A new study found that states in New England, the Midwest, and West had a higher prevalence of alcohol use disorder among women, but fewer services that address women’s unique concerns and common barriers to alcohol treatment.
The historical gap in binge drinking, alcohol use disorder (AUD), and alcohol-related deaths between men and women has narrowed substantially over the last several decades in the United States, with binge drinking rates among women ages 18-25 exceeding men’s rates in the same age group for the first time in 2024.
With this rapid increase in risk for AUD and AUD-related complications, women could benefit substantially from alcohol treatment programs that are tailored to their unique needs. But there is a dearth of knowledge on the availability of women-specific alcohol treatment in the US and how these services may differ by state.
A new study led by researchers at Boston University School of Public Health (BUSPH) now fills this gap, finding that the estimated prevalence of AUD among women—as well as the availability of women-specific alcohol treatment services—vary widely across US states.
Published in Substance Use & Addiction Journal , the results showed that estimated state-level AUD among women ranged from approximately 6-13 percent, with all New England states and several in the West and Midwest exceeding the national average of 8 percent among women. More than 40 percent of addiction treatment facilities did not offer women-specific treatment, and services targeted toward women—especially childcare—were disproportionately unavailable in many states that had higher-than-average estimated AUD prevalence among women. The study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and is the first to explore state-level differences in AUD among women and the availability of women-specific services in treatment facilities.
“Women are drinking more and experiencing significant health consequences from alcohol use,” says study senior author Dr. Maureen Stewart , research associate professor of health law, policy & management at BUSPH. “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. Making alcohol treatment more tailored to women’s needs could help women access treatment."
Research shows that alcohol treatment programs that are tailored to women’s needs have had greater success in reducing substance use and mental health symptoms among women than programs that lack these services, she adds. "Knowing the states in which women bear the greatest burden of AUD yet lack access to treatment services for their needs can help direct resources efficiently and reduce the barriers preventing women from accessing treatment."
For the study, researchers from BUSPH, Columbia University Mailman School of Public Health (Columbia), and Boston Medical Center’s (BMC) Grayken Center for Addiction utilized publicly available national and state-level data to estimate the state-level prevalence of AUD among women, as well as the state-level 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.
The estimated prevalence of AUD among women ranged from 6.2 percent of women in Utah to 12.7 percent of women in Washington, DC. The researchers say the disproportionate burden of AUD among women across states in New England, the Midwest, and West, with lower prevalence in southern states, is likely a result of multiple factors, including alcohol taxes and other policies, cultural differences in attitudes towards drinking, persistent stigma towards AUD, and AUD healthcare availability.
“Women’s estimated burden of alcohol use disorder varied substantially from state to state," says study coauthor Dr. Rachel Sayko Adams , research associate professor of health law, policy & management at BUSPH. “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.”
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. Most of the treatment facilities in states with a higher estimated prevalence of AUD among women 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 that could be especially valuable for women who lack reliable transportation or struggle with stigma or other fears of seeking in-person treatment.
Only 4.6 percent of addiction treatment facilities provided childcare in 2024.
“For many women, lack of childcare is a persistent barrier to AUD treatment, as women are more likely to be the primary caregivers of their children,” says study lead author Sage Feltus , research associate in the Department of Health Law, Policy & Management at BUSPH. “Parenting women may find it difficult to obtain reliable, affordable, and trustworthy childcare in their communities while they participate in lifesaving AUD treatment, and most treatment centers do not provide childcare options. Supporting women's recovery from AUD would mean providing solutions to the childcare barrier and other barriers women face.”
This insight into women-specific AUD treatment comes amid changing norms of how society views alcohol use among women—now widely accepted and normalized in daily life, despite copious research showing that even moderate amounts of drinking place women at greater risks for developing breast cancer, liver disease, suicidal ideation, and reproductive health complications. In a previous study , the researchers found that women without children by age 35 were at highest risk for binge drinking and AUD, but 35-year-old women with children also remained at an increased risk, perhaps influenced by a proliferation of messaging on social media and in popular culture embraces drinking as a form of stress relief and enjoyment.
“Despite the well-established health risks of drinking, popular culture often presents alcohol as a way for women to celebrate or unwind,” says Dr. Adams. “Women need clear information about alcohol-related health risks and access to treatment that is responsive to their needs.”
The researchers outline several actions that states can take to expand women’s access to tailored AUD treatment, particularly in regions with the greatest need. In addition to incentivizing facilities to provide childcare and telehealth services, they note that states can require health plans to cover alcohol treatment services and medications—perhaps a necessary mandate, as a previous analysis by the researchers 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 primary care offices and mental health facilities screen and treat for AUD, as women with AUD are more likely to seek treatment for co-occurring mental health conditions at these healthcare facilities more than at an addiction treatment facility.
The study was coauthored by Dr. Katherine Keyes , professor of epidemiology and Susan Lasker Brody Professor of Population Mental Health at Columbia; Dr. Jake Morgan , research assistant professor of health law, policy & management at BUSPH; and Dr. Miriam Harris , primary care addiction specialist at BMC. This research was supported by the NIAAA under Award Number R01AA029821. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
Substance Use & Addiction Journal
Observational study
People
State Variation in the Availability of Women-Specific Alcohol Use Disorder Treatment
14-Oct-2026