health disparities

Researchers Receive $3.4M Grant to Study Alcohol Use Disorder Among People with Disabilities

Rachel Sayko Adams and colleagues will investigate disparities in alcohol use, health consequences, and access to treatment to produce a comprehensive picture of how the disability community is affected by alcohol-related problems and to guide future improvements to care.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has awarded a $3.4 million grant to Boston University School of Public Health and The Heller School for Social Policy and Management at Brandeis University to explore the intersection of disability and alcohol use.

Over the next five years, researchers from the two schools will investigate alcohol use, health consequences, and access to treatment among people with disabilities compared to those without disabilities to produce a comprehensive picture of how the disability community is affected by alcohol-related problems.

Rachel Sayko Adams, a research associate professor in the Department of Health Law, Policy & Management, and her long-time collaborator Sharon Reif, a professor at the Institute for Behavioral Health within the Heller School, are the principal investigators. Between them, Adams and Reif have more than three decades of experience in addiction services research.

A study published by Adams and Reif last year suggests that while people with disabilities are more likely to abstain from alcohol than people without disabilities, those who do drink are more likely to do so at problematic levels. Additionally, while recently partnering on the Intersecting Research on Opioid Misuse, Addiction, and Disability Services (INROADS) study, their team found that experiencing a traumatic brain injury made people more vulnerable to prescription opioid misuse. In the INROADS study, Adams, Reif, and their team emphasized the complex interplay between the range of adverse social determinants of health associated with disability and the risk factors for addiction, underscoring the need to address these critical gaps in the literature.

“There has been an alarming escalation in alcohol-related harms and mortality in the US over the past two decades, yet people with disabilities have generally been overlooked in addiction research,” says Adams (SPH’08), who, after completing her MPH in health policy and management at SPH and doctorate in social policy at Brandeis, led a portfolio of addiction health services research at the Institute for Behavioral Health for over a decade prior to joining the faculty at SPH last year. “Our study will provide essential information to improve access and quality of addiction treatment for people with disabilities who also have alcohol use disorder.”

Adams notes that the NIAAA award follows a recent decision by the National Institutes of Health to designate people with disabilities a population with health disparities, alongside racial and ethnic minority groups, people with lower socioeconomic status, underserved rural communities, and sexual and gender minority groups. She hopes SPH and Brandeis’s research, like the NIH-designation, will highlight the barriers to care and unmet health needs of people with disabilities and promote health equity moving forward.

Three streams of data will inform the analysis, including survey data from the National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), and health care utilization data on insurance claims submitted by employer-based plan holders and public insurance beneficiaries, from MarketScan and Medicaid respectively.

By evaluating the full timeline during which an individual might receive care, from self-reported alcohol use and consequences in the NSDUH data through alcohol treatment services in the claims data, the researchers will be able to highlight where interventions in practice and policy would be most beneficial, says Adams.

Joining the team are co-investigator Jake Morgan, a fellow research assistant professor in the Department of Health Law, Policy & Management; Maureen Stewart and Mary Brolin, senior scientists and health services researchers at Brandeis; Marc LaRochelle, a primary care physician specializing in addiction at Boston Medical Center; and collaborator Dennis Heaphy (STH’90,’23, Questrom’84, SPH’99), a health justice advocate and researcher at the Massachusetts Disability Policy Consortium, who has lived experience with disability and completed his MPH at SPH.

“Disability is a highly stigmatized condition. People with disabilities and alcohol problems become multiply stigmatized, further reducing access to care,” says Reif. “That health care disparities remain prevalent reflects a lack of accommodations and other structural barriers. This study will allow us to examine, in-depth, how and when alcohol use and alcohol use disorders occur and what treatment services look like, across different types of disabilities in comparison to people without disabilities. Ultimately, we want to inform practice and policy to improve the health of people with disabilities and advance recovery from alcohol problems more equitably.”