Rethinking addiction treatment for women: what new research reveals

Alcohol use has risen sharply in recent years — but this upward trajectory began well before the COVID-19 pandemic. From 2001 to 2013, there was a 35% increase in alcohol misuse in men; women’s misuse of alcohol jumped 84% in that same period. During the pandemic those numbers continued to climb, with women experiencing a 39% increase in alcohol-related problems.

After pandemic restrictions were eased, men largely returned to their pre-COVID drinking levels. However, elevated use in women has persisted. Ashley Addiction Treatment, a nonprofit with four Maryland locations, is collaborating with Johns Hopkins University and other academic institutions and industry partners on studies to improve addiction treatment outcomes.

Ashley has released its “Healing, Measured & Meaningful” Report, summarizing the outcomes and implications of some of its most recent research; these studies were designed by Hopkins faculty, with Ashley serving as the study site. Ashley looked at data from over 1,700 patients in 2024 to understand the factors most important to sustainable recovery. This included exploring similarities and differences in ways men and women enter substance abuse treatment and the drivers of long-term recovery for both genders.

There were several notable outcomes, including the differences in recovery success. Women enter treatment for substance use disorders later than men and with higher levels of anxiety (85% of women versus 67% of men), depression (72% versus 52%) and trauma (49% versus 38%). When the women in the study received gender-directed care that met their unique needs, they experienced a roughly 50% reduction in their underlying symptoms, and this reduction occurred faster in the women than the men.

RELATED: Coinsurance, not deductibles, drives racial gaps in maternity costs

Understanding the patient experience

The level of satisfaction a person has with their treatment is a direct result of their ability to be actively engaged during treatment, which ultimately drives whether they’ll continue with their recovery, both in treatment and once they leave. To better understand the gender differences in a person’s engagement and ultimate success, Wendy Insalaco, Ph.D., LCADC, LCPC, senior director of clinical quality outcomes at Ashley, looked at data from patients in active treatment.

According to Insalaco, it became clear through her research that what was important for females was very different from what was most important for men. The analysis showed significantly higher engagement for women in spiritual counseling and physical wellness therapies and higher satisfaction with mental wellness and social wellness programs. Overall, female patient satisfaction was most closely linked to the quality of the environment (things like housekeeping, comfort and food), supportive interactions with staff (such as nursing and medical teams) and access to spiritual care. Together, these factors explained more than half of the variation in women’s treatment satisfaction. By contrast, education and facts influenced satisfaction levels of the male participants.

This data provides actionable insights for enhancing the female patient experience and ensuring consistently high-quality care. “Recovery for women is about relationships,” Insalaco explains. “They thrive when treatment fosters community and connection, and their sense of belonging and safety with peers and staff is central to [their] healing.”

RELATED: UMMS launches first-of-its-kind remote fetal monitoring center on East Coast

Jennifer Aguglia, LCSW-C, vice president of clinical services at Ashley, and head of the Ashley Health Disparities Committee — the committee which drove the focus on research around gender differences in treatment — notes that this research supports the belief that providing gender-responsive care, by addressing women’s mental health, trauma, family involvement and holistic wellness, keeps women better engaged and supports lasting recovery.

“When women feel supported across all these areas,” Aguglia says, “their engagement and outcomes improve dramatically. “We know that women have a harder time getting into treatment. “It’s exciting to understand how and why they’re going to respond to the treatment once they get here.”

Building a workplace that supports recovery

The obstacles that prevent women from seeking care are often tied to caregiving responsibilities, stigma and workplace constraints, as women frequently prioritize children or family obligations over treatment, and guilt and societal expectations can make taking time away from daily responsibilities feel impossible. As a result, even with outpatient or virtual treatment options, participation among women lags men.

RELATED: vNOTES provides women with a scarless option for fibroid surgery

At the time of the study, Ashley’s treatment population was 27% female and 73% male. The findings of this Ashley report underscore the importance of the need for support in the workplace that makes it easier for women to receive treatment. Flexible scheduling, robust health benefits and a culture that normalizes seeking help can all make a tangible difference.

As the holiday season approaches, a time when alcohol often plays a prominent role in celebrations, the impact of alcoholism on women and the need for access to treatment is especially important to consider. Aguglia encourages business owners to find alcohol-free ways to celebrate, like group outings, wellness activities, community service, etc.

The need for gender-directed substance treatment

This research shows the promise of focusing on gender-directed treatment. “When you treat a woman,” Aguglia says, “you’re treating the whole family. The education and information we’re now armed with can be profoundly helpful when working with women and their families.”

Ashley is engaging in several additional academic research studies and collaborations, in areas including cognitive decline in older adults with alcohol use disorder; insomnia medication for patients on medication-assisted therapy for opioid use disorder; and the safety and efficacy of GLP-1s and Naltrexone in early recovery. All of these studies, and others, have the goal, according to the Ashley report, of delivering “new, improved treatment strategies for the patients we serve today—and those we will serve tomorrow.”

“We do this research,” Insalaco explains, “so we can continuously refine the quality of the care we provide, and we as an organization continue to be responsive to the needs of all the patients that we serve.”