Non-engagement in substance use treatment among women with an unmet need for treatment: A latent class analysis on multidimensional barriers

Background: Women with substance use disorders experience multifaceted barriers in accessing substance use treatment. Little is known about how these barriers may aggregate. Using a person-centered approach, this study evaluates patterns of treatment barriers and the factors associated with experiencing distinct sets of barriers among women. Methods: Data were from the NSDUH (2015–2019). 461 adult women with an unmet need for substance use treatment in the last year reported on 14 treatment barriers. Latent class analysis examined classes of barriers; multinomial logistic regression assessed predictors of class membership. Results: Three classes were identified: just not ready to abstain (71.2%), logistical barriers and stigmatization (18.2%), and barriers across all dimensions (10.6%). Higher education (aOR:1.94, p = 0.03) and psychological distress (aOR:2.19, p = 0.02) predicted higher odds—and identifying as African American predicted lower odds (aOR:0.17, p = 0.02)—of belonging to the “Logistics and Stigma Barriers” class relative to the “Just Not Ready” class. Similarly, higher education (aOR: 2.57, p = 0.02) and having children (aOR:2.28, p = 0.03) predicted higher odds—and marriage predicted lower odds (aOR:0.22, p = 0.02)—of belonging to the “High and Diverse Barriers” class relative to the “Just Not Ready” class. Having children predicted higher odds (aOR: 2.93, p =.02), and marriage predicted lower odds (aOR:0.19, p = 0.02) of belonging to the “High and Diverse Barriers” class relative to the “Logistics and Stigma” class. Conclusion: A lack of readiness to abstain, socioeconomic circumstances, and family obligations are main barriers to SUD treatment among women. Interventions incorporating motivational interviewing, family systems, and social networks are needed.