Trends in Alcohol Use Disorder Treatment Utilization and Location from 2008 to 2017 Open Access

Larsen, Aidan (Spring 2020)

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Alcohol Use Disorder (AUD) is the most common substance use disorder in the United States, and causes more deaths per year than opioid overdoses, but the vast majority of those with AUD do not receive treatment. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and the Affordable Care Act (ACA) of 2010 contained several provisions that aimed to increase treatment rates for substance use disorders, including AUD. Though prior research has studied the trends in treatment for mental health and overall SUD care, no known study has specifically examined trends in treatment for AUD in recent years using nationally representative data. Additionally, no study of AUD has tested whether the location in which treatment for AUD is received has changed since MHPAEA and ACA passage. This study investigated the national trend in the treatment rate of AUD before, during, and after the MHPAEA and ACA went into effect and the trends in alcohol treatment location. Survey data from 10 years of the National Survey of Drug Use and Health (NSDUH) were used to estimate logistic regression models to test whether treatment rates for AUD increased in 2011-2014 and 2015-2017 compared to 2008-2010, whether treatment in medical locations increased during those same time frames, and whether gains in insurance coverage were responsible for this increase. In adjusted analyses, the probability of receiving any alcohol treatment declined by 1.1 percentage points in 2011-2014 (95% CI = 0.1, 2.1) and 1.9 percentage points (95% CI = 0.7, 3.1) in 2015-2017 compared to 2008-2010. The probability of receiving treatment in any medical location declined by 1.1 percentage points (95% CI = 0.2, 1.9) in 2011-2014 and 1.2 percentage points in 2015-2017 (95% CI = 0.2, 2.1 ) compared to 2008-2010, while the probability of receiving self-help only treatment declined by 0.6 percentage points (95% CI = 0.3, 0.9) in 2015-2017 compared to 2008-2010. The probability of mental health treatment did not change over this time period. Future research is needed to elucidate the mechanisms and ensuing negative outcomes behind the observed decline in treatment.

Table of Contents


Literature Review

Alcohol Use Disorder

The Mental Health Parity and Addiction Equity Act and the Affordable Care Act

Parity and SUD Treatment Access

ACA and SUD Treatment Access

Literature Gap and Policy Relevance


Theoretical Framework

Focal Relationship



Predisposing Characteristics

Enabling and Need Characteristics

Testable Hypothesis

Data Description


Data Analysis


Supplementary Analysis


Strengths and Limitations


Recommendations for Future Research




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