Expanding alcohol interventions into primary care settings: Unintended consequences for alcohol-related disparities

Background: Federal health policy is aimed toward expanding alcohol services beyond specialized treatment facilities through implementation of early screening and brief interventions (SBI) in primary care. This effort is intended to increase awareness of, and reduce, heavy drinking in the general population. However, there is concern that a policy focused largely on expansion into primary care settings could inadvertently increase racial disparities in alcohol services access and, hence, alcohol-related health problems.

Methods: Using longitudinal data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we examined racial disparities in the receipt of alcohol services from primary care and specialized settings among at-risk drinkers and persons with alcohol abuse. (Dependent drinkers were excluded because SBI, alone, is less effective for them.) A simulation model assessed whether disparities would persist if SBI were expanded to alternative service venues.

Results: Racial/ethnic minorities as a group were less likely than whites to receive alcohol services (AOR = 0.47, 95% CI: 0.28-.80). The data also indicated that minorities were more likely than whites to receive alcohol counseling from clergy. The simulation showed that expanding SBI into alternative venues reduced the disparity between U.S.-born Hispanics and whites by 39%, to non-significance.

Conclusions: Alcohol SBI is an important strategy for early intervention with persons at risk for drinking problems. However, targeting SBI mostly to primary care settings is likely to result in racial disparities. Adapting SBI for alternative service settings should be considered, especially to address the service needs of Hispanics.