Racial/ethnic health disparities have been well-documented in the onset, rate, course, and consequences of alcohol and other drug (AOD) use problems, often with substantially poorer outcomes in non-White racial/ethnic groups compared to non-Hispanic Whites. As a result, the NIAAA has made it a central strategic aim to investigate and eliminate health disparities. Despite 30 years of research documenting the presence of AOD-related racial/ethnic health disparities, the degree to which disparities negatively impact the emerging standard of assessing the effectiveness of AOD treatments (i.e., ? 5 years AOD problem resolution),53 which is also when risk of problematic use is no higher than in the general population,84 is unknown. Publicly available datasets are very limited by their ability to directly measure AOD recovery-related constructs and national prevalence rates of non-White racial/ethnic groups who have achieved long-term problem resolution. In turn, this compromises our ability to assess the extent to which racial/ethnic health equality exists in terms of long- term AOD problem resolution and the recovery-related mechanisms associated with potential disparities. To begin to fill this knowledge gap, we propose to conduct secondary data analyses of the first recovery-focused nationally representative probability-based study to test if racial/ethnic health disparities exist. The National Recovery Study (PI: Kelly) consists of a web-based probability sampling frame of 39,809 adults who were screened to identify if they once had a problem with drugs or alcohol and no longer do. Complete data on 2,002 participants who answered ?yes? is available. Participants were assessed with a battery of quantitative and qualitative survey items in 2016 which captured their AOD clinical history and recovery-related mechanisms associated racial/ethnic health equality in AOD problem resolution. This design will enable us to address the following aims: 1a. Test if racial/ethnic health disparities exist in (i) the duration between onset of alcohol and other drug problems and onset of problem resolution; and, (ii) the likelihood of achieving long-term problem resolution (? 5 years) 1b. If health disparities are observed, explore the mediating potential of psychosocial (accrued recovery capital, degree of treatment utilization, degree of recovery support-service utilization) and structural recovery-related factors (health insurance coverage, socioeconomic status, and recovery-related discrimination) in explaining observed disparities. 2. Conduct concurrent qualitative analysis to identify the top three strategies that participants report having used to resolve their alcohol or other drug problem (e.g., social support, secure accommodations, mental and physical health, financial management, employment, and recreation) and compare these strategies according to racial/ethnic characteristics. Mix the qualitative and quantitative data to determine if race/ethnicity is associated with themes identified in the recovery strategies.

Public Health Relevance

Despite 30 years of research documenting the disproportionate burden that alcohol and other drug (AOD)- related problems have on non-White racial/ethnic groups, the degree to which racial/ethnic health disparities negatively impact emerging standards for assessing the effectiveness of AOD treatments (? 5 years AOD problem resolution), which is when the risk of problematic use is no higher than in the general population, is unknown. This F32 postdoctoral training will aid the applicant in documenting US prevalence estimates of the number of non-White individuals who have resolved an AOD problem using data from the first nationally representative, probability-based, study of recovery. Specifically, the candidate will investigate the associations between race/ethnicity and stages of AOD problem resolution in the: 1. duration between onset of AOD problems and onset of problem resolution; and, 2. the likelihood of achieving stable long-term problem resolution. In doing so, we will establish the first line of nationally representative research on health equality in long-term AOD problem resolution and associated recovery-related mechanisms, ultimately translating findings into actionable targets for clinicians, policy, and public health proposals that can address the identified disparities.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZAA1)
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Kwako, Laura Elizabeth
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Massachusetts General Hospital
United States
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