Text Box: The Extent and Impact of Alcohol Use Disorders Among Disadvantaged Tennesseans Seeking Primary Care Treatment Principle Investigator: Alan L. Shields, PhD Co-Investigators: Michael Floyd, EdD James D. Holt, MD Michael Kauzlarich, DO Abstract Background: Alcohol use and pattern of consumption compromises treatment outcomes for patients seeking healthcare use among outpatients are estimated to range from 7-20%. The prevalence of unhealthy alcohol use among disadvantaged Northeast Tennesseans seeking primary care treatment is thought to exceed theses national averages. Nevertheless, accurate prevalence rates among these historically marginalized patients are not available and, thus, the personal, social, and economic impact of their alcohol use on them and their care is unknown. Project goals: Specific goals of this proposal are to 1) determine the prevalence of alcohol use disorders (AUDS) among the disadvantaged community patients referred from the Northeast Tennessee Regional Health office to the Johnson City Family Medicine Clinic for their primary care; 2) translate research supporting the usefulness of alcohol screening within this underserved community population; and 3) explore the extent to which AUDs are associated with important primary care treatment outcomes. Broadly, this project will foster a research infrastructure able to support larger treatment outcome studies among disadvantaged and underserved Appalachian Tennesseans suffering from medical problems and co-occurring AUDs. Method: Cross-sectional (Study A) and observational prospective (Study B) study designs are used to meet project goals. A total of n = 150 patients will be recruited for Study A and a total of n = 200 patients will be enrolled in Study B. All participants will be administered the Alcohol Use Disorders Identification Test (AUDIT) as standard clinic procedure. Study A participants will consent to a face-to-face clinical interview and be assessed via the Structured Clinical Interview for DSM Axis I Disorders (alcohol use module). Both Study A and Study B patient charts will be subject to review to extract AUDIT scores and information related to reason for treatment, health utilization, and outcomes. The data analytic plan will use conventional descriptive statistics to characterize the sample, including prevalence of AUDs, co-occurring medical problems, and health outcomes. The performance characteristics of the AUDIT will be evaluated via internal consistency and factor analyses. Further, the AUDIT’s ability to diagnose individuals with AUDs will be determined by assessing the receiver operating characteristics of the AUDIT compared with the SCID AUD diagnosis. Results: The state of Tennessee does not currently offer empirically supported guidelines for the treatment of AUDs in primary care settings or among patients with co-occurring medical problems. Results of the present study can be used to inform local treatment providers and policy makers as to the extent of the problem and aid in the development of interventions. Importantly data gathered in the present study will pilot federal grant applications evaluating the effectiveness of alcohol screening and brief interventions among disadvantaged Northeast Tennesseans seeking primary care treatment for problems other than their alcohol use.