The main objectives of this study are to assess racial/ethnic disparities in access to appropriate alcohol treatment services, to identify factors that contribute to these disparities, and to better understand how these disparities impact remission of alcohol problems across ethnic groups and over time. Prior findings from national treatment censuses and general population surveys provide a limited, inconsistent picture of the variation in treatment access and utilization across racial/ethnic groups. However, there are growing indications that the care provided to minority groups tends to be inappropriate relative to their profiles of need. Given the disproportionately high rates of alcohol-related morbidity and mortality in some racial/ethnic groups, it is important to assess the magnitude of, and factors underlying, disparities in access to appropriate treatment. The proposed study brings insights from health services research to bear on these issues by adapting models of treatment-seeking to the longitudinal analysis of multiple outcomes that reflect both the appropriateness of treatment received, and end-point remission. The project is based on secondary analyses of the NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative longitudinal survey conducted between 2001 and 2005. Using new techniques for the longitudinal analysis of complex survey data, analyses will disentangle the effects of race/ethnicity from important covariates, such as severity of need, comorbidities, and socioeconomic indicators, and assess competing explanations for why there exist disparities in treatment utilization. Analyses will document and inventory the extent of racial/ethnic variation in the patterning of alcohol problems and co-occurring drug and psychiatric disorders over time. Then, informed by clinical practice guidelines, analyses will document racial/ethnic differences in the receipt of appropriate treatment in relation to the severity of need.
The Specific Aims thus include: (1) to describe racial/ethnic variation in the need for alcohol treatment services, and the persistence of need over time, using multiple need indicators; (2) to assess the extent of racial/ethnic disparities in unmet need for services, with a particular emphasis on the degree to which services appropriately fit racial/ethnic profiles of need, (3) to examine how racial/ethnic disparities in unmet need and access to appropriate care are explained by attitudinal, logistical, and structural barriers to treatment, and (4) to assess the impact of the utilization of appropriate treatment services on racial/ethnic differences in the remission of alcohol problems over time. Relevance This study investigates the degree to which racial/ethnic groups' needs for alcohol services are met with appropriate treatment services, based on published clinical guidelines. The project further examines factors that may help to explain disparities in appropriate treatment access, and the impact that these disparities have on recovery from alcohol problems. This study will thus help to inform policymaking and treatment planning efforts to reduce inequities in the delivery of alcohol treatment services, and to assess the impact of these inequities on the burden of alcohol disorders across different racial/ethnic groups in America. ? ? ?
