Toward Inclusivity: Validation of A Gender-Sensitive Tool to Measure Barriers to Alcohol Use Disorder Treatment Among Cis- and Transgender People

Individuals with alcohol use disorder (AUD) frequently encounter significant barriers to seeking treatment, with these obstacles often greater for cisgender women and transgender individuals. Negative consequences of AUD are particularly severe in these groups, yet research on their specific treatment barriers is lacking. This study aimed to develop and evaluate the Barriers to AUD Treatment Questionnaire (BAT-Q) and exploratorily examine differences in reported barriers among 112 cisgender men, 154 cisgender women, and 98 transgender individuals who had considered AUD treatment in the past five years. Exploratory factor analysis identified seven reliable domains of barriers: social stigma, comorbid problems and negative care experiences, limited care accessibility, fear of limited inclusivity and discrimination, limited social support, socioeconomic constraints, and negative expectations of care. While comparisons among groups yielded preliminary insights these findings should be interpreted with caution, as confirmatory factor analysis have not yet been conducted. However, transgender individuals reported higher barriers than both cisgender men and women across all domains except socioeconomic constraints. Both cisgender women and transgender individuals experienced greater stigma-related barriers than cisgender men. Higher alcohol and drug use severity predicted greater overall treatment barriers in all groups. Notably, poorer perceived socioeconomic status and low social support were more strongly associated with barriers among women than among cisgender men or transgender individuals. These findings underscore the need for gender-affirming and accessible AUD services. The BAT-Q provides a promising new tool for identifying and addressing specific barriers to treatment, although further validation of its structure is warranted to strengthen the interpretation of group differences.