Data shows disparities among alcohol use disorder diagnosis among veterans

New Penn Medicine research shows how AUD diagnoses differ among veterans, given evidence that exposure to trauma, including combat, is a risk factor.

Americans have a long, complicated and mostly social history with alcohol. However, drinking to excess or developing an alcohol use disorder can also be a deeply personal experience. One expert has long sought answers to how genetics may affect the likelihood of developing an alcohol use disorder.

Henry Kranzler, professor of psychiatry and the director of the Center for Studies of Addiction at the Perelman School of Medicine, has focused on identifying genetic contributors to alcohol misuse and what is known as alcohol use disorder (AUD) to help account for who may be predisposed to alcohol misuse and why, along with helping untangle questions around differences in how AUD is diagnosed.

A veteran drinking alcohol in a wheelchair.
Image: iStock/Boris Jovanovic

AUD is a brain disorder that encompasses a broader spectrum of conditions, including alcohol abuse, alcohol dependence, alcohol addiction, and alcoholism, according to the National Institutes of Health. AUD is characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

Genetics play a role, with genes responsible for up to half the risk for AUD, according to the NIH. However, the other half of that risk is accounted for by environmental factors, with behaviors such as early childhood adverse experiences (e.g., abuse and neglect) and co-occurring psychiatric disorders (e.g., antisocial personality disorder) contributing to the risk of AUD.

New research from Kranzler sheds light on how diagnoses differ among veterans, given evidence that exposure to trauma, including combat, is a risk factor for heavy drinking and AUD.

Veterans are at greater risk of AUD than the general population because AUD is more common among males and veterans who receive care from Veterans Affairs (VA) are predominantly male, a figure that is a match for the overall percentage of male veterans. In addition, according to the National Institute on Drug Abuse, 65% of veterans who enter a treatment program report alcohol as the substance they most frequently misuse. This is almost double that of the general population.

However, clinicians and researchers involved in veterans’ care are concerned about providing accurate diagnoses of AUD to patients who most need treatment, and past studies have shown that there are differences in diagnoses along racial and ethnic lines. A new study, published in The American Journal of Psychiatry finds that Black and Hispanic military veterans were more likely to be diagnosed with AUD than their white counterparts—even when alcohol consumption levels were the same.

Based on these findings, a team of military and civilian addiction conclude that racial bias might play a role in how clinicians identify AUD at the U.S. Department of Veterans Affairs (VA) and potentially beyond.

“No other factors emerged to explain this discrepancy, which strongly suggests the presence of racial and ethnic biases in the diagnosis of AUD. Efforts are needed to reduce these biases in the diagnostic process for AUD,” says Kranzler, who is also the co-associate director of Research with the VISN 4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia.

This story is by Eric Horvath. Read more at Penn Medicine News.