Sex and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence

Background: Prior studies on treatment or services used for alcohol problems have yielded mixed results with respect to sex and race/ethnicity disparities. Additionally, little is known about differences in time to first alcohol-related service contact amongst persons with alcohol dependence. In this study, we explored sex and race/ethnicity differences in first alcohol-related service utilization in a population-based sample. Methods: Using data from Wave I of the National Epidemiologic Survey on Alcohol and Related Conditions, we used weighted bivariate analyses and Cox proportional hazard methods to assess adults with lifetime alcohol dependence within sex and race/ethnicity strata (n=3,311). Covariates for multivariate analyses included: age, drinking onset age, education, income, insurance, urbanicity, family history, alcohol consumption, and comorbid psychiatric and drug use disorders. Results: Of the 3,311 persons with lifetime alcohol dependence, only 19.5% reported seeking alcohol-related services. Overall, women had a lower prevalence and were less likely than men to receive alcohol-related services. Women initiated services at a younger age than men and had a shorter interval between drinking onset and first service. These findings are primarily explained by differences between White women and men, with inconsistent sex differences between Blacks and Hispanics likely reflective of smaller sample sizes. There were few race/ethnicity differences. Conclusions: There are important sex differences in receipt of and time from drinking initiation to alcohol-related service utilization among persons with alcohol dependence. Increased recognition of these differences may promote investigation of the factors underlying these differences and identification of the barriers to service utilization for women.