People with disabilities are diagnosed with alcohol use disorder at much higher rates than non-disabled people

People with disabilities are diagnosed with alcohol use disorder at much higher rates than nondisabled people

A new study found that adults with disabilities had more than three times the rate of AUD diagnoses compared with adults without disabilities in the U.S., with particularly high rates among disabled men and people with serious mental illness and acquired brain injuries.

Although people with disabilities are less likely to drink alcohol than people without disabilities, a new study led by Boston University School of Public Health (BUSPH) researchers found that disabled adults have strikingly higher rates of diagnosed alcohol use disorder (AUD) than nondisabled adults in the United States.

The study, published in the journal Drug and Alcohol Dependence Reports, found that adults with disabilities received AUD diagnoses at more than three times the rate of adults without disabilities between 2016–2023.

The study builds on previous research suggesting that people with disabilities are vulnerable to excessive drinking, and it is the first to explore differences in AUD diagnoses by disability status and type among commercially insured adults. It focused on a study group of more than 42 million people.

Adults with serious mental illness, such as severe depression, schizophrenia and bipolar disorder, had the highest rates of AUD, at more than 10 times the rate of adults without disabilities. Adults with acquired brain injuries, such as traumatic brain injury and stroke, had the second-highest rates of AUD, at more than five times the rate of adults without disabilities. Adults with all types of disabilities had higher rates of AUD than adults without disabilities.

The study also identified differences by sex: Men with disabilities had the highest rates of AUD, but women with disabilities had higher rates of AUD than both nondisabled men and women.

As AUD is a chronic condition linked to an increased risk of alcohol-related morbidity and mortality, these findings highlight the need for health care providers to recognize that patients with disabilities are at high risk for AUD and provide tailored AUD screening and treatment.

“The disability community is not a homogeneous population, and certain subgroups are at even higher risk for AUD and associated adverse outcomes,” says study lead and corresponding author Dr. Rachel Sayko Adams, research associate professor of health law, policy & management (HLPM) at BUSPH. “We know that people with serious mental illnesses and traumatic brain injuries are at greater risk of developing AUD, so the high rates of AUD diagnoses that we observed are not surprising, yet they are alarming.”

For the analysis, Adams, Reif and colleagues from BUSPH, Boston Medical Center (BMC), BU Chobanian & Avedisian School of Medicine, the Disability Policy Consortium and The Ohio State University examined data by disability status, type and sex among more than 42 million U.S. adults ages 18–64 with employer-sponsored commercial health insurance from 2016–2023.

Overall rates of AUD increased by an annual average of 5.4% during the study period, from 85 per 10,000 people in 2016 to 128 per 10,000 people in 2023. AUD diagnosis rates increased from 223.4 per 10,000 in 2016 to 312.2 per 10,000 in 2023 for adults with disabilities, compared with an increase from 61 per 10,000 in 2016 to 94.3 per 10,000 in 2023 for adults without disabilities.

“Over the seven years of our study, diagnosed AUD increased by more than 50% with no sign of reversing, with disabled people at more than three times the risk of developing AUD compared to their nondisabled peers,” says Dr. Jake Morgan, research assistant professor of HLPM at BUSPH and study senior author. “This gap in AUD risk between adults with and without disabilities will not close on its own and demands targeted action from clinicians and public health professionals.”

While people with serious mental illness maintained the highest rates of AUD during the entire study period, the results revealed concerning trends among people with other disabilities. For example, people with intellectual and developmental disabilities had lower-than-average rates of AUD among disabled people overall but experienced an increase in diagnosed AUD rates of more than 9% each year during the study period.

“While we need more information about why people with disabilities are more likely to develop AUD, this increased risk is likely affected by the higher rates of unemployment, depression, trauma, isolation, chronic pain and stigma experienced by disabled people,” says study co-author Dennis Heaphy, DMin, MPH, lead researcher and health justice advocate at the Disability Policy Consortium.

What the findings revealed about heavy drinking among women with disabilities was striking, the researchers say. The fact that women with disabilities had higher AUD rates than men without disabilities likely reflects the narrowing gap in binge drinking between males and females.

“It is unprecedented to see such a large group of women with higher rates of AUD compared to men,” Adams says. “It is critical that clinicians understand that women with disabilities are at particularly high risk of AUD, given that women are uniquely vulnerable to alcohol-related health conditions, injuries and death.”

The researchers say clinicians should be prepared to recognize AUD among people with all types of disabilities, not just those for which substance use is already known to be a more common issue. By being informed about the unique and varied experiences of people within broad disability populations, clinicians will be better positioned to inquire about and understand the underlying causes contributing to their patients’ excessive drinking and prevent the development of AUD and associated harms.

This insight can also help prevent clinicians from harboring biases or stigma toward people who are disabled and/or who experience substance use disorders. Prior research suggests that only half of physicians in the U.S. felt confident about their ability to provide the same quality of care to disabled patients as to those without disabilities.

“Due to stigma, there is an erroneous assumption that people with disabilities either do not drink or will not benefit from alcohol treatment,” Heaphy says. “For disabled people with AUD, this stigma is coupled with bias in the addiction treatment system itself, which creates barriers to care that can be challenging to overcome.”

Following these findings, the research team is conducting additional studies within Medicaid and commercial insurance populations to evaluate whether people with disabilities have reduced access to or quality of AUD treatment.

“These striking findings warrant a call to action for clinicians and public health professionals to recognize that disabled people should not be overlooked as at risk for excessive drinking and AUD,” Adams says. “It is imperative that we train clinicians to screen their patients with disabilities for excessive alcohol use to prevent the development of AUD and to provide person-centered alcohol treatment options for disabled patients when needed.”

The study was also co-authored by Yassir Mohamed, doctoral student in health services and policy research at BUSPH; Dr. Maureen Stewart, research associate professor of HLPM at BUSPH; Dr. Marc LaRochelle, general internist and clinical investigator at BMC and associate professor at the Chobanian & Avedisian School; Dr. John Corrigan, academy professor in the Department of Physical Medicine and Rehabilitation at Ohio State; and Dr. Fatema Shafie Khorassani, assistant professor of biostatistics at BUSPH.

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