Binge Drinking among Veterans Receiving VA Healthcare: Who Initiates Specialty Substance Use Disorder Treatment?

Background and Purpose: Many treatments exist in the VA for alcohol problems, including alcohol-related advice and brief interventions in primary care, and more intense forms of specialty substance use disorder (SUD) treatment conducted in outpatient, residential, and inpatient settings. Typically, the intensity of treatment varies based on alcohol consumption levels or alcohol-related problems (Bradley et al., 2004). Even with the successful implementation of system-wide alcohol screenings conducted in VA primary care settings, some studies have shown that few people who binge drink actually initiate SUD treatment. More work is needed to identify potential reasons that binge drinkers do not initiate SUD treatment. We sought to identify the individual-level characteristics of past-month binge drinkers that may influence initiation of specialty care for SUD's.

Method: This study used data from a large sample of veterans using VA healthcare during 1998-2001, who also completed the 1999 Large Health Survey of Veteran Enrollees, and who endorsed any past-month binge drinking (N=5,423). Survey data provided information on past-month binge drinking (drinking five or more drinks in one setting), past-month heavy drinking (binging five or more times), sociodemographic characteristics, and SF-36 physical and mental health summary measures. Administrative healthcare data provided information on the use of VA health services, as well as additional indicators of morbidity (drug use disorders, service-connected disability, past year inpatient stays). Initiation of SUD treatment was defined as receiving any inpatient or outpatient SUD treatment during 1999-2001. To help ensure only new episodes of SUD treatment were measured, individuals were excluded if they received SUD care in the 1998. We assessed the frequency of SUD treatment initiation, and bivariate and multivariate tests identified individual-level characteristics that were associated with initiating SUD treatment.

Results: Only 4.5% of veterans in this study with past-month binge drinking initiated specialty SUD treatment. Adjusted multivariate logistic regressions revealed that that being of older age (OR=.51, 95% CI=.35-.75) or elderly age (OR=.24, 95% CI=.13-.43), being employed (OR=.54, 95% CI=.33-.89), and having better mental health (OR=.97, 95% CI=.96-.98) significantly decreased the likelihood of receiving SUD treatment. Having a drug use disorder (OR=10.49, 95% CI=7.42-14.84), and meeting criteria for heavy drinking as compared to only binge drinking (OR=1.76, 95% CI=1.24-2.51) increased the likelihood of initiating SUD treatment. Race/ethnicity did not predict SUD treatment.

Conclusions and Implications: Very few veterans in this study with past-month binge drinking initiated SUD treatment. Treatment initiation was less common for older adults, suggesting that outreach efforts such as telephone interventions, home visits, family involvement, or transportation assistance could be indicated for this group. Additionally, employed veterans were less likely to initiate treatment. Future research should explore this relationship, as conflicting work schedules may contribute as a treatment barrier, and/or unemployment may be an alcohol-related problem that motivates treatment seeking. Recent national VA treatment initiatives include the integration of mental health care into primary care clinics, the expansion of specialty clinic hours, and monitoring the disposition of alcohol screenings. These initiatives will likely increase the number of binge drinkers who receive some sort of SUD interventions.