October 4, 2007

Substance Use Treatment among Women of Childrearing Age

Research suggests that most people who have a substance use problem do not receive treatment.¹ In 2006, 7.4 million women aged 18 or older needed treatment for a substance abuse disorder involving alcohol or illicit drugs, but only 822,000 (11.2 percent) received treatment.² This report focuses on substance use treatment among women of childrearing age (18 to 49), for whom substance use may pose particular risks to vulnerable offspring.

The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older to report on their use of alcohol and illicit drugs,³ as well as symptoms of substance dependence or abuse during the past year. NSDUH defines dependence on or abuse of illicit drugs or alcohol using criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),⁴ which includes such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year.

Respondents also are asked about the treatment they received for a substance use problem. For these analyses, an individual is defined as having received treatment only if he or she reported receiving specialty treatment for alcohol or illicit drug use in the past year.⁵ Persons are classified as needing treatment for a substance use problem if they met the criteria for dependence on or abuse of a substance or if they received specialty substance use treatment in the past year. Respondents also were asked whether there was any time during this period when they felt they needed treatment or counseling for their alcohol or illicit drug use but did not receive it. Persons who felt the need for treatment but did not receive it were asked about their reasons for not receiving substance use treatment.

This report presents estimates of substance use treatment need, receipt of treatment, perceived need for treatment, and reasons for not receiving treatment among women of childrearing age (i.e., women aged 18 to 49). All findings presented in this report are annual averages based on combined 2004, 2005, and 2006 NSDUH data.

Combined data from 2004 to 2006 indicate that an annual average of 9.4 percent of women aged 18 to 49 (an estimated 6.3 million women annually) needed treatment for a substance use problem. Women aged 18 to 25 were more likely to need substance use treatment (16.9 percent) than women aged 26 to 34 (8.2 percent) or those aged 35 to 49 (6.5 percent). American Indian or Alaska Native women and women of two or more races were more likely to have met the criteria for past year substance use treatment need than women in other racial/ethnic groups (21.5 and 17.0 percent, respectively) (Figure 1).

Figure 1. Percentages of Women Aged 18 to 49 Who Needed Treatment in the Past Year, by Race/Ethnicity^*: 2004-2006

Women with lower family incomes were more likely to have been classified as needing substance use treatment in the past year than women with higher family incomes. Approximately 14.3 percent of women with a family income of less than $20,000 per year were classified as needing substance use treatment compared with 9.0 percent of women with a family income of $20,000 to $49,999, 7.5 percent with a family income of $50,000 to $74,999, and 7.4 percent with a family income of $75,000 or more. Women who did not have children under the age of 18 were more likely to have met the criteria for past year substance use treatment need than women who had one or more children under the age of 18 (13.8 vs. 5.9 percent).⁶

Of the 6.3 million women aged 18 to 49 who needed treatment in the past year, 10.4 percent received treatment at a specialty substance use treatment facility. Among women who needed treatment, those aged 35 to 49 and those aged 26 to 34 were more likely than women aged 18 to 25 to have received substance use treatment in the past year (13.7, 12.0, and 6.9 percent, respectively). Among women aged 18 to 49 who needed treatment, those with family incomes of less than $20,000 were more likely to have received treatment at a specialty substance use treatment facility in the past year than those with higher family incomes. Women who had one or more children under the age of 18 were more likely than women who did not have children under the age of 18 to have needed and received substance use treatment in the past year (13.1 vs. 8.8 percent).

Of the women who were classified as needing substance use treatment in the past year, 84.2 percent neither received it nor perceived the need for it (Figure 2). Only 5.5 percent of women aged 18 to 49 had a perceived unmet treatment need (i.e., did not receive substance use treatment even though they thought they needed it).

Figure 2. Receipt of and Perceived Need for Substance Use Treatment in the Past Year among Women Aged 18 to 49 Who Needed Treatment: 2004-2006

Of the 345,000 women aged 18 to 49 who needed and felt the need for substance use treatment in the past year, but did not receive specialty substance use treatment, 36.1 percent indicated they did not receive it because they were not ready to stop using alcohol or illicit drugs, 34.4 percent did not have health insurance coverage and could not afford to pay for the cost of treatment or had health insurance but it did not cover treatment or the cost of services, and 28.9 percent said they did not receive substance use treatment because of social stigma (Figure 3).

Figure 3. Percentages of Reasons^** for Not Receiving Substance Use Treatment in the Past Year among Women Aged 18 to 49 Who Needed Treatment and Who Perceived a Need for It: 2004-2006