Providers’ perceptions of barriers and facilitators to disclosure of alcohol use by women veterans

Abraham, Traci H.; Lewis, Eleanor T.; Drummond, Karen L.; Timko, Christine; Cucciare, Michael A.

doi:10.1017/s1463423616000384

Cited by 15 publications

(7 citation statements)

References 23 publications

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“…Female veterans may find it difficult to disclose substance use to providers due to perceived stigma and shame associated with being a female substance user. 60 Additionally, female veterans with SUDs have higher rates of childhood sexual abuse, military sexual trauma, and domestic violence than female veterans without SUDs, and women with PTSD are particularly at risk of developing substance-related problems. 61 , 62 SUD treatments are often provided in groups made up primarily of male veterans.…”

Section: Introductionmentioning

confidence: 99%

Substance use disorders in military veterans: prevalence and treatment challenges

Teeters

Lancaster

Brown

et al. 2017

SAR

216

118

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Substance use disorders (SUDs) are a significant problem among our nation’s military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.

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Section: Introductionmentioning

confidence: 99%

Substance use disorders in military veterans: prevalence and treatment challenges

Teeters

Lancaster

Brown

et al. 2017

SAR

216

118

View full text Add to dashboard Cite

show abstract

“…A study involving provider's perceptions of barriers to disclosure of alcohol use by women veterans found that practitioners who had developed a good rapport with their patients felt more confident with SBI. The established therapeutic relationship allowed providers to be more forthcoming with questions and probe deeper when they sensed a patient's reluctance to disclose HAU (Abraham et al, 2017). The findings from this study call into question whether SBI can be effective when applied in acute care settings like same-day clinics/EDs.…”

Section: Avoidance Biasmentioning

confidence: 87%

“…In the presence of chronic medical/mental health conditions, SBI for HAU is viewed as less relevant to other patient care issues (Abraham et al, 2017;Goldstein et al, 2015;McNeely et al, 2018). A qualitative study involving 67 primary care providers (PCPs) conducted in two U.S. urban hospital settings found that PCPs demonstrated inconsistent screening practices.…”

Section: Avoidance Biasmentioning

confidence: 99%

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use

Johnston

2021

J Am Psychiatr Nurses Assoc

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Background: Screening for harmful alcohol use (HAU) is standard in clinical settings; however, self-reports of the quantity/frequency of use are often inconsistent with population survey data and objective assessment. Inaccuracies of self-reported alcohol use prompt exploration of patients’ reluctance to share this information with their health care providers. Objectives: The purpose of this article is to identify the assumptions and biases that affect screening and brief interventions for HAU. Method: A total of 22 research articles were selected for a systematic review of the literature. The studies included prospective and retrospective studies, randomized controlled trials, case studies, and quantitative and qualitative research from 2015 to 2021. Results: This systematic review identified alcohol health literacy, the inherent bias of surveys and screening tools, stigma, avoidance bias, and the normalization/villainization of alcohol use as contributors to the assumptions and biases that affect screening and brief interventions for HAU. Conclusions: Exploring these assumptions and biases presents opportunities to develop strategies that promote positive change.

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“…34 Although women consume less alcohol than men, the sex/gender difference has been decreasing in recent years. 35 In studies of unhealthy alcohol use, women experience greater alcohol use related stigma than men, 36,37 which could impact how providers respond to 38,39 and document 40 use among women. More research is needed to understand sex/gender differences in substance use reporting and its documentation in the EHR.…”

Section: Discussionmentioning

confidence: 99%

Racial Inequalities in Alcohol Use Disorder Diagnosis in a Sample of 700,000 Veterans

Vickers‐Smith

Justice

Becker

et al. 2021

Preprint

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Background: Studies show that Black and Hispanic Veterans have a higher prevalence of alcohol use disorder (AUD) than White Veterans. We examined whether the relationship between self–reported race/ethnicity and AUD diagnosis varies by self–reported alcohol consumption. Methods: The sample included 700,013 Black, Hispanic, and White Veterans enrolled in the Million Veteran Program cohort. Alcohol consumption was defined as an individual's maximum score on the Alcohol Use Disorders Identification Test–Consumption (AUDIT–C) questionnaire, a screen for hazardous or harmful drinking. The primary outcome, AUD, was defined by the presence of ICD–9/10 codes in the electronic health record. We used logistic regression with interactions to assess the association between race/ethnicity and AUD by maximum AUDIT–C score. Results: Black and Hispanic Veterans were more likely to have an AUD diagnosis than White Veterans despite similar levels of alcohol consumption. The difference was greatest between Black and White men. At all but the lowest and highest levels of alcohol consumption, Black men had 24%–111% greater odds of an AUD diagnosis. The association between race/ethnicity and AUD diagnosis remained after adjustment for alcohol consumption, alcohol–related disorders, and other potential confounders. Conclusions: The large discrepancy in AUD diagnosis across groups despite a similar distribution of alcohol consumption measures suggests that Veterans are differentially assigned an AUD diagnosis by race/ethnicity. Efforts are needed to examine the causes of the observed differences and to implement changes, such as structured diagnostic methods, to address a likely contributor to racial differences (i.e., bias) in AUD diagnosis.

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Providers’ perceptions of barriers and facilitators to disclosure of alcohol use by women veterans

Cited by 15 publications

References 23 publications

Substance use disorders in military veterans: prevalence and treatment challenges

Substance use disorders in military veterans: prevalence and treatment challenges

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use

Racial Inequalities in Alcohol Use Disorder Diagnosis in a Sample of 700,000 Veterans

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