The question of what kinds of alcoholism treatment services should be covered by health insurance is an important topic in health services research and it has received increased attention as proposed health care reforms are debated. Central to the debate over what alcoholism treatment services should be covered is an understanding of how alcoholism treatment services are presently used. Very little research has been carried out on women's use of alcoholism treatment or on how health insurance coverage affects their use of alcoholism treatment services. This study will employ a sample of Maryland alcoholism treatment units and female patients in these units to investigate patterns of alcoholism treatment utilization among women and among particular subpopulations of women in different treatment settings. Information on the women included in the study will be gathered at two points in time: shortly after entry into treatment and after six months. Though the present study is designed to stand alone, its design is also consistent with that of the planned National Treatment Study and can supplement that study's findings by providing a special analysis of women in treatment. The proposed study will assess the individual and combined effects of patient characteristics such as previous treatment, referral source, insurance coverage, age, race, severity of alcoholism, drug use, presence of psychiatric comorbidities, motivation for treatment, treatment goals, and social network on pathways to treatment and on services received. Services received by each client will be measured using an adaptation of McClellan's Treatment Services Review that includes measures of services addressing needs specific to women, such as child care, sexual abuse counseling, family programs, etc. The effects of treatment facility characteristics (e.g. public vs. private; inpatient vs. outpatient; specialized for women vs. mixed; hospital-based vs. free-standing) on alcoholism treatment services received by women will also be studied, both separately and as they may interact with patient characteristics. Pathways to alcoholism treatment and patterns of treatment services utilization will be characterized, for women in general and for particular subpopulations of women.
