Q&A: Alcohol use disorder treatment in sexually diverse and gender-diverse patients

Alex Keuroghlian, MD, MPH, and Michal McDowell, MD, MPH, from the Department of Psychiatry at Mass General, have authored a new study in the Journal of Clinical Psychiatry, titled "Alcohol Use Disorder Treatment in Sexually and Gender Diverse Patients: A Retrospective Cohort Study." Here, they discuss their work.

What question were you investigating?

While sexually and gender diverse (SGD) people have higher odds of alcohol use disorder (AUD) compared to heterosexual and cisgender people, AUD treatment access and use disparities are not well characterized. The purpose of this study was to assess differences in AUD treatment among SGD versus non-SGD populations.

What was your approach?

We performed a retrospective cohort study using data from a federally qualified health center electronic health record system in Boston, Massachusetts.

Patients were 18 years or older with an International Classification of Diseases (ICD)-9 or ICD- 10 AUD diagnosis and any clinic visit from January 2013 until June 2021 (N = 3,607). Treatment for AUD was identified using binary variables for medication prescription orders and visits for AUD.

What were the results?

Among patients identifying as lesbian/gay, 6.9% had an AUD diagnosis, as compared to 2.6% of patients identifying as straight/ heterosexual (P < .001).

The prevalence of AUD was higher in the gender diverse group as compared to the cisgender group (5.5% vs. 4.4%, P < .001). There were no significant differences in receipt of a prescription for injectable naltrexone, acamprosate or disulfiram between SGD and non-SGD patients.

For oral naltrexone, 16.1% of sexually diverse patients received a prescription, as compared to 9.8% of straight/heterosexual patients (P < .001). For visits, both the straight/ heterosexual cohort and the cisgender cohorts had the lowest proportion of AUD-related pharmacotherapy and individual psychotherapy visits, as compared to SGD cohorts.

What are the potential clinical applications?

SGD patients had higher proportions of AUD diagnosis and AUD care utilization through behavioral health as compared to non-SGD patients. AUD treatment access and engagement are critical for addressing AUD-related disparities among SGD people.