Abstract People with disabilities (PWD) are an overlooked health disparity population who routinely experience stigma, discrimination, ableism, and lower socioeconomic status. Barriers to health care are generally high for PWD, and despite over three decades of the Americans with Disabilities Act, many health care settings including addiction treatment are not fully accessible for PWD. Recent studies have found that PWD abstain from alcohol more frequently than people without disabilities (PWoD); however, among current drinkers, PWD have elevated rates of at-risk alcohol use. Furthermore, PWD have greater risk for addiction, given higher rates of mental and physical health comorbidities, social isolation, trauma history and adverse social determinants of health. Despite this constellation of risk factors, very little is known about risk for alcohol use disorder (AUD) or alcohol-related morbidity or consequences among PWD, or whether disparities exist for PWD in accessing or engaging in AUD treatment compared to PWoD. We will use rigorous quasi-experimental methods to compare PWD to PWoD, using household survey data (National Survey on Drug Use and Health) and complementary medical claims datasets (Medicaid in 13 states; commercial insurance in MarketScan) to examine alcohol use, AUD indicators, morbidity and consequences, AUD treatment services, quality measures and outcomes by disability status. Disability status is defined by functional limitations in survey data and by diagnoses of disabling conditions in claims. Because disability is not homogeneous, analyses will consider any disability and types of disability. Analyses will be replicated to investigate outcomes for women with disabilities, an understudied and further stigmatized population. Our approach is organized by the cascade of care framework, and informed by intersectionality, critical disability theory, and the Institute of Medicine definition of health care disparities that separates needs-related differences from true disparities. The proposed specific aims are to: 1) identify differences in alcohol use, alcohol-related morbidity, and AUD diagnoses, by disability status; 2) among people with AUD, investigate disparities by disability status in alcohol-related morbidity, consequences, and access to AUD treatment; and 3) among people receiving AUD treatment, assess disparities by disability status in receiving quality-aligned AUD treatment and experiencing acute alcohol-related outcomes. Our multifaceted approach to data source selection and focus on disparities between PWD and PWoD will allow a more comprehensive picture of how the disability community is affected by alcohol problems. Findings are expected to provide policy makers, researchers, and clinicians with critical information to address disparities in access to, engagement in, and outcomes of AUD treatment for PWD, helping to reduce alcohol-related morbidity and improve the health of this commonly overlooked health disparity population.

Narrative To improve health outcomes for people with disabilities, an overlooked health disparities population, this proposed study will use complementary datasets from the National Survey on Drug Use and Health, and commercial (MarketScan) and public (Medicaid) health care claims, to investigate differences in alcohol use, alcohol-related morbidity, and alcohol use disorder by disability status. Uniquely, this study will determine if disparities exist for people with disabilities regarding access, quality, and outcomes of treatment for alcohol use disorder. Knowledge gained will inform improvements in the health and wellbeing for people with disabilities by identifying where policy and practice changes are most needed to reduce future alcohol-related morbidity and consequences.