Health assets of women seeking treatment for alcohol use disorders: A descriptive qualitative study

Health assets of women seeking treatment for alcohol use disorders: A descriptive qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health assets of women seeking treatment for alcohol use disorders: A descriptive qualitative study Melise Ammit, Jo River, Angela Dawson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9411828/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Women with alcohol use disorders (AUD) can face barriers to alcohol use treatment, including deficit-focused services that often lack understanding of the specific needs and challenges of women. Asset-based approach to AUD treatment, which emphasizes the strengths and resources of service users, could enhance women’s treatment engagement and outcomes. However, to date, little is known about the strengths of women accessing alcohol treatment services. Design and Method We used a descriptive qualitative design to explore women’s experiences of accessing treatment for AUD and the health assets that they draw on. Semi-structured interviews were conducted with twelve participants to identify patterns across women’s narratives, with particular attention to strengths that enable health-seeking behavior and maintenance of treatment. A framework analysis was undertaken using Rotegåard and colleagues four dimensions of strength, including motivational, volitional, relational, and protective strengths. Results The framework analysis made visible women’s key health assets that promoted treatment engagement, and are captured in four themes: Volitional strength: transforming despair into action, which shows how women’s experience of desperation and hopelessness could act as a catalyst for them to seek AUD treatment; Motivational strength: mothering and change , which captures how women’s drive to initiate or maintain treatment could be influenced by crisis points in their caregiving role and concerns for children’s safety; Relational strength: the value of supportive partners and networks, which describes the vital role of intimate partners and social connections in supporting women to pursue treatment; and Protective strength: positive curiosity , describes individual attributes that facilitate women to seek and maintain treatment, including persistence, a positive outlook on life, a desire to promote personal health, and a sense of curiosity and openness to learning. Taken together, data show that women draw on a range of health assets to support them to pursue and maintain AUD treatment. Conclusion These findings contribute to evidence on the health assets of women accessing treatment for AUD and inform strengths-based approaches to alcohol treatment for women that could improve access, enhance care, and improve health outcomes for women. Women alcohol health assets 1. Introduction Globally, an estimated 400 million people, approximately 7% of the world’s population, are living with an alcohol use disorder (AUD).( 1 ) Over the past two decades, while many countries across Asia and the Middle East have seen a decline in consumption of alcohol by around 2.5% - with some countries reporting close to zero levels of alcohol usage - others have reported increases in alcohol consumption, including across Eastern Europe.( 2 ) In Australia, data from the National Drug Strategy Household Survey 2022–2023 indicates that over two-thirds of people aged 14 years and over (69%) consumed alcohol in the previous 12 months, while the proportion of the population reporting daily consumption (5.4%) remained stable in the past five years.( 3 ) Nationally alcohol use has decreased by 3.7%, in that time (equivalent to approximately five fewer bottles of wine per person annually). While Australians are drinking less alcohol overall, this decline may hide ongoing alcohol-related harms among some groups, including people with AUD, midlife women, and communities facing socioeconomic disadvantage.( 4 ) Alcohol consumption is associated with more than 200 health conditions, including liver disease, cardiovascular complications, and certain cancers.(WHO, 2024) For example, alcohol-related liver disease (ALD) affects approximately 0.5% of women worldwide and 2.9% of men.( 5 ) According to the WHO (2024) alcohol use was responsible for 2.4% of all female deaths globally in 2019, (compared to 6.7% of men) underscoring the significant public health burden of alcohol related health conditions.( 1 ) Recent global trends in alcohol use among women indicate a rise worldwide, with some studies showing faster growth in alcohol use among women than men, in countries like the United States, United Kingdom and New Zealand.( 6 , 7 ) In Australia, national data from 2021 show that 13% of Australian women exceeded the recommended weekly alcohol intake, and among these, 71% consumed more than 14 drinks per week.( 8 ) Alcohol use among women is linked to higher rates of trauma, mental health conditions and cognitive impairment, with excessive drinking contributing to dementia and injury risks.( 9 , 10 ) Additionally, women are more likely than men to experience hangovers and alcohol-induced blackouts at comparable doses,( 11 ) and alcohol use by women and their partners is a well-documented risk factor for trauma and violence.( 12 ) In our study we use the category ‘women’ and ‘men’ to refer to the alcohol use of cis-gender women and men. Women are more vulnerable to alcohol’s effects due to generally lower body water content and smaller liver size, which results in higher blood alcohol concentrations.( 13 ) Women also experience the “telescoping effect,” progressing more rapidly than men from initial use to dependence and related health risks due to lower body weight ( 14 ) Furthermore, alcohol can have specific health impacts at women’s different life stages. even one additional drink per day increases the risk of breast cancer by 5% in perimenopausal women and 9% in postmenopausal women, ( 15 ) and alcohol exposure in pregnancy increases the risk of miscarriage, stillbirth, and other health conditions for the developing foetus, including Fetal Alcohol Spectrum Disorder (FASD).( 16 ) Despite the availability of effective treatments for AUD, treatment seeking among women remains low.( 17 – 19 ) While mental health co-morbidity and alcohol use severity predict higher uptake of AUD treatment,( 17 – 20 ) women are less likely than men to seek treatment, with an average delay of around ten years between recognizing harm and accessing care.( 20 ) Attitudinal barriers to treatment among women have been reported, including low perceived need for alcohol use treatment; expectations that the problematic alcohol use will resolve without help; and reliance on personal willpower to cease drinking.( 21 )Misconceptions about AUD and its treatments also exist, including the belief that residential rehabilitation is the only effective option, or that severe dependence is required for care.( 18 ) Additional barriers for women include difficulty recognising problematic alcohol use, prior negative treatment experiences, and limited knowledge of treatment availability and efficacy.( 22 ) Women may also avoid AUD treatment due to stigma related to alcohol use.( 19 , 21 , 23 , 24 ) Gender shapes not only how women experience and perceive alcohol-related harm and treatments, but also how health services respond. Historically alcohol use has been perceived as a male health issue, and service models have been primarily been configured around men’s patterns of use and service needs.( 25 ) As a result, treatment models have not adequately accounted for the unique needs of women, such as a need to support treatment access due to higher levels of shame, economic disparities and caregiving responsibilities.( 19 ) Additionally, alcohol and other drug (AOD) services have traditionally been deficit-based, focusing on identifying and fixing problems, often overlooking individual strengths. This approach can reinforce stigma and limit empowerment, making it harder for people to engage with treatment.( 26 ) A strengths-based approach to AOD care, which recognizes the personal and social strengths of service users rather than focusing on deficits, could enhance treatment engagement. Various dimensions of strengths have been identified, including willpower, motivation, supportive relationships and social connections.(Rotegaard 2019) These strengths have been referred to as ‘health assets’, in recognition that factors such as personal resilience, optimism, social support, and access to education and other social assets, can play a critical role in enabling people to engage with healthcare.( 27 ) Asset-based approaches for people living with AUD within community settings have found that participation in community groups are an important determinant of health and wellbeing.( 28 , 29 ) Research has also explored the role of peer support in AOD treatment as a health asset, demonstrating how peer workers can act as external, relational health assets that complement clinical care by offering hope, building trust, and providing practical guidance.( 30 ) Furthermore, resilience models for women in substance use treatment highlight the need for a holistic approach that incorporate and recognise the multiple life areas that contribute to resilience in women.( 31 ) Women’s access and engagement improve when services are flexible, nonjudgemental, and cater to their holistic needs.( 32 ) A focus on health assets in particular shifts the emphasis in health services toward recognizing and building on existing strengths and resources of individuals and communities.( 33 ). This approach draws on a salutogenic orientation, where the focus shifts to what supports an individual’s wellbeing and how these resources can be strengthened.( 34 ) While resilience, optimism, social support, and education are important health assets for everyone, women’s health assets in the context of AUD may support women to navigate gender-specific pressures such as heightened shame around drinking, cultural expectations of caregiving responsibilities, fear of judgement, and limited treatment flexibility.( 35 , 36 ) An asset-based model for women encourages practitioners and policymakers to reframe health promotion and treatment by focusing on what women already possess that supports wellbeing, rather than what they lack.( 27 ) In practice, this involves fostering connections between people and organizations, raising awareness of existing resources, and creating environments where these health assets can be enhanced.( 37 ) Key facilitators to an asset-based approach for women with AUD also includes gender-responsive and trauma-informed care, and integrated models that address co-occurring mental health conditions, parenting and social issues.( 38 ) These features are consistent with Australian AOD treatment guidelines for women that emphasize strengths-based and women-centred models of care.( 39 ) Although these guidelines reflect asset based principles, they are rarely described or evaluated using asset based language. There is a lack of research that assesses the existing assets of women as part of a process to understand women’s needs so that treatment can be tailored to optimize access and outcomes. While tools such as Sense of Coherence (SOC); social network and self-efficacy scales ( 40 , 41 ) can be used to assess a women’s existing assets these may require adaptation and validation for diverse cultural and gender specific contexts.( 42 ). However, understanding the perceptions of women themselves and the ways in which they have leveraged their assets to access and engage with treatment is a useful starting point to identify existing strengths to design appropriate health care. Therefore, we undertook a qualitative study to explore the perspectives of women accessing alcohol services in the Australian context, with a focus on exploring assets and strengths. 2. Methods 2.1. Design We employed a qualitative interpretive descriptive method, developed by Thorne (2025), to explore the experience of women accessing AUD treatment, with a specific focus on health assets. This methodology has been used previously in health services research to support improvements in clinical practice(43) and is particularly suited to research aiming to capture the complexity of women’s lived experiences of health service use, while generating findings that are directly relevant to clinical practice. This approach, under-pinned by a strengths-based framework, aligns with COREQ guidelines,(44) and provides flexibility, while maintaining coherence and rigour.(43) 2.2. Recruitment Recruitment was conducted between July 2024 and November 2024. Sampling was purposeful. All twelve participants were recruited from an urban public treatment setting in a large metropolitan health service in Australia. The inclusion criteria required participants to be women aged 18 or older who were accessing or had accessed treatment for AUD within the past two years. Participants were initially identified through an online survey that was conducted as part of a larger doctoral study, which captured demographic and treatment-related data. From this survey cohort, interview participants were purposefully selected based on their expressed willingness to participate in a follow-up interview, indicated during the survey consent process. Contact details provided in the survey were used to confirm interest and schedule interviews at participants’ convenience. Interview options included face-to-face, online, or telephone, allowing flexibility to accommodate individual preferences (see Table 1). Prior to interviews, participants received detailed study information, assurances of confidentiality, and a reiteration of voluntary participation. Written consent obtained during the survey phase was reaffirmed before interviews commenced. As a gesture of appreciation, participants received a $20 payment, a nominal amount intended to acknowledge their time without exerting undue influence. Ethics approval: This study has been approved by the Northern Sydney Local Health District HREC, reference number: 2024/PIDO1516 2.3 Data Collection Semi-structured interviews were conducted with participants and guided by open-ended questions designed to elicit narratives around personal and social strengths. Interviews were audio-recorded and transcribed verbatim. In addition to interviews, participants were invited to complete a brief survey assessing their understanding of AUD treatment options. This provided supplementary data on health literacy and informed engagement. 2.4 Data Analysis Interview transcripts were analysed using a framework analysis approach, guided by interpretive description. (Thorne, 2025) Data were coded deductively using the four dimensions of strength identified in a review undertaken by Rotegåard and colleagues, (45) which provides a structured framework for the examining participants’ experiences and capturing the health assets they draw on to access and maintain AUD treatment. Rotegåard and colleagues identify four key categories that reflect various dimensions of strength, including volitional strength , defined as women’s capacity to exercise will and resolve in pursuing change-related goals; motivational strength , referring to a future-oriented internal drive to initiate and sustain positive health change for oneself and significant others(45); relational strength , encompassing experiences of belonging, trust, and connectedness within supportive relationships that facilitate engagement with care (46); and protective strengths , including attributes such as optimism, positivity, and curiosity that buffer stress and support adaptive, health-promoting responses.(47) Using these strengths as a framework for the analysis also helped to ensure the findings stay aligned with the study’s strengths‑based focus. The analysis involved repeated readings of the transcripts and coding the data into the predefined categories, readings of each transcript to gain a holistic sense of participants’ accounts, followed by deductive line by line coding to identify segments of text that aligned with the four predefined strength dimensions outlined by Rotegaard et al.(43, 45, 48) These initial deductive codes were then refined through iterative comparison, using notes to document reflections and decision-making. Participant quotations were incorporated throughout to preserve authenticity and reflect women’s perspectives and experiences. 3. Results Interviews were conducted with 12 women ranging in age from 32 to 60 years. All participants had accessed treatment for AUD within the past two years. The women in the study had a median age of 49, with ages ranging from 32 to 60 years. Most participants were Caucasian (n = 11), with one identifying as Asian. Employment varied, with five women in fulltime work, three parttime, one seeking work, and four not in paid employment. Educational attainment was generally high: six held a degree, four a graduate certificate, and two had completed Year 12. Just under half were partnered (n = 5), while seven were single. Most participants were mothers; with ten reporting they had children in their care. Participant demographic details are provided in Table 1 . Fourteen individual attributes were grouped into four overarching strengths concepts in line with Rotegaard et al. (2010) four key strengths: Motivational Strength, Volitional Strength, Relational Strength, and Protective Strengths. These concepts represent individual health assets that were interconnected and facilitated treatment access and are outlined in Table 2 with exemplar quotations from participants. Table 1 Participant demographics Age (median) 49 (range: 32–60 years) Ethnicity Caucasian Asian 11 1 Employment status Full time Part time Unemployed Not in paid work 5 3 1 4 Highest education completed 1 Doctoral Degree Degree Graduate certificate Higher school certificate (year 12) 5 4 2 Relationship status Partnered Single 5 7 Children Yes No 10 2 Note n = 12 Table 2 Strengths Concepts Strength Concepts Personal and social factors Definition Quotes VOLITIONAL Determination Persistence Desperation Previous experience of treatment Capacity to exercise will and resolve in pursuing change-related goals. “I am strong willed, when I make up my mind to do something, I do it…like I did with smoking.” “I was desperate, I just kept ringing places until I found [the clinic].” “I just knew I needed help; I couldn’t do this on my own.” MOTIVATIONAL Desire for better health Desire to be a good parent. Interest in being informed A future-oriented internal drive to initiate and sustain positive health change for oneself and significant others. ‘My children can notice when I’ve been drinking – I don’t want them to see that; I want to be a good mother.” RELATIONAL Trust in healthcare provider Workplace support Partner support Peer recovery networks Experiences of belonging, trust, and connectedness within supportive relationships that facilitate engagement with care. “I had a network of people I could contact.” “It’s 100% easier when he stops drinking too.” PROTECTIVE ​ Curiosity Optimism Positivity Attributes such as optimism, positivity, and curiosity that buffer stress and support adaptive, health-promoting responses. ”I’m a bit woo woo, I think the right thing will happen when the time is right.” “I’m interested in meeting the woman I become” “I always wondered what not drinking would be like” Volitional Strength: transforming despair into action Volitional strength can be defined as women’s capacity to exercise will and resolve in pursuing change-related goals.( 45 ) Eight women described drawing on attributes such as determination and persistence to access treatment, even when faced with uncertainty and significant barriers. However, this often followed a protracted period during which women faced significant barriers to help seeking. Women participants spoke of repeatedly contacting AOD services despite not knowing what treatment they needed or where to find it. They were often motivated by the hope that reducing alcohol would improve their wellbeing. In many cases, participants described how they had reached a point of hopelessness or despair prior to reaching out, and how they transformed that into action. For example, one participant stated: “I was desperate, I just kept ringing places until I found [the clinic].” (Participant 7) Another participant described reaching a breaking point that propelled her to seek help: “I was just at like at breaking point, and I really felt quite hopeless. So, I went to the doctor and said I need help. I don't know what else to do.” (Participant 9) These quotes suggest that, while often perceived negatively, desperation or hopelessness can operate as a constructive force motivating individuals to pursue AOD care. Other participants acknowledged that personal willpower was insufficient to manage their alcohol consumption, recognising this loss of control as the point at which seeking treatment became necessary to achieve their goals: “Realising that I do have a problem with alcohol and that on my own will and means I just cannot do it, I just need help -it's just like I'm obsessed, and when I am actually drinking you can't even tell, which is even worse because I started drinking a bottle of wine each day and now almost two.” (Participant 4) “ I just knew I needed help; I couldn’t do this on my own ” (Participant 8) Volitional strength was also evident in stories of willpower to continue with treatment. One woman drew on previous evidence of her willpower to seek AOD treatment, describing her history of navigating a divorce, giving up smoking cigarettes, and raising two children while maintaining full-time employment: “Once I make up my mind, I do it, like I did with smoking, that gave me a feeling that I could do it with drinking as well.” (Participant 2) For some participants, previous positive experiences with AOD services supported them to have the volitional strength to seek support. One participant explained how prior knowledge and trust in the treatment environment reduced uncertainty and facilitated determination in accessing help. “I’d been here before, I knew where to go.” (Participant 6) Similarly, one participant described how past experiences of success influenced their commitment to change: “I had previous experience of recovery, I understood powerlessness, and I knew I needed to come back to treatment (Participant 5) Data show how experience of success and knowledge of treatment can positively influence commitment to change. The accounts also highlight how volitional strengths, such as persistence and determination, helped women access services and stay committed to seeking help. Motivational Strength: Mothering and change Motivational strength, refers to a future-oriented drive to initiate positive health change for oneself and significant others.( 45 ) For five participants with children, motivation was strongly shaped by caregiving roles and hope for improved quality of life for themselves and their children. Women frequently linked their motivation to seek alcohol treatment to their parental responsibilities, expressing concern about the impact of drinking on their children. For example, one participant shared: “I don’t even kiss them when I’ve been drinking because I try to hide the smell—it removes me from them. I want to be present for my children. Seeing how I separate myself from my family led me to get help.” (Participant 1) Concerns about parenting, and openness to treatment options, combined to create motivational strength in some participants. For some participants, a further requirement for motivation was access to services that supported them to maintain their caregiving role. For example, one participant described, how the desire to access help can conflict with care for young children, and service options supported her to seek help: “What a relief to find out that I didn’t have to go to rehab …I have young children, I can’t leave them to get treatment.” (Participant 7) As this quote describes, motivation strengthened may be particularly enhanced for women if outpatient options are available that support parenting. However, access to such services is also reflective of women’s health service literacy and fit with specific goals and circumstances. For some participants, motivational strength came when they reached a crisis point. Women participants described these as times when alcohol use began to place their children at risk, such as drink‑driving with them in the car, or women experiencing alcohol‑related injuries. For example, when asked about her motivation for seeking treatment, one participant explained: “my kids, I was drink driving with them in the car, and the head injury”. Relational strength: The value of supportive partners and networks. Relational strength refers to the social connections and supportive interactions that foster trust, belonging, and confidence to engage in health-promoting behaviours. It encompasses experiences of encouragement, connectedness, and supportive relationships that facilitate engagement with care. ( 46 ) Relational strength was evident in the way six women described support provided by a partner, peer networks, or work colleagues. Three participants described the importance of a supportive partner and supportive home environments for reducing exposure to alcohol cues and offered practical and emotional encouragement. For one woman, her partner’s decision to stop drinking alongside her played an important role in increasing confidence in the change process. She explained, “It’s 100% easier when he stops too.” Another described how she worried that seeing alcohol at home would be challenging and how her partner’s willingness to remove alcohol from the household made her feel supported: “Knowing I don’t have to see alcohol, or him drinking it, helped me feel supported at home and not so ashamed about it.” (Participant 7) Partner support also extended beyond the home environment. One participant, who feared how she would manage social occasions without drinking, described how her partner offered to drink non-alcoholic beverages with her in these situations. This not only reduced her anxiety but also reinforced a shared commitment to change. Together, these accounts illustrate how relational strength was enacted by partner involvement that did not only provide stated support, but it also change the social and physical environment to align with women’s treatment goals Two participants with prior experience of mutual aid and peer recovery networks, described how they drew on peer support as a relational strength. The active ingredients of mutual aid groups are rooted in social processes that facilitate connection and self-efficacy through community goal direction and the establishment of supportive norms.( 49 ) Some participants described how familiarity with supportive peers and the positive memory of sobriety reinforced motivation to seek help again: “I had a network of people I could connect with, I’d been in recovery before, I knew how good it felt to be sober (Participant 3) “Having a purpose, a group of people doing the same and an ethos of service works for me.”(Participant 5) One participant found that relational connections outside the home, such as supportive workplace relationships, functioned as a relational asset by providing understanding, and flexibility that reduced barriers to accessing alcohol treatment: “My boss is really good, she knows what’s going on, and gives me time to come (to appointments)”(Participant 1). This quote illustrates how work relationships can function as relational assets, reinforcing a sense of being supported strengthening confidence to continue health promoting behavior. Protective strength: Positive curiosity Protective strengths are individual attributes such as optimism, positivity, and curiosity, that buffer stress and support adaptive, health-promoting actions.( 47 ) In this study, three women exhibited these attributes, which fostered hope and positive expectations which helped positive expectation. One woman participant described how she maintained a positive outlook through her alternative view of the world: “‘I am a bit woo -woo, that helped me to keep going, I think the right things will happen at the right time.“ (Participant 8) , This quote described how a person’s specific beliefs about the world can drive protective strengths, and support treatment uptake and continuation as well as reduce the impact of consequences such as relapse. Some participants expressed curiosity about life without alcohol, even while doubting their capacity to achieve change, indicating how curiosity can coexist with self-doubt, creating a starting point for behaviour change: “I’ve always wondered what not drinking would be like, but never thought I could do it”(Participant 11) Similarly, another participant expressed curiosity and creativity as a key driver of persevering in accessing support for alcohol use. Despite repeated relapses and experiencing barriers such as time constraints and competing priorities, this participants’ desire for better well-being motivated her to return to treatment multiple times. “I’m interested to meet the woman I am becoming,” describing a protective strength that helped her to manage her emotional response to relapse and feel a sense of control in the situation. These accounts illustrate how women drew on a combination of volitional, motivational, relational and protective strengths to navigate barriers and initiate help-seeking. These interrelated assets shaped their readiness for change and supported their capacity to access alcohol treatment. 4. Discussion This qualitative study used Rotegåard’s four dimensions of strength (volitional, motivational, relational, and protective), to analyse findings of women’s health assets when actively seeking and accessing treatment for alcohol use. Twelve women in this study provided context for interpreting how personal strengths shaped their engagement with alcohol treatment and the personal and social resources they mobilised when accessing care. While volition is often compromised in AUD due to impaired decision-making, which can weaken intentional action,( 50 ) the findings of this study demonstrate that women can nonetheless harness volitional strengths. Our results suggest that women’s volitional capacity is not absent in the context of AUD; rather, it is activated at key turning points, often when crisis reframes hopelessness into action and is amplified by prior mastery experiences (e.g., quitting smoking). This reframes desperation as a constructive catalyst for treatment entry and points to a form of cumulative attempt capital, where lessons from previous attempts build self‑efficacy and make subsequent help‑seeking more likely.( 51 ) Findings also indicate that for women, mothering and the desire to protect children can be a strong motivator to seek and maintain treatment. This finding aligns with prior research showing that parenting can be a powerful motivator for women to seek help for alcohol use.( 52 , 53 ) However, our findings provide more specific detail on the meaning of mothering for women who use alcohol. Women did not simply want to be better mothers, they identified specific moments where alcohol created emotional distance from their children, and recognizing this disconnection and the potential risk to children intensified their motivation to seek change. This study also shows that women’s motivation can be strengthened when service options, particularly outpatient care, reduced the perceived conflict between treatment and caregiving responsibilities. In this way, motivation was not only an internal state, but was shaped by how well treatment options aligned with women’s caregiving responsibilities, which is consistent with studies of how the ‘system’ impacts treatment access for mothers outside of pregnancy.( 54 ) . This study also found that women’s relational supports could be vital for facilitating treatment engagement, which further illustrate the importance of social context in women’s treatment engagement. This is consistent with literature characterising treatment engagement as socially mediated, with supportive partners, peer connections, and supportive workplaces providing both emotional reinforcement and practical assistance.( 31 ) Importantly, this study found that workplace flexibility reduced structural barriers to attending AUD appointments, which is significant given that women in demanding work or professional roles may experience elevated rates of high-risk drinking associated with stress and competing responsibilities ( 55 ). While women’s parenting needs have been previously investigated, this finding indicates that organisational work cultures are an often-overlooked contextual factor that can either enable or constrain women’s access to treatment. Individual characteristics such as optimism, positivity, and curiosity were found to be important protective strengths. This is consistent with literature positioning optimism as a health asset that also occurs across cultural groups.( 56 ) Building on previous research, this study shows that curiosity about life without alcohol acted as a starting point for women contemplating change. Even when self-doubt was present, women described wondering what sobriety might feel like or imagining the person they might become without alcohol. This forward-looking curiosity helped to sustain motivation despite denial, shame and service delivery barriers. Additionally, this data show that the belief that events would unfold at the right time could foster an optimistic outlook among women. This could function as a protective asset by helping women frame setbacks within a broader trajectory of growth and change and to remain engaged in the treatment rather than disengage in response to perceived failure. ( 57 ) Making women’s strengths visible could guide strengths-based care planning and enable clinicians to tailor support in ways that build on what is already working for each woman.( 58 ) However, while personal attributes are important, our findings support the view that an asset-based approach to women’s AUD treatment must extend beyond supporting individual qualities, to activating relational resources and peer networks. Peer networks, particularly ones that are women focused and culturally relevant, could build social capital.( 59 ) In the context of alcohol treatment, social capital refers to the networks and relationships that provide emotional and practical support, helping women manage the challenges they face.( 60 ) These connections do more than offer assistance; they create a sense of social cohesion. This cohesion can reduce psychosocial stressors such as stigma, shame, and social isolation, which are commonly reported as barriers to seeking help for AUD.( 61 ) Our findings also indicate that it is important consider women’s strengths as a whole, rather than in isolation. Women’s strengths and attributes identified in this study work together to support resilience and treatment engagement. This resilience appears closely connected to the individual and social capital available to women.( 62 ) For example, the development of personal coping skills within the community group context further supported individual women to build personal protective attributes.( 31 , 62 ) The overlap of individual traits and strengths reflects the connection between personal and community resources described in the broader health assets literature.( 33 , 58 , 63 ) Services can adopt an holistic approach to health assets by explicitly identifying women’s personal, social, and community strengths during assessment and looking for how these overlap, as well as embedding these assets into shared care plans that actively link women to relevant peer, community, and culturally appropriate supports such as mutual aid groups, peer workers, and parenting‑friendly services, and community organisations to build personal strengths.( 28 , 33 ) Implications for practice While asset-based approaches are well recognised in the literature, until now there has been limited understanding of women’s health assets in AUD treatment. This in turn has limited guidance on how to design and evaluate interventions that leverage these effectively in health care to improve women’s health and reduce inequalities.( 64 ). The findings from this study could support healthcare workers to consider and develop the health assets of women. The sustained contact nurses typically have with patients means they are particularly well placed to identify women’s health assets and integrate them into care. Nurses are central to health education, coaching, and behaviour change support and can assist patients to recognise their own strengths, build motivation and confidence and connect with community or peer resources.( 65 ) This is well within nurses scope of practice as it is strongly aligned with self-management models in chronic disease, which provide ongoing sustained support through a combination of face to face and telephone or digital interventions to promote goal-setting and confidence in problem-solving.( 66 ) Nurses therefore can activate women’s strengths in AUD treatment, helping them to gain independence and continue caring for themselves after discharge.( 67 ) However, promoting women’s health assets will require workforce development and systems that support asset based care as a legitimate and valued component of women’s alcohol treatment.( 68 ) For example, healthcare workers may need training in asset-based approaches to AUD treatment that are women specific, and systems may need to be adapted to ensure they assess and promote the health assets of women. In terms of systems, it is both feasible and clinically meaningful to identify assets at treatment intake by incorporating health asset questions alongside existing tools. In the Australian context, information is gathered from patients using the Australian Treatment Outcomes Profile (ATOP), a 22 item substance use questionnaire which also captures social functioning, and the Kessler scale (K10) which measures psychological distress.( 69 , 70 ) Additional measures to assess social networks or self-efficacy could be integrated to capture culturally and gender relevant health assets into assessment processes.( 42 ) Furthermore, health professionals could be supported to ground care planning in identified health assets to enable treatment goals to be a collaborative and strengths affirming- process that develops women’s skills and self-confidence and promotes treatment engagement and commitment.( 71 ) Referral practices can further mobilise protective and relational assets by linking women to peer support, mutual aid groups, and community based- resources, aligning with nursing literature, where asset based- models have been used to promote resilience and self-care.( 72 ) Strengths and limitations This study provides valuable insights into the individual and relational strengths women harness to access treatment for problematic alcohol use. It draws attention to women’s health assets, including those not typically described or evaluated using asset-based language. However, the study sample was small and drawn from women from a high-income area. It is not, therefore, representative of all women with AUD. Addition, this study includes women who received treatment, and it is unclear if women who chose not to access treatment have less health assets or whether they are less able to activate these. Future research should explore women’s health assets across a broader and more diverse group of women and include women who pursue and avoid AUD treatment. Furthermore, future research should examine the real-world implementation of asset-based frameworks of care and how these influence women’s treatment uptake and maximise engagement. Conclusion This study highlights the multifaceted nature of health assets and their role in supporting women’s access to treatment for AUD. Women mobilized volitional strength by transforming despair into action, motivational strength through caregiving roles and concern for children, relational strength through supportive partners, and social networks, and protective strength through curiosity, optimism, and openness to learning. These finding demonstrate that women’s access to AUD treatment is facilitated by overlapping individual and social assets. By adopting an asset-based approach, healthcare providers can better understand and respond to the strengths and needs of women receiving AUD treatment, promoting equitable and effective careto improve health outcomes. Future research should explore how health assets are mobilised across diverse groups of women with AUD, including those who seek or do not seek care. Furthermore, research should examine the real-world implementation of health asset frameworks and to influence treatment uptake and maximise engagement. Declarations Ethics approval and consent to participate Ethics approval: This study has been approved by the Northern Sydney Local Health District HREC, reference number: 2024/PIDO1516 Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This research received no funding. Authors’ contribution MA collected, analyzed and interpreted the patient data regarding individual, social and community health assets. RV and AD supervised the study, reviewed and contributed to the analysis, and were major contributors to drafting and critically revising the manuscript. All authors read and approved the final manuscript. Acknowledgment This study is part of a PhD research project by Melise Ammit, University of Technology Sydney. This research is supported by an Australian Government Research Training Program Scholarship. References WHO. Alcohol fact sheet. World Health Organization, 2024. https://www.who.int/news-room/fact-sheets/detail/alcohol. Accessed 13 Feb 2026. OECD. Health at a Glance: OECD indicators, Organizaton for Economic Co-operation and Development, Paris. 2025. https://www.oecd.org/en/publications/2025/11/health-at-a-glance-2025_a894f72e.html. Accessed 13 Feb 2026. ADF. Women and alcohol and other drug treatment. Australian Drug Foundation. 2024. https://adf.org.au/insights/women-aod-treatment/. Accessed 13 Feb 2026. AIHW. Alcohol, tobacco & other drugs in Australia: Health impacts. Australian Institute of Health and Welfare. 2025. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/tobacco. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 08 May, 2026 Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 21 Apr, 2026 Submission checks completed at journal 20 Apr, 2026 First submitted to journal 14 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9411828","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":632884736,"identity":"a77d84bc-b806-4078-9c15-31f20c1e85b6","order_by":0,"name":"Melise Ammit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYFAC5oYDEAZjA8MHCMuAgBZGuJbGxhkQ1YS1wFnNPMRo0W1vbDz4o4JBXnfa4fbHtm1/7BnYm7dJMNQcxqnF7MzBhsM8ZxgMt91ObGzObTNIbOA5VibBcAyPlhuJDYcZ2xgYYVoSGCRyzCQY2PBouf+w4eDPfwz2YC2WbQb2DPJvgFr+4bMFGGK8DQyJYC2MbQaMDRI8ZhKMbfj8AnQYzzGJZJCWmT3njBPbeNKKLRL70nFrOX748McfNTa2226nP/jwo0zOnp/98MYbH75Z49QCBRIIJhuISCCkYRSMglEwCkYBXgAAkbxaCigr1kwAAAAASUVORK5CYII=","orcid":"","institution":"University of Technology Sydney","correspondingAuthor":true,"prefix":"","firstName":"Melise","middleName":"","lastName":"Ammit","suffix":""},{"id":632884738,"identity":"19eaa1b9-9057-4991-a185-5b77eab1c121","order_by":1,"name":"Jo River","email":"","orcid":"","institution":"University of Technology Sydney","correspondingAuthor":false,"prefix":"","firstName":"Jo","middleName":"","lastName":"River","suffix":""},{"id":632884740,"identity":"be403382-7989-4afe-9c7a-73830b8e4ca2","order_by":2,"name":"Angela Dawson","email":"","orcid":"","institution":"University of Technology Sydney","correspondingAuthor":false,"prefix":"","firstName":"Angela","middleName":"","lastName":"Dawson","suffix":""}],"badges":[],"createdAt":"2026-04-14 07:23:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9411828/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9411828/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108806361,"identity":"4f6f241b-21f8-4a9d-b865-0d78f8eb7e53","added_by":"auto","created_at":"2026-05-08 15:28:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":303477,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9411828/v1/c88de1c7-2a46-46e1-b7ef-9ad7142003d1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health assets of women seeking treatment for alcohol use disorders: A descriptive qualitative study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGlobally, an estimated 400\u0026nbsp;million people, approximately 7% of the world\u0026rsquo;s population, are living with an alcohol use disorder (AUD).(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Over the past two decades, while many countries across Asia and the Middle East have seen a decline in consumption of alcohol by around 2.5% - with some countries reporting close to zero levels of alcohol usage - others have reported increases in alcohol consumption, including across Eastern Europe.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn Australia, data from the National Drug Strategy Household Survey 2022\u0026ndash;2023 indicates that over two-thirds of people aged 14 years and over (69%) consumed alcohol in the previous 12 months, while the proportion of the population reporting daily consumption (5.4%) remained stable in the past five years.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Nationally alcohol use has decreased by 3.7%, in that time (equivalent to approximately five fewer bottles of wine per person annually). While Australians are drinking less alcohol overall, this decline may hide ongoing alcohol-related harms among some groups, including people with AUD, midlife women, and communities facing socioeconomic disadvantage.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlcohol consumption is associated with more than 200 health conditions, including liver disease, cardiovascular complications, and certain cancers.(WHO, 2024) For example, alcohol-related liver disease (ALD) affects approximately 0.5% of women worldwide and 2.9% of men.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) According to the WHO (2024) alcohol use was responsible for 2.4% of all female deaths globally in 2019, (compared to 6.7% of men) underscoring the significant public health burden of alcohol related health conditions.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eRecent global trends in alcohol use among women indicate a rise worldwide, with some studies showing faster growth in alcohol use among women than men, in countries like the United States, United Kingdom and New Zealand.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) In Australia, national data from 2021 show that 13% of Australian women exceeded the recommended weekly alcohol intake, and among these, 71% consumed more than 14 drinks per week.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Alcohol use among women is linked to higher rates of trauma, mental health conditions and cognitive impairment, with excessive drinking contributing to dementia and injury risks.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Additionally, women are more likely than men to experience hangovers and alcohol-induced blackouts at comparable doses,(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and alcohol use by women and their partners is a well-documented risk factor for trauma and violence.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) In our study we use the category \u0026lsquo;women\u0026rsquo; and \u0026lsquo;men\u0026rsquo; to refer to the alcohol use of cis-gender women and men.\u003c/p\u003e \u003cp\u003eWomen are more vulnerable to alcohol\u0026rsquo;s effects due to generally lower body water content and smaller liver size, which results in higher blood alcohol concentrations.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Women also experience the \u0026ldquo;telescoping effect,\u0026rdquo; progressing more rapidly than men from initial use to dependence and related health risks due to lower body weight (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Furthermore, alcohol can have specific health impacts at women\u0026rsquo;s different life stages. even one additional drink per day increases the risk of breast cancer by 5% in perimenopausal women and 9% in postmenopausal women, (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and alcohol exposure in pregnancy increases the risk of miscarriage, stillbirth, and other health conditions for the developing foetus, including Fetal Alcohol Spectrum Disorder (FASD).(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDespite the availability of effective treatments for AUD, treatment seeking among women remains low.(\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) While mental health co-morbidity and alcohol use severity predict higher uptake of AUD treatment,(\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) women are less likely than men to seek treatment, with an average delay of around ten years between recognizing harm and accessing care.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Attitudinal barriers to treatment among women have been reported, including low perceived need for alcohol use treatment; expectations that the problematic alcohol use will resolve without help; and reliance on personal willpower to cease drinking.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)Misconceptions about AUD and its treatments also exist, including the belief that residential rehabilitation is the only effective option, or that severe dependence is required for care.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Additional barriers for women include difficulty recognising problematic alcohol use, prior negative treatment experiences, and limited knowledge of treatment availability and efficacy.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Women may also avoid AUD treatment due to stigma related to alcohol use.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eGender shapes not only how women experience and perceive alcohol-related harm and treatments, but also how health services respond. Historically alcohol use has been perceived as a male health issue, and service models have been primarily been configured around men\u0026rsquo;s patterns of use and service needs.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) As a result, treatment models have not adequately accounted for the unique needs of women, such as a need to support treatment access due to higher levels of shame, economic disparities and caregiving responsibilities.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Additionally, alcohol and other drug (AOD) services have traditionally been deficit-based, focusing on identifying and fixing problems, often overlooking individual strengths. This approach can reinforce stigma and limit empowerment, making it harder for people to engage with treatment.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA strengths-based approach to AOD care, which recognizes the personal and social strengths of service users rather than focusing on deficits, could enhance treatment engagement. Various dimensions of strengths have been identified, including willpower, motivation, supportive relationships and social connections.(Rotegaard 2019) These strengths have been referred to as \u0026lsquo;health assets\u0026rsquo;, in recognition that factors such as personal resilience, optimism, social support, and access to education and other social assets, can play a critical role in enabling people to engage with healthcare.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) Asset-based approaches for people living with AUD within community settings have found that participation in community groups are an important determinant of health and wellbeing.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) Research has also explored the role of peer support in AOD treatment as a health asset, demonstrating how peer workers can act as external, relational health assets that complement clinical care by offering hope, building trust, and providing practical guidance.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore, resilience models for women in substance use treatment highlight the need for a holistic approach that incorporate and recognise the multiple life areas that contribute to resilience in women.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) Women\u0026rsquo;s access and engagement improve when services are flexible, nonjudgemental, and cater to their holistic needs.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) A focus on health assets in particular shifts the emphasis in health services toward recognizing and building on existing strengths and resources of individuals and communities.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This approach draws on a salutogenic orientation, where the focus shifts to what supports an individual\u0026rsquo;s wellbeing and how these resources can be strengthened.(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWhile resilience, optimism, social support, and education are important health assets for everyone, women\u0026rsquo;s health assets in the context of AUD may support women to navigate gender-specific pressures such as heightened shame around drinking, cultural expectations of caregiving responsibilities, fear of judgement, and limited treatment flexibility.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) An asset-based model for women encourages practitioners and policymakers to reframe health promotion and treatment by focusing on what women already possess that supports wellbeing, rather than what they lack.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) In practice, this involves fostering connections between people and organizations, raising awareness of existing resources, and creating environments where these health assets can be enhanced.(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e Key facilitators to an asset-based approach for women with AUD also includes gender-responsive and trauma-informed care, and integrated models that address co-occurring mental health conditions, parenting and social issues.(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) These features are consistent with Australian AOD treatment guidelines for women that emphasize strengths-based and women-centred models of care.(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) Although these guidelines reflect asset based principles, they are rarely described or evaluated using asset based language.\u003c/p\u003e \u003cp\u003eThere is a lack of research that assesses the existing assets of women as part of a process to understand women\u0026rsquo;s needs so that treatment can be tailored to optimize access and outcomes. While tools such as Sense of Coherence (SOC); social network and self-efficacy scales (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) can be used to assess a women\u0026rsquo;s existing assets these may require adaptation and validation for diverse cultural and gender specific contexts.(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). However, understanding the perceptions of women themselves and the ways in which they have leveraged their assets to access and engage with treatment is a useful starting point to identify existing strengths to design appropriate health care. Therefore, we undertook a qualitative study to explore the perspectives of women accessing alcohol services in the Australian context, with a focus on exploring assets and strengths.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch3\u003e2.1. Design\u003c/h3\u003e\n\u003cp\u003eWe employed a qualitative interpretive descriptive method, developed by Thorne (2025), to explore the experience of women accessing AUD treatment, with a specific focus on health assets. This methodology has been used previously in health services research to support improvements in clinical practice(43) and is particularly suited to research aiming to capture the complexity of women’s lived experiences of health service use, while generating findings that are directly relevant to clinical practice. This approach, under-pinned by a strengths-based framework, aligns with COREQ guidelines,(44) and provides flexibility, while maintaining coherence and rigour.(43)\u003c/p\u003e\n\u003ch3\u003e2.2. Recruitment\u003c/h3\u003e\n\u003cp\u003eRecruitment was conducted between\u0026nbsp;July 2024 and November 2024. Sampling was purposeful. All twelve participants were recruited from an urban public treatment setting in a large metropolitan health service in Australia. The inclusion criteria required participants to be women aged 18 or older who were accessing or had accessed treatment for AUD within the past two years.\u003c/p\u003e\n\u003cp\u003eParticipants were initially identified through an online survey that was conducted as part of a larger doctoral study, which captured demographic and treatment-related data. From this survey cohort, interview participants were\u0026nbsp;purposefully selected\u0026nbsp;based on their expressed willingness to participate in a follow-up interview, indicated during the survey consent process. Contact details provided in the survey were used to confirm interest and schedule interviews at participants’ convenience. Interview options included\u0026nbsp;face-to-face,\u0026nbsp;online, or\u0026nbsp;telephone, allowing flexibility to accommodate individual preferences (see Table 1).\u003c/p\u003e\n\u003cp\u003ePrior to interviews, participants received detailed study information, assurances of confidentiality, and a reiteration of voluntary participation. Written consent obtained during the survey phase was reaffirmed before interviews commenced. As a gesture of appreciation, participants received a\u0026nbsp;$20 payment, a nominal amount intended to acknowledge their time without exerting undue influence.\u003c/p\u003e\n\u003cp\u003eEthics approval: This study has been approved by the Northern Sydney Local Health District HREC, reference number: \u0026nbsp;2024/PIDO1516\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e2.3 Data Collection\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews were conducted with participants and guided by open-ended questions designed to elicit narratives around personal and social strengths. Interviews were audio-recorded and transcribed verbatim.\u003c/p\u003e\n\u003cp\u003eIn addition to interviews, participants were invited to complete a brief survey assessing their understanding of AUD treatment options. This provided supplementary data on health literacy and informed engagement.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e2.4 Data Analysis\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eInterview transcripts were analysed using a framework analysis approach, guided by interpretive description. (Thorne, 2025) Data were coded deductively using the four dimensions of strength identified in a review undertaken by Rotegåard and colleagues, (45) which provides a structured framework for the examining participants’ experiences and capturing the health assets they draw on to access and maintain AUD treatment. Rotegåard and colleagues identify four key categories that reflect various dimensions of strength, including \u003cem\u003evolitional strength\u003c/em\u003e, defined as women’s capacity to exercise will and resolve in pursuing change-related goals; \u003cem\u003emotivational strength\u003c/em\u003e, referring to a future-oriented internal drive to initiate and sustain positive health change for oneself and significant others(45); \u003cem\u003erelational strength\u003c/em\u003e, encompassing experiences of belonging, trust, and connectedness within supportive relationships that facilitate engagement with care (46); and \u003cem\u003eprotective strengths\u003c/em\u003e, including attributes such as optimism, positivity, and curiosity that buffer stress and support adaptive, health-promoting responses.(47) Using these strengths as a framework for the analysis also helped to ensure the findings stay aligned with the study’s strengths‑based focus.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis involved repeated readings of the transcripts and coding the data into the predefined categories, readings of each transcript to gain a holistic sense of participants’ accounts, followed by deductive line by line coding to identify segments of text that aligned with the four predefined strength dimensions outlined by Rotegaard et al.(43, 45, 48) These initial deductive codes were then refined through iterative comparison, using notes to document reflections and decision-making. Participant quotations were incorporated throughout to preserve authenticity and reflect women’s perspectives and experiences.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eInterviews were conducted with 12 women ranging in age from 32 to 60 years. All participants had accessed treatment for AUD within the past two years. The women in the study had a median age of 49, with ages ranging from 32 to 60 years. Most participants were Caucasian (n\u0026thinsp;=\u0026thinsp;11), with one identifying as Asian. Employment varied, with five women in fulltime work, three parttime, one seeking work, and four not in paid employment. Educational attainment was generally high: six held a degree, four a graduate certificate, and two had completed Year 12. Just under half were partnered (n\u0026thinsp;=\u0026thinsp;5), while seven were single. Most participants were mothers; with ten reporting they had children in their care. Participant demographic details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eFourteen individual attributes were grouped into four overarching strengths concepts in line with Rotegaard et al. (2010) four key strengths: Motivational Strength, Volitional Strength, Relational Strength, and Protective Strengths. These concepts represent individual health assets that were interconnected and facilitated treatment access and are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e with exemplar quotations from participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant demographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (median)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003cp\u003e(range: 32\u0026ndash;60 years)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaucasian\u003c/p\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull time\u003c/p\u003e \u003cp\u003ePart time\u003c/p\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003cp\u003eNot in paid work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education completed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctoral Degree\u003c/p\u003e \u003cp\u003eDegree\u003c/p\u003e \u003cp\u003eGraduate certificate\u003c/p\u003e \u003cp\u003eHigher school certificate (year 12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartnered\u003c/p\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eNote n\u0026thinsp;=\u0026thinsp;12\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStrengths Concepts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrength Concepts\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal and social factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVOLITIONAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetermination\u003c/p\u003e \u003cp\u003ePersistence\u003c/p\u003e \u003cp\u003eDesperation\u003c/p\u003e \u003cp\u003ePrevious experience of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCapacity to exercise will and resolve in pursuing change-related goals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I am strong willed, when I make up my mind to do something, I do it\u0026hellip;like I did with smoking.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I was desperate, I just kept ringing places until I found [the clinic].\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I just knew I needed help; I couldn\u0026rsquo;t do this on my own.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOTIVATIONAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesire for better health\u003c/p\u003e \u003cp\u003eDesire to be a good parent.\u003c/p\u003e \u003cp\u003eInterest in being informed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA future-oriented internal drive to initiate and sustain positive health change for oneself and significant others.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;My children can notice when I\u0026rsquo;ve been drinking \u0026ndash; I don\u0026rsquo;t want them to see that; I want to be a good mother.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRELATIONAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrust in healthcare provider\u003c/p\u003e \u003cp\u003eWorkplace support\u003c/p\u003e \u003cp\u003ePartner support\u003c/p\u003e \u003cp\u003ePeer recovery networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperiences of belonging, trust, and connectedness within supportive relationships that facilitate engagement with care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I had a network of people I could contact.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s 100% easier when he stops drinking too.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROTECTIVE ​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCuriosity\u003c/p\u003e \u003cp\u003eOptimism\u003c/p\u003e \u003cp\u003ePositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAttributes such as optimism, positivity, and curiosity that buffer stress and support adaptive, health-promoting responses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026rdquo;I\u0026rsquo;m a bit woo woo, I think the right thing will happen when the time is right.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m interested in meeting the woman I become\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I always wondered what not drinking would be like\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVolitional Strength: transforming despair into action\u003c/p\u003e \u003cp\u003eVolitional strength can be defined as women\u0026rsquo;s capacity to exercise will and resolve in pursuing change-related goals.(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) Eight women described drawing on attributes such as determination and persistence to access treatment, even when faced with uncertainty and significant barriers. However, this often followed a protracted period during which women faced significant barriers to help seeking.\u003c/p\u003e \u003cp\u003eWomen participants spoke of repeatedly contacting AOD services despite not knowing what treatment they needed or where to find it. They were often motivated by the hope that reducing alcohol would improve their wellbeing. In many cases, participants described how they had reached a point of hopelessness or despair prior to reaching out, and how they transformed that into action. For example, one participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I was desperate, I just kept ringing places until I found [the clinic].\u0026rdquo; (Participant 7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant described reaching a breaking point that propelled her to seek help:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I was just at like at breaking point, and I really felt quite hopeless. So, I went to the doctor and said I need help. I don't know what else to do.\u0026rdquo; (Participant 9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese quotes suggest that, while often perceived negatively, desperation or hopelessness can operate as a constructive force motivating individuals to pursue AOD care.\u003c/p\u003e \u003cp\u003eOther participants acknowledged that personal willpower was insufficient to manage their alcohol consumption, recognising this loss of control as the point at which seeking treatment became necessary to achieve their goals:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Realising that I do have a problem with alcohol and that on my own will and means I just cannot do it, I just need help -it's just like I'm obsessed, and when I am actually drinking you can't even tell, which is even worse because I started drinking a bottle of wine each day and now almost two.\u0026rdquo; (Participant 4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo; I just knew I needed help; I couldn\u0026rsquo;t do this on my own\u003c/em\u003e\u0026rdquo; \u003cem\u003e(Participant 8)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eVolitional strength was also evident in stories of willpower to continue with treatment. One woman drew on previous evidence of her willpower to seek AOD treatment, describing her history of navigating a divorce, giving up smoking cigarettes, and raising two children while maintaining full-time employment:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Once I make up my mind, I do it, like I did with smoking, that gave me a feeling that I could do it with drinking as well.\u0026rdquo; (Participant 2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFor some participants, previous positive experiences with AOD services supported them to have the volitional strength to seek support. One participant explained how prior knowledge and trust in the treatment environment reduced uncertainty and facilitated determination in accessing help. \u0026ldquo;I\u0026rsquo;d been here before, I knew where to go.\u0026rdquo; (Participant 6) Similarly, one participant described how past experiences of success influenced their commitment to change:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I had previous experience of recovery, I understood powerlessness, and I knew I needed to come back to treatment (Participant 5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eData show how experience of success and knowledge of treatment can positively influence commitment to change. The accounts also highlight how volitional strengths, such as persistence and determination, helped women access services and stay committed to seeking help.\u003c/p\u003e \u003cp\u003eMotivational Strength: Mothering and change\u003c/p\u003e \u003cp\u003eMotivational strength, refers to a future-oriented drive to initiate positive health change for oneself and significant others.(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) For five participants with children, motivation was strongly shaped by caregiving roles and hope for improved quality of life for themselves and their children.\u003c/p\u003e \u003cp\u003eWomen frequently linked their motivation to seek alcohol treatment to their parental responsibilities, expressing concern about the impact of drinking on their children. For example, one participant shared:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t even kiss them when I\u0026rsquo;ve been drinking because I try to hide the smell\u0026mdash;it removes me from them. I want to be present for my children. Seeing how I separate myself from my family led me to get help.\u0026rdquo; (Participant 1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConcerns about parenting, and openness to treatment options, combined to create motivational strength in some participants.\u003c/p\u003e \u003cp\u003eFor some participants, a further requirement for motivation was access to services that supported them to maintain their caregiving role. For example, one participant described, how the desire to access help can conflict with care for young children, and service options supported her to seek help:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;What a relief to find out that I didn\u0026rsquo;t have to go to rehab \u0026hellip;I have young children, I can\u0026rsquo;t leave them to get treatment.\u0026rdquo; (Participant 7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAs this quote describes, motivation strengthened may be particularly enhanced for women if outpatient options are available that support parenting. However, access to such services is also reflective of women\u0026rsquo;s health service literacy and fit with specific goals and circumstances.\u003c/p\u003e \u003cp\u003eFor some participants, motivational strength came when they reached a crisis point. Women participants described these as times when alcohol use began to place their children at risk, such as drink‑driving with them in the car, or women experiencing alcohol‑related injuries. For example, when asked about her motivation for seeking treatment, one participant explained: \u0026ldquo;my kids, I was drink driving with them in the car, and the head injury\u0026rdquo;.\u003c/p\u003e \u003cp\u003eRelational strength: The value of supportive partners and networks.\u003c/p\u003e \u003cp\u003eRelational strength refers to the social connections and supportive interactions that foster trust, belonging, and confidence to engage in health-promoting behaviours. It encompasses experiences of encouragement, connectedness, and supportive relationships that facilitate engagement with care. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) Relational strength was evident in the way six women described support provided by a partner, peer networks, or work colleagues.\u003c/p\u003e \u003cp\u003e Three participants described the importance of a supportive partner and supportive home environments for reducing exposure to alcohol cues and offered practical and emotional encouragement. For one woman, her partner\u0026rsquo;s decision to stop drinking alongside her played an important role in increasing confidence in the change process. She explained, \u0026ldquo;It\u0026rsquo;s 100% easier when he stops too.\u0026rdquo;\u003c/p\u003e \u003cp\u003eAnother described how she worried that seeing alcohol at home would be challenging and how her partner\u0026rsquo;s willingness to remove alcohol from the household made her feel supported:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Knowing I don\u0026rsquo;t have to see alcohol, or him drinking it, helped me feel supported at home and not so ashamed about it.\u0026rdquo; (Participant 7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePartner support also extended beyond the home environment. One participant, who feared how she would manage social occasions without drinking, described how her partner offered to drink non-alcoholic beverages with her in these situations. This not only reduced her anxiety but also reinforced a shared commitment to change.\u003c/p\u003e \u003cp\u003eTogether, these accounts illustrate how relational strength was enacted by partner involvement that did not only provide stated support, but it also change the social and physical environment to align with women\u0026rsquo;s treatment goals\u003c/p\u003e \u003cp\u003eTwo participants with prior experience of mutual aid and peer recovery networks, described how they drew on peer support as a relational strength. The active ingredients of mutual aid groups are rooted in social processes that facilitate connection and self-efficacy through community goal direction and the establishment of supportive norms.(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e) Some participants described how familiarity with supportive peers and the positive memory of sobriety reinforced motivation to seek help again:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I had a network of people I could connect with, I\u0026rsquo;d been in recovery before, I knew how good it felt to be sober (Participant 3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Having a purpose, a group of people doing the same and an ethos of service works for me.\u0026rdquo;(Participant 5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne participant found that relational connections outside the home, such as supportive workplace relationships, functioned as a relational asset by providing understanding, and flexibility that reduced barriers to accessing alcohol treatment:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;My boss is really good, she knows what\u0026rsquo;s going on, and gives me time to come (to appointments)\u0026rdquo;(Participant 1).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis quote illustrates how work relationships can function as relational assets, reinforcing a sense of being supported strengthening confidence to continue health promoting behavior.\u003c/p\u003e \u003cp\u003eProtective strength: Positive curiosity\u003c/p\u003e \u003cp\u003eProtective strengths are individual attributes such as optimism, positivity, and curiosity, that buffer stress and support adaptive, health-promoting actions.(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) In this study, three women exhibited these attributes, which fostered hope and positive expectations which helped positive expectation.\u003c/p\u003e \u003cp\u003eOne woman participant described how she maintained a positive outlook through her alternative view of the world:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026lsquo;I am a bit woo -woo, that helped me to keep going, I think the right things will happen at the right time.\u0026ldquo; (Participant 8)\u003c/em\u003e,\u003c/p\u003e \u003cp\u003eThis quote described how a person\u0026rsquo;s specific beliefs about the world can drive protective strengths, and support treatment uptake and continuation as well as reduce the impact of consequences such as relapse.\u003c/p\u003e \u003cp\u003eSome participants expressed curiosity about life without alcohol, even while doubting their capacity to achieve change, indicating how curiosity can coexist with self-doubt, creating a starting point for behaviour change:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I\u0026rsquo;ve always wondered what not drinking would be like, but never thought I could do it\u0026rdquo;(Participant 11)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSimilarly, another participant expressed curiosity and creativity as a key driver of persevering in accessing support for alcohol use. Despite repeated relapses and experiencing barriers such as time constraints and competing priorities, this participants\u0026rsquo; desire for better well-being motivated her to return to treatment multiple times. \u0026ldquo;I\u0026rsquo;m interested to meet the woman I am becoming,\u0026rdquo; describing a protective strength that helped her to manage her emotional response to relapse and feel a sense of control in the situation.\u003c/p\u003e \u003cp\u003eThese accounts illustrate how women drew on a combination of volitional, motivational, relational and protective strengths to navigate barriers and initiate help-seeking. These interrelated assets shaped their readiness for change and supported their capacity to access alcohol treatment.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis qualitative study used Roteg\u0026aring;ard\u0026rsquo;s four dimensions of strength (volitional, motivational, relational, and protective), to analyse findings of women\u0026rsquo;s health assets when actively seeking and accessing treatment for alcohol use. Twelve women in this study provided context for interpreting how personal strengths shaped their engagement with alcohol treatment and the personal and social resources they mobilised when accessing care.\u003c/p\u003e \u003cp\u003eWhile volition is often compromised in AUD due to impaired decision-making, which can weaken intentional action,(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) the findings of this study demonstrate that women can nonetheless harness volitional strengths. Our results suggest that women\u0026rsquo;s volitional capacity is not absent in the context of AUD; rather, it is activated at key turning points, often when crisis reframes hopelessness into action and is amplified by prior mastery experiences (e.g., quitting smoking). This reframes desperation as a constructive catalyst for treatment entry and points to a form of cumulative attempt capital, where lessons from previous attempts build self‑efficacy and make subsequent help‑seeking more likely.(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFindings also indicate that for women, mothering and the desire to protect children can be a strong motivator to seek and maintain treatment. This finding aligns with prior research showing that parenting can be a powerful motivator for women to seek help for alcohol use.(\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e) However, our findings provide more specific detail on the meaning of mothering for women who use alcohol. Women did not simply want to be better mothers, they identified specific moments where alcohol created emotional distance from their children, and recognizing this disconnection and the potential risk to children intensified their motivation to seek change. This study also shows that women\u0026rsquo;s motivation can be strengthened when service options, particularly outpatient care, reduced the perceived conflict between treatment and caregiving responsibilities. In this way, motivation was not only an internal state, but was shaped by how well treatment options aligned with women\u0026rsquo;s caregiving responsibilities, which is consistent with studies of how the \u0026lsquo;system\u0026rsquo; impacts treatment access for mothers outside of pregnancy.(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003cp\u003eThis study also found that women\u0026rsquo;s relational supports could be vital for facilitating treatment engagement, which further illustrate the importance of social context in women\u0026rsquo;s treatment engagement. This is consistent with literature characterising treatment engagement as socially mediated, with supportive partners, peer connections, and supportive workplaces providing both emotional reinforcement and practical assistance.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) Importantly, this study found that workplace flexibility reduced structural barriers to attending AUD appointments, which is significant given that women in demanding work or professional roles may experience elevated rates of high-risk drinking associated with stress and competing responsibilities (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). While women\u0026rsquo;s parenting needs have been previously investigated, this finding indicates that organisational work cultures are an often-overlooked contextual factor that can either enable or constrain women\u0026rsquo;s access to treatment.\u003c/p\u003e \u003cp\u003eIndividual characteristics such as optimism, positivity, and curiosity were found to be important protective strengths. This is consistent with literature positioning optimism as a health asset that also occurs across cultural groups.(\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e) Building on previous research, this study shows that curiosity about life without alcohol acted as a starting point for women contemplating change. Even when self-doubt was present, women described wondering what sobriety might feel like or imagining the person they might become without alcohol. This forward-looking curiosity helped to sustain motivation despite denial, shame and service delivery barriers. Additionally, this data show that the belief that events would unfold at the right time could foster an optimistic outlook among women. This could function as a protective asset by helping women frame setbacks within a broader trajectory of growth and change and to remain engaged in the treatment rather than disengage in response to perceived failure. (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMaking women\u0026rsquo;s strengths visible could guide strengths-based care planning and enable clinicians to tailor support in ways that build on what is already working for each woman.(\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) However, while personal attributes are important, our findings support the view that an asset-based approach to women\u0026rsquo;s AUD treatment must extend beyond supporting individual qualities, to activating relational resources and peer networks. Peer networks, particularly ones that are women focused and culturally relevant, could build social capital.(\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e) In the context of alcohol treatment, social capital refers to the networks and relationships that provide emotional and practical support, helping women manage the challenges they face.(\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) These connections do more than offer assistance; they create a sense of social cohesion. This cohesion can reduce psychosocial stressors such as stigma, shame, and social isolation, which are commonly reported as barriers to seeking help for AUD.(\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOur findings also indicate that it is important consider women\u0026rsquo;s strengths as a whole, rather than in isolation. Women\u0026rsquo;s strengths and attributes identified in this study work together to support resilience and treatment engagement. This resilience appears closely connected to the individual and social capital available to women.(\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e) For example, the development of personal coping skills within the community group context further supported individual women to build personal protective attributes.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e) The overlap of individual traits and strengths reflects the connection between personal and community resources described in the broader health assets literature.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e) Services can adopt an holistic approach to health assets by explicitly identifying women\u0026rsquo;s personal, social, and community strengths during assessment and looking for how these overlap, as well as embedding these assets into shared care plans that actively link women to relevant peer, community, and culturally appropriate supports such as mutual aid groups, peer workers, and parenting‑friendly services, and community organisations to build personal strengths.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eImplications for practice\u003c/p\u003e \u003cp\u003eWhile asset-based approaches are well recognised in the literature, until now there has been limited understanding of women\u0026rsquo;s health assets in AUD treatment. This in turn has limited guidance on how to design and evaluate interventions that leverage these effectively in health care to improve women\u0026rsquo;s health and reduce inequalities.(\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). The findings from this study could support healthcare workers to consider and develop the health assets of women. The sustained contact nurses typically have with patients means they are particularly well placed to identify women\u0026rsquo;s health assets and integrate them into care. Nurses are central to health education, coaching, and behaviour change support and can assist patients to recognise their own strengths, build motivation and confidence and connect with community or peer resources.(\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e) This is well within nurses scope of practice as it is strongly aligned with self-management models in chronic disease, which provide ongoing sustained support through a combination of face to face and telephone or digital interventions to promote goal-setting and confidence in problem-solving.(\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e) Nurses therefore can activate women\u0026rsquo;s strengths in AUD treatment, helping them to gain independence and continue caring for themselves after discharge.(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHowever, promoting women\u0026rsquo;s health assets will require workforce development and systems that support asset based care as a legitimate and valued component of women\u0026rsquo;s alcohol treatment.(\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) For example, healthcare workers may need training in asset-based approaches to AUD treatment that are women specific, and systems may need to be adapted to ensure they assess and promote the health assets of women. In terms of systems, it is both feasible and clinically meaningful to identify assets at treatment intake by incorporating health asset questions alongside existing tools. In the Australian context, information is gathered from patients using the Australian Treatment Outcomes Profile (ATOP), a 22 item substance use questionnaire which also captures social functioning, and the Kessler scale (K10) which measures psychological distress.(\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e) Additional measures to assess social networks or self-efficacy could be integrated to capture culturally and gender relevant health assets into assessment processes.(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) Furthermore, health professionals could be supported to ground care planning in identified health assets to enable treatment goals to be a collaborative and strengths affirming- process that develops women\u0026rsquo;s skills and self-confidence and promotes treatment engagement and commitment.(\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e) Referral practices can further mobilise protective and relational assets by linking women to peer support, mutual aid groups, and community based- resources, aligning with nursing literature, where asset based- models have been used to promote resilience and self-care.(\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eStrengths and limitations\u003c/p\u003e \u003cp\u003eThis study provides valuable insights into the individual and relational strengths women harness to access treatment for problematic alcohol use. It draws attention to women\u0026rsquo;s health assets, including those not typically described or evaluated using asset-based language. However, the study sample was small and drawn from women from a high-income area. It is not, therefore, representative of all women with AUD. Addition, this study includes women who received treatment, and it is unclear if women who chose not to access treatment have less health assets or whether they are less able to activate these. Future research should explore women\u0026rsquo;s health assets across a broader and more diverse group of women and include women who pursue and avoid AUD treatment. Furthermore, future research should examine the real-world implementation of asset-based frameworks of care and how these influence women\u0026rsquo;s treatment uptake and maximise engagement.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the multifaceted nature of health assets and their role in supporting women\u0026rsquo;s access to treatment for AUD. Women mobilized volitional strength by transforming despair into action, motivational strength through caregiving roles and concern for children, relational strength through supportive partners, and social networks, and protective strength through curiosity, optimism, and openness to learning. These finding demonstrate that women\u0026rsquo;s access to AUD treatment is facilitated by overlapping individual and social assets. By adopting an asset-based approach, healthcare providers can better understand and respond to the strengths and needs of women receiving AUD treatment, promoting equitable and effective careto improve health outcomes. Future research should explore how health assets are mobilised across diverse groups of women with AUD, including those who seek or do not seek care. Furthermore, research should examine the real-world implementation of health asset frameworks and to influence treatment uptake and maximise engagement.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthics approval: This study has been approved by the Northern Sydney Local Health District HREC, reference number: \u0026nbsp;2024/PIDO1516\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no funding.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contribution\u003c/p\u003e\n\u003cp\u003eMA collected, analyzed and interpreted the patient data regarding individual, social and community health assets. RV and AD supervised the study, reviewed and contributed to the analysis, and were major contributors to drafting and critically revising the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgment\u003c/p\u003e\n\u003cp\u003eThis study is part of a PhD research project by Melise Ammit, University of Technology Sydney.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research is supported by an Australian Government Research Training Program Scholarship.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO. Alcohol fact sheet. World Health Organization, 2024. https://www.who.int/news-room/fact-sheets/detail/alcohol. Accessed 13 Feb 2026.\u003c/li\u003e\n \u003cli\u003eOECD. Health at a Glance: OECD indicators, Organizaton for Economic Co-operation and Development, Paris. 2025. https://www.oecd.org/en/publications/2025/11/health-at-a-glance-2025_a894f72e.html. 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Am J Geriatr Psychiatry. 2013;21(7):596-606.\u003c/li\u003e\n \u003cli\u003eCassetti V, Powell K, Barnes A, Sanders T. How can asset-based approaches reduce inequalities? Exploring processes of change in England and Spain. Health promotion international. 2024;39(2).\u003c/li\u003e\n \u003cli\u003eMarshall K, Easton, C, . The role of asset-based approaches in community nursing. Primary Health Care,. 2018;28(5):35-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"addiction-science-and-clinical-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ascp","sideBox":"Learn more about [Addiction Science \u0026 Clinical Practice](https://ascpjournal.biomedcentral.com/)","snPcode":"13722","submissionUrl":"https://submission.nature.com/new-submission/13722/3","title":"Addiction Science \u0026 Clinical Practice","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Women, alcohol, health assets","lastPublishedDoi":"10.21203/rs.3.rs-9411828/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9411828/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eWomen with alcohol use disorders (AUD) can face barriers to alcohol use treatment, including deficit-focused services that often lack understanding of the specific needs and challenges of women. Asset-based approach to AUD treatment, which emphasizes the strengths and resources of service users, could enhance women’s treatment engagement and outcomes. However, to date, little is known about the strengths of women accessing alcohol treatment services.\u003c/p\u003e\n\u003cp\u003eDesign and Method\u003c/p\u003e\n\u003cp\u003eWe used a descriptive qualitative design to explore women’s experiences of accessing treatment for AUD and the health assets that they draw on. Semi-structured interviews were conducted with twelve participants to identify patterns across women’s narratives, with particular attention to strengths that enable health-seeking behavior and maintenance of treatment. A framework analysis was undertaken using Rotegåard and colleagues four dimensions of strength, including motivational, volitional, relational, and protective strengths.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eThe framework analysis made visible women’s key health assets that promoted treatment engagement, and are captured in four themes: \u0026nbsp;\u003cem\u003eVolitional strength: transforming despair into action,\u003c/em\u003e which shows how women’s experience of desperation and hopelessness could act as a catalyst for them to seek AUD treatment; \u003cem\u003eMotivational strength: mothering and change\u003c/em\u003e, which captures how women’s drive to initiate or maintain treatment could be influenced by crisis points in their caregiving role and concerns for children’s safety; \u003cem\u003eRelational strength: the value of supportive partners and networks, \u003c/em\u003ewhich describes the vital role of intimate partners and social connections in supporting women to pursue treatment; and \u003cem\u003eProtective strength: positive curiosity\u003c/em\u003e, describes individual attributes that facilitate women to seek and maintain treatment, including persistence, a positive outlook on life, a desire to promote personal health, and a sense of curiosity and openness to learning. Taken together, data show that women draw on a range of health assets to support them to pursue and maintain AUD treatment.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eThese findings contribute to evidence on the health assets of women accessing treatment for AUD and inform strengths-based approaches to alcohol treatment for women that could improve access, enhance care, and improve health outcomes for women.\u003c/p\u003e","manuscriptTitle":"Health assets of women seeking treatment for alcohol use disorders: A descriptive qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 12:45:39","doi":"10.21203/rs.3.rs-9411828/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"283448003676505382271884804547646843175","date":"2026-05-08T12:40:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T11:33:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-21T17:25:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-20T07:25:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Addiction Science \u0026 Clinical Practice","date":"2026-04-14T07:17:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"addiction-science-and-clinical-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ascp","sideBox":"Learn more about [Addiction Science \u0026 Clinical Practice](https://ascpjournal.biomedcentral.com/)","snPcode":"13722","submissionUrl":"https://submission.nature.com/new-submission/13722/3","title":"Addiction Science \u0026 Clinical Practice","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e4b261f-7859-4566-8188-632866fa54d8","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"283448003676505382271884804547646843175","date":"2026-05-08T12:40:16+00:00","index":14,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T12:45:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 12:45:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9411828","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9411828","identity":"rs-9411828","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}