Aside from offering a comprehensive look at differences due to its confluence of age, cohort, and period effects, studying generational differences are important in part due to policy changes and cultural shifts related to AUD that have occurred over the last few decades. These differences may reflect influences on help-seeking and treatment utilization that are more clinically relevant than arbitrary cohort cutoffs or broad age groupings. For example, AUD has been highly regarded as a social and moral failing until recently (HHS, 2016), a view that millennials are less likely to have been exposed to as much as older generations. Addiction as a whole is also increasingly seen as a problem in America, a social shift that likely affects each generation (Pew Research Center, 2018b). Shifts toward outpatient service options for AUD and other substance use disorders occurred in the 1970s and 1980s would have only affected silent, baby boomer, and oldest generation X individuals (HHS, 2016). In the 1990s, private insurance increased by coverage for alcohol and related services decreased (HHS, 2016), possibly affecting generation X individuals the most.
