Alcohol taxation, policy environment, and alcohol health services

About This Grant

Alcohol use disorders (AUDs), including alcohol abuse and alcohol dependence, account for a substantial portion of alcohol-related mortality, morbidity and economic costs. Most efforts to address AUDs involve individually-oriented treatment approaches including clinical interventions and self-help groups. However, most of those with diagnosable AUDs do not receive treatment, and population-based policy factors associated with access to treatment and remission from dependence are not well understood. Environmental factors can affect AUDs; alcohol policies are modifiable environmental factors that vary widely between states. State alcohol taxation contributes to state funds that in part provide alcohol and drug treatment services. We conceptualize that alcohol policies could be protective environmental factors for clinical AUDs. There is evidence that alcohol policies can yield population-level reductions in youth drinking, adult binge drinking, and reductions in outcomes related to AUD diagnostic criteria such as motor vehicle crashes. The overall objective of our proposal is to advance the evidence base for alcohol policy and treatment services research by conducting a comprehensive evaluation with the use of generalized mixed effects regression analysis as well as individual- based propensity score matching and synthetic control methods to assess the associations of alcohol taxation, and related policy environment with state-level alcohol treatment facilities capacity and key AUD health service outcomes. For these outcomes, we will use national data from the National Survey of Substance Abuse Treatment Services (N-SSATS, 2000-2022), the Treatment Episode Data Set (2000-2022), and the National Survey on Drug Use and Health (NSDUH, 2000-2022). Our aims include Aim 1: assessing the associations of state alcohol taxation with treatment facility’s receipt of government funding and the number of beds per capita designated for alcohol treatment. Aim 2a: determining the associations of state alcohol taxation and policy environment with state rates of alcohol treatment episodes, overall and moderated by policy subgroups (taxation vs. non-taxation policies) and by treatment types (inpatient vs. outpatient); and Aim 2b: assessing whether state-level binge drinking prevalence mediates the association of alcohol taxation and policy environment with state rates of treatment episodes. Aim 3a: assessing the associations of alcohol taxation and policy environment with participant-level AUD, treatment gap, and perceived stigma; and Aim 3b: examining the associations of alcohol taxation and policy environment with episode-level wait time to enter treatment. Our proposal is responsive to the NIH PAR-23-185 that highlights the needs to understand geographic differences in alcohol control policies and their impact on alcohol health services. Our study is innovative, leverages previous work by our team of experienced investigators, and will use causally rigorous methods to study relationships and underlying mechanisms between alcohol policies and alcohol services outcomes. This work has important implications for developing population-level strategies to address AUDs.