Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google 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.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

  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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Counseling Psychology Program, Department of Psychological and Quantitative Foundations, College of Education, University of Iowa, Iowa City, IA, USA

    Ethan Sahker

  2. Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City, IA, USA

    Ethan Sahker & DeShauna Jones

  3. Office of Consultation and Research in Medical Education, Carver College of Medicine, University of Iowa, Iowa City, IA, USA

    Donna A. Lancianese

  4. Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA

    George Pro

  5. Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA

    Stephan Arndt

  6. Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, 52245-5000, USA

    Stephan Arndt

Authors
  1. Ethan Sahker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. DeShauna Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donna A. Lancianese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George Pro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephan Arndt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephan Arndt.

Ethics declarations

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sahker, E., Jones, D., Lancianese, D.A. et al. Racial/Ethnic Differences in Alcohol and Drug Use Outcomes Following Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Federally Qualified Health Centers. J. Racial and Ethnic Health Disparities 6, 1192–1199 (2019). https://doi.org/10.1007/s40615-019-00620-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-019-00620-w

Keywords

Search

Navigation