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Much of our knowledge of alcoholism has been gathered from studies
conducted with a predominance of male subjects. Recent studies involving
more female subjects reveal that drinking differs between men and women.
Men Drink More Than Women
Studies in the general population indicate that fewer women than men
drink. It is estimated that of the 15.1 million alcohol-abusing or
alcohol-dependent individuals in the United States, approximately 4.6
million (nearly one-third) are women. On the whole, women who drink
consume less alcohol and have fewer alcohol-related problems and
dependence symptoms than men, yet among the heaviest drinkers, women
equal or surpass men in the number of problems that result from their
drinking.
Alcohol Problems Increase With Age
Drinking behavior differs with the age, life role, and marital status
of women. Whereas younger women (aged 18-34) report higher rates of
drinking-related problems than do older women, the incidence of alcohol
dependence is greater among middle-aged women (aged 35-49).
Marital Status Affects Alcoholism
Heath and colleagues studied drinking behavior among a select sample
of female twins to identify possible environmental factors that may
modulate drinking behavior. They reported that, among women, marital
status appears to modify the effects drinking habits.
Alcoholism Not Much Different Among Races
Several researchers have explored whether drinking patterns and
alcohol-related problems vary among women of different racial or ethnic
groups. Black women (46 percent) are more likely to abstain from alcohol
than white women (34 percent). Further, although it is commonly assumed
that a larger proportion of black women drink heavily, researchers have
disproved this assumption: Equal proportions of black and white women
drink heavily. Black women report fewer alcohol-related personal and
social problems than white women, yet a greater proportion of black
women experience alcohol-related health problems.
Data from self-report surveys suggest that Hispanic women are
infrequent drinkers or abstainers, but this may change as they enter new
social and work arenas. Gilbert found that reports of abstention are
greater among Hispanic women who have immigrated to the United States;
reports of moderate or heavy drinking are greater among younger,
American-born Hispanic women.
Women Seek Treatment for Alcoholism Sooner
The interval between onset of drinking-related problems and entry
into treatment appears to be shorter for women than for men. Moreover,
studies of women alcoholics in treatment suggest that they often
experience greater physiological impairment earlier in their drinking
careers, despite having consumed less alcohol than men. These findings
suggest that the development of consequences associated with heavy
drinking may be accelerated or "telescoped" in women.
Alcohol Affects Women More Quickly Than Men
In addition to these many psychosocial and epidemiological
differences, the sexes also experience different physiological effects
of alcohol. Women become intoxicated after drinking smaller quantities
of alcohol than are needed to produce intoxication in men. Three
possible mechanisms may explain this response.
First, women have lower total body water content than men of
comparable size. After alcohol is consumed, it diffuses uniformly into
all body water, both inside and outside cells. Because of their smaller
quantity of body water, women achieve higher concentrations of alcohol
in their blood than men after drinking equivalent amounts of alcohol.
More simply, blood alcohol concentration in women may be likened to the
result of dropping the same quantity of alcohol into a smaller pail of
water.
Third, fluctuations in gonadal hormone levels during the menstrual
cycle may affect the rate of alcohol metabolism, making a woman more
susceptible to elevated blood alcohol concentrations at different points
in the cycle. Research findings to date, however, have been
inconsistent.
Liver Damage from Alcohol Abuse Greater in Women
Chronic alcohol abuse exacts a greater physical toll on women than on
men. Female alcoholics have death rates 50 to 100 percent higher than
those of male alcoholics. Further, a greater percentage of female
alcoholics die from suicides, alcohol-related accidents, circulatory
disorders, and cirrhosis of the liver.
Increasing evidence suggests that the detrimental effects of alcohol
on the liver are more severe for women than for men. Women develop
alcoholic liver disease, particularly alcoholic cirrhosis and hepatitis,
after a comparatively shorter period of heavy drinking and at a lower
level of daily drinking than men. Proportionately more alcoholic women
die from cirrhosis than do alcoholic men.
The exact mechanisms that underlie women's heightened vulnerability
to alcohol-induced liver damage are unclear. Differences in body weight
and fluid content between men and women may be contributing factors. In
addition, Johnson and Williams suggested that the combined effect of
estrogens and alcohol may augment liver damage. Finally, alcoholic women
may be more susceptible to liver damage because of the diminished
activity of gastric alcohol dehydrogenase in first-pass metabolism.
Alcohol Abuse Increases Breast Cancer Rates
Drinking also may be associated with an increased risk for breast
cancer. After reviewing epidemiological data on alcohol consumption and
the incidence of breast cancer, Longnecker and colleagues reported that
risk increases when a woman consumes 1 ounce or more of absolute alcohol
daily. Increased risk appears to be related directly to the effects of
alcohol. Moreover, risk for breast cancer and lower levels of alcohol
consumption are weakly associated. Data from other studies, however, do
not concur with these findings, suggesting that more research is needed
to explore the relationship between drinking and breast cancer.
Alcohol Abuse Increases Menstrual Problems
Menstrual disorders (e.g., painful menstruation, heavy flow,
premenstrual discomfort, and irregular or absent cycles) have been
associated with chronic heavy drinking. These disorders can have adverse
effects on fertility. Further, continued drinking may lead to early
menopause.
Animal studies have provided data that replicate the findings of
studies in humans to determine the effects of chronic alcohol
consumption on female reproductive function. Studies in rodents and
monkeys demonstrated that prolonged alcohol exposure disrupts estrus
regularity and increases the incidence of ovulatory failure
Researchers have begun to examine whether women and men require
distinct treatment approaches. It has been suggested that women
alcoholics may encounter different conditions that facilitate or
discourage their entry into treatment.
Alcoholism Treatment Statistics Reveal Differences
Women represent 25.4 percent of alcoholism clients in traditional
treatment centers in the United States. Although it appears that they
comprise a small proportion of the treatment population (25 percent
women compared with 75 percent men), the proportion of female alcoholics
to male alcoholics in treatment is similar to the proportion of all
female alcoholics to male alcoholics (30 percent women to 70 percent
men).
Women alcoholics may encounter motivators and barriers to seeking
treatment that differ from those encountered by men. Fewer women than
men reach treatment through the criminal justice system or through
employee assistance programs. Lack of child care is one of the most
frequently reported barriers to treatment for alcoholic women.
Sokolow and colleagues attempted to compare treatment outcome between
men and women and reported that, among those who completed treatment,
abstinence was slightly higher among women than among men. Women had a
higher abstinence rate if treated in a medically oriented alcoholism
facility, whereas the abstinence rate was higher for men treated in a
peer group-oriented facility.
Treatment outcome was better for women treated in a facility with a
smaller proportion of female clients and better for men in a facility
with a larger proportion of female clients. This study provided
preliminary data on gender-specific treatment outcome; however, the
trials were not controlled. Although the question of whether women
should have separate treatment opportunities is an important one, the
supporting evidence still has not been found.
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