Racial/Ethnic Differences in Alcohol and Drug Use Outcomes Following Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Federally Qualified Health Centers.

BACKGROUND: Substance use disorders (SUDs) pose a significant public health concern. Previous findings, while equivocal, demonstrate screening, brief intervention, and referral to treatment (SBIRT) is effective in reducing substance use and improving overall health. While race/ethnic and sex differences in SBIRT outcomes exist, racial/ethnic differences within sex groups remain unclear. The present study sought to quantify differences within race/ethnicity and sex in drug and alcohol use following SBIRT screenings. METHODS: Using health service data (N = 29,121) from a Midwestern state in four federally qualified health centers (FQHC) from 2012 to 2016, we assessed racial/ethnic and sex differences in the effect of SBIRT screening on alcohol and drug use between visits. We used McNemar's tests and multiple logistic regression to predict substance use at follow-up visits. RESULTS: We found a significant race/ethnicity by sex interaction predicting a positive alcohol prescreening (p < 0.001), precipitating a full alcohol screening, and subsequent hazardous drinking (p < 0.001) at full alcohol screening follow-up. Black males demonstrated the largest reduction in positive alcohol prescreenings at follow-up (9.24%). Patients identifying as White, Black, or Other demonstrated a reduction in hazardous drinking, though effect sizes were small and not clinically meaningful. No interactions in our drug outcome models were significant. CONCLUSION: SBIRT is useful in addressing health services equity among Black and male populations. Public health policy should support universal substance use screening and targeting interventions for underserved groups in clinical facilities likely to benefit the most. Resources should be directed to groups with the most pressing SUD treatment needs.

Stability of the alcohol use disorders identification test in practical service settings.

OBJECTIVE: The purpose of the present study is to explore the stability of the Alcohol Use Disorders Identification Test (AUDIT) in a clinical setting by comparing prescreening heavy drinking questions and AUDIT scores over time. Because instrument stability is equal to test-retest reliability at worst, investigating the stability of the AUDIT would help better understand patient behavior change in context and the appropriateness of the AUDIT in a clinical setting. METHODS: This was a retrospective exploratory analysis of Visit 1 to Visit 2 AUDIT stability (n=1,099; male [75.4%], female [24.6%]) from all patients with first-time and second-time records in the Iowa Screening, Brief Intervention, and Referral to Treatment project, October 2012 to July 7, 2015 (N=17,699; male [40.6%], female [59.4%]). RESULTS: The AUDIT demonstrated moderate stability (intraclass correlation=0.56, 95% confidence interval: 0.52-0.60). In a multiple regression predicting the (absolute) difference between the two AUDIT scores, the participants' age was highly significant, t(1,092)=6.23, p<0.001. Younger participants clearly showed less stability than their older counterparts. Results are limited/biased by the observational nature of the study design and the use of clinical service data. CONCLUSION: The present findings contribute to the literature by demonstrating that the AUDIT changes are moderately dependable from Visit 1 to Visit 2 while taking into account patient drinking behavior variability. It is important to know the stability of the AUDIT for continued use in Screening, Brief Intervention, and Referral to Treatment programming.