Examining the state policies and external organizational ties that affect women’s access to and engagement in substance use disorder treatment services

Women’s access to substance use disorder (SUD) treatment is affected by their social status and policies that present both opportunities and barriers to treatment. Motherhood, including pregnancy, tends to increase participation in health care and thus opportunities for referral to and engagement in SUD treatment. However, the multiple challenges of motherhood along with the social and legal sanctions that may be visited on mothers who use alcohol or drugs may impede access to treatment. Moreover, motherhood and drug use lie at the focus on great public and policy concerns due to the ways it has been construed in health policy discourse. There is a moral connotation regarding the criminalization of substance use during pregnancy. Mothers’ pathways to SUD treatment are complex, at turn they may be positively supported or seek to avoid opprobrium. Moreover, the opportunities and barriers continue to evolve. This dissertation sought to elucidate the contemporary settings in which mothers access SUD treatment, focusing on women’s use of health and social services and macro-level public policies, particularly the expansion of Medicaid with the Affordable Care Act and state laws that specifically criminalize drug use by mothers. In Study 1, I reviewed the literature on access to SUD treatment services among pregnant women and women who have children. I found that women have unique opportunities and barriers to access treatment services. I built a conceptual model of women’s pathways into care according to the type of barriers that may encounter by each “gateway.” Gateways are formal institutions or settings that may act as “gates” between pathways and may refer patients to treatment, but not all gateways may be actively referring patients. These sources became the foundation for Study 2, in which I empirically tested whether women’s engagement in gateways identified in Study 1 would be an effective mechanism for promoting SUD treatment. The findings suggest that Medicaid eligibility and criminal justice involvement increased women’s access to SUD treatment services. In Study 3, I examined the effects of Medicaid Expansion on medications for opioid use disorder (MOUD) and treatment completion as it relates to state laws that criminalize substance use during pregnancy among pregnant women. I found that criminalization policies prevented Medicaid expansion from realizing its full effect on increasing access to MOUD for pregnant women. Altogether, these studies elucidated the need for women-centered and life-course adjusted approaches in engaging women in treatment.2023-05-14T00:00:00