Drinking contexts, coping motive, simultaneous cannabis use, and high-intensity drinking among adults in the United States.

AIMS: High-intensity drinking (HID), extreme drinking considerably above the level of heavy episodic drinking (HED), is associated with long-term health and social consequences. There is limited understanding of HID beyond young adulthood. This study aims to identify concurrent risk factors for HID, comparing age differences among all adults. METHODS: Multinomial logistic and linear regression modeling was performed using a nationally-representative sample of adults (analytic n = 7956) from the 2015 and 2020 National Alcohol Surveys. The outcomes were any HID of 8-11 drinks and 12+ drinks for men, and 8+ drinks for women, and corresponding frequencies. Concurrent risk factors included coping motive, sensation seeking, simultaneous use of alcohol and cannabis (SAC), and drinking at a bar or party. Analyses were stratified by age (18-29 vs. older) and sex. RESULTS: For younger men, sensation-seeking was significantly associated with HID (vs. no HED) at both levels and frequency of HID 8-11 drinks, while drinking to cope was only significant for 12+ drinks. For older men, drinking to cope was a consistent predictor for both HID level and its frequency, but sensation-seeking was not significant. Both coping and sensation-seeking were significantly associated with any HID for all women, while coping was significant for HID frequency for younger women. Frequent drinking at bars and parties were associated with greater odds of HID for all adults. With HED as referent, similar patterns of (though fewer significant) associations were observed. CONCLUSIONS: Younger and older adults share similar risk factors for HID, with coping more consistent for older men.

Associations between alcohol taxes and varied health outcomes among women of reproductive age and infants.

OBJECTIVE: No studies have examined whether alcohol taxes may be relevant for reducing harms related to pregnant people's drinking. METHOD: We examined how beverage-specific ad valorem, volume-based, and sales taxes are associated with outcomes across three data sets. Drinking outcomes came from women of reproductive age in the 1990-2020 US National Alcohol Surveys (N = 11 659 women $\le$ 44 years); treatment admissions data came from the 1992-2019 Treatment Episode Data Set: Admissions (N = 1331 state-years; 582 436 pregnant women admitted to treatment); and infant and maternal outcomes came from the 2005-19 Merative Marketscan® database (1 432 979 birthing person-infant dyads). Adjusted analyses for all data sets included year fixed effects, state-year unemployment and poverty, and accounted for clustering by state. RESULTS: Models yield no robust significant associations between taxes and drinking. Increased spirits ad valorem taxes were robustly associated with lower rates of treatment admissions [adjusted IRR = 0.95, 95% CI: 0.91, 0.99]. Increased wine and spirits volume-based taxes were both robustly associated with lower odds of infant morbidities [wine aOR = 0.98, 95% CI: 0.96, 0.99; spirits aOR = 0.99, 95% CI: 0.98, 1.00] and lower odds of severe maternal morbidities [wine aOR = 0.91, 95% CI: 0.86, 0.97; spirits aOR = 0.95, 95% CI: 0.92, 0.97]. Having an off-premise spirits sales tax was also robustly related to lower odds of severe maternal morbidities [aOR = 0.78, 95% CI: 0.64, 0.96]. CONCLUSIONS: Results show protective associations between increased wine and spirits volume-based and sales taxes with infant and maternal morbidities. Policies that index tax rates to inflation might yield more public health benefits, including for pregnant people and infants.

Relationships Between Alcohol Policies and Infant Morbidities and Injuries.

INTRODUCTION: Previous research has found that policies specifically focused on pregnant people's alcohol use are largely ineffective. Therefore, the purpose of this study is to analyze the relationships between general population policies regulating alcohol physical availability and outcomes related to pregnant people's alcohol use, specifically infant morbidities and injuries. METHODS: Outcome data were obtained from Merative MarketScan, a longitudinal commercial insurance claims data set. Policy data were obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System, the National Alcohol Beverage Control Association, and Liquor Handbooks and merged using policies in effect during the estimated year of conception. Relationships between state-level policies regulating sites, days/hours, and government monopoly of liquor sales and infant morbidities and injuries were examined. Analyses used logistic regression with individual controls, fixed effects for state and year, state-specific time trends, and SEs clustered by state. The study analysis was conducted from 2021 to 2023. RESULTS: The analytic sample included 1,432,979 infant-birthing person pairs, specifically people aged 25-50 years who gave birth to a singleton between 2006 and 2019. A total of 3.1% of infants had a morbidity and 2.1% of infants had an injury. State government monopoly on liquor sales was associated with reduced odds of infant morbidities and injuries, whereas gas station liquor sales were associated with increased odds of infant morbidities and injuries. Allowing liquor sales after 10PM was associated with increased odds for infant injuries. No effect was found for allowing liquor sales in grocery stores or on Sundays. CONCLUSIONS: Findings suggest that limiting alcohol availability for the general population may help reduce adverse infant outcomes related to pregnant people's alcohol use.

Intersectional disparities in outpatient alcohol treatment completion by gender and race and ethnicity.

BACKGROUND: Untreated alcohol use disorder (AUD) can have negative outcomes, including premature death. Completing specialty treatment for AUD can improve economic and educational outcomes. However, there are large racial and ethnic disparities in treatment completion, and how these disparities vary intersectionally (e.g., by gender and race and ethnicity) is unknown. Recent studies suggest that not using an intersectional approach can mask important disparities. We estimated disparities in AUD nonintensive outpatient treatment completion by gender alone, race and ethnicity alone, and intersectionally in a gender-by-race-and-ethnicity model. Accurately quantifying treatment completion disparities is critical not only for understanding healthcare disparities but reducing them to advance health equity. METHODS: Data are from SAMHSA's 2017 to 2019 Treatment Episode Dataset-Discharges for adults aged 18+ who entered nonintensive outpatient treatment primarily for alcohol (n = 559,447 episodes; 30.3% women; 63.7% White, 18.0% Black, 14.4% Hispanic/Latinx, 2.1% American Indian/Alaska Native [AIAN], 1.0% Asian/Pacific Islander). Using the rank-and-replace method, treatment completion disparities were estimated by gender, race and ethnicity, and gender-by-race-and-ethnicity due to any reason other than differences in need for treatment, consistent with the Institute of Medicine's definition of a healthcare disparity. RESULTS: The intersectional gender-by-race-and-ethnicity model identified the widest range of disparities among all models tested. Using this model, the largest disparities were identified for minoritized women's treatment episodes. Compared to White men whose completion rate was 60.79% (95% confidence interval [CI]: 60.06, 60.98), Black, Hispanic/Latina, AIAN, and Asian-American/Pacific Islander women had treatment episode completion rates that were 12.35 (CI: 12.33, 12.37), 9.08 (CI: 9.06, 9.11), 10.27 (CI: 10.22, 10.32), and 4.87 (CI: 4.78, 4.95) percentage points lower, respectively. CONCLUSIONS: In the United States, treatment completion rates for non-intensive outpatient alcohol treatment episodes are significantly lower for minoritized women than White men. The extent of the disparity is not apparent in univariate models, highlighting the importance of an intersectional approach to understanding disparities in the completion of non-intensive outpatient treatment for AUD.

Associations between state-level general population alcohol policies and drinking outcomes among women of reproductive age: Results from 1984 to 2020 National Alcohol Surveys.

BACKGROUND: Policies specific to alcohol use during pregnancy have not been found to reduce risks related to alcohol use during pregnancy. In contrast, general population alcohol policies are protective for the general population. Here, we assessed whether US state-level general population alcohol policies are related to drinking outcomes among women of reproductive age. METHODS: We conducted secondary analyses of 1984-2020 National Alcohol Survey data (N = 13,555 women ≤44 years old). State-level policy exposures were government control of liquor retail sales, heavy beer at gas stations, heavy beer at grocery stores, liquor at grocery stores, Sunday off-premise liquor sales, and blood alcohol concentration (BAC) driving limits (no law, 0.10 limit, 0.05-0.08 limit). Outcomes were past 12-month number of drinks, ≥5 drink days, ≥8 drink days, and any DSM-IV alcohol abuse/dependence symptoms. Regressions adjusted for individual and state-level controls, clustering by state, and included fixed effects for survey month and year. RESULTS: Allowing Sunday off-premise liquor sales versus not was related to having 1.20 times as many drinks (95% CI: 1.01, 1.42), 1.41 times as many ≥5 drink days (95% CI: 1.08, 1.85), and 1.91 times as many ≥8 drink days (95% CI: 1.28, 2.83). BAC limits of 0.05-0.08 for driving versus no BAC limit was related to 0.51 times fewer drinks (95% CI: 0.27, 0.96), 0.28 times fewer days with ≥5 drinks (95% CI: 0.10, 0.75), and 0.20 times fewer days with ≥8 drinks (95% CI: 0.08, 0.47). CONCLUSIONS: US state-level policies prohibiting Sunday off-premise liquor sales and BAC limits of 0.05-0.08 for driving are related to less past 12-month overall and heavy drinking among women 18-44 years old.

Social Model Recovery and Recovery Housing.

Recovery housing is an important resource for many in their recovery from alcohol and other drug use disorders. Yet providers of recovery housing face a number of challenges. Many of these challenges are rooted in stigma and bias about recovery housing. The ability to describe the service and purported mechanisms of action vis-a-vis an overarching framework, approach, or orientation could also go a long way in adding credence to recovery housing as a service delivery mechanism. Several aspects of social model recovery are often explicitly built or organically reflected in how recovery housing operates, yet describing recovery housing in these terms often does little to demystify key features of recovery housing. To more fully cement social model recovery as the organizing framework for recovery housing this article aims to: review the history, current status, and evidence base for social model recovery; comment on challenges to implementing the social model in recovery housing; and delineate steps to overcome these challenges and establish an evidence base for social model recovery housing.

Mapping COVID vulnerability in relation to drug and alcohol recovery residence availability across the United States.

Recovery housing is an important resource for those in recovery from substance use disorders. Unfortunately, we know little about its relationship to key community health risk and protective factors, potentially limiting the role it could play as a broader health resource. Leveraging county-level data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR), this study used multilevel modeling to examine Community COVID Vulnerability Index (CCVI) scores as well as availability of COVID testing and vaccination sites in relation to recovery housing. CCVI composite scores were positively associated with recovery housing availability. Analyses using CCVI thematic sub-scores found that population density and number of churches were positively associated with recovery housing availability, while epidemiological factors and healthcare system factors were negatively associated with recovery housing availability. In counties with recovery housing, there also was a positive association between CCVI and both COVID testing and vaccination availability. Recovery residences tend to be located in areas of high COVID vulnerability, reflecting effective targeting in areas with higher population density, more housing risk factors, and other high-risk environments and signaling a key point of contact to address broader health issues among those in recovery from substance use disorders.

Giving and Receiving Help among Persons Entering Sober Living Houses.

Giving and receiving help are integral to creating the social environments necessary to support recovery. However, studies assessing the effects of helping behaviors have focused primarily on the benefits derived from giving help to others in 12-step programs and treatment. The current study examined the frequency of giving and receiving help among 188 persons entering sober living houses (SLHs), a type of recovery home that is common in California. Helping was assessed in three contexts: the SLH, 12-step meetings they attended, and interactions with their family and friends. Residents who gave help to others in one of these contexts tended to also receive help in that context. Residents who reported giving or receiving help in one context tended to report giving and receiving help in other contexts. Study findings suggest helping in recovery occurs in a broader, more reciprocal manner than currently conceptualized. Studies should address how giving and receiving help in different contexts affects recovery outcomes. Research is also needed to describe the determinants of giving and receiving help. Considerations for facilitating help among SLH residents are described.

Six-month length of stay associated with better recovery outcomes among residents of sober living houses.

Background: Sober living houses are designed for individuals in recovery to live with others in recovery, yet no guidelines exist for the time needed in a sober living house to significantly impact outcomes.Objectives: To examine how the length of stay in sober living houses is related to substance use and related outcomes, focusing on early discontinuation (length of stay less than six months) and stable residence (length of stay six months or longer).Methods: Baseline and 12-month data were collected from 455 sober living house residents (36% female). Longitudinal mixed models tested associations between early discontinuation vs. stable residence and abstinence, recovery capital, psychiatric, and legal outcomes. Final models were adjusted for resident demographics, treatment, 12-step attendance, use in social network, and psychiatric symptoms, with a random effect for house.Results: Both early discontinuers (n = 284) and stable residents (n = 171) improved significantly (Ps ≤ .05) between baseline and 12 months on all outcomes. Compared to early discontinuation, stable residence was related to 7.76% points more percent days abstinent (95% CI: 4.21, 11.31); 0.88 times fewer psychiatric symptoms (95% CI: 0.81, 0.94); 0.84 times fewer depression symptoms (95% CI: 0.76, 0.92); and lower odds of any DSM-SUD (OR = 0.65, 95% CI: 0.47, 0.89) and any legal problems (OR = 0.58, 95% CI: 0.40, 0.86).Conclusion: In this study of sober living houses in California, staying in a sober living house for at least six months was related to better outcomes than leaving before six months. Residents and providers should consider this in long-term recovery planning.

Pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA.

AIMS: We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. METHODS: We merged state-level policy and treatment admissions data for 1992-2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility. RESULTS: When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10-1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04-1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08-1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00-1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72-0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78-0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions. CONCLUSIONS: Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness.

Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough?

BACKGROUND: We investigate whether living in a state that expanded Medicaid eligibility is associated with receiving alcohol screening and brief counseling among nonelderly, low-income adults and a subgroup with chronic health conditions caused or exacerbated by alcohol use. METHOD: Data are from the 2017 and 2019 Behavioral Risk Factor Surveillance System (N = 15,743 low-income adults; n = 7062 with a chronic condition). We used propensity score-weighted, covariate-adjusted, modified Poisson regression to estimate associations between residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling. Models estimated associations in the overall sample and chronic conditions subsample, as well as differential associations across sex, race, and ethnicity using interaction terms. RESULTS: Living in a state that expanded Medicaid eligibility was associated with being asked whether one drank (prevalence ratio (PR) = 1.15, 95% confidence interval (CI) = 1.08, 1.22), but not with further alcohol screening, guidance about harmful drinking, or advice to reduce drinking. Among individuals with alcohol-related chronic conditions, expansion state residence was associated with being asked about drinking (PR = 1.13, 95% CI = 1.05, 1.20) and, among past 30-day drinkers with chronic conditions, being asked how much one drank (PR = 1.28, 95% CI = 1.04, 1.59) and about binge drinking (PR = 1.43, 95% CI = 1.03, 1.99). Interaction terms suggest that some associations differ by race and ethnicity. CONCLUSIONS: Living in a state that expanded Medicaid is associated with a higher prevalence of receiving some alcohol screening at a check-up in the past 2 years among low-income residents, particularly among individuals with alcohol-related chronic conditions, but not with the receipt of high-quality screening and brief counseling. Policies may have to address provider barriers to delivery of these services in addition to access to care.

Multilevel Effects of Environmental and Neighborhood Factors on Sober Living House Resident 12-Month Outcomes.

OBJECTIVE: Sober living houses (SLHs) are abstinence-based environments designed for individuals in recovery to live with others in recovery. Research shows that SLHs help some individuals maintain recovery and that certain SLH-related factors may be particularly protective. Here we assess how SLH housing and neighborhood characteristics are related to abstinence and psychiatric symptoms over time. METHOD: Baseline, 6-month, and 12-month data were collected from 557 SLH residents. Multilevel mixed models tested associations between house and neighborhood characteristics and individual-level percent days abstinent (PDA) and the number of psychiatric symptoms (measured with the Psychiatric Diagnostic Screening Questionnaire [PDSQ]) as outcomes. Final models adjusted for sex, age, and race/ethnicity; ratings of house characteristics; and objective measurements of neighborhood-level exposures. RESULTS: Both PDA and PDSQ improved significantly (ps ≤ .05) over time in both unadjusted and adjusted models. More self-help groups and fewer alcohol outlets within one mile were significantly protective for PDA, whereas walkability was significantly related to worse PDA and PDSQ (ps ≤ .05). For house-level factors, better ratings of house maintenance were related to significantly fewer psychiatric symptoms, whereas higher scores on SLH's safety measures and personal or residence identity were related to more psychiatric symptoms (ps ≤ .05). No house-level factor was significantly related to PDA. CONCLUSIONS: Neighborhood-level factors such as increased availability of self-help groups and fewer nearby alcohol outlets may increase abstinence among individuals living in SLHs. House-level factors related to better maintenance may also facilitate improved mental health.

Outcomes Among Sober Living House Residents Who Relapse: Role of Recovery Capital.

Studies show individuals living in residential recovery homes on average make significant improvements in multiple areas of functioning. Residents who achieve and maintain complete abstinence have particularly good outcomes. Residents who relapse after entering the houses have been studied minimally. The current study examined outcomes for 197 residents who relapsed within six months after entering sober living houses (SLHs), which is one type of residential recovery home that is common in California. Despite having relapsed, these residents made significant improvements between entry into the house and 6-month follow-up on measures of percent days abstinent from alcohol and drugs (PDA), psychiatric symptoms, severity of employment problems, and stable housing. Higher recovery capital predicted higher PDA (coefficient = 0.28, SE = 0.09, p = .001) and lower severity of employment problems (coefficient = -0.00, SE = 0.00, p = .007). Recovery capital showed a significant decrease between baseline and 6-month follow-up among persons who relapsed and were no longer living in the house. SLH providers can draw upon social model recovery principles to enhance recovery capital. However, residents should also seek other sources of recovery capital outside the SLH, which may be particularly important for individuals who leave the home.

Does the relationship between alcohol retail environment and alcohol outcomes vary by depressive symptoms? Findings from a U.S. Survey of Black, Hispanic and White drinkers.

AIMS: To assess whether associations between alcohol availability and consumption, drinking to drunkenness, and negative drinking consequences vary among individuals with elevated depressive symptoms. METHODS: 10,482 current drinkers in 2005-2015 National Alcohol Surveys (50.0% female; 74.4% White, 8.7% Black, 11.1% Hispanic). Elevated depressive symptoms was defined as having symptoms suggestive of major depressive disorder (above CES-D8/PHQ-2 cut-offs) versus no/sub-threshold symptoms (below cut-offs). Inverse probability of treatment weighted and covariate adjusted Poisson models with robust standard errors estimated associations of ZIP-code bar density and off-premise outlet density (locations/1,000 residents), elevated depressive symptoms, and their interaction with past-year volume consumed, monthly drinking to drunkenness, and negative drinking consequences. Models were then stratified by sex and race and ethnicity. RESULTS: Overall, 13.7% of respondents had elevated depressive symptoms. Regarding density, the only statistically significant association observed was between off-premise density and volume consumed (rate ratio = 1.3, 95% confidence interval = 1.0, 1.7). Elevated depressive symptoms were associated with higher volume consumed, prevalence of drinking to drunkenness, and prevalence of negative consequences when controlling for off-premise density or bar density. However, there was no evidence of interaction between symptoms and density in the full sample nor among subgroups. CONCLUSION: This study suggests that, while elevated depressive symptoms do not alter associations between alcohol availability and alcohol use and problems, they remain associated with these outcomes among past-year drinkers in a U.S. general population sample even when accounting for differential availability. Addressing depressive symptoms should be considered along with other policies to reduce population-level drinking and alcohol problems.

Measuring Architecture in Recovery Homes: Recovery Home Architecture Scale.

Background: The settings where we live shape our daily experiences and interactions. Social environment and physical setting characteristics may be particularly important in communal living services, such as recovery homes for alcohol and drug disorders. Objectives: This paper describes the measurement and mobilization of architectural characteristics in one type of recovery home, sober living houses (SLHs). The Recovery Home Architecture Scale (RHAS) is a 25-item measure comprised of six subscales designed to assess architecture in SLHs. Results: Using a sample of 528 individuals residing in 41 houses, we found the RHAS had good interrater reliability, factor structure, and internal consistency. The measure also showed modest construct validity. The RHAS was not associated with length of stay (LOS) but did interact with a measure of the social environment that predicted LOS, the Recovery Home Environment Scale (RHES). Conclusions: Future studies should include a more diverse sample of SLHs and assess how house management, recovery capital, and other factors work in concert with architecture.

Do neighborhood characteristics of sober living houses impact recovery outcomes? A multilevel analysis of observational data from Los Angeles County.

OBJECTIVE: To identify neighborhood factors associated with recovery outcomes for sober living house (SLH) residents. METHODS: Six-month longitudinal data for new SLH residents (n = 557) was linked with census tract data, services available, alcohol outlets, and Walk Scores® (0-100 score indicating access to neighborhood resources) for 48 SLHs in 44 neighborhoods in Los Angeles County. RESULTS: Non-significant neighborhood characteristics in separate regressions for all outcomes were residents' ratings of perceived risk, percentage of residences with access to a car, percentage of homes over $500,000, percentage of renter-occupied units, percentage with income less than $25,000, percentage that were non-white, the density of substance inpatient within 10 miles, and transit scores from Walk Score®. Multilevel regressions found outpatient substance abuse treatment and density of AA groups were positively associated with more abstinent days. No neighborhood variables were associated with psychiatric symptoms. Higher perceived neighborhood cohesion, lower crime ratings, and better transportation ratings were associated with higher recovery capital. CONCLUSION: Greater neighborhood densities of substance abuse services and AA groups may help residents achieve more days abstinent. While residents may achieve better substance use outcomes even with negative perceptions of the neighborhood, positive perceptions of the neighborhoods may help them acquire more recovery capital.

Consumer Knowledge of Insurance Coverage of Alcohol Treatment Services in the United States: Changes Since 2015.

OBJECTIVE: Aims of this study are to examine (a) whether consumer knowledge about their health insurance coverage for alcohol-related services has changed over time and (b) whether racial, ethnic, and income disparities in known coverage have changed over time. METHOD: This was a general population study comparing the 2015 and 2020 National Alcohol Surveys (N = 12,076 combined 2015 and 2020; 7,215 women, 4,858 men). Knowledge of alcohol treatment coverage (insured with coverage, insured without coverage, insured with coverage unknown, uninsured, or insurance status unknown) was estimated and compared for the total sample ages 18-64 and compared separately by subgroups. Multinomial logistic regression was used to formally test changes in knowledge of coverage over time. Regression models were adjusted for sociodemographics, health insurance type, and current alcohol use disorder. All bivariate and multivariable analyses were survey-weighted to account for probability of selection. RESULTS: Between 2015 and 2020, the prevalence of those reporting being insured without alcohol treatment coverage decreased (-2.8%, p < .001), and the prevalence of those insured with coverage unknown increased (8.1%, p < .001). Compared with White respondents, foreign-born Hispanic respondents were more likely to report being insured without coverage, and Black or African American respondents were less likely to be insured with coverage and had a steeper decrease in knowledge of coverage status over time. CONCLUSIONS: Results suggest some persistent disparities in known alcohol treatment coverage. They also suggest a need for both greater insurance coverage of alcohol-related services and greater efforts by employers, insurers, and practitioners to inform their constituents and increase knowledge about what alcohol-related services are available to them.

Predictors of alcohol screening quality in a US general population sample and subgroups of heavy drinkers.

Alcohol screening is one of the most cost-effective clinical preventive services and important for intervening in the development of alcohol problems. We examine predictors of the quality of alcohol screening, approximated by alcohol quantity screening, which is a prerequisite for appropriate counseling, and compare conventional regression approach with Classification and Regression Trees (CART). Data come from the 2020 National Alcohol Survey, a population survey of US adults aged 18 years and over. Analyses focus on those reporting any alcohol screening at all (N = 989). The primary outcome was whether a healthcare profession had ever asked how much they drink, which is necessary to identify heavy drinking. We examined 12 potential predictors of alcohol quantity: gender, age, race and ethnicity, education, marital status, having a usual source of primary care, insurance, and health conditions. Analyses were replicated in heavy episodic drinking (HED) and high intensity drinking (HID) subgroups, both warranting alcohol counseling. Logistic regression results show that having diabetes and not having a college degree predict missed alcohol quantity screening in the sample overall, and younger age predicts missed alcohol quantity screening in the HED/HID subgroups. CART identified Black and Hispanic respondents who had not attended college at high risk of missed screening for heavy drinking in the overall sample, and those with public insurance at high risk of missed screening for heavy drinking in the HED/HID subgroups. The quality of alcohol screening needs improvement in general, and to avoid unintended disparities in alcohol-related health services.

Effects of Medicaid expansion on alcohol and opioid treatment admissions in U.S. racial/ethnic groups.

BACKGROUND: Excessive drinking and opioid misuse exact a high toll on U.S. lives and differentially affect U.S. racial/ethnic groups in exposure and resultant harms. Increasing access to specialty treatment is an important policy strategy to mitigate this, particularly for lower-income and racial/ethnic minority persons who face distinctive barriers to care. We examined whether the U.S. Affordable Care Act's Medicaid expansion improved treatment utilization in the overall population and for Black, Latino, and White Americans separately. METHODS: We analyzed total and Medicaid-insured alcohol and opioid treatment admissions per 10,000 adult, state residents using 2010-2016 data from SAMHSA's Treatment Episode Data Set (N = 20 states), with difference-in-difference models accounting for state fixed effects and time-varying state demographic characteristics, treatment need, and treatment supply. RESULTS: Total treatment admission rates in the overall population declined for alcohol and remained roughly flat for opioids in both expansion and non-expansion states from 2010 through 2016. By contrast, estimated Medicaid-insured alcohol and opioid treatment rates rose in expansion states and decreased in non-expansion states following Medicaid expansion in 2014. The latter results were found for alcohol treatment in the total population and in each racial/ethnic group, as well as for Black and White Americans for opioid treatment. CONCLUSIONS: Medicaid expansion was associated with greater specialty treatment entry at a time when alcohol and opioid treatment rates were declining or flat. Findings underscore benefits of expanding Medicaid eligibility to increase treatment utilization for diverse racial/ethnic groups, but also suggest an emerging treatment disparity between lower-income Americans in expansion and non-expansion states.