Women and men veterans' initiation, engagement, and retention in treatment for substance use disorders: A cross-sectional investigation using VHA administrative data.

Introduction: More men have substance use disorders (SUD) in the US compared to women; however, the gender gap is closing, including among US veterans. Little information is available about gender differences in patterns of SUD treatment receipt. The current study evaluated gender differences in SUD outpatient, residential, and medication treatment receipt to address critical gaps in the literature.

Methods: Veterans Health Administration patients with SUD diagnoses between 10/01/2014 and 9/30/2018 were included (women = 40,841, men = 615,002). The study tracks treatment initiation, engagement, retention, and treatment transitions for 12 months following study entry. Unadjusted Chi-square tests and logistic regressions, adjusted for race/ethnicity, age study entry year, and facility complexity test for gender differences.

Results: Women had higher initiation, engagement, and retention than men in outpatient and residential settings in unadjusted comparisons. However, after adjustment, women were less likely to initiate, engage, and retain. Post-hoc analyses indicate findings were driven by age and race/ethnicity; specifically, women under 60 and non-Hispanic White and Black women were less likely to initiate or retain in SUD care than men. Women were also less likely to transition through outpatient treatment and utilize opioid use medication; however, women were more likely to transition through residential treatment and utilize alcohol use medication.

Conclusions: Women were found to have lower outpatient and residential SUD treatment receipt and opioid medication utilization but greater alcohol use medication utilization compared to men. Future research is needed to better understand factors leading to these gender differences and to develop tailored treatment approaches to address gender disparities.