Women and Alcoholism

PiNK 2019 Spring pp.18-19

The child of two alcoholics, Dawn King was never a big drinker. For years she and her hus­band would enjoy an occasional glass of wine, but alcohol just didn’t figure largely into their lives. Then several years ago, stress started creeping into Dawn’s life — and with it alcohol came creeping too.

As the stress piled on, Dawn drank more. It was a gradual progression until she found herself isolated and drinking every day. “Basically, I was drinking on a daily basis,” she recalls.

Dawn knew deep down that her drinking was a prob­lem, but it took a few wake-up calls before she was ready to face it — and these were literal wake-up calls in the emergency room, once after a blackout and another time after alcohol-related breathing problems.

Finally, her husband told her, “This is a problem. Your family and friends are frightened, and we are asking you to seek treatment.” The statement came as a relief to Dawn. It was just the push she needed to enroll in a five-week inpatient treatment program.

RAISE A GLASS

Dawn’s story is not all that unusual. According to data from the National Survey on Drug Use and Health, binge drinking among younger women has increased significantly over the past several decades. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), more than 5 percent of women in the United States have alcohol use disorder.

And it’s no wonder — we are a culture obsessed with alcohol. Got a promotion? Let’s have a toast! Hard day at work? Unwind with a glass of wine. Dinner with the in-laws? Better have a drink. Alcohol can serve as a social lubricant, relaxant, or numbing agent.

The rise of binge drinking among women specifically reflects, in part, the expanding role of alcohol in female social culture. Drinking continues to be glamorised in media — from Carrie Bradshaw’s cosmopolitans to the Mad Men martini craze to Kathie Lee Gifford and Hoda Kotb’s daily wine habit on Today. But what is driving the trend?
Underlying the humor and the stylish promotion that accompany images of women drinking in today’s culture, there is a new, disturbing, message: women are so overwhelmed by juggling work, motherhood, and life that they not only feel that they need alcohol to unwind, but that they deserve it.

This entitlement is clear in new catch phrases and viral social media postings that tout naptime as the new happy hour, bemoan “book club” hangovers, profess “mommy needs a cocktail,” and dub wine glasses “mommy’s sippy cup.” Smart marketers are keying into this feminisation of drinking culture, with marketing campaigns that highlight these cultural trends and acknowledge the power that women have as consumers of alcohol. Women comprise the majority of wine sales — 57 percent according to the Wine Institute — which may be why we see wine brands like Cupcake, MommyJuice, and Girls’ Night Out cropping up. But beneath the shiny, sassy veneer of popular representations of women and alcohol, there rests the disturbing truth of the driving force behind these trends: women are drinking more and more, and some of them are drinking too much.

While many women begin drinking regularly during college, the habit can continue as they enter the workforce and start families. Women who are drinking to excess are often busy professionals and mothers. In fact, women with college degrees are twice as likely to drink daily compared with women without a degree. What’s more, women are twice as likely as their male counterparts to struggle with depression and anxiety, two co-occurring disorders often linked with alcoholism.

In summary: alcohol is legal and socially accepted — and a prevalent and powerful force in our cultural landscape — and abuse among women is growing. Of course, there is nothing inherently wrong with alcohol, but overuse is associated with certain risks. Not everyone who drinks is overdoing it, but it behooves us to pay attention to why, when, and how much we drink.

WHAT IS ALCOHOLISM?

Alcoholism can be tricky to define, as evidenced by the different terminology used to describe it. In the past, professionals used the term alcohol abuse to describe a milder, earlier phase of alcoholism and alcohol dependence to describe a more severe manifestation of the disease.

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, combines those two disorders under one heading: alcohol use disorder. The single diagnosis of alcohol use disorder can be characterised as mild, moderate, or severe. It is simply a new name for the same disease.

A severe alcohol use disorder — or alcoholism—is characterised by such symptoms as craving, loss of control, dependence, and tolerance. People with a severe alcohol use disorder spend a great deal of time drinking and recovering from drinking — often at the expense of work and family obligations. As they build a tolerance to alcohol, they may need to drink greater amounts to feel the same effect— and if they stop, they may experience withdrawal symptoms. In contrast, people with mild alcohol use disorder — or alcohol abuse — are not necessarily physically dependent, but alcohol may be interfering with their work and family obligations or they may encounter legal and social problems as a result of their drinking. A mild alcohol use disorder can progress into a severe one over time.

“We refer to this disorder as a common, complex, inheritable disease,” explains Deidra Roach, MD, health scientist administrator in the Division of Treatment and Recovery Research at the NIAAA. “There are people who are inclined to condemn people with this disease as morally deficient or weak, but there is a very strong genetic component to it.

A COMPLEX DISEASE

Disease is the key word with alcoholism. “This is a disease. It is not a good person/bad person issue. It is not a weakness or a moral issue. It is a disease,” explains Dianne Sullivan, CSAC, a certified clinical substance abuse counselor from Hayward, Wisconsin.

What’s more, although most people who develop alcohol use disorder in their lifetime do completely recover, it may be a chronic, relapsing disease; meaning that it may last a lifetime — and it is progressive, meaning it can creep up on you as you gradually drink more until more becomes too much.

Genetics are a big factor, but so are anxiety, depression, and trauma. In fact, Sullivan notes that at least 75 percent of women with alcohol use disorders have some sort of underlying trauma.

That was certainly the case for Dawn, who as a result of her mother’s alcoholism found herself living on her own at age 14. She dropped out of school and worked two jobs to support herself; and while this helped her develop into a resilient, strong woman, it left a mark. “I learned in treatment that most alcoholics come from unsafe or traumatic environments,” Dawn explains. “I learned to be hyper-vigilant at a very young age because I was in an unsafe environment.

“That created such a deep, progressive sense of anxiety that self-medication through alcohol was inevitable.”

THE IMPACT OF ALCOHOL

Some people can drink sparingly or moderately without much impact, but for those with alcohol use disorders, alcohol can have serious physical and emotional consequences.

Heavy drinking is associated with increased inflammation in the body. Over time chronic inflammation can lead to more-serious damage, such as esophagitis, gastritis, pancreatitis, and alcohol-related hepatitis. The inflammation may lead to scarring and shrinkage of the liver — referred to as cirrhosis of the liver — which impairs its ability to function normally.

Chronic inflammation can also increase the risk of tumor formation. Heavy drinking is associated with an increased risk of head and neck cancer and liver cancer. Regarding breast cancer, women should note that even moderate drinking increases the risk of its development. “A woman who drinks one drink per day has a 10 percent higher risk of breast cancer than a woman who doesn’t drink at all,” Dr. Roach says.

There are also other, trickle-down physical effects of alcohol. Heavy drinking can lead to more-risky behavior, such as unprotected sex, which of course leads to an increased risk of sexually transmitted infections, including HIV. Dr. Roach says there is an alcohol-HIV connection: not only is there an increased risk of infection but alcohol also accelerates the rate of HIV progression.

Alcohol has the potential to leave a variety of emotional scars, too. It is associated with higher levels of depression and isolation. Some heavy drinkers exhibit volatile behaviour, which can lead to legal problems and damaged relationships. The bottom line is that alcoholism can leave a trail of devastation in its wake.

TREATMENT

That may sound grim, but there is hope. “Most people who experience alcohol use disorder in their lifetime have a milder form of the disease and recover on their own. But for those with the chronic, relapsing form of the disease, treatment is very helpful — and it works,” Dr. Roach insists.

Many people benefit from outpatient treatment, whereas others opt for intensive residential treatment. Some find help through 12-step programs.

Sullivan says the key to treatment is to provide people with a toolbox of strategies to cope with whatever triggers a drinking thought. She starts by educating people about the disease and teaching them to recognise the signs and the symptoms. Treatment may involve a variety of approaches, including cognitive behavioral therapy. If there is a co-occurring disorder, such as depression or anxiety, treatment will focus on that as well.

“This is a disease characterised by a tendency to relapse,” Sullivan explains. “There is no cure, but we can teach you how to manage the disease.”

She says that education is the key, and that women should learn everything they can about the disease and how to manage it. In addition to education, Sullivan emphasises three key components of recovery: building support with other women, journaling, and connecting with some sort of spirituality.

“The women who make it are the women who find some sort of spirituality and use it in their everyday life,” she says.

Journaling is an important tool because it allows women to write down their feelings and thoughts and then begin to recognise a pattern. When we understand a pattern, it helps us learn to be proactive rather than reactive.

For Dawn, treatment was an opportunity to take stock. When she looks back on her 14-year-old self, working so hard to keep the apartment her mother had just abandoned, Dawn says, “I did what I had to do to survive.” But her treatment professionals saw it differently and diagnosed her with post-traumatic stress disorder. With that diagnosis came new tools for learning how to reframe her anxiety.

“It was actually a godsend,” she says of her treatment program. “It allowed me to open up to the feelings of the past and get rid of the hypervigilance and reframe the deep subconscious memories.”

Dawn chose a residential program so that she could really stop everything else and focus 100 percent on her recovery. The program allowed her to revisit the question ‘Who am I?’ at a very deep level. “I had to ask myself, ‘Who am I?’, and ‘what is my relationship to my addiction?’” she says.

Answering that question was a spiritual journey. “My relationship to my spiritual life has deepened so profoundly,” she says. “I’m feeling more peaceful, grounded, and spiritually guided than I have ever felt in my life. I have come home. After 50 years of growing and learning, I have finally come home to the real me.”

CHANGING THE CONVERSATION

As awareness grows, the conversation about women and alcohol is changing. Dawn is determined to destigmatise the disease by talking openly about it. “Addiction doesn’t discriminate. I was a superhigh-functioning person with alcoholism,” Dawn says. “But there is all of this denial, hush-hush, and shame behind it. It is no wonder people don’t go for help because there is a stigma.”
Sullivan hopes that education and awareness will change this. “This is a disease. If someone had cancer or diabetes, you wouldn’t tell them to stop it — but we do that with addicted people every day,” she says.

ALCOHOL GUIDELINES

According to the NIAAA, here are the low-risk drinking limits for women:

• No more than three drinks per occasion
• No more than seven drinks per week

To be considered low risk, the NIAAA recommends adhering to both the single-event and the weekly limits. Women who exceed these guidelines are considered to be engaging in at-risk or heavy drinking.

DO YOU HAVE A DRINKING PROBLEM?

Do you think you might be drinking too much? Dianne Sullivan, CSAC, asks the following questions.

• Has anybody ever com­plained about your drinking?
• Have you given up things that were important to you in order to use alcohol?
• Have you ever lost time dur­ing drinking, where you can’t recall what you said or did?
• Has drinking affected your normal day-to-day routine? Has it ever affected your work per­formance?
• If anyone has ever made a comment about your drinking, has that made you angry?

HEALTHY HABITS

For those who do not struggle with alcoholism, it is possible to drink responsibly. Deidra Roach, MD, shares the following tips from the NIAAA.

• Standard drink. Know how much alcohol is really in the drinks you are consuming. If you are not sure, ask the bartender. Many specialty drinks have as much alcohol as two to three standard drinks.
• Space and pace. Pace yourself with no more than one standard drink per hour and space those drinks out by consuming a nonalcoholic beverage between alcoholic drinks.
• Don’t drink on an empty stomach. Having food in your stomach will slow down the absorption of alcohol.
• Designated driver. Do not drive, period. There is no amount of alcohol that is okay to mix with driving.
• Beware the binge.

“There is encouraging evidence that the rise in binge drinking among younger women that we saw from 1979 to 2006 has been leveling off over recent years,” Dr. Roach says, “but rates of binge drinking in this group are still very high (as much as 30 percent in some studies.” Drinking to intoxication is considered a binge. The average woman will reach intoxication with four standard drinks consumed in a two-hour period.

【参考情報】
（米国）

• 米国立アルコール乱用・アルコール依存研究所（National Institute on Alcohol Abuse and Alcoholism、NIAAA）　www.niaaa.nih.gov
• 米アルコール中毒者更正会　www.aa.org
• 米薬物乱用・精神衛生管理庁（Substance Abuse and Mental Health Services Administration）　www.samhsa.gov

（日本）

• 厚生労働省　知ることからはじめよう、みんなのメンタルヘルスwww.mhlw.go.jp/kokoro/speciality/detail_alcohol.html
• アルコホーリクス・アノニマス® （無名のアルコール依存症者たち）http://www.aajapan.org/