Heavy Drinking in a National Sample of Veterans: Racial and Ethnic Differences in Alcohol Consumption

Background and Purpose: Heavy drinking, defined by SAMSHA as binge drinking five or more times in one month, is associated with negative medical and social consequences in veteran and non-veteran populations. Heavy drinking is significantly more common in veterans, with a prevalence of 7.5%, as compared to 6.5% in non-veterans (Wagner, et al., 2007). Across racial/ethnic groups, rates of heavy drinking differ. Recently, data suggests that in the general population, rates were the highest among American Indians or Alaskan Natives, followed by whites, and multiracial individuals (SAMSHA, 2008). Furthermore, recent studies suggest that the social consequences of heavy drinking are worse for racial/ethnic minorities, likely attributed to issues around stigma (Mulia et al., 2009). To date, no large-scale studies exist that compare SAMHSA-defined heavy drinking across racial/ethnic groups among veterans; also, the differential risk factors for heavy drinking within racial/ethnic groups are unknown. The purpose of this study was to address these gaps in the literature using data from the Large Health Survey of Veteran Enrollees (LHSV.)

Method: This study included a large sample of veterans receiving VA healthcare in FY1998-2000, who also completed the 1999 LHSV (total N=19,959). Survey items assessed the self-report of race/ethnicity, past-month frequency of binge drinking (drinking five or more drinks in one setting), socio-demographic characteristics, and SF-36 physical and mental health summary measures. Survey data were linked to healthcare administrative records to identify indicators of poor health (e.g. service-connected disability, and drug use disorder) and prior VA healthcare use (in FY98). The binge drinking item was categorized to reflect SAMHSA heavy drinking criteria. Bivariate and multivariate tests identified risk factors for past-month heavy drinking among blacks, Hispanics, whites, and Native Americans.

Results: Blacks exhibited the highest rates (22.3%) of past-month heavy drinking, followed by Hispanics (18.0%), Native Americans (15.3%), and whites (14.6%; p <.001). Adjusting for sociodemographic and clinical characteristics, logistic regressions found in comparison to whites, blacks (OR=1.45; 95% CI=1.27-1.64) and Hispanics (OR=1.25; CI=1.04-1.52) were at increased risk of heavy drinking. Separate adjusted regression models examining within-group risks showed that significant risk factors for heavy drinking differed across racial/ethnic groups. Prior mental health treatment decreased risk for all groups. Physical health, older age, being unmarried, and female gender were associated with a decreased risk, whereas a drug use diagnosis increased risk. For only whites, higher education decreased risk, and being employed increased risk.

Conclusions and Implications: Blacks and Hispanics were at highest risk for past-month heavy drinking in adjusted analyses. Across racial/ethnic groups, receiving mental health care in the year prior to being surveyed was associated with a decreased risk of heavy drinking. This finding raises the possibility that general mental health care may offer benefit to heavy drinkers, although additional research is needed to explore this issue. Longitudinal surveys may help determine if a temporal relationship exists between the receipt of mental health care and decreased heavy drinking. Although differences in risk factors existed across racial/ethnic groups, future studies with larger samples are needed to confirm those findings.