The States Where the Most Women Drink Are the Ones With the Least Treatment Built for Them

In 2024, binge drinking among women aged 18 to 25 exceeded the rate among men the same age for the first time on record. The treatment system that is supposed to catch the consequences was largely designed around male patients, and a study from Boston University's School of Public Health now puts a number on the mismatch: among nearly 14,000 adult alcohol treatment facilities nationwide, only 58.5 percent offered women-specific programming, and more than 40 percent offered none at all.

Published in Substance Use & Addiction Journal and funded by the National Institute on Alcohol Abuse and Alcoholism, the analysis is the first to compare two maps state by state — where women carry the heaviest burden of alcohol use disorder and where the treatment infrastructure to serve them actually exists.

A 6.2-to-12.7 Percent Spread

Estimated state-level prevalence of alcohol use disorder among women ranged from about 6 percent to 13 percent, bracketing a national average of 8 percent. Utah sat at the low end with 6.2 percent. Washington, DC topped the range at 12.7 percent.

The geography is not random noise. All six New England states came in above the national average, joined by states across the West and Midwest, while prevalence ran lower through most of the South. The authors attribute the pattern to a bundle of factors — alcohol tax policy, cultural norms around drinking, persistent stigma, and uneven availability of care — rather than to any single driver.

The availability numbers are where the study gets uncomfortable. Twenty-three states and Puerto Rico had fewer than 10 facilities offering women-specific treatment per 10,000 women with alcohol use disorder. In the states where estimated prevalence was above average, most treatment facilities also fell below average on trauma therapy, intimate partner violence support and transportation assistance — the services that most often determine whether a woman can stay in care.

Childcare may be the starkest gap of all. In 2024, only 4.6 percent of addiction treatment facilities provided it. Lead author Sage Feltus pointed to caregiving as one of the most persistent obstacles keeping women out of treatment: mothers are more likely to be primary caregivers, and parenting women can struggle to find reliable, affordable childcare while attending treatment.

Fewer than half of all facilities offered telehealth, an option the researchers note matters disproportionately for women facing transportation barriers or concerns about being seen entering an addiction clinic.

What the Authors Say States Should Do

The recommendations are deliberately concrete. Incentivize facilities to add childcare and telehealth capacity. Require health plans to cover alcohol treatment and medications — the same team has previously found that fewer than half of Medicaid managed care plans cover all FDA-approved medications for alcohol use disorder. And push screening into primary care and mental health settings, because women with alcohol use disorder are more likely to present for a co-occurring mental health condition than at a dedicated addiction clinic.

Senior author Maureen Stewart framed the point as one of allocation: knowing which states carry the greatest burden without matching access lets resources go where they are actually needed.

There is a limit worth naming. The study measures the supply of women-specific services and the estimated prevalence of alcohol use disorder, not outcomes, and it cannot say whether adding a service shifts recovery rates. But the same team's prior work found that women-tailored programs outperform programs without those services on both substance use and mental health measures — which makes the 41.5 percent of facilities offering nothing tailored the more difficult figure to defend.