Ethnic Disparities in Clinical Severity and Services
for Alcohol Problems: Results from the National
Laura A. Schmidt, Yu Ye, Thomas K. Greenfeld, and Jason Bond
This study reports lifetime estimates of the extent of unmet need for alcohol services
across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic
differences in service use. Prior studies report mixed Fndings as to the existence of ethnic disparities in
alcohol services, with some suggesting that minorities are over-represented in treatment settings.
Drawing on the most recent National Alcohol Surveys, we compare rates and factors
associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics
who meet lifetime criteria for alcohol abuse or dependence.
While bivariate analyses revealed few ethnic differences in service use, there were signif-
icant differences by ethnicity in multivariate models that included alcohol problem severity and its
interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less
likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-
severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment
and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as
reasons for not obtaining care.
±uture efforts to study ethnic disparities in alcohol services should utilize analytic
approaches that address potential confounding between ethnicity and other factors in service use,
such as alcohol problem severity. Our Fndings suggest that Hispanics and Blacks with higher-severity
alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly
for Hispanics, this may in part be attributable to Fnancial and logistical barriers to care.
Ethnic Differences, Ethnic Disparities, Alcohol Problems, Health Services, Treatment.
HERE IS GROWING national attention to dispari-
ties in minority access to health care services, including
services for alcohol problems (Ibrahim et al., 2003;
National Institute on Alcohol Abuse and Alcoholism,
2001; Smedley et al., 2002; United States Department of
Health and Human Services, 2000). Studies show that, in
recent years, as rates of alcohol problems and dependence
have remained stable or even declined among Whites, they
have increased in America’s largest minority groups,
among Hispanics and Blacks (Caetano and Clark, 1998;
Grant et al., 2004). ±urthermore, national surveys found
that only between 9 and 15% of Americans with alcohol
abuse or dependence have obtained treatment for the
problem (Green-Hennessy, 2002; Kessler et al., 1996;
Woodward et al., 1997), suggesting a high level of unmet