Even though women are drinking at historically high rates, they are less likely than men to access treatment, according to a new study.
Cirrhosis, a serious liver disease, is one of the most severe complications of alcoholism. While there’s no known cure, patients who’ve been diagnosed with the disease can improve their prognosis if they stop drinking.
However, a recent study found that most people, especially women, with cirrhosis are not receiving substance abuse treatment to help them recover from alcoholism — even if their insurance plan offers coverage for addiction disorders.
The report, released by the Research Society on Alcoholism last month, looked at data on 66,053 privately insured patients between the ages of 18 and 64 who had been diagnosed with alcohol-associated cirrhosis from 2009 to 2016. They found that those who attended alcohol abuse treatment or took a medication known to help with drinking disorders were 15 percent less likely to see their cirrhosis worsen than people who received no substance abuse treatment.
Despite the positive effect treatment for alcoholism can have on liver disease, most patients don’t receive it. The researchers found that only 10 percent of the group received in-person mental health or substance abuse treatment and less than 1 percent were prescribed a Food and Drug Administration–approved medicine that could help prevent a drinking relapse. The vast majority of patients had insurance plans that covered these interventions.
While alarming, the statistics don’t come as a surprise to some experts, including Dr. Robert Brown, a hepatologist and director of the Center for Liver Disease and Transplantation at NewYork-Presbyterian/Weill Cornell Medical Center.
“The study confirms what anyone who is in the practice of managing patients with liver disease already knows — that while alcohol cessation treatment programs can improve outcomes, very few patients avail themselves to it,” he said.
The gender of the patients made a difference in how likely they were to receive treatment. Researchers found that women with alcohol-associated cirrhosis were less likely than men with the disease to receive any type of substance abuse treatment, when all other factors were equal. This is especially troublesome, considering the rates of women diagnosed with drinking-related cirrhosis spiked 50 percent in the same seven-year period.
The findings on gender disparity and substance abuse treatment reflect societal and social challenges that specifically impact women, said Deni Carise, PhD, a clinical psychologist with expertise in addiction and chief scientific officer at Recovery Centers of America, which provides treatment for drug and alcohol addiction.
“Women face additional barriers to treatment for substance abuse. They have family pressure not to admit they have a disorder or seek treatment, they generally have less financial freedom, and they tend to have more child care responsibilities than men, making it harder to get treatment,” said Carise, who has been in recovery from drug and alcohol abuse for more than 30 years.
Women’s drinking habits have changed over time. A 2017 report published in the journal JAMA Psychiatry found that high-risk drinking climbed by almost 60 percent for women from 2001-2002 to 2012-2013. The researchers defined high-risk drinking for women as having four or more drinks at least one day per week during the previous 12 months.
The way men and women process alcohol differs. Women may be more vulnerable to the health repercussions of alcohol use than men, according to the National Institute on Alcohol Abuse and Alcoholism.
“[Women] can develop cirrhosis with less alcohol and in a shorter time frame. The hypothesis is that certain hormones make women more susceptible, though we don’t know exactly why they are so much more susceptible,” said Dr. Jessica Mellinger, lead author of the recent Research Society on Alcoholism study and a Michigan Medicine hepatologist, in a statement about earlier research.
Given that alcoholism has historically been considered a disease that primarily affects men, women may be slipping through the cracks in getting a diagnosis and treatment.
“There’s a real bias [in the medical community] against asking women about substance use disorders or even suspecting there might be a problem,” said Carise.
Traditional screening tools, like medical questionnaires, may fail to detect drinking problems in women, as well.
“Most of these questionnaires were validated primarily on men,” said Brown. “We need far better research and tools focused on women and alcohol.”
Improving the diagnostic tools and encouraging doctors to ask all patients about their substance use habits could help women become more aware of potential addictions, Brown and Carise agreed.
Furthermore, developing more gender-specific alcohol abuse programs may increase the number of women who receive treatment and benefit from it.
“There are subgroups of women, such as those with certain mental health disorders or a history of trauma, who are much more likely to benefit from gender-specific treatment, and some women will only go for treatment if it’s separate from men,” said Carise.
Doctors hope the latest findings will help break down the biggest barrier alcoholics face to getting treatment: the stigma.
“Effective treatment works, and people can go on to have great lives. The recovery can be so transformative for someone, so we need to keep pushing people to get the care they need,” said Carise.