Alcohol-related Services Research Articles

Stand Down–Think Before You Drink: protocol for an effectiveness-implementation trial of a mobile application for unhealthy alcohol use with and without peer support

IntroductionMobile apps can increase access to alcohol-related care but only if patients actively engage with them. Peers have shown promise for facilitating patients’ engagement with mobile apps. However, the effectiveness...

Consumer Knowledge of Insurance Coverage of Alcohol Treatment Services in the United States: Changes Since 2015.

Aims of this study are to examine (a) whether consumer knowledge about their health insurance coverage for alcohol-related services has changed over time and (b) whether racial, ethnic, and income disparities in known coverage have changed over time. This was a general population study comparing the 2015 and 2020 National Alcohol Surveys (N = 12,076 combined 2015 and 2020; 7,215 women, 4,858 men). Knowledge of alcohol treatment coverage (insured with coverage, insured without coverage, insured with coverage unknown, uninsured, or insurance status unknown) was estimated and compared for the total sample ages 18-64 and compared separately by subgroups. Multinomial logistic regression was used to formally test changes in knowledge of coverage over time. Regression models were adjusted for sociodemographics, health insurance type, and current alcohol use disorder. All bivariate and multivariable analyses were survey-weighted to account for probability of selection. Between 2015 and 2020, the prevalence of those reporting being insured without alcohol treatment coverage decreased (-2.8%, p < .001), and the prevalence of those insured with coverage unknown increased (8.1%, p < .001). Compared with White respondents, foreign-born Hispanic respondents were more likely to report being insured without coverage, and Black or African American respondents were less likely to be insured with coverage and had a steeper decrease in knowledge of coverage status over time. Results suggest some persistent disparities in known alcohol treatment coverage. They also suggest a need for both greater insurance coverage of alcohol-related services and greater efforts by employers, insurers, and practitioners to inform their constituents and increase knowledge about what alcohol-related services are available to them.

Alcohol-attributable deaths and years of potential life lost due to alcohol among veterans: Overall and between persons with minoritized and non-minoritized sexual orientations

BackgroundUnhealthy alcohol use is disproportionally experienced by individuals with minoritized sexual orientations. Unlike the general US population, for whom the burden of alcohol as it relates to mortality is consistently monitored across time with national survey data, the impact of unhealthy alcohol use among veterans with minoritized sexual orientations, for whom addressing substance use is a national priority, is largely unknown. MethodsUsing Alcohol Use Disorders Identification Test Consumption data from the Department of Veterans Affairs electronic health record and underlying cause of death from National Death Index from 2014 to 2018 we quantified alcohol consumption and related mortality among veterans with (n = 102,085) and without minoritized sexual orientations (n = 5300,521). Age adjusted rates of alcohol attributed deaths (AAD) per 100,000 persons and years of potential life lost (YPLL) were estimated by sexual orientation, sex, and sexual orientation stratified by sex. ResultsAlcohol attributable deaths (n = 21,861) were higher among veterans with minoritized sexual orientations than veterans without after adjustment for age (486.5 deaths/100,000 versus 309.7 deaths/100,000, respectively). Veterans with minoritized sexual orientations also experienced more YPLL (13,772.8 years/100,000 versus 7618.9 years/100,000). Years of potential life lost per AAD was higher in women (33.2 years) than men (18.7 years). ConclusionsAlcohol consumption results in substantial disability and death among veterans, particularly veterans with minoritized sexual orientations. Findings suggest need for increased alcohol-related services for all VA patients, and potential targeted approaches to for veterans with minoritized sexual orientations and women to offset risk for, and years of potential life lost from, alcohol attributable death.

Alcohol-related health service use as predictor of death and remission in patients with AUD

Alcohol-related health service use as predictor of death and remission in patients with AUD

Transition to problem stimulant use marked by amplified insular responding to pleasant interoceptive stimuli

The EU Early Warning System currently monitors more than 560 new psychoactive substances, far outweighing the total number of illicit drugs under international control. Due to the recent emergence of NPS and rapidly changing nature of the market, evidence about the way in which the emerging drugs are managed in health and social care settings is limited.The study adopted a mixed methods design, utilising a cross sectional survey and telephone interviews to capture data from staff working in drug and alcohol related services in statutory and voluntary sectors, across the five Health and Social Care (HSC) Trust areas in Northern Ireland. 196 staff participated in the survey and 13 participated in follow up in telephone interviews between August and November 2015.Study respondents reported that addressing NPS related issues with service users was a key aspect of their daily role and function. Levels of injecting behaviours were also viewed as relatively high by study participants. Almost all workers used harm reduction as their primary approach when working with service users and the majority of respondents called for additional practical training in relation to addressing drug interactions and intervening with NPS related issues.

Health and Social Care workers’ perceptions of NPS use in Northern Ireland

BackgroundThe EU Early Warning System currently monitors more than 560 new psychoactive substances, far outweighing the total number of illicit drugs under international control. Due to the recent emergence of NPS and rapidly changing nature of the market, evidence about the way in which the emerging drugs are managed in health and social care settings is limited. MethodsThe study adopted a mixed methods design, utilising a cross sectional survey and telephone interviews to capture data from staff working in drug and alcohol related services in statutory and voluntary sectors, across the five Health and Social Care (HSC) Trust areas in Northern Ireland. 196 staff participated in the survey and 13 participated in follow up in telephone interviews between August and November 2015. ResultsStudy respondents reported that addressing NPS related issues with service users was a key aspect of their daily role and function. Levels of injecting behaviours were also viewed as relatively high by study participants. Almost all workers used harm reduction as their primary approach when working with service users and the majority of respondents called for additional practical training in relation to addressing drug interactions and intervening with NPS related issues.

Impact of a workplace intervention on attitudes and practices related to gender equity in Bengaluru, India

ABSTRACTWe describe the evaluation of a participatory, garment factory-based intervention to promote gender equity. The intervention comprised four campaigns focused on gender and violence against women, alcoholism, sexual and reproductive health, and HIV/AIDS, which were implemented using information displays (standees and posters) and interactive methods (street play, one-to-one interactions, experience-sharing, and health camps). Each campaign lasted six days and the entire intervention was implemented over 10 months. We evaluated the intervention using a quasi-experimental design in which one factory served as the intervention site and a second as a delayed control. Two mobile-phone-based cross-sectional surveys were conducted at baseline and 12 months with separate systematic random samples of employees from each site. Data on socio-demographic characteristics and knowledge and attitudes related to gender equity, intimate partner violence (IPV) and alcohol use were assessed, and differences in these variables associated with the intervention were examined using difference-in-difference estimation. Analyses of data from 835 respondents revealed substantial, statistically significant improvements in attitudes related to gender equity, unacceptability of IPV, and awareness of IPV and alcohol-related support services. In conclusion, our study offers compelling evidence on the effectiveness of workplace-based interventions in advancing gender equity.

Alcohol Screening and Intervention Among United States Adults who Attend Ambulatory Healthcare.

There is limited data on the extent to which indicated alcohol interventions are delivered in U.S. ambulatory care settings. To assess the receipt of alcohol-related services, including assessment of use, advice to reduce drinking, and information about alcohol treatment, during ambulatory care visits. Secondary data analysis of the 2013 National Survey on Drug Use and Health, a cross-sectional, nationally representative survey of civilians in the non-institutionalized U.S. general population (response rate 71.7 %). Adult ambulatory care users in the public use data file who did not obtain emergency or inpatient services (n = 17,266). Measurements included respondents' alcohol consumption, heavy episodic drinking, alcohol use disorder, healthcare use, and receipt of alcohol-related interventions. Approximately 71.1 % of ambulatory care users received an alcohol assessment. Among past-month heavy episodic drinkers without an alcohol use disorder who reported receiving an alcohol assessment, 4.4 % were advised to cut back. Among individuals with alcohol abuse and alcohol dependence who reported receiving an alcohol assessment, 2.9 % and 7.0 %, respectively, were offered information about treatment. Rates of alcohol screening and assessment were relatively high among adults who attended healthcare visits, but rates of intervention were low, even when individuals were assessed for use. Efforts are needed to expand delivery of interventions when patients are identified as positive for risky drinking, hazardous alcohol use, and alcohol use disorders during ambulatory care visits.

Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials.

Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.

The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates.

To formulate harmful dysfunction (HD) diagnostic criteria for alcohol use disorder (AUD) and test whether they increase validity relative to standard DSM criteria, as evidenced by lowered prevalence, increased validator levels including service use, severity and family history and enhanced specificity. DSM-IV AUD, DSM-IV dependence, DSM-5 AUD and HD AUD definitions were compared on eight validity related tests using nationally representative community data. United States. National Epidemiologic Survey of Alcoholism and Related Conditions (NESARC) respondents, aged 18-54 years (wave 1, n = 29 673; wave 2, n = 24 244). NESARC DSM-IV and DSM-5 criteria were taken from published studies. Whereas DSM-5 diagnosis requires any two AUD symptoms, HD criteria were constructed from NESARC items to require symptoms of both impaired-control dysfunction [withdrawal, drink to prevent/stop withdrawal, cannot stop/reduce drinking, or craving (wave 2 only)] and harm (sacrificed important activities, problems caring for home/family, job/school problems, health problems, psychological problems or problems with family/friends). Validators included service use, severity and family history, among others. Specificity was tested using a teen transient drinker criterion group. Compared with DSM-5 AUD (DSM-IV results were similar), HD criteria yielded lower prevalence (95% confidence intervals): HD life-time 6.7% (6.2, 7.2%), 1-year 2.3% (2.0, 2.5%); and DSM-5 life-time 38.2% (36.5, 39.9%), 1-year 12.4% (11.7, 13.1%). HD AUD was higher than DSM-5 on pathology validators, including: life-time alcohol-related service use: HD 41.0% (38.1, 43.9%), DSM-5 11.5% (10.7, 12.3%); severity (number of life-time alcohol symptoms): HD 20.8 (20.4, 21.2), DSM-5 10.6 (10.4, 10.8); and family history of alcohol problems: HD 50.1% (47.3, 52.9), DSM-5 32.8% (31.6, 34.0). HD criteria eliminated 83% of a DSM-5 teen transient drinker false-positives criterion group. Prevalence estimates of alcohol use disorder are lowered and diagnostic validity improved when using 'harmful dysfunction' diagnostic criteria compared with standard DSM criteria, partly by reducing misdiagnosis of teenage transient drinkers.

Talk About Alcohol: impact of a school-based alcohol intervention on early adolescents

Despite a downward trend in alcohol consumption among 11–15-year-olds in recent years (Fuller, E, ed. 2013. Smoking, Drinking and Drug Use Among Young People in England in 2012. London: Health and Social Care Information Centre. http://www.hscic.gov.uk/catalogue/PUB11334), the proportion of young people seeking support from alcohol-related specialist services, and the societal and monetary costs associated with alcohol consumption, need to be addressed. Education can play an important role in this. The evaluation of the Alcohol Education Trust's Talk About Alcohol school-based intervention was conducted across England between November 2011 and October 2013 by independent evaluators. The aim was to compare the alcohol-related knowledge, awareness, and behaviour of students aged 12–14 in an intervention group with a statistically matched comparison group. Three identical surveys were carried out with approximately 4000 students to explore change over time over a 16–18-month timeframe. Multilevel modelling looked at changes in outcomes over the three time points and control for measured differences between intervention and comparison groups. There was evidence of a statistically significant delay in the age at which teenagers start to drink. There was also a significant association between the intervention and knowledge of alcohol and its effects. Although levels of frequency of drinking and binge drinking were lower than in the comparison schools, there were no statistically significant differences. Students from both groups identified personal, social, and health education lessons as a preferred source of information about alcohol and its effects. The positive impact on alcohol knowledge and the delayed onset of drinking show that the materials may support England's policy priorities around alcohol.

Disparities in the Use and Quality of Alcohol Treatment Services and Some Proposed Solutions to Narrow the Gap

This study assessed racial-ethnic disparities in access to high-quality treatment for at-risk drinking and alcohol abuse in the United States and simulated strategies to narrow the gap. Longitudinal data collected in 2001-2002 and 2004-2005 from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed to examine racial-ethnic disparities in receipt of alcohol interventions that were provided in primary care and specialty treatment settings and that met published clinical guidelines. The sample consisted of 9,116 respondents who met criteria for at-risk drinking or alcohol abuse in 2001-2002. Simulation analyses projected how disparities in treatment services utilization might change if clinical guidelines promoted access to care in more varied health and human service settings. Compared with whites, members of racial-ethnic minority groups had less than two-thirds the odds of receiving an alcohol intervention over the roughly four-year study period (odds ratio [OR]=.62, p<.05). This disparity increased after adjustment for socioeconomic confounders and frequency of heavy drinking (adjusted OR=.47, p=.003). The most pronounced disparities were between whites and U.S.-born and foreign-born Hispanics. Simulation analyses suggested that these disparities could be partially mitigated by extending care into nonmedical service venues. Current efforts to extend evidence-based alcohol interventions into medical settings address an important need but are likely to increase racial-ethnic disparities in access to high-quality treatment. Partial solutions may be found in expanding the range and quality of alcohol-related services provided in alternative delivery sites, including faith-based and social service institutions.

Gender and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence

BackgroundPrior studies on treatment for alcohol-related problems have yielded mixed results with respect to gender and race/ethnicity disparities. Additionally, little is known about gender and racial differences in time to first alcohol-related service contact amongst persons with alcohol dependence. This study explored gender and race/ethnicity differences for first alcohol-related service utilization in a population-based sample. MethodsPrimary analyses were restricted to Blacks, Whites and Hispanics, ages 18–44, with lifetime alcohol dependence (n=3311) in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions. We compared time to service use among men and women within and across race/ethnicity strata using multivariable Cox proportional hazard methods. ResultsIn the sample of individuals age <45 with alcohol dependence, only 19.5% reported alcohol-related service use. Overall, women were less likely than men to receive alcohol-related services in their lifetime. However, women who did receive treatment were younger at first service utilization and had a shorter interval between drinking onset and service use than men. Gender differences were consistent across racial/ethnic groups but only statistically significant for Whites. There were no appreciable race/ethnicity differences in hazard ratios for alcohol-related service use or time from drinking initiation to first service contact. Results of sensitivity analyses for persons ≥45 years old are discussed. ConclusionsThere are important gender differences in receipt of and time from drinking initiation to service utilization among persons with alcohol dependence. Increased recognition of these differences may promote investigation of factors underlying differences and identification of barriers to services.

Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences

Studies indicate that community pharmacy-based alcohol brief intervention (BI) is feasible. However, few studies report significant reductions in post-BI alcohol consumption and customer experience. Cost-effectiveness has not been previously examined. This 5 month study adopted a single group pre- and post-experimental design to: (1) assess uptake of the community pharmacy alcohol BI service; (2) establish post-BI changes in alcohol consumption for hazardous drinkers; (3) report the acceptability of the service to customers who received it; and (4) undertake a preliminary economic evaluation of the service through establishing whether pharmacy-based alcohol BI affected health and social care costs, including lost employment costs, and whether it was cost-effective. 26 community pharmacies in south London, UK. Trained pharmacists used the AUDIT-C and a retrospective 7-day Drinking Diary to identify risky drinkers and inform feedback and advice. Harmful drinkers were referred to their general practitioner and/or specialist alcohol services. A confidential service feedback questionnaire was completed by alcohol BI recipients. Baseline and 3-month follow-up telephone interviews were conducted with hazardous and low risk drinkers to assess post-BI alcohol use change and service cost-effectiveness. AUDIT-C, 7-day alcohol unit consumption, drinking days, cost utilisation data. Of the 663 eligible customers offered alcohol BI, 141 (21 %) took up the service. Three-quarters of customers were identified as risky drinkers. Follow-up interviews were conducted with 61 hazardous/low risk drinkers (response rate = 58 %). Hazardous drinkers were found to significantly reduce their 7-day alcohol unit consumption and drinking days, but not AUDIT-C scores. The majority of harmful drinkers (91 %, n = 10) who were contactable post-BI had accessed further alcohol related services. Customer feedback was generally positive. Over 75 % of customers would recommend the service to others. The cost of delivering the service was estimated to be £ 134. The difference in service costs pre-BI and post-BI was not statistically significant and remained non-significant when calculated on 500 customers receiving the intervention. Community pharmacy-based alcohol BI is a low cost service that may not have immediate beneficial impact on health and social service use, but can be effective in reducing drinking in hazardous drinkers.

Assessing alcohol use in college: is it time for a new approach to identify risky drinking behavior?

Objectives: The purpose of this study is to demonstrate how traditional risky drinking indicators, such as binge drinking, are inefficient when identifying college students who are in need of alcohol-related services. Methods: Using data collected from the 2010 National College Health Assessment II (NCHA-II), the sensitivity, specificity, positive predictive value and negative predictive value of binge drinking was analyzed relative to experiencing negative alcohol-related consequences in the previous 12 months. Results: Despite a considerable mathematical advantage, binge drinking demonstrated a sensitivity of 0.80 and a specificity of 0.69. Additionally, more than 56% of the sample who were identified as binge drinkers did not experience a major negative consequence in the previous 12 months. Conclusions: Risky drinking indicators constructed solely of frequency, quantity and duration items have a limited capacity to discriminate at-risk college drinkers from the general student body. New indicators comprised of novel drinking behaviors are necessary to properly identify students at high risk.

Peer Victimization and Alcohol Involvement among Adolescents Self-Selecting into a School-Based Alcohol Intervention

To increase understanding of factors that prompt adolescents to seek alcohol-related services, this research examined the characteristics of youths who self-selected into a secondary alcohol intervention. Using a cross-sectional study of high school students (N = 6,748), the authors explored participants' alcohol involvement, alcohol-related problems, and bullying/peer victimization. Compared to students that did not self-select, intervention students were more likely to have more hazardous drinking experience, to drink alone, experience alcohol-related problems, report more bullying/peer victimization, be male, and be in the tenth grade. Findings provide support that this developmentally tailored approach to early intervention successfully attracted youths with an array of risk factors.

Stigma and Treatment for Alcohol Disorders in the United States

Among a nationally representative sample of adults with an alcohol use disorder, the authors tested whether perceived stigmatization of alcoholism was associated with a lower likelihood of receiving alcohol-related services. Data were drawn from a face-to-face epidemiologic survey of 34,653 adults interviewed in 2004-2005 who were aged 20 years or older and residing in households and group quarters in the United States. Alcohol abuse/dependence was diagnosed by using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version (AUDADIS-IV). The stigma measure used was the Perceived Devaluation-Discrimination Scale. The main outcome was lifetime intervention including professional services and 12-step groups for alcohol disorders. Individuals with a lifetime diagnosis of an alcohol use disorder were less likely to utilize alcohol services if they perceived higher stigma toward individuals with alcohol disorders (odds ratio = 0.37, 95% confidence interval: 0.18, 0.76). Higher perceived stigma was associated with male gender (β = -0.75; P < 0.01), nonwhite compared with non-Hispanic white race/ethnicity, lower income (β = 1.0; P < 0.01), education (β = 1.48; P < 0.01), and being previously married (β = 0.47; P = 0.02). Individuals reporting close contact with an alcohol-disordered individual (e.g., relative with an alcohol problem) reported lower perceived stigma (β = -1.70; P < 0.01). A link between highly stigmatized views of alcoholism and lack of services suggests that stigma reduction should be integrated into public health efforts to promote alcohol treatment.

Variation among state-level approaches to addressing alcohol abuse in opioid treatment programs

In view of their role in licensing opioid treatment programs (OTPs), state opioid treatment authorities (SOTAs) are in a unique position to influence how OTPs address their patients' alcohol abuse. Using data from a telephone survey of SOTAs from the District of Columbia and states that have at least one OTP ( n = 46), this study examines the extent to which SOTAs address alcohol abuse in their respective state policies and guidelines for OTPs. Findings indicate that 27 states have overall measures on how to address patients' problematic alcohol use, 23 states require or recommend alcohol education to be provided to all patients, and 17 states have stipulations that address specific actions to be taken if patients present at daily dosing under the influence of alcohol. Although SOTAs generally rate alcohol of at least moderate importance in formulating regulations, many of their policies and guidelines do not deal with various alcohol-related services and issues.

Alcohol use disorders and the use of treatment services among college-age young adults.

This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18-22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously. Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health. Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling. College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.

A Gender-Focused Perspective on Health Service Utilization in Comorbid Bipolar I Disorder and Alcohol Use Disorders

This study compares health service utilization by individuals with comorbid lifetime bipolar I disorder and lifetime alcohol use disorders (AUD) to that of individuals with either diagnosis alone, using nationally representative data. The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with bipolar I disorder only (BD-only; N = 636), AUD only (N = 11,068), and comorbid bipolar I disorder and AUD (BD-AUD; N = 775). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The 3 groups were compared with respect to self-reported health service utilization. For both men and women, respondents in the BD-AUD group were significantly more likely than AUD-only respondents to report any alcohol-related service utilization (p < .001). BD-AUD respondents were significantly more likely to report bipolar disorder-related hospital admissions as compared with BD-only respondents among males only (p = .009). Within the BD-AUD group, males reported significantly greater utilization of AUD treatment only (p < .001), and females reported significantly greater utilization of bipolar disorder treatment only (p < .001) and significantly greater likelihood of utilizing mental health services overall (p < .001). There was no gender difference in the proportion of respondents who utilized both AUD and bipolar disorder services. As expected, individuals with comorbid bipolar I disorder and AUD utilize significantly more mental health services than individuals with either disorder alone. The primary original finding is that among those with comorbid bipolar I disorder and AUD, bipolar I disorder is more likely to go untreated among males and AUD is more likely to go untreated among females. Gender may be an important factor to consider in future health service planning for comorbid bipolar I disorder and AUD.