Racial/Ethnic Differences in Alcohol and Drug Use Outcomes Following Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Federally Qualified Health Centers
- 30 Downloads
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.
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.
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.
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.
KeywordsHealth disparity Substance use Federally qualified health centers Substance use services
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Data were existing and reidentified prior to authors receiving the dataset. Thus, informed consent was not obtained and deemed unnecessary by the IRB.
Research was determined to be non-human subjects by the IRB.
- 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.
- 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
- 13.Iowa Department of Public Health. (2012). SBIRT Iowa Policy Manual. Retrieved from www.idph.state.ia.us. Accessed 08/07/2017.
- 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.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.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
- 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.
- 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.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