Racial/ethnic discrimination and alcohol use disorder severity among United States adults

Drug Alcohol Depend. 2020 Nov 1;216:108203. doi: 10.1016/j.drugalcdep.2020.108203. Epub 2020 Aug 10.


Background: Racism, and resultant racial/ethnic discrimination is a ubiquitous social determinant of health that is linked to adverse alcohol-related outcomes. To our knowledge, no studies have examined whether manifestations of racial/ethnic discrimination increase risk of DSM-5 alcohol use disorder (AUD) severity levels.

Methods: Analyses were conducted among 17,115 racial/ethnic minority respondents of the National Epidemiologic Survey on Alcohol-Related Conditions III (NESARC-III), a cross-sectional survey fielded in 2012-2013. We used multinomial logistic regression to examine the associations between measures of racial/ethnic discrimination and past-year AUD severity levels following the DSM-5 definition, while adjusting for poverty thresholds set by the U.S. Census Bureau, and race/ethnicity (American Indian or Alaskan Native; Asian, Native Hawaiian, or Other Pacific Islander; Black or African American; Hispanic or Latino). We also evaluated whether associations between discrimination and AUD severity varied by poverty status and race/ethnicity.

Results: Covariate-adjusted multinomial logistic regressions suggested that in comparison to those who did not experience discrimination, those who experienced discrimination had a 1.5-fold greater risk of mild AUD, a 1.6-fold greater risk of moderate AUD, and a 2.3-fold greater risk of severe AUD. We found no evidence to suggest that the strength of the association between racial/ethnic discrimination and AUD severity varied across race/ethnic group or poverty status.

Conclusions: Experience of racial/ethnic discrimination is associated with greater AUD severity in the U.S. regardless of one's specific racial/ethnic group membership or poverty status. Strategies to reduce risk for severe AUD should include efforts to minimize the occurrence and impact of interpersonal and institutional racism.

Keywords: Alcohol use disorders; Discrimination; Poverty; Racial/ethnicity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Alcohol-Related Disorders / ethnology
  • Alcoholism / epidemiology*
  • Alcoholism / ethnology
  • Cross-Sectional Studies
  • Diagnostic and Statistical Manual of Mental Disorders
  • Ethnicity / statistics & numerical data
  • Female
  • Hawaii
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Minority Groups
  • Racism*
  • United States / epidemiology
  • Young Adult