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Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 6, pp 1192–1199 | Cite as

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

  • Ethan Sahker
  • DeShauna Jones
  • Donna A. Lancianese
  • George Pro
  • Stephan ArndtEmail author
Article
  • 30 Downloads

Abstract

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.

Keywords

Health disparity Substance use Federally qualified health centers Substance use services 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Data were existing and reidentified prior to authors receiving the dataset. Thus, informed consent was not obtained and deemed unnecessary by the IRB.

Ethical Approval

Research was determined to be non-human subjects by the IRB.

References

  1. 1.
    Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med. 2007;50(6):699–709.  https://doi.org/10.1016/j.annemergmed.2007.06.486.CrossRefGoogle Scholar
  2. 2.
    Aldridge A, Linford R, Bray J. Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT). Addiction. 2017;112(459 599):43–53.  https://doi.org/10.1111/add.13651.CrossRefPubMedGoogle Scholar
  3. 3.
    Alegria M, Carson NJ, Goncalves M, Keefe K. Disparities in treatment for substance use disorders and co-occurring disorders for ethnic/racial minority youth. J Am Acad Child Adolesc Psychiatry. 2011;50:22–31.  https://doi.org/10.1016/j.jaac.2010.10.005.CrossRefPubMedGoogle Scholar
  4. 4.
    Arndt S, Acion L, White K. How the states stack up: disparities in substance abuse outpatient treatment completion rates for minorities. Drug Alcohol Depend. 2013;132:547–55.CrossRefGoogle Scholar
  5. 5.
    Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30.CrossRefGoogle Scholar
  6. 6.
    Babor TF, Higgins-Biddle JC, Saunders JB, & Monteiro MG (2001). The alcohol use disorders identification test: guidelines for use in primary care (WHO/MSD/MSB/01.6a) (Vol. 2). Retrieved from http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf. Accessed 08/07/2017.
  7. 7.
    Babor TF, Del Boca F, Bray JW. Screening, brief intervention and referral to treatment: implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction. 2017;112:110–7.  https://doi.org/10.1111/add.13675.CrossRefPubMedGoogle Scholar
  8. 8.
    Betancourt J, Green A, Carrillo J, Ananeh-Firempong O II. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118(4):293–302.  https://doi.org/10.1093/phr/118.4.293.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bray JW, Del Boca FK, McRee BG, Hayashi SW, Babor TF. Screening, brief intervention and referral to treatment (SBIRT): rationale, program overview and cross-site evaluation. Addiction. 2017;112:3–11.  https://doi.org/10.1111/add.13676.CrossRefPubMedGoogle Scholar
  10. 10.
    Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, et al. Public health and international drug policy. Lancet. 2016;387(10026):1427–80.  https://doi.org/10.1016/S0140-6736(16)00619-X.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gavin DR, Ross HE, Skinner HA. Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. Br J Addict. 1989;84:301–7.  https://doi.org/10.1111/j.1360-0443.1989.tb03463.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Guerrero EG, Marsh JC, Duan L, Oh C, Perron B, Lee B. Disparities in completion of substance abuse treatment between and within racial and ethnic groups. Health Serv Res. 2013;48(4):1450–67.  https://doi.org/10.1111/1475-6773.12031.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Iowa Department of Public Health. (2012). SBIRT Iowa Policy Manual. Retrieved from www.idph.state.ia.us. Accessed 08/07/2017.
  14. 14.
    Jacobson JO, Robinson PL, Bluthenthal RN. Racial disparities in completion rates from publicly funded alcohol treatment: economic resources explain more than demographics and addiction severity. Health Serv Res. 2007;42(2):773–94.  https://doi.org/10.1111/j.1475-6773.2006.00612.x.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1–3):280–95.  https://doi.org/10.1016/j.drugalcdep.2008.08.003.CrossRefPubMedGoogle Scholar
  16. 16.
    Manuel JK, Satre DD, Tsoh J, Moreno-John G, Ramos JS, Mccance-Katz EF, et al. Adapting screening, brief intervention and referral to treatment (SBIRT) for alcohol and drugs to culturally diverse clinical populations. J Addict Med. 2015;9(5):343–51.  https://doi.org/10.1097/ADM.0000000000000150.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Marshall T, Goldberg RW, Braude L, Dougherty RH, Daniels AS, Ghose SS, et al. Supported employment: assessing the evidence. Psychiatr Serv. 2014;65:16–23.  https://doi.org/10.1176/appi.ps.201300262.CrossRefPubMedGoogle Scholar
  18. 18.
    Marzell M, Sahker E, Pro G, Arndt S. A brief report on Hispanic youth marijuana use: trends in substance abuse treatment admissions in the United States. J Ethn Subst Abus. 2017;16(2):155–64.  https://doi.org/10.1080/15332640.2015.1108256.CrossRefGoogle Scholar
  19. 19.
    Mays VM, Jones AL, Delany-Brumsey A, Coles C, Cochran SD. Perceived discrimination in healthcare and mental health/substance abuse treatment among Blacks, Latinos, and Whites. Med Care. 2017;55(2):173–81.  https://doi.org/10.1097/MLR.0000000000000638.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Mills BA, Caetano R. Decomposing associations between acculturation and drinking in Mexican Americans. Alcohol Clin Exp Res. 2012;36(7):1205–11.  https://doi.org/10.1111/j.1530-0277.2011.01712.x.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mundt MP, French MT, Roebuck MC, Manwell LB, Barry KL. Brief physician advice for problem drinking among older adults: an economic analysis of costs and benefits. J Stud Alcohol. 2005;66(3):389–94.CrossRefGoogle Scholar
  22. 22.
    Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.  https://doi.org/10.1023/A:1022433018736.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res. 2007;31(2):185–99.  https://doi.org/10.1111/j.1530-0277.2006.00295.x.CrossRefPubMedGoogle Scholar
  24. 24.
    Sahker E, Toussaint MN, Ramirez M, Ali SR, Arndt S. Evaluating racial disparity in referral source and successful completion of substance abuse treatment. Addict Behav. 2015;48:25–9.  https://doi.org/10.1016/j.addbeh.2015.04.006.CrossRefPubMedGoogle Scholar
  25. 25.
    Sahker E, Yeung CW, Garrison YL, Park S, Arndt S. Asian American and Pacific Islander substance use treatment admission trends. Drug Alcohol Depend. 2017;171(1–8):1–8.  https://doi.org/10.1016/j.drugalcdep.2016.11.022.CrossRefPubMedGoogle Scholar
  26. 26.
    Saitz R. Alcohol screening and brief intervention in primary care: absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alcohol Rev. 2010;29(6):631–40.  https://doi.org/10.1111/j.1465-3362.2010.00217.x.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Saloner B, Lê Cook B. Blacks and Hispanics are less likely than Whites to complete addiction treatment, largely due to socioeconomic factors. Health Aff. 2013;32:135–45.  https://doi.org/10.1377/hlthaff.2011.0983.CrossRefGoogle Scholar
  28. 28.
    SAMHSA. (2014). SBIRT Implementation: The Iowa Army National Guard Program. Retrieved from www.idph.state.ia.us/IDPHChannelsService/file.ashx?file=02C1A989-06E9-4993-B7F8-5371C6111959. Accessed 08/07/2017.
  29. 29.
    Skinner HA. The drug abuse screening test. Addict Behav. 1982;7(4):363–71.  https://doi.org/10.1016/0306-4603(82)90005-3.CrossRefPubMedGoogle Scholar
  30. 30.
    U.S. Department of health and human services. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Retrieved from Addiction.SurgeonGeneral.gov.
  31. 31.
    United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. (2015). Treatment episode data set -- admissions (TEDS-A) -- concatenated, 1992 to 2012.Google Scholar
  32. 32.
    Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abus Treat. 2007;32(2):189–98.  https://doi.org/10.1016/j.jsat.2006.08.002.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Counseling Psychology Program, Department of Psychological and Quantitative Foundations, College of EducationUniversity of IowaIowa CityUSA
  2. 2.Iowa Consortium for Substance Abuse Research and EvaluationUniversity of IowaIowa CityUSA
  3. 3.Office of Consultation and Research in Medical Education, Carver College of MedicineUniversity of IowaIowa CityUSA
  4. 4.Center for Health Equity ResearchNorthern Arizona UniversityFlagstaffUSA
  5. 5.Department of Psychiatry, Carver College of MedicineUniversity of IowaIowa CityUSA
  6. 6.Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityUSA

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