WVSUD-PACT: a Primary-Care-Based Substance Use Disorder Team for Women Veterans

Abstract: Women Veterans are the fastest growing demographic within the Veterans Health Administration (VHA). Substance use disorders (SUDs) are among the many conditions for which gender-specific considerations have implications for care delivery. Thirty-seven percent of women Veterans misuse alcohol and 16% have SUDs. SUDs are associated with key woman Veteran experiences, including combat and military sexual trauma. Increasing access to office-based SUD care has been an important goal in initiatives aimed at curbing SUD-related deaths. Doing so in other settings has been associated with improved acceptance of SUD care, lower costs, and increased uptake of preventive healthcare. Women with SUDs have complex needs in both primary care and SUD treatment domains. They have higher rates of unintended pregnancy and abnormal cervical cancer screens than those without SUDs. Among Veterans, women with SUDs are less likely to receive prescription contraception or medications for opioid use disorder (MOUD). Most women Veterans with at-risk alcohol use are not engaged in treatment. Women Veterans cite discomfort with mixed-gender programming and stigma surrounding mental health treatment. Experiences from within and outside VHA in providing integrated care for complex populations can be used to inform efforts to approach the care disparities and barriers as described for women Veterans with SUDs.