Women and Alcohol: Special Risks A HELPGUIDE.ORG Educational Supplement from Harvard Health Publications

Men are more likely to drink alcohol than women—and to develop problems because of their drinking. Various studies have found that 15% to 20% of men and 8% to 10% of women will develop problems with alcohol over their lifetimes.

Yet women are much more vulnerable to alcohol’s harmful effects. Women tend to develop alcohol-related diseases and other consequences of drinking sooner than men, and after drinking smaller cumulative amounts of alcohol.

Several biological factors make women more vulnerable to the effects of alcohol. First, women tend to weigh less than men, and—pound for pound—a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, a woman’s organs sustain greater exposure.

In addition, women have lower levels of two enzymes—alcohol dehydrogenase and aldehyde dehydrogenase—that break down in the stomach and liver. As a result, women absorb more alcohol into the bloodstream.

These biological factors explain why women become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking smaller quantities and for fewer years than men. Some experts believe that women who drink even one alcoholic drink per day may be putting themselves at risk for health problems such as cancer, hypertension, stroke, and suicide. For pregnant women, no amount of alcohol is safe.

Women — and girls — are drinking more

According to the 2009 National Survey on Drug Use and Health, approximately 47% of women ages 12 and over in the United States reported being current drinkers, defined as having had a drink in the past 30 days.

Trends suggest that white, employed women are drinking greater amounts of alcohol and with greater frequency. Some of this increase may reflect a greater comfort on the part of women to discuss their drinking.

Social stigmas are starting to fade

Historically, getting drunk hasn’t held the same stigma for men as it has for women. This difference may be part of the reason that men are more likely to drink — and to binge. According to data from a nationwide survey of almost 18,000 college students, binge drinkers are likely to be male, members of fraternities, involved in athletics, and socially active.

Although about one in three female college students engages in binge drinking, compared with nearly one in every two male college students, college women are drinking more, and more often, than they did in the past.  Consider:

• The rate of binge drinking in all-female colleges more than doubled between 1993 and 2001.
• While more college men are dependent on alcohol, women constitute more than half of alcohol abusers among college students.

These trends are disturbing, given that binge drinking not only carries health risks for both men and women but also increases the chance of unwanted and unplanned sexual activity. Women risk becoming pregnant, and both men and women risk contracting a sexually transmitted disease.

It's easy to cross the line into risky drinking

For women in particular, there is a very fine line between healthful and harmful drinking—one that is easy to cross. While moderate drinking is defined as no more than seven drinks a week and no more than three on any given day, those levels aren’t set in stone. 

The amount a woman can safely drink depends on:

• her weight and health
• personal genetic makeup and family history
• the time since eating
• her age

Because women become addicted to alcohol more easily than men, drinking even moderately can be a slippery slope. This is especially true for older women.  In fact, about half of all cases of alcoholism in women begin after age 59.

Certainly, no one should feel obliged to start drinking for the health benefits. There are plenty of other ways to safeguard your health, such as regular exercise, a nutritious diet, keeping your weight under control, and not smoking. But if you enjoy alcoholic beverages, it’s important to know where to draw the line, and to be prepared to redraw it as you get older, especially if you are a woman.

Alcohol affects women in unique ways

A woman’s body processes alcohol more slowly than a man’s. One drink for a woman has about twice the effect of one for a man. Plus, women have a “telescoping,” or accelerated, course of alcohol dependence, meaning that they generally advance from their first drink to their first alcohol-related problem to the need for treatment more quickly than men.

Biology plays a role in alcohol sensitivity

Why is a woman more sensitive than a man to the effects of alcohol?  There are several reasons.

• Enzymes. Alcohol is metabolized (broken down) in the liver and stomach lining by an enzyme called alcohol dehydrogenase (ADH), which goes to work breaking down alcohol before it’s absorbed into the blood. Women have considerably less ADH in their stomach linings than men. Since women metabolize very little alcohol in their stomachs, more is left to be absorbed into their blood.
• Hormones. Changes in hormone levels during the menstrual cycle may also affect how a woman metabolizes alcohol.
• Body fat. Pound for pound, a woman’s body contains less water and more fatty tissue than a man’s. Water dilutes alcohol in the blood; fat retains it. So alcohol remains at higher concentrations for longer periods of time in a woman’s body, exposing her brain and other organs to more alcohol.

The increased absorption of alcohol through the stomach lining plus lower total body water, taken together, explain why women become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking less and for fewer years than men.

Sexual and physical abuse increases risk

Evidence suggests that sexual or physical abuse during childhood may predispose both men and women to alcohol and drug problems in adulthood. Since women are more likely to have been victims of childhood sexual abuse, they are disproportionately affected. Research shows that:

• Women who have been physically or sexually abused as children are far more likely to drink, have alcohol-related problems, or become dependent on alcohol.
• Physical abuse during adulthood, which is suffered more by women than men, seems to raise a woman’s risk of using and abusing alcohol.
• Alcohol is a major factor in violence against women, playing a role in as many as three of every four rapes and nearly the same percentage of domestic violence incidents.
• Women with a family history of alcohol abuse are more likely than men with the same background to abuse alcohol.

Alcohol abuse causes serious health consequences for women

Although alcohol use disorders are more prevalent among men than women, women’s vulnerability to becoming dependent is equivalent to men’s. Women who abuse alcohol are more likely to damage their health and well-being and to die as a result of their drinking.

Women who abuse or are dependent on alcohol are more vulnerable than men to:

• Liver disease. Women are more likely to contract alcoholic liver disease, such as hepatitis (an inflammation of the liver), and are more likely to die from liver cirrhosis (a chronic disease that progressively destroys the liver’s ability to aid in digestion and detoxification).
• Brain damage. Women are more likely than men to suffer alcohol-induced brain damage, such as loss of mental function and reduced brain size.

Compared with women who don’t drink or who drink in moderation, women who drink heavily also have an increased risk of:

• osteoporosis (a thinning of the bones)
• falls and hip fractures
• premature menopause
• infertility and miscarriages
• high blood pressure and heart disease

Drinking during pregnancy—Never a good idea

When a pregnant woman drinks, alcohol passes through the placenta to her fetus. In the fetus’s developing digestive system, alcohol breaks down much more slowly than it does in an adult body, meaning that the fetus’s blood alcohol level can remain high for longer periods.

Any kind of alcohol in any amount can harm a developing fetus, especially during the first and second trimester. Physicians and public health officials recommend that women avoid drinking any alcohol during pregnancy.

While the vast majority of women heed this advice, the 2009 National Survey on Drug Use and Health found that 10% of pregnant women reported drinking some alcohol, and 4.4% reported binge drinking.

Risks to offspring

Drinking alcohol during pregnancy can cause a constellation of physical and mental birth defects that together constitute the leading preventable cause of mental retardation in the United States.

The National Organization on Fetal Alcohol Syndrome estimates that each year in the United States, 40,000 babies — or one in every 100 — are born with fetal alcohol spectrum disorders (a term that encompasses fetal alcohol syndrome and several related disorders).

Babies with these problems usually:

• have a low birth weight
• have facial abnormalities, including smaller eye openings, flattened cheek bones, and an underdeveloped groove between the nose and the upper lip
• have problems eating and sleeping
• develop learning disabilities
• develop behavioral problems
• need special education
• need special medical care through much of their lives

Overcoming barriers to treatment and recovery

Men who abuse alcohol are more likely to enter alcohol-treatment programs, whereas women are inclined to seek help from primary care practitioners and mental health counselors.

Women with drinking problems:

• are particularly reluctant to be labeled alcoholics
• may tend to shy away from treatment programs specifically designed to deal with alcohol problems because of the social stigma about women drinking
• may be more likely to ascribe their problems to depression, anxiety, or family trouble

As a result, women may seek treatment in general medical or mental health settings. Even brief counseling in this type of setting has been shown to lower a woman’s use of alcohol by nearly one-third.

Women and men are equally capable of recovery

For a long time, professionals believed that women with substance use disorders were less likely than men to recover from them. Yet limited evidence on the matter was available, because many studies on the outcome of substance abuse treatment conducted before the 1990s enrolled only men. The few studies that enrolled both men and women did not examine the impact of gender differences.

The situation changed in the early 1990s after the FDA and the National Institutes of Health issued guidelines aimed at increasing the representation of women and minorities in research studies. A review in Drug and Alcohol Dependence found that women are equally able to recover as men. Still, women face some unique challenges.

Women may have difficulty gaining access to treatment

A number of studies conclude that women are less likely than men to enter treatment programs for substance abuse problems, including those involving alcohol. Although it remains unclear why this is so, particular barriers to treatment seem to affect women more often than men.  These include:

• Access to child care. Women with young children need access to appropriate child care services before they can undergo treatment. They may be concerned about losing custody of their children if they reveal that they have an alcohol problem.
• Economic challenges. Women are more likely to face economic challenges such as lower-paying jobs with little flexibility in scheduling or paid time off.
• Mental health disorders. Women are more likely than men to suffer from mood, anxiety, and eating disorders that may benefit from being treated at the same time as the substance abuse disorder. However, few substance abuse treatment programs provide adequate treatment of psychiatric disorders.

Adapted with permission from Alcohol Use and Abuse, a special health report published by Harvard Health Publications.