Many of us think of alcoholism as a predominantly male problem, but it’s an issue that is increasingly concerning for women too.
In this article, we’ll examine the rates of alcohol use amongst both sexes and look at how alcohol affects women differently.
We’ll also look at how alcohol specifically affects women’s health and lastly examine how women may benefit from specialist treatment for alcohol dependence or addiction.
Women and Alcohol Misuse Summary
- The sex ratio for risky drinking habits used to be 3-1 men to women and is now globally closer to 1-1
- Rates of alcohol consumption and binge drinking in women have increased at more than twice the general population rate
- Women typically have higher body fat and less of the enzymes required to metabolise alcohol, which means they are more susceptible to damage caused by alcohol
- As such women may experience the negative health consequences of drinking alcohol – like brain damage, blackouts and heart disease – sooner and at higher rates
- From childcare issues to financial insecurity, women face unique challenges in accessing the right treatment,
- Women are less likely to access specialist help for alcohol addiction, instead turning to primary care providers or mental health specialists
- Women would benefit from single-sex treatment where research has found they receive more care, are twice as likely to complete treatment and are more than two times less likely to relapse
Women are Drinking More
While historically men are more likely than women to be drinkers, and among those that drink, males are more likely to drink heavily than females, this sex gap in alcohol use is shifting. There is mounting evidence that alcohol intake, and binge drinking, are both increasing among women.
Research on Alcohol Consumption by Sex
The sex ratio for risky drinking habits used to be around 3-1 (men to women), but an analysis of multiple studies found that, globally, it is now closer to 1-1.
Further research, based on two nationally representative surveys conducted a decade apart in the US, found that the prevalence of binge drinking and Alcohol Use Disorder (AUD) increased at a much higher rate in women than in men.
A meta-analysis of six US surveys that took place between 2000 and 2016 found that rates of alcohol consumption and binge drinking in women increased by more than twice the general population rate. While overall women’s consumption of alcohol remained lower than men’s, the gap is narrowing.
Emergency Room Visits
A 2018 study looked at emergency department visits that resulted from acute or chronic alcohol consumption, such as alcohol-related liver damage, between 2006 and 2014. The study found an overall increase in alcohol-related emergency department visits of 61.6%, with the change in rates being greater for women (5.3%) than men (4%).
Hospital Inpatient Diagnosis
This is consistent with other research which found that alcohol-related hospital inpatient diagnosis of AUD in adults between 45 and 64 increased by 30% in men, but 90% in women.
Liver Disease Rates
Research shows that liver disease (which can be caused by chronic alcohol misuse) among 15-39-year-olds increased 90% in men and 240% in women between 1998 and 2012. And while the all-cause mortality rate in the US has declined from 2000 to 2015, the age-adjusted mortality rate from alcohol-related liver cirrhosis increased from 4.3 deaths per 100,000 to 5.8 deaths. Rates for white males increased 32.4%, whereas rates for white females increased 85%.
DUIs
Another way to measure the increase in women’s alcohol consumption is to look at driving under the influence. A nationally representative survey carried out by the National Highway Traffic Safety Administration found rates of driving while under the influence of alcohol have decreased dramatically since 1973.
In 1996 during the first survey, 4.8% of men and 2.9% of women tested positive for DUI. In 2014 the survey found that 1.4% of men and 1.7% of women tested positive. So while overall the rates for both sexes have gone down, more women than men were found driving under the influence in the more recent survey.
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The Harmful Effects of Alcohol Are More Rapid and Severe for Women
More women are drinking than before, but is that necessarily a problem? Well, like men, they are susceptible to the harmful effects associated with misusing alcohol, from blackouts to liver damage.
But what is even more concerning is that women are usually more susceptible to the damage caused by alcohol.
Considering the many documented sex differences, from sex hormones to neurochemistry, it’s not surprising that women and men metabolise alcohol differently. Here are just two of the main factors that contribute to this phenomenon.
Body Fat
Women usually weigh less than men and, in most cases, a woman’s body has more fat and less water compared with a man’s body. This is perfectly normal and there are a number of complex genetic, epigenetic, and hormonal reasons driving this. However, because fat retains alcohol and water dilutes it, alcohol remains in the body at higher levels over a longer period of time in a woman’s body compared to a man’s body. This means if both drink the same amount, she’ll likely experience the immediate effects of alcohol sooner, and her brain and other organs will ultimately be exposed to more alcohol.
Enzymes
There are two enzymes, alcohol dehydrogenase and aldehyde dehydrogenase, which help to break down alcohol in the stomach and liver. Research has found that men have significantly higher levels of both enzymes, which means women absorb more alcohol into their bloodstream.
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Women’s Health Risks for Alcohol Consumption
Women don’t just metabolise alcohol differently than men, but they also experience the symptoms and health risks associated with alcohol misuse differently too.
On the whole, women experience the harmful consequences of excessive drinking sooner, and while drinking less alcohol than men. Next, we’ll take a look at some of the specific health risks women face when consuming alcohol.
Worse alcohol withdrawal
Research has found that there is more damage and inflammation in a woman’s brain during alcohol withdrawal. The authors of this study write:
“These results indicate a fundamentally distinct neuroadaptive response in females compared to males during chronic ethanol withdrawal and are consistent with observations that female alcoholics may be more vulnerable than males to ethanol-induced brain damage associated with alcohol misuse”
Brain Damage
Research suggests that alcohol misuse can result in brain damage more quickly in women compared with men. There is also mounting evidence that suggests alcohol misuse can get in the way of normal brain development during teenage years, with sex-based differences observed. One study found that teenage girls who binge drank showed less brain activity and performed worse on memory tests than teenage boys who also binge drank (along with teenagers who drank lightly or not at all).
Blackouts
Blackouts are brief periods of amnesia. Excessive alcohol consumption can cause these memory gaps, as the alcohol interferes with the person’s memory consolidation process (the ability to move the memory from short-term to long-term storage). Some research has found that women may be more susceptible to alcohol-related blackouts compared to men.
Breast Cancer
Research has found a link between drinking alcohol and developing breast cancer. One review of the current research literature concluded:
“All levels of evidence showed a risk relationship between alcohol consumption and the risk of breast cancer, even at low levels of consumption. Due to this strong relationship, and to the amount of alcohol consumed globally, the incidence of and mortality from alcohol-attributable breast cancer is large.”
According to further research, the association between alcohol consumption and breast cancer is believed to be driven by hormones, so alcohol use may be more linked to hormonally sensitive breast cancers.
Liver Damage
Research has found women who regularly abuse alcohol are more likely to develop alcoholic hepatitis (a liver condition which can be fatal) compared with men who consume the same amount of alcohol.
A recent study of people with alcohol dependence admitted to a detox program found higher elevations in liver injury markers among women, compared with men. This was despite the fact they have been drinking heavily for a shorter period of time and consumed a lower mean number of drinks each day.
Heart Disease
Abusing alcohol over the long term is a risk factor for developing heart disease. Even though women consume less alcohol over their lifetime compared to men, research has found they remain more susceptible to alcohol-related heart disease than men.
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Foetal Alcohol Spectrum Disorders
Another sex difference between men and women is the ability to get pregnant and carry a baby, and this too can be affected by alcohol consumption. Drinking during pregnancy can be harmful and as such the NHS advises:
“Experts are still unsure exactly how much – if any – alcohol is completely safe for you to have while you’re pregnant, so the safest approach is not to drink at all while you’re expecting.”
Alcohol drunk while pregnant passes through the blood and into the placenta to the baby. This can cause a range of physical, cognitive and behavioural problems in children.
Drinking while pregnant could also cause foetal alcohol spectrum disorder (FASD) and can cause irreversible brain damage. The World Health Organization estimates around 1 in 100 babies are both with alcohol-related damage.
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Getting the Right Help
Women and men who abuse alcohol also differ in how they access help. Women are less likely than men to seek specific help for their drinking problems, contacting primary care providers and mental health professionals rather than alcohol-specific treatment options.
Results from the 2015 National Survey on Drug Use and Health suggested that of those diagnosed with AUD in the previous year, 7.4% of men and 5.4% of women received treatment. This means that women struggling with alcohol misuse problems could be underrepresented in specialist treatment programs, and this is despite the fact they typically have a shorter time frame between the onset of problem drinking and the requirement for treatment.
According to Harvard Health Publications and Help Guide, an independent nonprofit focused on mental health, women with drinking problems do not want to be labelled “alcoholic”, and are more likely to say their problems are caused by mental health or family issues and tend to avoid specific treatment because of the social stigma and shame associated with women having a drinking problem. Yet getting the right help is key to their recovery.
Women Are Just as Capable of Recovery
According to the aforementioned report, it was believed that women with substance misuse or addiction were less capable of recovery than men, yet a review in Drug and Alcohol Dependence found no difference in recovery ability between men and women.
The initial discrepancy may be because there was little in the way of research on alcoholism and women, as relevant studies carried out before the 1990s only enrolled men and those few which did include women didn’t look at any sex-based differences. This changed in the 90s when the National Institutes of Health set about increasing the representation of women in research.
Barriers to Accessing Help
Despite their equal ability to recover from alcohol misuse, women do face some unique challenges including:
- Financial restraints: According to the Institute for Fiscal Studies, “the average working-age woman in the UK earned 40% less than her male counterpart in 2019”. Having less money has a multifaceted impact on getting better; from affording treatment to having less flexible work and being unable to take time off.
- More unpaid care work: Globally, women spend two to ten times more time on unpaid care work than men. While this work – which includes childcare and caring for elderly relatives – is valuable, it means more responsibilities and less flexibility.
- Access to childcare: Women are more likely to be the primary caregiver, so childcare (which can be complex and unaffordable in ordinary circumstances) would need to be in place before they can access treatment. Women accessing treatment may also be further complicated by pregnancy or worries about child custody.
Women Benefit From Different Treatment
Research has found that although women and men have the same outcomes in standard mixed-sex alcohol treatment programs, specialised treatment in women-only settings, or treatments that target issues relevant specifically to women, may improve outcomes for women with alcohol use disorder.
It has proved an especially beneficial option for women who are pregnant, affected by trauma or experiencing comorbid psychiatric conditions. Along with providing a woman-only setting for treatment, women also benefit from wrap-around services like childcare, assertiveness training and family planning.
There is plenty of research and studies which have found that women at women-only treatment centres on average spent more time receiving care, were more than twice as likely to complete treatment and were over two times less likely to relapse, compared with women receiving mixed-sex treatment.
Further research found that women and men may also benefit from managing their ongoing recovery and sobriety differently too. For example, relapse triggers seem to vary between the sexes with women more likely to start drinking again in response to interpersonal conflict, whereas men are more likely to relapse in response to isolation.
Likewise, although being married appears to protect men against relapse, it can be a trigger for relapse for women. Another sex difference in avoiding relapse is support outside of marriage. Women benefit from having at least one close friend to discuss their drinking issues with.
Where to Go From Here
If you are a woman experiencing issues with alcohol, it’s important to realise that you’re not alone, there is help available and a full recovery is possible.
If you’d like to talk through any concerns or worries either about yourself or a loved one, you can call our 24-hour helpline for free, confidential advice from one of our specialists: 01721 546 263.
