Prevalence of Substance Use Disorder and Interventions for Unhealthy Substance Use among Parents by Race and Hispanic Origin in the United States, 2015–2017

RESEARCH REPORT Prevalence of Substance Use Disorder and Interventions for Unhealthy Substance Use among Parents by Race and Hispanic Origin in the United States, 2015–17 Victoria Lynch Lisa Clemans-Cope Emma Winiski July 2019 (corrected July 30, 2019) HEALTH POLICY CENTER ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is a leading research organization dedicated to developing evidence-based insights that improve people’s lives and strengthen communities. For 50 years, Urban has been the trusted source for rigorous analysis of complex social and economic issues; strategic advice to policymakers, philanthropists, and practitioners; and new, promising ideas that expand opportunities for all. Our work inspires effective decisions that advance fairness and enhance the well-being of people and places. Copyright © July 2019. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image by Tim Meko. Contents Acknowledgments iv Executive Summary v Errata ix Prevalence of Substance Use Disorder and Interventions for Unhealthy Substance Use among Parents by Race and Hispanic Origin in the United States, 2015–17 1 Introduction 1Methods 3Sample 3Measures for SUD 3Measures for Asking Parents about Substance Use 4Measure for SUD Treatment 4Sociodemographic and Health Measures 5Analysis and Estimation Strategy 5Limitations 5Results 6Parents’ Sociodemographic Characteristics and Selected Measures of Health Status and Health Care Use 6Prevalence of Parental SUDs 9Prevalence of Parental SUDs by Low-Income and Employment Statuses 11Share of Parents Asked about Substance Use by a Medical Provider 12Rates of SUD Treatment among Parents with SUDs 15Discussion 17Conclusion 19Appendix A. Detailed Estimates 21 Appendix B. Definitions and Estimation 28 Substance Use Disorder Definitions 28Estimation 31Notes 32 References 33 About the Authors 36 Statement of Independence 37 IV ACKNOWLEDGMENTS Acknowledgments This report was funded by the Annie E. Casey Foundation. We thank them for their support but acknowledge that the findings and conclusions presented in this report are those of the authors alone, and do not necessarily reflect the opinions of the Foundation. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of Urban experts. Further information on the Urban Institute’s funding principles is available at urban.org/fundingprinciples. The authors gratefully acknowledge the contributions of Gina Adams, Margaret Simms, and Genevieve Kenney. EXECUTIVE SUMMARY V Executive Summary Unhealthy alcohol and drug use is especially problematic among parents with dependent children. In addition to the negative consequences for parents, their children are also at risk of negative consequences, such as neglect and developmental problems. Researchers have identified medical interventions that can reduce the extent and negative consequences of unhealthy substance use including  universally screening adult and adolescent patients,  performing brief interventions to motivate change among patients who have unhealthy alcohol or drug use, and  initiating treatment or helping patients get treatment elsewhere if their use is problematic enough to be a substance use disorder (SUD). Though a body of research describes negative outcomes of unhealthy substance use among parents on children, little is known about the rates of screening and brief intervention for unhealthy use, SUD diagnosis, and SUD treatment among parents, and whether these vary by race and Hispanic origin. This is important because evidence shows that unhealthy substance use among black and Hispanic people can have worse health and justice-system consequences. In this research on US parents living with dependent children, we used data from 2015 to 2017 to explore these questions. We highlight the substantial levels of parental SUD, identify gaps in the interventions that can reduce the consequences of substance misuse for parents and their families, and show differences by race and Hispanic origin. Findings SUD prevalence. We found that SUDs affect families with children in all racial/Hispanic origin populations. The burden was especially high among American Indian/Alaska Native and multiple-race parents, among whom 16.1 percent and 11.9 percent, respectively, had an SUD. Parents who were Hispanic or Asian had relatively low levels of SUDs, but even these lower levels imply that substantial numbers of families with children are affected, with roughly 5 in 100 Hispanic parents and 2 in 100 Asian parents having an SUD. Patterns of any SUD by race and Hispanic origin were similar when we separately looked at higher- and lower-income parents, and SUDs were higher among lower-income parents for all groups. The prevalence of specific types of SUDs var