States Where Women Face Highest Alcohol Use Disorder Burden Often Lack Tailored Treatment Services

The gap between men and women in binge drinking, alcohol use disorder, and alcohol-related deaths has narrowed substantially in the United States over the past several decades, and in 2024 binge drinking rates among women ages 18 to 25 exceeded those of men in the same age group for the first time. As women’s drinking has risen, so has their risk of developing alcohol use disorder, or AUD, along with the serious health complications that accompany it. Yet the treatment system built to help people recover from alcohol problems was largely designed around men, and a new study suggests it is failing to keep pace with the changing profile of who needs care. The research, led by scientists at Boston University School of Public Health and published in Substance Use & Addiction Journal, is the first to examine how the prevalence of AUD among women and the availability of women-specific treatment services differ from state to state across the country.

The findings reveal a striking mismatch between where women carry the heaviest burden of alcohol problems and where treatment facilities offer services designed for their needs. Estimated state-level prevalence of AUD among women ranged from approximately 6 to 13 percent, well above and below the national average of 8 percent among women. All six New England states exceeded the national average, as did several states in the West and the Midwest, while prevalence was generally lower across southern states. At the extremes, an estimated 6.2 percent of women in Utah had AUD compared with 12.7 percent of women in Washington, DC. More than 40 percent of addiction treatment facilities nationwide did not offer women-specific treatment at all, and services targeted toward women were disproportionately unavailable in many of the very states where estimated AUD prevalence among women was higher than average.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism and conducted by researchers from Boston University School of Public Health, Columbia University Mailman School of Public Health, and Boston Medical Center’s Grayken Center for Addiction. The team used publicly available national and state-level data to estimate the prevalence of AUD among women in each state, the prevalence of addiction treatment facilities offering women-specific services in 2024, and the proportion of facilities with these specialized services per 10,000 adult women with AUD. This approach allowed the researchers to compare, for the first time, not just how many women struggle with alcohol in each state, but how well the local treatment infrastructure is equipped to serve them.

Senior author Dr. Maureen Stewart, research associate professor of health law, policy & management at Boston University School of Public Health, emphasized that the rising toll of alcohol on women coincides with persistently low treatment engagement. Women are drinking more and experiencing significant health consequences from alcohol use, she noted, while alcohol treatment rates remain abysmally low. She pointed to evidence that alcohol treatment programs tailored to women’s needs have achieved greater success in reducing substance use and mental health symptoms than programs lacking these services. Knowing which states have the greatest burden of AUD among women yet lack access to appropriate treatment, she argued, can help direct resources efficiently and reduce the barriers that prevent women from getting help.

The researchers attribute the geographic pattern of AUD among women to a combination of factors rather than any single cause. Alcohol taxes and other alcohol policies, cultural differences in attitudes toward drinking, persistent stigma surrounding AUD, and uneven availability of AUD healthcare all likely contribute to the disproportionate burden observed in New England, the Midwest, and the West relative to southern states. Coauthor Dr. Rachel Sayko Adams, also a research associate professor of health law, policy & management at Boston University, said that women’s estimated burden of alcohol use disorder varied substantially from state to state, and that these differences highlight the importance of understanding local needs when shaping prevention efforts and designing treatment programs that are accessible and responsive to women.

The availability of specialized services proved to be the study’s most sobering finding. Among nearly 14,000 alcohol treatment facilities for adults across the nation, only 58.5 percent offered women-specific programming. Twenty-three states and Puerto Rico had fewer than 10 facilities offering women-specific treatment per 10,000 women with AUD. In states with a higher estimated prevalence of AUD among women, most treatment facilities had below-average availability of critical services such as trauma therapy, intimate partner violence support, and transportation assistance. Less than half of all treatment facilities offered telehealth services, an accommodation the researchers note could be especially valuable for women who lack reliable transportation or who struggle with stigma or other fears associated with seeking in-person treatment.

Childcare emerged as perhaps the most glaring gap of all. In 2024, only 4.6 percent of addiction treatment facilities provided childcare, even though caring responsibilities are one of the most persistent obstacles keeping women out of treatment. Study lead author Sage Feltus, a research associate in the Department of Health Law, Policy & Management at Boston University, explained that women are more likely to be the primary caregivers of their children, and that parenting women may find it difficult to obtain reliable, affordable, and trustworthy childcare in their communities while they participate in lifesaving AUD treatment. Supporting women’s recovery, the researchers argue, means providing concrete solutions to the childcare barrier and the other practical obstacles women face when trying to enter care.

The study arrives amid shifting cultural norms in which alcohol use among women has become widely accepted and normalized in daily life, despite substantial evidence that even moderate drinking places women at greater risk of developing breast cancer, liver disease, suicidal ideation, and reproductive health complications. In previous work, the same research team found that women without children by age 35 were at highest risk for binge drinking and AUD, but that 35-year-old women with children also remained at increased risk, possibly influenced by the proliferation of messaging on social media and in popular culture that embraces drinking as a form of stress relief and enjoyment. Dr. Adams observed that despite the well-established health risks of drinking, popular culture often presents alcohol as a way for women to celebrate or unwind, and that women need clear information about alcohol-related health risks alongside access to treatment that is responsive to their needs.

To close the gap between need and availability, the researchers outlined several actions states can take, particularly in the regions where the burden is greatest. They recommend incentivizing treatment facilities to provide childcare and telehealth services, and requiring health plans to cover alcohol treatment services and medications. The latter may be a necessary mandate: a previous analysis by the team found that fewer than half of Medicaid managed care plans provide all AUD medications approved by the Food and Drug Administration. The team also recommends that primary care offices and mental health facilities screen for and treat AUD, since women with AUD are more likely to seek treatment for co-occurring mental health conditions in those settings than at dedicated addiction treatment facilities.

The study was coauthored by Dr. Katherine Keyes, professor of epidemiology and Susan Lasker Brody Professor of Population Mental Health at Columbia University; Dr. Jake Morgan, research assistant professor of health law, policy & management at Boston University School of Public Health; and Dr. Miriam Harris, primary care addiction specialist at Boston Medical Center. The research was supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number R01AA029821, and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. As women’s drinking continues to climb and the historical gender gap in alcohol-related harm closes, the study makes clear that the map of who needs help and the map of where tailored help exists do not currently align, and that closing that distance will require deliberate policy choices at the state level.

Subject of Research: State-level variation in alcohol use disorder prevalence among women and the availability of women-specific addiction treatment services in the United States

Article Title: Many states with higher burden of alcohol use disorder among women have fewer treatment facilities tailored to their needs

Article References: Many states with higher burden of alcohol use disorder among women have fewer treatment facilities tailored to their needs. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: alcohol use disorder, women's health, addiction treatment, health services research, childcare barriers, telehealth, state health policy, binge drinking, New England, Boston University School of Public Health, NIAAA, Substance Use & Addiction Journal