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. 2021 Jun;45(6):1276-1286.
doi: 10.1111/acer.14609. Epub 2021 May 16.

A cascade of care for alcohol use disorder: Using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care

Carrie M Mintz  1 , Sarah M Hartz  1 , Sherri L Fisher  1 , Alex T Ramsey  1 , Elvin H Geng  2 , Richard A Grucza  3 , Laura J Bierut  1
Affiliations

A cascade of care for alcohol use disorder: Using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care

Carrie M Mintz et al. Alcohol Clin Exp Res. 2021 Jun.

Abstract

Background: Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care for persons with AUD.

Methods: Using 2015-2019 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: (1) adult prevalence of AUD; (2) proportion of adults with AUD who utilized health care in the past 12 months; (3) proportion with AUD screened about their alcohol use; (4) proportion with AUD who received a brief intervention about their alcohol misuse; (5) proportion with AUD who received information about treatment for alcohol misuse; and (6) proportion with AUD who received treatment. Analyses were stratified by AUD severity.

Results: Of the 214,505 persons included in the sample, the weighted prevalence of AUD was 7.8% (95% CI 7.6-8.0%). Cascades of care showed the majority of individuals with AUD utilized health care in the past 12 months [81.4% (95% CI 80.7-82.1%)] and were screened about alcohol use [69.9% (95% CI 68.9-70.8%)]. However, only a minority of individuals received subsequent steps of care, including 11.6% (95% CI 11.0-12.2%) who reported receiving a brief intervention, 5.1% (95% CI 4.6-5.6%) who were referred to treatment, and 5.8% (95% CI 5.4-6.3%) who received treatment. Similar patterns were observed when cascades of care were stratified by AUD severity.

Conclusions: Persons with AUD commonly utilize health care and are often screened about alcohol use, but few receive treatment. Healthcare settings-particularly primary care settings-represent a prime opportunity to implement AUD treatment to improve outcomes in this high-risk population.

Keywords: alcohol use disorder; alcohol use screening; cascade of care; evidence-based treatment.

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Conflict of interest statement

CONFLICT OF INTEREST

LJB is listed as an inventor on Issued U.S. Patent 8,080,371,“Markers for Addiction” covering the use of certain SNPs in determining the diagnosis, prognosis, and treatment of addiction. The other authors report no conflict of interest.

Figures

Figure 1a-d.
Figure 1a-d.
Cascade of care for combined severities (1a), mild (1b), moderate (1c), and severe (1d) alcohol use disorder using data from persons 18 years of age and older from the 2015–2019 National Surveys on Drug Use and Health. All data refer to past-year prevalence. Error bars represent 95% confidence intervals.
Figure 1a-d.
Figure 1a-d.
Cascade of care for combined severities (1a), mild (1b), moderate (1c), and severe (1d) alcohol use disorder using data from persons 18 years of age and older from the 2015–2019 National Surveys on Drug Use and Health. All data refer to past-year prevalence. Error bars represent 95% confidence intervals.
Figure 2.
Figure 2.
Conceptual model of cascade of care for alcohol use disorder.
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