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

项目总结/摘要 酒精使用障碍（AUD）在美国非常普遍，并给个人带来沉重的负担， 家庭和社会。公众对AUD和成瘾疾病的理解已经演变为 科学的进步证明了成瘾的神经生物学基础以及它是可治疗的事实 条件尽管如此，对AUD患者的个人和机构歧视仍然存在。为 例如，与公众意识的转变相反，许多州仍然有酒精排除法（AELs）。 这些法律（属于《统一事故和疾病保险规定法》的一部分）允许保险 各种类型的公司（事故，汽车，残疾，健康）拒绝为那些遭受伤害的人提供保险 因酒精而受损有人担心这些法律会阻止或阻碍医疗保健提供者 测试受伤病人的血液酒精含量，筛查和识别那些有酒精相关问题的人， 以及转诊治疗。因此，在过去的20年里，16个州和哥伦比亚特区 废除了AEL。然而，废除的影响尚未得到科学评估。响应于 NIAAA PA-17-135，拟议的研究将通过进行第一次严格的 分析废除AELs如何影响酒精寻求治疗的行为， 医疗保健提供者，以及对这些法律的行为反应如何受到支付来源的影响。 此外，我们还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。我们提出了一个准实验设计，利用变化， 作为一个自然的实验。我们将使用来自五个大型国家调查的数据， 行政来源：治疗事件数据集、州住院患者数据库、州紧急情况 响应数据库、全国药物使用和健康调查以及行为风险因素 监控系统。我们还将使用NIAAA的酒精政策信息系统， 法律的研究和其他政策数据来源。这个项目解决了一个高度欠研究领域的高公众 健康意义：国家医疗保健系统层面因素的潜力-保险排除法-成为一个 治疗AUDs的障碍-在AUDs的流行是 治疗服务的增加和使用率低。这项研究将增强我们对 保险排他性法律与物质相关行为和结果之间的关系。在 作为对PA-17-135的回应，该项目提出了对政策和政策影响的创新研究，这些政策和政策影响不是 很好理解。我们预计，拟议的研究将提供一个证据基础，为今后的研究提供信息。 在州和国家一级采取立法行动，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 As a result, over the past 20 years, 16 states and the District of Columbia have repealed AELs.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.