Women and the Dangers of Drinking

Lauren Cronin, National Center for Health Research

Men drink more alcohol than women, but women who drink are at a much higher risk for alcohol-related problems. Short-term problems from excessive drinking can include amnesia, coma, and alcohol poisoning. In the long run, alcohol abuse can lead to an increased risk of heart disease, liver disease, stroke, and various cancers [1]. For many of these alcohol-related problems, women who drink progress to the more serious stages of these diseases more quickly and may be more likely to die from them.

Experts estimate that 5.3 million women in the United States suffer from alcohol use disorder (AUD) [2]. This is the term that psychiatrists have decided to use instead of “alcoholism,” or “binge drinking” and is included in their diagnostic manual (DSM-V) from 2013 [3]. AUD is defined to include a relatively wide range of alcohol use and abuse problems that include but are not limited to alcoholism and binge drinking. People with AUD may drink excessively, suffer from withdrawal symptoms, be dependent on alcohol, and experience negative life effects from an inability to stop drinking [4]. Here’s what you need to know

The Effects of Abusing Alcohol

You may already know that alcohol affects women differently than men due to differences in body weight and composition. As a result of these differences, women absorb alcohol more quickly — immediately after each drink, a woman’s blood alcohol content rises much faster. Alcohol is distributed through the body in water and since women have less water in their bodies than men, alcohol is more concentrated as it moves through a woman’s bloodstream [5].

It also takes longer for a female to metabolize (break down) alcohol, so the effects last much longer. Even after drinking equal amounts, it will take longer for a woman to remove all alcohol from her body. Since it takes longer for women to break down alcohol, vital organs such as the brain, liver, and heart are more likely to be damaged [5].

Binge drinking is defined as drinking enough to reach a blood alcohol content of .08. In the average woman, this takes 4 or more drinks within 2 hours while it takes 5 or more drinks within 2 hours for the average man [2]. The National Survey of Drug Use and Health indicates that almost 40% of college students report binge drinking in the last month [2]. You can learn more about binge drinking in teen and young adults here.

Heavy drinking is different from binge drinking. In women, heavy drinking is defined as 8 or more drinks per week. For men, this means 15 or more drinks per week. Experts believe that it is safe for most men to consume up to two drinks per day but women can safely consume only one drink per day [6].

The fact that many alcohol-related health problems progress faster in women who abuse alcohol, even when they drink at lower levels than men, is known as telescoping [5]. In fact, women with severe alcohol use disorder (AUD) only drink 60% as much as men with the disorder, but suffer greater damage to their vital organs. For example, women who drink the same amount as men are more likely to get alcoholic hepatitis (liver inflammation) and heart disease [7].

Women are Changing How Much They Drink

Women’s drinking patterns have been changing rapidly over the past century. Women are drinking more often and at higher concentrations. They are also drinking earlier and later in life.

During the 20th century, the difference between the level of alcohol that men and women consumed became much smaller. In three out of four studies that noted this change, the narrowing of the gap was due to increased drinking by women, not decreased drinking by men. In the early 1900s, men were 2.2 times more likely to consume alcohol than women and 3.6 times as likely to be harmed by alcohol-related causes. By the end of the 1900s, men were only 1.1 times more likely to drink alcohol than women and 1.3 times more likely to be harmed by alcohol related causes [8].

For many years, the impact of drinking during pregnancy was not known. Now, research shows that alcohol can harm a fetus during pregnancy. Experts warn that no amount of alcoholic beverages during pregnancy is guaranteed to be safe. Heavy drinking is most dangerous, however, and can lead to a variety of birth defects including fetal alcohol disorder [9]. You can see the results of fetal alcohol syndrome here. A recent CDC study suggests that women who are pregnant drink at lower levels and binge drink less often than women who are not pregnant. However, among women who binge drink, those who are pregnant binge drink more often and at higher levels than those who are not [10].

Treatment

The needs of women who abuse alcohol differ from those of men. A major concern for many women is that seeking treatment will interfere with their ability to care for their children, and they could even lose custody of their children if they admit to having a drinking problem [5]. Additionally, women are more likely to be on Medicaid than men, which indicates that many do not have the financial resources needed for treatment [11].

Can screening for alcohol abuse help? Doctors often ask about alcohol use, but they don’t probe further if the patients respond that they do not drink excessively. One screening strategy that appears to be useful for women is the TWEAK method, which assigns points based on risky drinking behaviors. The categorizations and point assignment are on the table below.

If you scored two points or more, you may be a risky drinker [12].

Treatment options include counseling and behavioral treatments, medications, and support groups such as Alcoholics Anonymous [4]. When dealing with group counseling sessions and support groups, women have more success in women-only programs [5]. There is also evidence that couples therapy is more effective than individual therapy. Using medications to control alcohol consumption is equally effective for men and women. However, women experience more side effects, such as nausea, than men do when taking these medications [4]. For more information on how to receive treatment for alcohol abuse disorder, visit https://pubs.niaaa.nih.gov/publications/AA81/AA81.htm.

Next time you go to a bar or a liquor store, keep the risks of alcohol in mind. All women – regardless of size — need to remember that less alcohol could affect you more severely than it would a man. The good news is that treatment programs are now tailored to women as well as men.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Centers for Disease Control and Prevention. Fact Sheets – Alcohol Use and Your Health. 2016. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm. Accessed August 9, 2017.
  2. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/
  3. National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5. 2016. https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf
  4. Mayo Clinic. (2015). Diseases and condition: Alcohol use disorder. Retrieved August 10, 2017.
  5. Tuchman, E. (2010). Women and addiction: The importance of gender issues in substance abuse research. Journal of Addictive Diseases, 29(2), 127-138.Tuchman, E. (2010). Women and addiction: The importance of gender issues in substance abuse research. Journal of Addictive Diseases, 29(2), 127-138.
  6. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
  7. National Institute on Alcohol Abuse and Alcoholism. Women and Alcohol. 2015. https://pubs.niaaa.nih.gov/publications/womensfact/womensfact.htm. Accessed August 11, 2017
  8. Slade T, Chapman C, Swift W, et al Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression BMJ Open 2016;6:e011827. doi: 10.1136/bmjopen-2016-011827
  9. Center for Disease Control. (2013). Binge drinking: A serious, under-recognized problem among women and girls
  10. Tan, C., Denny, C., Cheal, N., Sniezek, J., & Kanny, D. (2015). Alcohol use and binge drinking among women of childbearing age in the united states, 2011-2013. Morbidity and Mortality Weekly Report, 64(37), 1042-1046.
  11. Kaiser Family Foundation. (2011). Medicaid enrollment by gender. Retrieved August, 9, 2017, from http://www.kff.org/medicaid/state-indicator/medicaid-enrollment-by-gender/?currentTimeframe=0&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7
  12. National Institute on Alcohol Abuse and Alcoholism. (2012). Tweak. In J. Allen, & V. Wilson (Eds.), Assessing alcohol problems: A guide for clinicians and researchers (Second ed., pp. 649-651)