR=0.75, 95% CI=0.64–0.88) individuals were less likely to receive medication than non-Hispanic White counterparts. There was no association between race/ethnicity and receipt of psychotherapy or combination treatment. Compared with private insurance, dual eligibility was associated with less use of medication, Medicare and Medicaid with less use of medication and combination treatment, and VA and no insurance with more use of psychotherapy and combination treatment. Higher income and lower ADI were positively associated with all treatment types.

Conclusions:

There are disparities in AUD treatment by race/ethnicity, socioeconomic status, and insurance. Systematic approaches are required to improve equitable access to effective treatment.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 973 - 987

History

Received: 12 September 2023
Revision received: 26 January 2024
Revision received: 23 February 2024
Revision received: 2 April 2024
Accepted: 16 April 2024
Published online: 1 November 2024
Published in print: November 01, 2024

Keywords

  1. disparities
  2. alcohol use disorder
  3. pharmacotherapy
  4. psychotherapy
  5. All of Us program

Authors

Details

Phuc Le, Ph.D., M.P.H. [email protected]
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Jacob James Rich, M.S.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Eden Y. Bernstein, M.D.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Joseph Glass, Ph.D.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Hamlet Gasoyan, Ph.D.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Sudie E. Back, Ph.D.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Thanh C. Bui, M.D., Dr.P.H.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Gina Ayers, Pharm.D.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Michael B. Rothberg, M.D., M.P.H.
Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).

Notes

Send correspondence to Dr. Le ([email protected]).
Presented in part at the Society of General Internal Medicine 2023 Annual Meeting.

Competing Interests

Mr. Rich is a policy analyst at the Reason Foundation. Dr. Bernstein reports receiving funding support from an Institutional National Research Service Award (T32HP32715) and personal fees from Alosa. Dr. Glass facilitated a quality improvement pilot study for which Pear Therapeutics Inc provided digital therapeutic prescriptions at no cost to Kaiser Permanente Washington. Dr. Rothberg serves as a consultant for Blue Cross Blue Shield Association. The other authors report no financial relationships with commercial interests.

Funding Information

The study was funded by the NIAAA (R01AA030970).

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