ABSTRACT: Quality of Alcohol-related Care Received: Missed Opportunities, Disparities and Impacts of Health Reform Nearly 20 years ago it was estimated that Americans with an alcohol use disorder (AUD) receive recommended care only 10% of the time. This was a striking, wake-up call to alcohol services providers and policymakers given the tremendous impact of unchecked harmful drinking in the US. Excessive drinking is a leading cause of preventable death among Americans, with 1 of every 4 US adults exceeding NIAAA's recommended drinking limits. Moreover, there are disparities in on-going heavy drinking beyond young adulthood, in later onset, persistence and recurrence of AUD, and in alcohol-related morbidity and mortality. The pressing need to address unhealthy drinking has motivated alcohol screening and brief intervention (ASBI) in primary care, and recognition of the chronic, relapsing nature of AUD has focused attention on treatment engagement, retention, and completion and the promise of alcohol pharmacotherapy. Yet new research suggests that the quality of ASBI falls far short of clinical guidelines, and that there may be disparities in access to pharmacotherapy. Now, more than ever, healthcare quality and disparities are key issues for US healthcare providers and policymakers, and targeted by health reform initiatives to improve patient outcomes and reduce medical costs. This Continuing Center Project aims to shed light on these issues by using national survey and administrative data to investigate alcohol-related care quality and disparities across the alcohol services system, from prevention to treatment. Study Aims are to: 1) Assess the magnitude and severity of missed opportunities for providing appropriate ASBI for unhealthy drinking and AUD; 2) Examine receipt of pharmacotherapy for AUD; and 3) Assess the effects of health reform on the receipt of appropriate ASBI, completion of alcohol treatment, and integrated care (receipt of specialty treatment and general health care by persons with AUD and especially health comorbidities). This population-based study will leverage our team's distinctive expertise studying drinking patterns, alcohol problems, alcohol services utilization and related disparities using national data sets; apply traditional analytic and quasi-experimental techniques as well as cutting-edge causal inference methods; and employ an integrative conceptual framework to highlight how inequities in care can add up across the alcohol services system. By defining the need for care based on alcohol and health comorbidities, this study will highlight the health implications of failing to provide quality care for unhealthy drinking and AUD. Findings can help to stimulate efforts by clinicians, healthcare administrators, treatment providers and policymakers to increase and improve alcohol-related care and equitable access.

PUBLIC HEALTH RELEVANCE Unhealthy drinking and alcohol use disorder (AUD) together affect more than one of every four American adults and are a leading cause of preventable death, with tremendous economic and social costs. This study seeks to increase understanding of gaps in the quality of alcohol-related care received among unhealthy drinkers and persons with AUD, and how this is changing with health reform. Based on analyses of national survey and specialty treatment data, study results may help to stimulate efforts of clinicians, healthcare administrators, treatment providers, and policymakers to improve access to quality alcohol-related care for all.