TREATMENT UTILIZATION, PERCEIVED NEED, AND BARRIERS TO CARE AMONG WOMEN OF REPRODUCTIVE AGE WITH CO-OCCURRING SUBSTANCE USE DISORDERS AND SERIOUS PSYCHOLOGICAL DISTRESS: FINDINGS FROM THE NATIONAL SURVEY ON DRUG USE AND HEALTH

Author

Mary York, Southern Illinois University CarbondaleFollow

Date of Award

5-1-2025

Degree Name

Doctor of Philosophy

Department

Education

First Advisor

McDermott, Robert

Second Advisor

McDaniel, Justin

Abstract

Objective: Co-occurring substance use and mental health conditions (COD) remain prevalent and frequently undertreated among women of reproductive age in the United States, despite increasing recognition of their impact on maternal and child health. However, research on treatment utilization, perceived unmet needs, and barriers to care in this population remains limited. Additionally, little is known about how treatment use differs among racial-ethnic minority groups, rural populations, and pregnant women.Methods: This study was an analysis of pooled data from the 2015-2019 National Survey on Drug Use and Health to examine treatment utilization patterns and barriers to care among women aged 18-49 with a past-year co-occurring substance use disorder and serious psychological distress (N=4,308). Logistic regression models revealed sociodemographic and behavioral health factors associated with substance use, mental health, and concurrent treatment utilization, as well as perceived unmet needs and treatment barriers. Results: Among women with COD, 42% received no treatment for either condition, while 14% accessed substance use treatment, 55% accessed mental health treatment, and 11% received concurrent treatment. Racial-ethnic minority status and rural residence were significantly associated with lower odds of treatment receipt across all categories, whereas pregnant women had decreased odds of receiving substance use and concurrent treatment. Among women who reported unmet treatment needs, the most frequently cited barriers included limited access to care, affordability concerns, low perceived treatment priority, and stigma. Conclusions: Critical disparities in treatment access highlight the need for coordinated approaches to improve engagement and retention in care for women with COD. Expanding low-threshold, technology-based, and culturally-responsive integrated care models can help to address the longstanding fragmentation of care and key identified barriers. Policymakers should prioritize expanding insurance coverage, increasing funding for integrated care, and removing regulatory barriers that limit access to evidence-based treatment, particularly for pregnant women, mothers, and those in underserved areas. Future research should examine the lived experiences and long-term treatment trajectories of this population, as well as the economic impact of expanded treatment access, to inform public health and policy strategies aimed at improving care access and outcomes.