Improving Alcohol Use Disorder Treatment for Women

Women are uniquely vulnerable to alcohol-related health problems. Alcohol use negatively affects every system in the body. Even at lower levels of consumption, women face a higher risk than men for alcohol-related health conditions, injury, and death. Women also bear a larger burden of alcohol-related cancer, driven by the risk of alcohol-related breast cancer. Of particular concern, alcohol-related deaths have doubled over the past two decades, accelerating faster for women than men. In 2024, at least 10 million adult women in the United States had an alcohol use disorder – a chronic, relapsing disease that contributes to many health problems and seven types of cancer.

Therapy and other behavioral interventions and medications to treat alcohol use disorder are effective. However, the vast majority of women who could benefit do not receive treatment—less than 7% receive behavioral treatment, and just 2% receive medication. Barriers include cost, transportation, and stigma. Women encounter additional obstacles, such as male-dominated treatment settings, childcare responsibilities, and fear of losing child custody. The alcohol treatment system is not meeting the unique needs of women with alcohol use disorder, and the consequences of this gap are dire.

Making alcohol treatment more accessible and appealing to women should be a public health priority. Women need treatment options designed specifically to meet their needs, but programs exclusively for women are rarely available. Many women with alcohol use disorder have a history of interpersonal violence—yet, interpersonal violence support services and trauma-informed evidence-based treatment are not widely available. Childcare is a major barrier to treatment for parenting women, and treatment facilities could offer childcare services to help more women engage.

At a time when alcohol-related harms are increasing among women, treatment services designed for women’s unique needs must be provided with uninterrupted coverage.

Medicaid plays an essential role in ensuring access to alcohol treatment for women. State Medicaid programs provide health insurance to approximately 80 million people, more than half of whom are women, and serve as the largest payer of alcohol treatment in the country. Most states contract with private managed care plans to administer Medicaid benefits to nearly 70% of the total Medicaid population. Medicaid managed care plans must follow federal and state requirements. However, they also have discretion to shape policies that define alcohol treatment coverage. Yet, in 2021, only 43% of Medicaid managed care plans reported covering all medications for alcohol use disorder. And states with higher percentages of women enrolled in Medicaid had the lowest coverage. These medications are safe, effective, and low-cost; they should be readily accessible without barriers.

People with alcohol use disorders may be disproportionately affected by new Medicaid eligibility requirements enacted in the 2025 H.R. 1 budget reconciliation bill (also known as the One Big Beautiful Bill Act), which must be implemented by January 1, 2027. Work requirements are likely to result in fewer people with Medicaid coverage, particularly due to the increased administrative burden required by more frequent eligibility determinations. The resulting gaps in Medicaid coverage will inevitably disrupt lifesaving alcohol treatment and impede recovery. Further, H.R. 1 will create budgetary pressure on states. This will force many states to make difficult decisions about the recovery supports they can provide and is likely to impact people who need childcare, transportation, and other support services offered outside of typical recovery services.

At a time when alcohol-related harms are increasing among women, treatment services designed for women’s unique needs must be provided with uninterrupted coverage. Medicaid managed care plans should cover the full range of treatment services, including medications and behavioral interventions. States and managed care plans should work together to communicate enrollment requirements and simplify processes that can help women maintain treatment access, helping to reduce the devastating consequences of untreated alcohol use disorder impacting women in the United States.

This post is in partnership with the Medicaid Policy Lab at Boston University School of Public Health. The views expressed here are the authors’ own and do not necessarily represent the views of Public Health Post or Boston University School of Public Health.