Black and Hispanic people in the US may encounter barriers to alcohol use disorder treatment. However, it is unclear how such treatment usage may vary at the intersection of racial/ethnic and gender identities, and how health insurance coverage might play a role. This study analyzed national survey data to examine how alcohol treatment utilization varied by race, ethnicity, and gender, and whether any disparities differed by insurance coverage.
l
There are many effective therapies, medications, and recovery support options for individuals with alcohol use disorder. However, evidence suggests that treatment may be underutilized by many who need it. A common barrier to treatment is the cost of care. Regardless of insurance coverage, those needing treatment may not be able to afford it due to variability in the types of services covered by insurance. This is especially problematic for those on Medicaid– public health insurance for low-income people. Despite over 72 million people in the US being on Medicaid, there is evidence that this insurance modality may constrain options for patients interested in alcohol use disorder treatment. Medicaid also disproportionately serves racially/ethnically minority groups (e.g., Black and Hispanic Americans). Despite Medicaid being a critical provider of care in the US it is unclear how effective it is at providing alcohol treatment to patients. Separately, because Medicaid is available only to those in lower socioeconomic strata, it may be a marker for a host of other challenges that make it hard for individuals to access and remain in care (i.e., limited recovery capital). In addition, it is unknown if differences in alcohol treatment utilization exist across intersecting social identities (racial and ethnic minority groups and women). Identifying disparities with this intersectional framework can help inform strategies to address barriers to accessing care among marginalized groups. This study conducted an intersectional analysis of national survey data to determine how treatment usage varied across racial, ethnic, and gender identities as well as insurance coverage.
The study was a cross-sectional analysis of 3 years of pooled data (2017-2019) from the National Survey on Drug Use and Health. The National Survey on Drug Use and Health is an annual survey conducted by the Substance Use and Mental Health Services Administration (SAMHSA) to gather information on substance use and mental health issues among the US population. Data are collected across all 50 states and the District of Columbia. Only non-institutionalized (e.g., non-incarcerated) individuals 12 years or older are sampled.
Participants were included in the present analyses if they 1) met Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for alcohol use disorder (i.e., “alcohol dependence” or “alcohol abuse”) in the past year, 2) reported only having Medicaid, private insurance, or being uninsured, and 3) identified as White, Black, or Latinx. The primary outcome of this study was past year alcohol use disorder treatment utilization. This was defined as receiving any kind of alcohol use disorder treatment in a specialty facility including hospitals (inpatient), rehabilitation facilities (inpatient or outpatient), or mental health centers.
The primary goal of the present study was to examine rates of alcohol use disorder treatment utilization among those who report alcohol use disorder symptomology. Specifically, this work set out to examine how alcohol use disorder treatment use varied based on an individual’s race, ethnicity, gender, and insurance coverage. To do this, the authors used multivariable logistic regression models– a type of statistical approach where the probability of an outcome is determined based on multiple independent variables, adjusting statistically for self-rated health status, co-occurring substance use disorders (e.g., stimulant or opioid use disorder in addition to alcohol use disorder), past-year major depressive episode (yes/no), elevated psychological distress (based on an accepted cut-off from a validated scale), age, marital status, and survey year (2017, 2018, or 2019). Through this analysis, the authors were able to demonstrate how actual rates of alcohol use disorder treatment varied across groups. In the present analysis the authors compared all groups to White men. The rational for this is that compared to other demographics, White men have higher income, lower unemployment, and more healthcare coverage. Data in the present analysis were weighted– that is adjusted for potential biases and differences between the target population and the sample.
The final sample was comprised of 7782 respondents from across the US. The sample consisted of White males (42%), White females (29%), Latino males (12%), Latina females (7%), Black males (6%), and Black females (5%). Most participants reported having private insurance (68.9%) with the remainder indicating they had Medicaid (15.7%) or were uninsured (15.4%). Participants’ age ranged from 18-64 years.
Only 5.4% of adults with an alcohol use disorder received alcohol use disorder treatment
The vast majority of US adults with alcohol use disorder did not receive specialty treatment. Treatment seeking rates were similar across participant race, ethnicity, gender, and insurance coverage.
Latina women on Medicaid and uninsured Latino men reported the lowest usage of alcohol use disorder treatment
The rate of Latina females on Medicaid who received alcohol use disorder treatment was 3.2% compared to 9.3% of White males on Medicaid, a statistically significant difference. Only 1.8% of Latino men who were uninsured reported past year alcohol use disorder treatment utilization compared to 6.2% of uninsured White men, also statistically significant. Among those with private insurance, gender/race sub-groups exhibiting very similar rates of treatment seeking.
Disparities for Latina women on Medicaid and Latino men without insurance persisted even when adjusting for other individual factors
The study also examined whether factors like criminal legal system involvement (e.g., ever having been arrested), education (e.g., having a college degree), and employment status (e.g., unemployment) might explain these disparities. If they did, such disparities would abate when accounting for these factors. Even when accounting for these variables, however, the disparities for these Latinx subgroups among Medicaid/uninsured individuals persisted. This suggests other factors are at play.
The results of this study suggest that alcohol use treatment is underutilized by those who could potentially benefit from it. Although all 7782 sampled participants across the US reported alcohol use disorder symptomology, less than 6% reported receiving treatment in the year prior, with no differences by race/gender sub-groups. There are many reasons why individuals with alcohol and other drug use disorders – diagnosed from their own reports regarding the impacts of substance use on their lives – do not seek services. For example, the majority of those with alcohol use disorder have milder cases and may wish to make a change while not feeling they need treatment; note that about half of US adults who resolve a substance use problem do so without the use of formal services.
Notably, Latina women who were on Medicaid used alcohol use disorder treatment less often than White men on Medicaid, independent of several indicators of clinical severity, such as co-occurring substance use disorders (e.g., opioid or stimulant), major depressive disorder, and overall current mental health. Similarly, uninsured Latino men reported lower alcohol use disorder treatment than White men who were uninsured. The authors controlled for factors relevant to healthcare access (e.g., education and criminal justice involvement) but found that these disparities persisted. This suggests unique barriers to treatment seeking for Latinx individuals in lower socioeconomic strata. Such barriers may be grounded in working class Latinx culture or language barriers in these under-resourced Spanish-speaking communities though such post-hoc explanations were not tested here. Interestingly, in another representative sample of US adults with alcohol use disorder, Latinx individuals were also less likely to attend Alcoholics Anonymous (AA) than their White counterparts. Given that AA is a free resource in the communities where people live and work, barriers to Latinx help-seeking may be unlikely to be financially driven, and possibly more likely to be grounded in cultural or language differences, but more explicit focused research is needed to understand the exact causes of these disparities.
These findings underscore the need for tailored strategies that address structural barriers within the U.S. healthcare system, especially for Medicaid enrollees, who often include racial and ethnic minoritized populations. Addressing these disparities can inform targeted policy adjustments, such as enhancing Medicaid coverage for alcohol use disorder treatments, expanding access to culturally specific and culturally sensitive support services, and strengthening provider networks in communities with high unmet treatment needs.
This study found that alcohol use disorder treatment usage is underutilized by those in the US who could potentially benefit from it. Only 5.4% of sampled adults with alcohol use disorder reported receiving specialty alcohol use disorder treatment. Additionally, this study highlights significant disparities in alcohol use disorder treatment access among uninsured and Medicaid-enrolled Hispanic individuals in the US. Latino men without insurance and Latina women with Medicaid coverage were found to utilize services less. These findings suggest that marginalized communities face compounded challenges in obtaining substance use disorder care. Improving Medicaid’s reach and culturally tailoring support to better serve the Latino community may help address these alcohol treatment disparities. Identifying and addressing alcohol treatment service gaps is essential to reducing health inequities and improving alcohol-related health outcomes in the US.
Acevedo, A., Adams, R. S., Cook, B. L., Feltus, S. R., Panas, L., & Stewart, M. T. (2024). Disparities in alcohol treatment use at the intersection of race, ethnicity, gender, and insurance. Substance Use & Addiction Journal, 64(1), 78-89. doi: 10.1177/29767342241278871.
l
There are many effective therapies, medications, and recovery support options for individuals with alcohol use disorder. However, evidence suggests that treatment may be underutilized by many who need it. A common barrier to treatment is the cost of care. Regardless of insurance coverage, those needing treatment may not be able to afford it due to variability in the types of services covered by insurance. This is especially problematic for those on Medicaid– public health insurance for low-income people. Despite over 72 million people in the US being on Medicaid, there is evidence that this insurance modality may constrain options for patients interested in alcohol use disorder treatment. Medicaid also disproportionately serves racially/ethnically minority groups (e.g., Black and Hispanic Americans). Despite Medicaid being a critical provider of care in the US it is unclear how effective it is at providing alcohol treatment to patients. Separately, because Medicaid is available only to those in lower socioeconomic strata, it may be a marker for a host of other challenges that make it hard for individuals to access and remain in care (i.e., limited recovery capital). In addition, it is unknown if differences in alcohol treatment utilization exist across intersecting social identities (racial and ethnic minority groups and women). Identifying disparities with this intersectional framework can help inform strategies to address barriers to accessing care among marginalized groups. This study conducted an intersectional analysis of national survey data to determine how treatment usage varied across racial, ethnic, and gender identities as well as insurance coverage.
The study was a cross-sectional analysis of 3 years of pooled data (2017-2019) from the National Survey on Drug Use and Health. The National Survey on Drug Use and Health is an annual survey conducted by the Substance Use and Mental Health Services Administration (SAMHSA) to gather information on substance use and mental health issues among the US population. Data are collected across all 50 states and the District of Columbia. Only non-institutionalized (e.g., non-incarcerated) individuals 12 years or older are sampled.
Participants were included in the present analyses if they 1) met Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for alcohol use disorder (i.e., “alcohol dependence” or “alcohol abuse”) in the past year, 2) reported only having Medicaid, private insurance, or being uninsured, and 3) identified as White, Black, or Latinx. The primary outcome of this study was past year alcohol use disorder treatment utilization. This was defined as receiving any kind of alcohol use disorder treatment in a specialty facility including hospitals (inpatient), rehabilitation facilities (inpatient or outpatient), or mental health centers.
The primary goal of the present study was to examine rates of alcohol use disorder treatment utilization among those who report alcohol use disorder symptomology. Specifically, this work set out to examine how alcohol use disorder treatment use varied based on an individual’s race, ethnicity, gender, and insurance coverage. To do this, the authors used multivariable logistic regression models– a type of statistical approach where the probability of an outcome is determined based on multiple independent variables, adjusting statistically for self-rated health status, co-occurring substance use disorders (e.g., stimulant or opioid use disorder in addition to alcohol use disorder), past-year major depressive episode (yes/no), elevated psychological distress (based on an accepted cut-off from a validated scale), age, marital status, and survey year (2017, 2018, or 2019). Through this analysis, the authors were able to demonstrate how actual rates of alcohol use disorder treatment varied across groups. In the present analysis the authors compared all groups to White men. The rational for this is that compared to other demographics, White men have higher income, lower unemployment, and more healthcare coverage. Data in the present analysis were weighted– that is adjusted for potential biases and differences between the target population and the sample.
The final sample was comprised of 7782 respondents from across the US. The sample consisted of White males (42%), White females (29%), Latino males (12%), Latina females (7%), Black males (6%), and Black females (5%). Most participants reported having private insurance (68.9%) with the remainder indicating they had Medicaid (15.7%) or were uninsured (15.4%). Participants’ age ranged from 18-64 years.
Only 5.4% of adults with an alcohol use disorder received alcohol use disorder treatment
The vast majority of US adults with alcohol use disorder did not receive specialty treatment. Treatment seeking rates were similar across participant race, ethnicity, gender, and insurance coverage.
Latina women on Medicaid and uninsured Latino men reported the lowest usage of alcohol use disorder treatment
The rate of Latina females on Medicaid who received alcohol use disorder treatment was 3.2% compared to 9.3% of White males on Medicaid, a statistically significant difference. Only 1.8% of Latino men who were uninsured reported past year alcohol use disorder treatment utilization compared to 6.2% of uninsured White men, also statistically significant. Among those with private insurance, gender/race sub-groups exhibiting very similar rates of treatment seeking.
Disparities for Latina women on Medicaid and Latino men without insurance persisted even when adjusting for other individual factors
The study also examined whether factors like criminal legal system involvement (e.g., ever having been arrested), education (e.g., having a college degree), and employment status (e.g., unemployment) might explain these disparities. If they did, such disparities would abate when accounting for these factors. Even when accounting for these variables, however, the disparities for these Latinx subgroups among Medicaid/uninsured individuals persisted. This suggests other factors are at play.
The results of this study suggest that alcohol use treatment is underutilized by those who could potentially benefit from it. Although all 7782 sampled participants across the US reported alcohol use disorder symptomology, less than 6% reported receiving treatment in the year prior, with no differences by race/gender sub-groups. There are many reasons why individuals with alcohol and other drug use disorders – diagnosed from their own reports regarding the impacts of substance use on their lives – do not seek services. For example, the majority of those with alcohol use disorder have milder cases and may wish to make a change while not feeling they need treatment; note that about half of US adults who resolve a substance use problem do so without the use of formal services.
Notably, Latina women who were on Medicaid used alcohol use disorder treatment less often than White men on Medicaid, independent of several indicators of clinical severity, such as co-occurring substance use disorders (e.g., opioid or stimulant), major depressive disorder, and overall current mental health. Similarly, uninsured Latino men reported lower alcohol use disorder treatment than White men who were uninsured. The authors controlled for factors relevant to healthcare access (e.g., education and criminal justice involvement) but found that these disparities persisted. This suggests unique barriers to treatment seeking for Latinx individuals in lower socioeconomic strata. Such barriers may be grounded in working class Latinx culture or language barriers in these under-resourced Spanish-speaking communities though such post-hoc explanations were not tested here. Interestingly, in another representative sample of US adults with alcohol use disorder, Latinx individuals were also less likely to attend Alcoholics Anonymous (AA) than their White counterparts. Given that AA is a free resource in the communities where people live and work, barriers to Latinx help-seeking may be unlikely to be financially driven, and possibly more likely to be grounded in cultural or language differences, but more explicit focused research is needed to understand the exact causes of these disparities.
These findings underscore the need for tailored strategies that address structural barriers within the U.S. healthcare system, especially for Medicaid enrollees, who often include racial and ethnic minoritized populations. Addressing these disparities can inform targeted policy adjustments, such as enhancing Medicaid coverage for alcohol use disorder treatments, expanding access to culturally specific and culturally sensitive support services, and strengthening provider networks in communities with high unmet treatment needs.
This study found that alcohol use disorder treatment usage is underutilized by those in the US who could potentially benefit from it. Only 5.4% of sampled adults with alcohol use disorder reported receiving specialty alcohol use disorder treatment. Additionally, this study highlights significant disparities in alcohol use disorder treatment access among uninsured and Medicaid-enrolled Hispanic individuals in the US. Latino men without insurance and Latina women with Medicaid coverage were found to utilize services less. These findings suggest that marginalized communities face compounded challenges in obtaining substance use disorder care. Improving Medicaid’s reach and culturally tailoring support to better serve the Latino community may help address these alcohol treatment disparities. Identifying and addressing alcohol treatment service gaps is essential to reducing health inequities and improving alcohol-related health outcomes in the US.
Acevedo, A., Adams, R. S., Cook, B. L., Feltus, S. R., Panas, L., & Stewart, M. T. (2024). Disparities in alcohol treatment use at the intersection of race, ethnicity, gender, and insurance. Substance Use & Addiction Journal, 64(1), 78-89. doi: 10.1177/29767342241278871.
l
There are many effective therapies, medications, and recovery support options for individuals with alcohol use disorder. However, evidence suggests that treatment may be underutilized by many who need it. A common barrier to treatment is the cost of care. Regardless of insurance coverage, those needing treatment may not be able to afford it due to variability in the types of services covered by insurance. This is especially problematic for those on Medicaid– public health insurance for low-income people. Despite over 72 million people in the US being on Medicaid, there is evidence that this insurance modality may constrain options for patients interested in alcohol use disorder treatment. Medicaid also disproportionately serves racially/ethnically minority groups (e.g., Black and Hispanic Americans). Despite Medicaid being a critical provider of care in the US it is unclear how effective it is at providing alcohol treatment to patients. Separately, because Medicaid is available only to those in lower socioeconomic strata, it may be a marker for a host of other challenges that make it hard for individuals to access and remain in care (i.e., limited recovery capital). In addition, it is unknown if differences in alcohol treatment utilization exist across intersecting social identities (racial and ethnic minority groups and women). Identifying disparities with this intersectional framework can help inform strategies to address barriers to accessing care among marginalized groups. This study conducted an intersectional analysis of national survey data to determine how treatment usage varied across racial, ethnic, and gender identities as well as insurance coverage.
The study was a cross-sectional analysis of 3 years of pooled data (2017-2019) from the National Survey on Drug Use and Health. The National Survey on Drug Use and Health is an annual survey conducted by the Substance Use and Mental Health Services Administration (SAMHSA) to gather information on substance use and mental health issues among the US population. Data are collected across all 50 states and the District of Columbia. Only non-institutionalized (e.g., non-incarcerated) individuals 12 years or older are sampled.
Participants were included in the present analyses if they 1) met Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for alcohol use disorder (i.e., “alcohol dependence” or “alcohol abuse”) in the past year, 2) reported only having Medicaid, private insurance, or being uninsured, and 3) identified as White, Black, or Latinx. The primary outcome of this study was past year alcohol use disorder treatment utilization. This was defined as receiving any kind of alcohol use disorder treatment in a specialty facility including hospitals (inpatient), rehabilitation facilities (inpatient or outpatient), or mental health centers.
The primary goal of the present study was to examine rates of alcohol use disorder treatment utilization among those who report alcohol use disorder symptomology. Specifically, this work set out to examine how alcohol use disorder treatment use varied based on an individual’s race, ethnicity, gender, and insurance coverage. To do this, the authors used multivariable logistic regression models– a type of statistical approach where the probability of an outcome is determined based on multiple independent variables, adjusting statistically for self-rated health status, co-occurring substance use disorders (e.g., stimulant or opioid use disorder in addition to alcohol use disorder), past-year major depressive episode (yes/no), elevated psychological distress (based on an accepted cut-off from a validated scale), age, marital status, and survey year (2017, 2018, or 2019). Through this analysis, the authors were able to demonstrate how actual rates of alcohol use disorder treatment varied across groups. In the present analysis the authors compared all groups to White men. The rational for this is that compared to other demographics, White men have higher income, lower unemployment, and more healthcare coverage. Data in the present analysis were weighted– that is adjusted for potential biases and differences between the target population and the sample.
The final sample was comprised of 7782 respondents from across the US. The sample consisted of White males (42%), White females (29%), Latino males (12%), Latina females (7%), Black males (6%), and Black females (5%). Most participants reported having private insurance (68.9%) with the remainder indicating they had Medicaid (15.7%) or were uninsured (15.4%). Participants’ age ranged from 18-64 years.
Only 5.4% of adults with an alcohol use disorder received alcohol use disorder treatment
The vast majority of US adults with alcohol use disorder did not receive specialty treatment. Treatment seeking rates were similar across participant race, ethnicity, gender, and insurance coverage.
Latina women on Medicaid and uninsured Latino men reported the lowest usage of alcohol use disorder treatment
The rate of Latina females on Medicaid who received alcohol use disorder treatment was 3.2% compared to 9.3% of White males on Medicaid, a statistically significant difference. Only 1.8% of Latino men who were uninsured reported past year alcohol use disorder treatment utilization compared to 6.2% of uninsured White men, also statistically significant. Among those with private insurance, gender/race sub-groups exhibiting very similar rates of treatment seeking.
Disparities for Latina women on Medicaid and Latino men without insurance persisted even when adjusting for other individual factors
The study also examined whether factors like criminal legal system involvement (e.g., ever having been arrested), education (e.g., having a college degree), and employment status (e.g., unemployment) might explain these disparities. If they did, such disparities would abate when accounting for these factors. Even when accounting for these variables, however, the disparities for these Latinx subgroups among Medicaid/uninsured individuals persisted. This suggests other factors are at play.
The results of this study suggest that alcohol use treatment is underutilized by those who could potentially benefit from it. Although all 7782 sampled participants across the US reported alcohol use disorder symptomology, less than 6% reported receiving treatment in the year prior, with no differences by race/gender sub-groups. There are many reasons why individuals with alcohol and other drug use disorders – diagnosed from their own reports regarding the impacts of substance use on their lives – do not seek services. For example, the majority of those with alcohol use disorder have milder cases and may wish to make a change while not feeling they need treatment; note that about half of US adults who resolve a substance use problem do so without the use of formal services.
Notably, Latina women who were on Medicaid used alcohol use disorder treatment less often than White men on Medicaid, independent of several indicators of clinical severity, such as co-occurring substance use disorders (e.g., opioid or stimulant), major depressive disorder, and overall current mental health. Similarly, uninsured Latino men reported lower alcohol use disorder treatment than White men who were uninsured. The authors controlled for factors relevant to healthcare access (e.g., education and criminal justice involvement) but found that these disparities persisted. This suggests unique barriers to treatment seeking for Latinx individuals in lower socioeconomic strata. Such barriers may be grounded in working class Latinx culture or language barriers in these under-resourced Spanish-speaking communities though such post-hoc explanations were not tested here. Interestingly, in another representative sample of US adults with alcohol use disorder, Latinx individuals were also less likely to attend Alcoholics Anonymous (AA) than their White counterparts. Given that AA is a free resource in the communities where people live and work, barriers to Latinx help-seeking may be unlikely to be financially driven, and possibly more likely to be grounded in cultural or language differences, but more explicit focused research is needed to understand the exact causes of these disparities.
These findings underscore the need for tailored strategies that address structural barriers within the U.S. healthcare system, especially for Medicaid enrollees, who often include racial and ethnic minoritized populations. Addressing these disparities can inform targeted policy adjustments, such as enhancing Medicaid coverage for alcohol use disorder treatments, expanding access to culturally specific and culturally sensitive support services, and strengthening provider networks in communities with high unmet treatment needs.
This study found that alcohol use disorder treatment usage is underutilized by those in the US who could potentially benefit from it. Only 5.4% of sampled adults with alcohol use disorder reported receiving specialty alcohol use disorder treatment. Additionally, this study highlights significant disparities in alcohol use disorder treatment access among uninsured and Medicaid-enrolled Hispanic individuals in the US. Latino men without insurance and Latina women with Medicaid coverage were found to utilize services less. These findings suggest that marginalized communities face compounded challenges in obtaining substance use disorder care. Improving Medicaid’s reach and culturally tailoring support to better serve the Latino community may help address these alcohol treatment disparities. Identifying and addressing alcohol treatment service gaps is essential to reducing health inequities and improving alcohol-related health outcomes in the US.
Acevedo, A., Adams, R. S., Cook, B. L., Feltus, S. R., Panas, L., & Stewart, M. T. (2024). Disparities in alcohol treatment use at the intersection of race, ethnicity, gender, and insurance. Substance Use & Addiction Journal, 64(1), 78-89. doi: 10.1177/29767342241278871.
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