What do we Know about Women and Alcohol?

Anna (name and history are fabricated, but typical of women treated in an outpatient program for alcohol use problems) is a 43 year old school teacher.  She is married to a successful attorney and has two children.

The eldest child left home two years ago to attend college in a different state.   The younger child is 15 and has been coming home later than curfew; Anna suspects he may be smoking marijuana.  Peter, her husband, spends most of his time at work, and likes to spend his spare time golfing and traveling with the family.

Anna began drinking 1 or 2 glasses of wine in the evening when she was in her early 30’s, after dinner and after the kids were in bed. She and her husband would relax together and have a nightcap.  As Peter became more and more involved with his work and as the kids grew up and spent more time out of the home, Anna’s nightcaps started earlier and earlier. Gradually Anna developed a habit of opening a bottle of wine at 5:00 as she prepared dinner and continuing to sip wine until she went to bed at 11 each night.  By the time she was 41 she found herself drinking up to a bottle of wine each evening. One day she felt her side aching after having a few drinks at a party, and her doctor referred her for assessment of her drinking habits. Anna realized that her drinking had become too important in her life. She cited daily drinking, sometimes not remembering parts of the evening before, hangovers, and a pre-occupation with controlling her alcohol intake as major concerns. In addition, her youngest son had given her a wake-up call: When she asked if he was smoking marijuana one night, he replied, “Aren’t you drunk every night Mom? What’s the difference?”    

What you should know about females and alcohol use

Historically, more information has been available about male alcohol misuse than about females and alcohol use, due to years of primarily male research samples used by researchers.  Only in the last 15 years, have women routinely been included in research on alcohol use disorders. In this time, we have learned a great deal about female alcohol use problems. For instance, a woman reaches a higher blood alcohol content than a male of similar weight who has consumed the same amount of alcohol over the same time period.  This is because women metabolize alcohol less efficiently than men do. Women who drink regularly are at greater risk for a host of health problems such as liver, cardiovascular, and brain damage as well as cancer. Rates of depression, anxiety, post-traumatic stress, and eating disorders, are alarmingly high among women with alcohol use disorders.  Women tend to drink in response to negative emotions – and interpersonal triggers, also alone, and at home. Drinking problems also puts women at higher risk for violence – both as perpetrator and victim.

How much is too much?  

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for “at risk” drinking among women under age 60 are: more than 3 standard drinks on any day or 7 per week for women.  For women over age 60, more than 1 standard drink per day is considered risky drinking.  A standard drink is probably less than you think: one standard drink of wine, for instance, is five ounces– about half of a small Styrofoam coffee cup. One bottle of wine equals five standard drinks.  Many women don’t realize that they are drinking more than is healthy because many of their friends and family drink the same amount or more. This is because people who drink tend to socialize with other drinkers.  In reality, most of the alcohol in this country is consumed by a relatively small percentage of people, and in fact, 40% of adult women in the U.S. don’t drink at all.

What treatments for cutting back on alcohol have proven most effective for women?  

Women-only  treatments that address both the alcohol problems and other common co-occurring problems such as depression, anxiety, or post-traumatic stress disorder,  treatments that include medications, if indicated, and treatments that address specific issues and concerns of women have been found so far to be effective for women. Very effective are treatments that include cognitive behavioral coping strategies to stop or reduce drinking and also address anxiety and depression.   In general, women prefer either seeing a therapist individually, or participating in a single-gender (women only) group therapy for alcohol use disorder compared to mixed gender groups, however, single gender therapy works only when it includes female-specific programming. Couple therapy for women with alcohol use disorder is also effective; the spouse or partner need not attend every session as a mix of individual and couple therapy is also effective.   There are a few researchers around the world who are developing female-specific treatments for alcohol dependent women, and the interest in treatment for female alcohol use is growing.