Racial/ethnic differences in alcohol problem severity: Implications for understanding disparities in treatment use

While national treatment censuses indicate that African Americans and Latinos are over-represented in alcohol treatment, findings from general population studies are mixed. To accurately assess racial disparities in treatment use it is important to capture differences in problem severity. This study examines multiple problem indicators, including alcohol abuse and dependence, their diagnostic criteria, and drug comorbidity.

Data are from the 2001-2 National Epidemiological Survey on Alcohol and Related Conditions. Analysis was restricted to current drinkers (N= 26,937) and compared the risk for problems among whites, African Americans, Latino subgroups and American Indians (AIANs). Preliminary analyses indicate that racial/ethnic minorities have similar or lower overall risk for alcohol abuse compared to whites, but a greater risk for specific symptoms of abuse, including social/interpersonal problems (ORs of 1.5-3.4), and among older Hispanic and AIAN drinkers, legal problems (ORs of 6.2-9.9). Odds of failed role obligations and hazardous drinking in particular were lower or similar among minorities relative to whites. By contrast, minorities had a greater risk for alcohol dependence, especially US-born Latinos and AIANs who reported more severe dependence and more co-occurring drug use, and African American women. The elevated risk for dependence increased with age among African Americans.

Because social and legal problems are strong predictors of treatment entry, minority drinkers' greater experience of these abuse criteria might help to explain discrepant findings of the public treatment system and general population studies. Similar to other recent work, these findings raise questions about the social determinants of alcohol abuse diagnoses.