Assessing the Effects of State Alcohol Exclusion Laws on Alcohol-Related Behaviors and Outcomes

项目摘要/摘要 酒精使用障碍(AUD)在美国非常普遍，给个人带来了沉重的负担， 家庭和社会。公众对AUD和成瘾疾病的理解是由于 证明成瘾的神经生物学基础和成瘾是可治疗的事实的科学进展 条件。尽管如此，对澳元患者的个人和机构歧视依然存在。为 例如，与公众意识的转变形成对比的是，许多州仍然有酒精排除法(AELS)。 这些法律(是《统一事故和疾病保险法》的一部分)允许投保。 各种类型的公司(事故、汽车、残疾、健康)拒绝为这些人所遭受的伤害提供保险 因酒精而受损的。有人担心，这样的法律会阻碍或阻碍医疗服务提供者 检测受伤患者的血液酒精水平，筛查和识别与酒精有关的问题， 并转介接受治疗。因此，在过去的20年里，16个州和哥伦比亚特区 已经废除了AELS。然而，废止的影响还没有得到科学的评估。作为对.的回应 NIAAA PA-17-135，拟议的研究将通过进行第一个严格的 分析AELS废止对饮酒求医行为的影响，实践模式 医疗保健提供者，以及支付来源可能如何影响对这些法律的行为反应。 此外，我们将研究废除这些法律的一个重要的潜在意外后果-- 这样做会增加饮酒问题。我们提出了一种准实验设计，利用了 随着时间的推移，州法律就像一个自然的实验。我们将使用来自五个大型全国性调查的数据 行政来源：治疗事件数据集、州住院患者数据库、州紧急情况 应对数据库、全国药物使用与健康调查和行为风险因素 监控系统。我们还将使用NIAAA的酒精政策信息系统，并辅之以原始的 法律研究和其他政策数据来源。该项目针对的是一个高度未被研究的高公众领域。 健康意义：国家医疗体系层面的因素--保险排他性法律--成为 AUDS治疗的障碍--在AUDS患病率为 治疗服务的增加和使用率较低。这项研究将加深我们对 保险排除法与实质相关行为和结果之间的关系。在……里面 响应PA-17-135，该项目建议对政策和政策效果进行创新研究，而不是 很好理解。我们预计，拟议的研究将提供一个证据基础，以告知未来 州和国家两级的立法行动，从而对公众产生有意义的积极影响 健康。

Project Summary/Abstract Alcohol use disorders (AUDs) are highly prevalent in the U.S., and impose a substantial burden on individuals, families and society. Public understanding of AUD and the disease of addiction has evolved as a result of advances in science demonstrating the neurobiological basis of addiction and the fact that it is a treatable condition. Nonetheless, individual and institutional discrimination against people with AUD persists. For example, in contrast to shifts in public awareness, many states still have Alcohol Exclusion Laws (AELs). These laws (which are part of the Uniform Accident and Sickness Policy Provision Law) allow insurance companies of various types (accident, auto, disability, health) to deny coverage for injuries sustained by those impaired by alcohol. There are concerns that such laws prevent or create disincentives to healthcare providers testing blood alcohol levels of injured patients, screening and identifying those with alcohol-related problems, and making referrals for treatment. As a result, over the past 20 years, 16 states and the District of Columbia have repealed AELs. However, the impact of repeal has not been assessed scientifically. In response to NIAAA PA-17-135, the proposed study will address this critical knowledge gap by conducting the first rigorous analyses of how the repealing of AELs has affected alcohol treatment-seeking behavior, practice patterns of healthcare providers, and how behavioral responses to these laws might be influenced by payment source. Additionally, we will examine an important potential unintended consequence of repealing these laws--whether doing so increases problem drinking. We propose a quasi-experimental design, exploiting variation across state laws over time as a natural experiment. We will use data from five large national surveys and administrative sources: the Treatment Episode Data Set, State Inpatient Databases, State Emergency Response databases, the National Survey on Drug Use and Health, and the Behavioral Risk Factor Surveillance System. We will also use NIAAA's Alcohol Policy Information System supplemented by original legal research and other policy data sources. This project addresses a highly understudied area of high public health significance: the potential of a state healthcare system-level factor--insurance exclusionary laws--to be a barrier to treatment for AUDs—a question that is especially critical at a time when the prevalence of AUDs is increasing and use of treatment services is low. This research will enhance our understanding of the relationships between insurance exclusionary laws and substance-related behaviors and outcomes. In response to PA-17-135, this project proposes innovative research into policies and policy effects that are not well understood. We anticipate that the proposed study will provide an evidence base to inform future legislative actions at both the state and national levels, thereby having a meaningful positive impact on public health.