Study: Women-Specific Alcohol Treatment Is Scarce in High-Need States

Only 58.5 percent of the nation's alcohol treatment facilities offer programming designed for women, and just 4.6 percent provide childcare, according to a study published Wednesday that is the first to map both the estimated burden of alcohol use disorder among women and the availability of services built for them, state by state.

The paper, "State Variation in the Availability of Women-Specific Alcohol Use Disorder Treatment," appeared in the Substance Use & Addiction Journal. Its authors come from the Boston University School of Public Health, Columbia University's Mailman School of Public Health and Boston Medical Center's Grayken Center for Addiction, and the work was funded by the National Institute on Alcohol Abuse and Alcoholism.

What the researchers actually measured

The team combined publicly available national and state-level data to produce two sets of estimates for all 50 states and the District of Columbia: the prevalence of alcohol use disorder among adult women, and the share of addiction treatment facilities offering women-specific services in 2024. They then calculated how many of those facilities existed per 10,000 adult women with the condition.

Because the prevalence figures are modeled from survey and facility data rather than counted patient by patient, the state numbers are estimates, not case tallies. The facility figures come from a national inventory of treatment programs and describe what programs reported offering in 2024.

A twelve-fold spread between states

Estimated alcohol use disorder among women ranged from 6.2 percent in Utah to 12.7 percent in the District of Columbia, against a national average of 8 percent. Every New England state and several states in the West and Midwest exceeded that average, while prevalence ran lower across the South.

"Women's estimated burden of alcohol use disorder varied substantially from state to state," said coauthor Rachel Sayko Adams, a research associate professor of health law, policy and management at BU's School of Public Health. "These differences highlight the importance of understanding local needs when shaping prevention efforts and designing treatment programs to be more accessible and responsive to women's needs."

The authors attributed the regional pattern to a mix of policy and culture: alcohol taxes and other alcohol control measures, local attitudes toward drinking, persistent stigma attached to alcohol use disorder, and how much treatment capacity a state's health care system already has.

The services are thinnest where the need is highest

Across nearly 14,000 alcohol treatment facilities serving adults nationwide, 58.5 percent offered women-specific programming, meaning more than 40 percent did not. Twenty-three states and Puerto Rico had fewer than 10 facilities offering women-specific treatment per 10,000 women living with alcohol use disorder.

In states with higher estimated prevalence among women, most facilities also fell below the national average on services the study treats as components of women-specific care: trauma therapy, support for intimate partner violence, and transportation assistance. Fewer than half of all facilities offered telehealth, an accommodation the authors note can matter most for women who lack reliable transportation or who avoid in-person care because of stigma. Existing telehealth services for substance use treatment have expanded substantially in recent years but remain unevenly distributed.

Childcare as the binding constraint

The single hardest service to find was childcare. Fewer than one in twenty addiction treatment facilities provided it in 2024.

"For many women, lack of childcare is a persistent barrier to alcohol use disorder treatment, as women are more likely to be the primary caregivers of their children," said lead author Sage Feltus, a research associate in BU's Department of Health Law, Policy and Management. "Parenting women may find it difficult to obtain reliable, affordable, and trustworthy childcare in their communities while they participate in lifesaving treatment, and most treatment centers do not provide childcare options."

Treatment programs tailored to women's needs have produced better outcomes on substance use and mental health symptoms than programs without those services, the authors note, citing earlier research. The practical case for alcohol treatment built around women's circumstances therefore rests on both access and effectiveness.

Why the gap matters now

Senior author Maureen Stewart, a research associate professor of health law, policy and management at BU's School of Public Health, framed the findings against a widening cultural tolerance for women's drinking.

"Women are drinking more and experiencing significant health consequences from alcohol use," Stewart said. "At the same time, alcohol treatment rates are abysmally low. Our findings show there is a substantial need for treatment targeted toward women's unique experiences."

The study arrives amid a run of federal and academic warnings that even moderate drinking carries elevated risks for women, including breast cancer, liver disease, suicidal ideation and reproductive health complications. The same research group has previously found that women who had not had children by age 35 were at the highest risk of binge drinking and alcohol use disorder, and that women with children at that age remained at elevated risk as well.

Stewart and her coauthors argue that state-level estimates of this kind exist to steer money and program design, not to rank states. "Knowing the states in which women bear the greatest burden of alcohol use disorder yet lack access to treatment services for their needs can help direct resources efficiently and reduce the barriers preventing women from accessing treatment," she said.