- Researchers have confirmed a significant interaction between alcohol-problem severity and ethnicity.
- Hispanics and blacks with higher-severity alcohol problems appear to utilize services at lower rates than whites with similar problems.
- For Hispanics especially, this may be due in part to financial and logistical barriers to obtaining care.
Prior research has had mixed findings regarding ethnic disparities in alcohol services. A new study appears to confirm that disparities do exist: Hispanics and blacks with higher-severity alcohol problems seem to utilize services at lower rates than whites with similar problems. This appears to be due in part – particularly for Hispanics – to financial and logistical barriers to obtaining care.
Results are published in the January issue of Alcoholism: Clinical & Experimental Research.
"National surveys suggest that, on the whole, only a fraction of Americans with alcohol abuse or dependence – between nine and 16 percent – have obtained treatment for their problems," said Laura A. Schmidt, assistant professor of health policy in the School of Medicine at the University of California, San Francisco, and lead author of the study. "However, researchers have been at odds about the degree to which minority problem drinkers are underserved."
This study differs from previous studies in several ways, according to Nina Mulia, associate scientist with the Alcohol Research Group, who commented on the study. "The current study is a population-based survey with large numbers of black and Hispanic respondents, data on a wide array of alcohol-treatment services, and analyses that take into account important factors such as socioeconomic status and alcohol problem severity," she said.
"We looked at a wide range of services for alcohol problems since minorities in this study sought different types of care than those in the majority population," explained Schmidt. "In addition to specialized programs for alcohol and drug treatment, we examined episodes of care in mutual aid groups, such as Alcoholics Anonymous, and help offered for drinking problems through medical settings such as hospitals, ERs and clinics, and from psychologists, counselors, psychiatrists and social-service providers. It turns out that the majority of services for alcohol problems are provided in these settings," she said.
Researchers drew their data from the most recent National Alcohol Surveys (1995, 2000). They compared rates of, as well as factors associated with, lifetime service use for alcohol problems among adults who met the criteria for alcohol abuse and/or dependence and were part of the three largest ethnic groups in the United States: whites, blacks and Hispanics.
"Once we began teasing apart the underlying relationships between factors that affect treatment use, significant ethnic differences began to emerge," said Schmidt. "First, Latinos have high rates of alcohol problems, more so than blacks or whites. By alcohol problems, we mean experiences like going into withdrawal, needing more alcohol to achieve the same effects as before, wishing to stop drinking but being unable to, and having family and work problems due to one's drinking."
However, added Mulia, Hispanics were less likely than whites were to receive any alcohol treatment services at all. "In addition, among persons with more severe alcohol problems," she added, "blacks and Hispanics are less likely than whites to have ever received treatment services. In other words, as the severity of alcohol problems increases, the odds of having received treatment services is lower among blacks and Hispanics relative to whites. This is a very important finding, especially considering that studies show higher rates of alcohol-related morbidity and mortality among Hispanics and blacks."
"As a nation, we need to be concerned about making services for alcohol problems equally available to all people," said Schmidt. "We should be particularly concerned that Hispanics and blacks with higher-severity alcohol problems receive the care that they need. We found some evidence that financial and logistical problems – such as not knowing how to find services, lacking means to pay, and being unable to obtain child care – have kept Hispanics from seeking help for an alcohol problem when they had considered going. Hispanics in the United States have some of the lowest rates of insurance coverage of all ethnic groups. Our findings, if supported in other research, would point to the value of expanding access to public programs and public insurance plans, such as Medicaid, to a broader segment of the minority population."
Mulia agrees. "Keeping in mind that blacks and Hispanics experience greater adverse health and social consequences from alcohol problems," she said, "it is particularly important that efforts be made to actively screen and refer Hispanics and blacks with severe alcohol problems into treatment, and to reduce structural and other barriers to care."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Ethnic Disparities in Clinical Severity and Services for Alcohol Problems: Results from the National Alcohol Survey," were Yu Ye, Thomas K. Greenfield, and Jason Bond, all with the Alcohol Research Group. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.