PROJECT SUMMARY/ABSTRACT
Excessive drinking results in tremendous economic and social costs and is a leading cause of preventable
death in the US. Only a small minority of people with alcohol use disorder (AUD) receive appropriate
services, and there are large disparities in access to alcohol health services for people based on
race/ethnicity, gender, socioeconomic status, and urbanicity. The proposed study will answer pressing
questions about how to reduce disparities in access, using simulation modeling to examine whether
universal increases in access to evidence-based practices (EBPs) such as screening, brief intervention, and
referral to treatment (SBIRT) or medication-assisted treatment can reduce disparities, or whether more
targeted efforts to improve access are needed to reach high-priority population subgroups. Simulation
models are well-suited for identifying unintended consequences of interventions implemented in complex
systems, as well as outcomes that may occur years after implementation. By projecting intervention effects
across population subgroups over time, simulation modeling can help identify and prioritize types of alcohol
health services interventions to reduce AUD disparities. Although simulation methods are being used to
address the opioid crisis, to date there is no published simulation model comprehensively describing the
continuum of alcohol health services in relation to AUD disparities. The proposed study fills this gap by
simulating effects of increased access to alcohol health services across the continuum of care from SBIRT,
to specialty care (including AUD medications) and informal treatment (including 12-step groups like
Alcoholics Anonymous), in relation to health disparities. First, we will build and calibrate a microsimulation
model of alcohol health services for people with mild, moderate, and severe AUD, guided by a conceptual
model that includes barriers to treatment at the individual, organizational, community, and policy levels. Next,
we will use a geographically situated simulated population representing the large, demographically and
geographically diverse states of California and Texas to make long-term projections for AUD severity and
recovery for key population subgroups over time. Finally, informed by theories of healthcare access and
utilization, we will project changes in AUD treatment disparities under several enhanced conditions to identify
the mix and distribution of services that would best reduce disparities, and we estimate costs and benefits of
improved service access. Study Aims are to assess effects of (1) universal implementation of EBPs in
traditional and non-traditional settings and (2) improving accessibility, availability, affordability, and
acceptability of alcohol health services on disparities, and to (3) estimate cost and cost-effectiveness of
these changes. Results will provide detailed information to inform service planning by states, counties, and
communities to improve health services, including projections for how and where to intervene in a cost-
effective manner to reduce the burden of AUD and increase long-term recovery for vulnerable populations.
