Women are less likely to seek substance use treatment due to stigma and logistics

According to the Substance Abuse and Mental Health Services Administration, less than 11% of women with a substance use disorder (SUD) received treatment in 2019.

Penn State University researchers investigated the barriers women with substance use disorders (SUD) identified that stopped them from seeking treatment. 

Abenaa Jones, assistant professor of human development and family studies, and the Ann Atherton Hertzler Early Career Professor in Health and Human Development said, “For this project, we hoped to determine which barriers women in different life circumstances face regarding seeking treatment for substance use, and this information could then be used to inform personalized interventions to encourage treatment-seeking.” 

The findings may help healthcare professionals develop personalized treatments encouraging more women to seek treatment.

From 2015 to 2019, the researchers examined the replies of 461 women to the National Survey on Drug Use and Health. 

The researchers looked at the responses of women who said they required treatment or counseling for their use of alcohol or drugs in the previous 12 months but did not seek it. 

Participants in the study were questioned about their reasons for not seeking treatment as part of the survey. Participants could list up to 14 specific reasons for not seeking treatment, including the fact that they did not feel ready to stop using, the lack of insurance coverage or the high cost of treatment, the lack of transportation, or the fact that treatment facilities were too far away or inconveniently located, the lack of time due to work, child care, or other commitments, and the worry that seeking treatment or counseling might make their neighbors or community think less of them.  

The researchers classified the women they interviewed into three groups based on their answers to why they did not seek treatment: “Just Not Ready,” “Moderate Logistics and Stigma,” and “High and Diverse.” 

The different categories collected the women’s various concerns and perceptions about seeking treatment for SUDs. 

Participants in all three categories reported a strong preference for alcohol over other drugs, such as marijuana, pain medications, and methamphetamines. 

More than 71% of the women surveyed fell into the “Just Not Ready” group, and their primary reason for not seeking SUD treatment was a desire to continue using substances.

Hannah B. Apsley, the lead researcher on the study, said, “The ‘Just Not Ready’ group is likely more socially disadvantaged than the other groups and denotes the need to address basic needs like employment and housing in addition to interventions for substance use disorders.” 

Less than half of the women in this category were working or had a higher education than a high school diploma.  

The women in the “Moderate Logistics and Stigma” category, which included more than 18% of those polled, expressed stigma and logistical worries, such as whether obtaining treatment would have a negative impact on their career or cause people to have an unfavorable opinion of them. The group was particularly concerned about health insurance and the ability to pay for SUD treatment. 

Apsley said, “What surprised us the most was that the second category of women surveyed was more educated and more likely to be employed but experienced more barriers than those who were not employed or were less educated.” 

The third type of women, “High and Diverse,” was also defined by the belief that they could manage their SUD without treatment and logistical and stigmatization issues. The researchers highlighted that the women in this category were most commonly single mothers, with nearly half having children at home. Multiple challenges may exist for single moms, including gendered responsibilities, a lack of access to childcare, and a perception of stigmatization for substance use by care providers, friends, and family.  

Other research has found that happy or close marriages predict better treatment outcomes, indicating that marriage could be a source of social support for women needing treatment. 

Jones, who is also a Social Science Research Institute (SSRI) co-funded faculty member, said, “The remaining 10% of women fell into the third category, which also had concerns about having time for treatment because of their job, childcare or other commitments, or they were worried about stigma related to receiving treatment.”   

Multiple challenges may exist for single moms, including gendered responsibilities, a lack of access to daycare, and a perception of stigma for their substance use.

The researchers suggested that clinicians and practitioners recognize that there is frequently more than one cause for why a woman is pregnant. Stigma, logistical issues such as transportation and childcare, a lack of perceived need for treatment, and a lack of willingness to even begin therapy are all valid concerns for women across economic, educational, and cultural boundaries. 

He said, “It is not enough to address logistical concerns like providing childcare or financial support to incentivize women to seek treatment.”  

Additional interventions, such as educational programs to reduce stigma and motivational interviewing, may be necessary to incentivize women to seek treatment. However, more work in this space is required. 

The researchers said they intend to explore how future interventions can address the multiple types of barriers to SUDs treatment that single mothers, working-class women, and those in psychological distress experience.    

This research was funded by the National Institute on Drug Abuse.

Journal Reference:

1. Apsley, H. B., Vest,etal. Non-engagement in substance use treatment among women with an unmet need for treatment: A latent class analysis on multidimensional barriers. Drug and Alcohol Dependence. DOI: 10.1016/j.drugalcdep.2022.109715