Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The purpose of the current study was to examine differences in physical health consequences experienced by persons with alcohol dependence and in factors associated with alcohol related physical health consequences by race (black and white) and gender.

Method: A secondary data analysis was conducted using the publicly available Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), August 2001 – May 2002. NESARC is a general population survey representative of civilian, noninstitutionalized adults, age 18 and older (n=43,093). A subsample of black and white NESARC respondents with a lifetime diagnosis for alcohol dependence was utilized for the study (n=3,852). Diagnoses for lifetime alcohol dependence were generated according to DSM-IV criteria. Differences in health consequences by race and gender were examined using analysis of variance. Health consequences were defined by positive responses to diagnosis by a health professional for 11 medical conditions (i.e. hardening of arteries, hypertension, cirrhosis, other liver disease, chest pain, rapid heart beat, heart attack, other heart disease, stomach ulcer, gastritis and arthritis) and a positive response for injury causing need for medical help or a cut down in usual activities in the last 12 months. Multiple group analysis in structural equation modeling was used to assess race and gender differences in factors associated with health consequences for persons with alcohol dependence. Factors assessed in the model as predictors of physical health consequences were socioeconomic status, family history of alcoholism, alcohol use patterns, co-occurring substance dependence, stress, psychiatric co-morbidity and medical care. Gender and race served as moderators in the model, and age as a covariate.

Results: Approximately forty-nine percent (48.82%) of black and white respondents identified with lifetime alcohol dependence reported 1 or more medical condition and injury in the past 12 months. The most frequently reported medical conditions were hypertension (18.5%), arthritis (15.7%), gastritis (5.9%), and chest pain (5.0%). The overall mean number of health consequences reported by respondents with alcohol dependence was .85 (sd=1.2). Mean differences in alcohol related health consequences between blacks and whites were determined to be statistically significant (p<.0001), with blacks (m=1.07, sd=1.4) reporting more health consequences than whites (m=.80, sd=1.1). A statistically significant interaction effect between race and gender was also identified (p<.05). For whites, men (m=.85, sd=1.2) were found to have a higher mean number of physical health consequences compared to women (m=.73, sd=1.1), while for blacks women (m=1.14, sd=1.5) were found to have a higher mean number of health consequences compared to men (m=1.03, sd=1.3).

Implications for practice: Findings generated from the current study will help social workers to: 1) enhance biopsychosocial screenings for physical health problems in substance abuse treatment and related settings, 2) develop targeted policies, interventions and prevention strategies to address health disparities experienced by substance abusers, and 3) provide leadership in the coordination of care systems for physical and mental health treatment needs in alcohol dependent persons.