Women and Alcoholism
No longer affecting men only, alcoholism today is an equal opportunity disease. But women and alcoholism are, in many ways, much different than their male counterparts. Researchers across the spectrum of alcohol prevention, treatment, education and outreach continue to study alcohol’s effects on women, whether different treatment protocols should be utilized, the effects of genetics and family history, and physiological, psychological and social differences.
When the Shift Occurred
A large research study of women born after World War II conducted by the University of Washington, led researchers to conclude that cultural changes paved the way for the increase in the number of women with alcohol dependence. These changes included:
• It was more socially acceptable for women to drink
• Women entered the workforce in greater numbers
• More women attended college
• Gender stereotypes were less restricting on women
• Purchasing power of women increased
Definition of Alcoholism
According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), alcoholism, or alcohol dependence, “is a disease that includes the following four symptoms:
• Craving – a strong need or urge to drink
• Loss of control – not being able to stop drinking once drinking has begun
• Physical dependence – withdrawal symptoms, such as nausea, sweating, shakiness and anxiety after drinking stopping drinking
• Tolerance – the need to drink greater amounts of alcohol to get ‘high’”
How Big is the Problem?
Of an estimated 15.1 million alcohol dependent or alcohol abusers in the U.S., approximately 4.6 million (about one-third) are women. Alcohol: A Women’s Health Issue, from the National Institute on Alcohol and Alcoholism (NIAAA), estimates that 5.3 million American women drink in a way that “threatens their health, safety and general well-being.” Black women are more likely to abstain from alcohol than white women, but although there are an equal proportion of black and white women who are heavy drinkers, black women have fewer alcohol-related personal and social problems, yet a greater proportion of black women experience alcohol-related health problems.
While Hispanic women are infrequent drinkers or abstainers, as they enter work/social arenas, this may change. Moderate or heavy drinking is increasing among younger, American-born Hispanic women.
Women Drink Differently than Men
Generally, women who drink consume less alcohol and have fewer alcohol dependency symptoms than man, but among the heaviest drinkers, women equal or surpass men in the number of drinking-related problems.
Studies have shown that the time period between the onset of alcohol-related problems and entry into treatment for alcohol dependency or alcoholism is shorter for women than for men. Women also experience greater physiological impairment than men earlier in their careers, even though they consume less alcohol than men. Consequences associated with heavy drinking may also be accelerated in women.
Other research shows that women’s drinking tends to resemble that of their husbands, siblings and close friends. Younger women, aged 18 to 34, have increased risks of alcohol-related problems than older women. Middle-aged women, aged 35 to 39, however, have higher incidences of alcohol dependence.
Researchers have also found that role deprivation (losing the role of a wife, mother or loss of employment) may increase women’s risk for abusing alcohol.
Depression, according to the NIAAA, is closely linked with alcoholism or heavy drinking in women. Drinking alone or at home puts women at greater risk of developing later drinking problems.
How Alcohol Affects Women’s Bodies
Differences in body weight and fluid content between men and women account for some of the differences in how alcohol affects the body. Alcohol and alcohol abuse have serious physical consequences for women as well. Some specific health risks for women include the following:
• Women are more likely than men to develop alcoholic hepatitis (inflammation of the liver) and to die from cirrhosis than men. Estrogen and alcohol combined may increase the risk of liver damage.
• Menstrual difficulties have been shown to be associated with heavy drinking, and may affect fertility as well as contribute to early menopause.
• Research suggests that women may be more vulnerable to alcohol-induced brain damage than men. This damage includes brain shrinkage in women, memory loss and learning difficulties.
• Heavy drinking increases the risk of breast cancer. A study by the Journal of the American Medical Association reported that women who drink 2 to 5 alcoholic drinks daily are 41 percent more likely to develop breast cancer. In addition, alcohol is linked to cancers of the neck, head and digestive tract (although not limited to women), and is more pronounced among those who also smoke.
• Even though women consume less alcohol than men over a lifetime, they are more susceptible to alcohol-related heart disease. Heavy drinking (chronic) is a leading cause of cardiovascular disease.
• Pregnant women who drink are at greater risk of delivering babies born with fetal alcohol syndrome (FAS), characterized by abnormal facial features and severe learning disabilities.
• Alcoholism is also linked to dementia, and women may be particularly at risk.
• In the late stages of alcoholism, according to the Centers for Disease Control (CDC), women develop hypertension, malnutrition and anemia much faster than men.
• Aging appears to reduce the body’s ability to adapt to alcohol. Alcohol problems among older people are often mistaken for age-related conditions, with the effect of alcohol problems being missed or left untreated, especially among older women.
Alcohol increases a woman’s risk of becoming a victim of domestic violence and sexual assault and of developing other serious diseases such as osteoporosis and pancreatitis.
Why Women Drink
Some of the reasons why women drink are the same as for men: stress, overwork, anxiety, and depression, striving to fit in, relax or overcome inhibitions. But, according to the book “Women Under the Influence”, the result of 10 years of research by the National Center on Addiction and Substance Abuse (CASA) at Columbia University (funded by Bristol-Myers Squibb and published in 2006 by The Johns Hopkins University Press):
• Women in substance abuse treatment are five times more likely than men (69 percent vs. 12 percent) to have been sexually abused as children. And girls are more likely than men to suffer eating disorders. Both sexual abuse and eating disorders are seen as contributing factors for substance abuse.
• Women, more than men, said they started drinking heavily following a crisis, such as divorce, unemployment, miscarriage or a child leaving home.
• Older women are more likely than men to self-medicate with alcohol and/or prescription drugs to deal with the loss of a spouse, financial difficulties or loneliness.
Women and Treatment for Alcoholism
Statistics from the National Institute on Alcohol Abuse and Prevention (NIAAA) show that women represent 25.4 percent of alcohol clients in U.S. treatment centers (versus 75 percent of men). Women often pursue non-traditional alcoholism treatment, instead preferring to see their personal physician or utilize psychiatric services.
Among the barriers to women seeking treatment for alcoholism, the most frequently cited is the lack of child care. Limited financial resources, not having access to employer-paid alcoholism treatment, stigma, and fear are other barriers.
Interestingly, treatment outcomes are better for women at facilities with a smaller proportion of female clients, while they are better for men at facilities with greater proportion of female clients.
Women Overcome Addiction Differently
The Center for Substance Abuse Prevention (CSAP) says that approximately 2.7 million American women abuse alcohol or are dependent on alcohol. This is one quarter of all abusers.
Following an 18-month study conducted in 2008 by a Canadian non-profit agency, researchers found that:
• While children are important, if women don’t recover for themselves, they usually relapse.
• There is no real “turning point” prior to seeking treatment. Women reported their recovery was a slow process.
• What they needed was to discover their real selves. It was not a matter of changing their identity from “addict” to “ex-addict.” For these study women, using drugs and/or alcohol was an activity, not their assumed identity.
• Half of the women went to Alcoholics Anonymous, while half overcame their addiction on their own.
• All the women in the study replaced their addiction with another life passion. This may have been physical exercise, volunteering, work, school or mentoring other women in recovery.
• Most of the study women began using drugs and alcohol in their early 20s.
• Most reported a family member who was also an addict.
• These incidences contributed to low self-esteem.
• Researchers also found a strong link between domestic violence and substance abuse.
Media Coverage of Women and Alcoholism
While tragic, it has not been uncommon for media to routinely report alcohol-related vehicular crashes, homicides, suicides and accidental deaths. For many years, however, this seemed relegated more toward males than females, since more men traditionally drank than women. But, as stated earlier, women have caught up to the men when it comes to use and abuse of alcohol – with predictable consequences.
Consider the headlines recently of the New York woman who was, according to toxicology reports, drunk and stoned on marijuana in late July 2009 when the minivan she was driving the wrong way on the Taconic State Parkway slammed head-on into another vehicle, triggering a three-car crash. Eight people were killed in the incident, including the woman, her daughter, three of her nieces, and three men. Her husband, who was not in the vehicle, said he had never seen his wife drunk, although he reportedly told police she occasionally smoked marijuana.
A recent report issued by the National Highway Traffic Safety Administration (NHTSA) points to a disturbing trend: the number of women arrested for drunk driving is on the rise. The agency calls the problem a national public health and safety issue, confirming Federal Bureau of Investigation figures that women arrested for driving under the influence (DUI) increased by nearly 30 percent from 1998 to 2007. During the same 10-year period, the number of men arrested for DUI decreased 7.5 percent.
According to a press release issued by the Governors Highway Safety Association (GHSA), state data backs up this trend in certain states. In California, nearly 19 percent of all 2007 arrests for DUI were of women, compared with 14 percent in 1998. New Mexico, Missouri, New Jersey and Vermont reported similar statistics. States stepped up campaigns targeting media messages to women, including New Mexico’s recently-conducted campaign, “Women Drive Drunk, Too.”
Women and Alcoholism – A Growing Problem
Clearly, the issue and frequency of women and alcoholism is becoming more prevalent in the U.S., and much more research needs to be done to address the complex and varied causes, mitigating factors, potential new treatment methods and protocols, education and public awareness.
The NIAAA supports about 90 percent of all research in this country on alcohol use and its effects. According to the NIAAA, finding out why some women drink too much is the first step in preventing problems with alcohol in women. Other areas of scientific study include the role of genetics and family environment, the type of job the woman has, whether she combines work and family, life changes such as divorce, marriage, birth of children or children leaving home, ethnic background, infertility, and sexual and relationship problems.
Researchers hope to learn how to identify women that may be at risk for problems with alcohol and to find new and more effective ways of treatint women with alcoholism.