Alcohol use screening, brief intervention and referral to treatment cascade of care in the USA: Variation by alcohol use and socio‐demographic characteristics
Carolina Barbosa, William Dowd, Ivette Rodriguez Borja, Shannon M. Blakey, Joanne Delk, Jessica Duncan Cance, Nina Mulia, Katherine J. Karriker‐JaffeAbstract
Background and aims
Screening, brief intervention and referral to treatment (SBIRT) can identify and reduce excessive drinking, reducing the risk of alcohol use disorder (AUD). We estimated the implementation of SBIRT care cascade steps in the United States using national data and quantified differences for key sociodemographic subgroups.
Design
Cross‐sectional analysis of National Survey on Drug Use and Health (NSDUH) 2022–2024 data. The SBIRT care cascade was assessed as reported: (1) health care use; and, amongst those with past‐year health care use, report of alcohol; (2) use screening; (3) brief intervention (BI) receipt; (4) treatment referral; and (5) treatment receipt.
Setting
United States.
Participants
Adults ( n = 139 532) stratified across five self‐reported alcohol use levels: abstinence or moderate alcohol use, heavy alcohol use, mild, moderate and severe AUD.
Measurements
Multivariable logistic regression models assessed the likelihood of receiving each cascade step overall, by alcohol use level, and by sociodemographic characteristics (age, sex, race/ethnicity, education, employment, income and insurance).
Results
About 81% of adults endorsed past‐year health care use, of which 69% reported screening for alcohol use. Individuals with severe AUD had the highest screening rates (89%), followed by moderate (84%) or mild (84%) AUD. Only 4% of individuals with heavy alcohol use reported receiving BI, with higher rates among individuals with severe (33%), moderate (17%) or mild AUD (9%). Prevalence of being referred to and receiving treatment increased with AUD severity but remained low overall (3% to 23%). Although women were more likely to use health care than men [marginal prevalence ratio (MPR) = 1.112; 95% confidence interval (CI) = 1.103–1.121], women were less likely to receive BI (MPR = 0.518, 95% CI = 0.447–0.588). Women with AUD were less likely to be referred to treatment (MPR = 0.621, 95% CI = 0.497–0.744) or receive treatment (MPR = 0.788, 95% CI = 0.618–0.957) than men with AUD. Individuals 50 years old and older were less likely to be screened than younger individuals (MPR = 0.944, 95% CI = 0.925–0.963). Compared with White individuals, Hispanic individuals were less likely to use health care (MPR = 0.946, 95% CI = 0.934–0.958) and Black and Hispanic individuals were less likely to be screened (MPR = 0.883 and 9.913, respectively), in particular if they reported heavy alcohol use (MPR = 0.898 and 0.921, respectively).
Summary
In the United States, despite wide health care use and high screening rates, there are substantial gaps in the remaining steps of the screening, brief intervention and referral to treatment (SBIRT) care cascade for heavy drinking. Sex and racial differences in receiving SBIRT need to be addressed.