Sociodemographic and Clinical Correlates of Missed Opportunities for Evidence-Based Alcohol Counseling Among Adults Who Report Binge Drinking.

Abstract

Alcohol use contributes to over 178,000 annual U.S. deaths, yet provider-delivered alcohol counseling remains underutilized. Guided by the National Institute on Minority Health and Health Disparities Research Framework, this study examines multilevel determinants of alcohol counseling receipt among adults who binge drink. A cross-sectional analysis of 2022 National Health Interview Survey data analyzed in 2025 included 3,093 U.S. adults with chronic conditions who reported binge drinking. Variables spanning 3 National Institute on Minority Health and Health Disparities framework domains (individual-level characteristics, healthcare system barriers, and geographic and socioeconomic factors) were examined using survey-weighted multivariable logistic regression. Nationally, 93.8% of adults received no alcohol counseling. Factors associated with counseling included older age (AOR=1.03, 95% CI=1.02, 1.04), male sex (AOR=1.92, 95% CI=1.36, 2.71), and fair or poor health status (AOR=2.37, 95% CI=1.51, 3.71). Depression was inversely associated with counseling receipt (AOR=0.39, 95% CI=0.27, 0.57). Residents of the Midwest (AOR=0.48, 95% CI=0.29, 0.80) and South (AOR=0.63, 95% CI=0.40, 1.00) had significantly lower odds of receiving counseling than Northeast residents. Higher household income was associated with lower odds of receiving counseling (AOR=0.45 at ≥400% federal poverty level vs <100% federal poverty level; 95% CI=0.22, 0.93). Systematic gaps in alcohol counseling delivery persist across National Institute on Minority Health and Health Disparities framework levels, disproportionately affecting individuals with depression and residents of certain geographic regions. Multilevel implementation strategies that address individual, community, and policy determinants are essential to achieving health equity in preventive care.