Alcohol and Women: Increased Use, Increased Harm

By Christopher Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers

Over the past century, women have worked tirelessly to level the playing field in our society. From securing the right to vote in the 1920s, to securing the right to apply for and receive credit and credit cards in the 1970s, to the rapid increase in women securing employment in upper and executive management in the business world through the 1980s and 90s, to a record number of women running for, winning, and holding public office in the 2000s, we’re finally getting a glimpse of what gender equity in the United States might look like.

That’s a good thing.

There’s one area of behavior, however, where women are drawing even with men and it’s not necessarily a sign of progress: alcohol consumption.

Typically, when I read a headline tag or teaser for a news article that says something like “data shows the gender gap is narrowing” I get interested, and read the article because I hope to find good news about gender equity in the U.S. In this case, though, the article I read, “Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States,” had the opposite effect. The narrowing gender gap they discussed was not something to cheer about.

Gender equity in alcohol consumption — from the data I can see — harms women rather than helps them.

That’s not a good thing.

I’m not saying I disapprove of women drinking. I’m saying men, for the most part, already drink too much, excessive alcohol consumption is a dangerous problem and damages individuals, families, and communities, and that the latest data on alcohol and women shows they’re not only drinking more than ever, but they’re also at greater risk of many of the negative emotional, psychological, and physical consequences of alcohol use.

Again, that’s not a good thing — and that’s why I’m concerned.

Alcohol and Gender: The Statistics

Before I hit you with a string of numbers, I want to make something clear.

People are not numbers.

The harm caused by alcohol is not theoretical.

Not to me, at least.

I’m a physician. I work in addiction treatment — so I see the harm caused by alcohol and drug addiction every day. I see it in my patients, and I do everything in my power to help them. But I have to tell you something else. Don’t worry — it’s not a confession. It’s a relevant fact: I’ve also seen and felt it in my personal life. The details of my experience with addiction — which include alcoholism, a.k.a. alcohol use disorder — are not important.

What is important is that I have first-hand, experiential knowledge of the pain, the harm, and the unnecessary suffering caused by alcohol use — and I want to play my part in warning everyone about this trend in alcohol consumption among women, so that they may help their friends, family members, and loved ones avoid the pain and suffering that I know are very real.

So, for me, this is personal.

Now, about those statistics.

This particular data set paints a broad picture, because the paper I mention above analyzed trends going back almost a hundred years, which is not common in my field. Data with this level of perspective helps my colleagues and I understand our work in the larger context, and offers us insight that we sometimes miss, when, for lack of a better phrase, we’re too busy focusing on the trees to see what’s happening with the forest.

Long-Term Trends: Gender and Alcohol Consumption in the U.S.

· Around 1900, men outnumbered women 3:1 across the following metrics:

o Prevalence of drinking

o Prevalence of problem drinking

o Experience of alcohol-related harm

· By 2000, the 3:1 difference all but disappeared:

o Prevalence of drinking: 1.1:1

o Prevalence of problem drinking: 1.2:1

o Experience of alcohol-related harm: 1.3:1

· Between 2001 and 2016, the gender gap in alcohol use narrowed further:

o Prevalence of drinking increased by 6% for women

o Prevalence of drinking decreased 0.2% for men

o Prevalence of binge drinking increased 14% for women

o Prevalence of binge drinking increased by 0.5% for men

While those trends are clear and unmistakable, we should still recognize that men drink more than women in the U.S., in general. Each year, men consume alcohol at a greater rate than women (68% compared to 64%) and men are diagnosed with alcohol use disorder at a greater rate than women (7% compared to 4%).

That brings us to the most concerning aspect of these statistics. It’s more concerning than the increased rates of alcohol use among women. The data show that despite the fact that women drink less than men, they experience greater alcohol related harm — even at their lower levels of consumption and exposure.

Gender Differences in Alcohol-Related Harm

The increased harm women experience due to alcohol occurs over both the short- and long-term. Studies show a range of short-term variations in the effect of drinking on women, compared to men. When drinking the same amount as men, they show:

· Higher blood alcohol levels

· Higher rates of impaired cognitive function

· Increased drowsiness

· Higher levels of intoxication (being drunk)

· Higher rates of alcohol-related injury

· Higher risk of sexual assault (as victim)

Long-term differences in the effect of alcohol consumption on women, compared to men, include increased risk of:

· Alcohol use disorder (AUD)

· Brain damage

· Depression

· Memory loss or impairment

· Cognitive decline

· Liver disease

· Cancer of the liver, breast, throat, and mouth

· Cardiovascular complication and heart disease

In addition to these harms, data on college women who binge drink show they experience more alcohol-related memory loss (blackouts) than their male peers — despite the fact they binge drink less frequently than their male peers. With regards to liver disease, women show a more rapid progression from initial diagnosis to fibrosis compared to men, and with regards to AUD, women show a more rapid progression from daily use to clinically disordered use when compared to men.

All this data gives us a simple message, which the authors of the paper I mention in the introduction to this article sum up well:

“Although men still account for more total alcohol consumption and the negative outcomes that follow, the gaps are slowly disappearing.”

Implications for Treatment and Prevention

Here’s one last factoid from the paper that’s particularly germane to the present moment:

“Females, in general, are more likely than males to drink to cope.”

It drives everything home because the latest data on alcohol consumption in the U.S., in general, shows that as a nation, one of our responses to COVID-19 and the associated restrictions — such as shelter-in-place orders, essential travel only, and working from home — has been to buy and drink alcohol at greater rates than any time in our history. Compared to the spring and summer of 2019, alcohol sales in the spring and summer of 2020 increased by over 250 percent, alcohol consumption among men increased 14 percent, alcohol consumption among women increased by 17 percent.

I apologize, I can’t stop giving you data. Yes, there’s more. Last bit, I promise. Compared to the spring and summer of 2019, women in the spring and summer of 2020 reported a 41 percent increase in days of heavy drinking, and a 39 percent increase in alcohol-related problems.

Okay, I’m done with the statistics.

I included those final numbers to point out that while we all face challenges during COVID-19, women are at increased risk of turning to alcohol due to pandemic stress. That’s not conjecture — that’s in the stats. When I integrate that information with the new data on long-term trends in drinking among women, and then form a comprehensive picture that includes the information on the increased physical, emotional, and psychological harms experience by women as the result of alcohol consumption, I see that I have work to do. It’s now critical that I recognize alcohol consumption poses a distinct set of health risks for women — and I must calibrate my diagnostic, preventive, and therapeutic strategies to account for these unique risks.

Let me rephrase that.

It’s critical for all of us to understand that in 2020, women are drinking more than ever before, and they’re also experiencing more harm from drinking — across all metrics — than ever before. Therefore, we must all recalibrate our diagnostic, preventive, and therapeutic strategies around women and alcohol.

Let me say that one last way.

Please help me look out for the women in our country who may be drinking too much, in danger of drinking too much, or are already experiencing the negative consequences of drinking too much. They’re in trouble — and we need to be there for them.