Access to Alcohol Use Disorder Treatment Among Women: An Empirical Examination of Health Service Utilization

Abstract

Alcohol use disorder (AUD) is a major public health concern for women, yet treatment utilization remains low, and few models adequately explain women’s enrollment in AUD treatment. This study evaluates Andersen’s Behavioral Model of Health Service Use (Andersen’s Model) as a framework for understanding AUD treatment enrollment and tests whether an empirically derived model provides a better fit. Using pooled data from the 2015–2023 National Survey on Drug Use and Health (NSDUH; unweighted n = 28,739, weighted N = 14,382,241), this study examines the influence of Andersen’s Model constructs—predisposing factors, enabling resources, and health needs—on past-year enrollment. Confirmatory factor analysis (CFA) showed poor fit for Andersen’s Model (χ²(147) = 52,408.27, p < .001, CFI = .73, RMSEA = .11). Exploratory factor analysis (EFA) identified five initial factors, but refinement led to a two-factor model: facilitators (e.g., income, education) and barriers (e.g., disability status, mental health status, AUD severity), explaining 70.4% of variance in treatment enrollment. The final model demonstrated excellent fit (χ²(14) = 203.15, p < .001, CFI = .995, RMSEA = .022), outperforming Andersen’s Model. Findings suggest an empirically derived framework better explains women’s AUD treatment access and can inform future research, policy, and interventions to improve treatment engagement.