As heavy drinking continues to rise among middle-aged women, Dr. Rachel Sayko Adams and Dr. Maureen Stewart will investigate differences in alcohol use disorder treatment and outcomes among women across the lifespan to identify strategies that can increase women’s access to these critical services.
Untreated alcohol use disorder (AUD) can lead to devastating health consequences among women, including a greater risk of liver disease, alcohol-related suicide, and alcohol-related cancer , even at lower levels of drinking in comparison to men. While treatment for alcohol use can reduce these adverse outcomes, very few women with AUD actually receive it, and there is little data on how alcohol treatment outcomes may differ among subgroups of women.
Researchers at Boston University School of Public Health (BUSPH) will fill this knowledge gap with a new $3.8 million grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to investigate potential differences in AUD treatment and health outcomes among women based on age group, and to identify health insurance and health system strategies to improve treatment use and outcomes.
Led by Dr. Rachel Sayko Adams and Dr. Maureen Stewart , research associate professors of health law, policy & management at BUSPH, the five-year study will examine how women of different age groups utilize alcohol treatment, and how state characteristics, treatment availability, and insurance plan characteristics may influence women’s access to and progression through alcohol treatment services.
Alcohol use increased substantially during the COVID-19 pandemic, and by 2023, more than 11 million women in the United States met criteria for AUD. “Research on women’s alcohol use and health is urgently needed and has been a priority for NIAAA for several years; we're thrilled to lead this important study to address this growing women’s health concern,” says Dr. Adams, whose research focuses on substance use and morbidity and mortality outcomes in high-risk populations. “More women than ever in the US have alcohol use disorder and would benefit from alcohol treatment services, yet we know very little about how women are accessing or progressing through alcohol treatment. Our findings will help clarify where gaps in care remain and identify strategies to improve alcohol treatment outcomes.”
This new project will build upon several studies by the researchers on high-risk alcohol use and treatment availability among women, including a recent study published in Substance Use & Addiction Journal, which found that availability of women-specific alcohol treatment varies widely across the US states.
“Alcohol treatment services have not been designed with specific needs of women in mind and this may contribute to low rates of treatment use.” says Dr. Stewart. “Our work will explore whether availability of women-specific treatment services, including women-only groups and treatment programs that offer childcare services, improves alcohol treatment use and outcomes.”
The researchers will also explore how parenting may affect women’s use of alcohol treatment services. In a 2023 study in Addiction, Dr. Adams and Dr. Stewart 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 embracing drinking as a form of stress relief and enjoyment for mothers. “Women who have children face additional barriers when seeking alcohol treatment because it can be difficult to attend appointments for services when also managing school, childcare, transportation, and other daily factors” says Dr. Adams. “We will examine how parenting is associated with use and progression in alcohol treatment services among women with AUD, and if women in states that prioritize alcohol treatment for pregnant or postpartum women, have increased treatment use and retention.”
For the project, the team will utilize data from the National Survey on Drug Use and Health, as well as Medicaid and commercial insurance claims, to determine the prevalence of high-risk alcohol use, AUD, and alcohol-attributable conditions and hospitalizations in the US between 2021-2025 among women, within both Medicaid and commercial insurance populations.
“Women are more likely to receive care for alcohol treatment from primary care providers, versus specialty care providers, but Medicaid plans tend to offer smaller primary care networks than commercial insurance plans,” says Dr. Stewart. “Therefore, we will examine whether women living in areas with fewer primary care providers are less likely to engage in alcohol treatment, and if this barrier is worse for women with Medicaid insurance.”
At BUSPH, coinvestigators of this project include Dr. Jake Morgan, research associate professor of health law, policy & management, and Dr. Fatema Shafie Khorassani, assistant professor of biostatistics. Dr. Miriam Harris, a primary care addiction specialist at Boston Medical Center, and Dr. Katherine Keyes, professor of epidemiology and the Susan Lasker Brody Professor of Population Mental Health at Columbia Mailman School of Public Health, are also coinvestigators. This work is funded by the NIAAA under award R01AA033066, and the team also conducted preliminary analyses with support from BUSPH’s Center for Trauma and Mental Health , for which Dr. Adams and Dr. Stewart are faculty affiliates. 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