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

BackgroundSubstance 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.MethodsUsing 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.ResultsWe 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.ConclusionSBIRT 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.