Rates of Diagnosis and Treatment for Alcohol Use Disorder Among All of Us Participants with Unhealthy Alcohol Use

Alcohol use disorder (AUD) is highly prevalent in the U.S., affecting approximately 10.9% of adults, yet remains underdiagnosed and undertreated.

To estimate the rate of AUD underdiagnosis in clinical practice, identify individual characteristics associated with underdiagnosis, and assess whether receiving a diagnosis increases the likelihood of treatment.

Retrospective cohort study.

Adults aged ≥ 18 years who screened positive for unhealthy alcohol use using AUD Identification Test-Consumption (AUDIT-C) score (≥ 4 for men, ≥ 3 for women). This study used data from the All of Us Research Program, a national, population-based cohort to reflect the diverse U.S.

AUD diagnoses were identified using ICD-9/10 codes. Treatment receipt was defined as either medication (disulfiram, acamprosate, or naltrexone prescriptions) or psychotherapy (identified via CPT-4 codes).

We identified 114,511 participants with unhealthy alcohol use (mean age = 50.4 years; 39.3% male). The overall AUD diagnosis rate was 10.1%, with rates of 6.8%, 21.5%, and 41.6% among participants with mild, moderate, and severe AUD risk, respectively. Factors associated with increased odds of receiving an AUD diagnosis were older age, male sex, non-Hispanic White, lower educational attainment and income, unemployment, unmarried status, public insurance coverage, and co-occurring substance use, mental health disorders, and alcohol-related medical conditions. The lifetime treatment rate was 2.55% for medication and 7.08% for psychotherapy. An AUD diagnosis was associated with increased odds of receiving medication (aOR = 10.68; 95% CI: 9.68-11.79) and psychotherapy (aOR = 1.57; 95% CI: 1.46-1.69).

In this cohort of U.S. adults with unhealthy alcohol use, AUD was underdiagnosed across all risk level with females, racial/ethnic minorities, residence in economically deprived areas, and private insurance holders more likely to be undiagnosed. Given the strong association between diagnosis and treatment receipt, these diagnostic disparities are likely to contribute to inequities in care.