Alcohol use disorder among reproductive-age women—and barriers to treatment

Three glasses of red wine

June 4, 2024—Anna Shchetinina, a PhD candidate in Population Health Sciences at the Harvard Griffin Graduate School of Arts and Sciences and Harvard T.H. Chan School of Public Health, has long been interested in alcohol use among women as a public health issue. Noticing the gap in research on recent trends in alcohol misuse and treatment among U.S. women, she decided to conduct such a study. Below, she discusses her findings, which were published in PLOS One this spring.

Q: What questions were you hoping to answer about women’s alcohol use—and what did you find?

A: We wanted to understand current trends in drinking among reproductive-age women in the U.S., with a particular interest in parenting and pregnant women. We also wanted to understand the unmet need for alcohol use disorder (AUD) treatment, and what barriers to treatment exist. Using 2015-2021 data from the National Survey on Drug Use and Health, we compiled a pool of more than 120,000 women, ages 18-49, who provided information about their drinking habits and, if treatment was desired or recommended, whether they received it. Those who did not receive treatment—which we defined as care or counseling for alcohol use in various contexts including hospitals, rehabilitation facilities, mental health centers, private physicians’ offices, substance abuse-related emergency rooms, or self-help groups—shared what prevented them from doing so. Half of our study population had at least one child but were not pregnant during the study period; 3% were pregnant during the study period, with or without at least one child already; and the remainder were neither pregnant nor parenting.

We found that among women who were neither pregnant nor parenting, nearly 13% had drinking habits that met the American Psychiatric Association’s criteria for AUD, but only 4% received treatment. The prevalence of AUD was lower among the parenting group (6.6%) and the pregnant group (6.3%), but a treatment gap still existed, with only 5% of each group receiving treatment.

Financial barriers—including costs and lack of insurance coverage—were the most frequently cited reason for not receiving treatment across our entire study population. Treatment not being a priority—including women’s belief they could handle their alcohol use on their own or didn’t have time, desire, or faith in treatment—was the next most common reason. Access barriers—including lack of transportation, treatment options being unavailable or programs being too full, or lack of knowledge of where to seek treatment—and stigma were next most common. Access barriers and stigma were more frequently cited by pregnant and parenting women.

Anna Shchetinina

Q: What are the public health takeaways?

A: Alcohol is a widely available, socially accepted substance that many see as benign—but it’s also the leading substance associated with birth defects and conditions like cardiovascular disease and cancer. Its use among women is on the rise—we especially observed a significant increase during the last couple years of our study, when the COVID pandemic was going on—so we must continue to monitor this group. We should continue to monitor not just pregnant and parenting women, but also women without children, who may seem like they are not a priority group when it comes to counseling and care around alcohol use, but in fact are at an increased risk of drinking’s harmful consequences. We need to invest in public education and spread awareness about these consequences. One common thing I’ve heard from women who struggle with AUD is that there are so many mixed messages about alcohol, even from health professionals, and that conversations about drinking don’t often happen with their health providers.

On that note, it also seems that the U.S. health care system is not operating the way it should in supportively, proactively providing help to women who are or may be struggling with alcohol use. One additional finding from our study was that women with a history of arrests were more likely to get treatment for AUD—suggesting that mandated treatment is a more guaranteed way through which to access treatment rather than a woman’s own willingness and readiness. We need to work to improve the health care system so that anyone who wants help with alcohol misuse can easily obtain it, and anyone who may benefit from treatment is reached out to. And we need to focus on reducing stigma, so that women—especially mothers—who need help aren’t deterred by shame.

Q: What drew you to studying women and alcohol, and what work in this arena do you hope to do in the future?

A: A decade ago, I was in law school and volunteered at a center that worked with women in difficult life situations, struggles with substance abuse being one of them. Many of them would bring their children with them to the center. That’s how I learned about fetal alcohol spectrum disorder. Observing that condition firsthand was very emotional and is an experience that has continued to stay with me. Now that I’m in the field of public health, I primarily focus on prenatal alcohol exposure. But to address this issue, it’s important, as we’ve done in this study, to understand environmental and social risk factors—why people drink during pregnancy as well as overall trends among women. Going forward, I’m interested in conducting studies exploring the intersections between AUD and use of other substances as well as AUD and mental health conditions like depression and anxiety.

Maya Brownstein

Photos: iStock/Dacharlie; courtesy of Anna Shchetinina