Alcohol Hits Women's Health Harder

It's commonly believed that men can hold their liquor better than women can, but that's only part of the story. Research shows that alcohol also takes more of a toll on women physically, mentally and socially. Although there are fewer women who drink heavily, they equal or surpass men in the number of problems that result from their drinking, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

• Over the long-term, drinking is more likely to damage a woman's health than a man's - even if she has been drinking less alcohol or a shorter period of time.
• Female alcoholics have death rates 50 to 100 percent higher than male alcoholics; this includes deaths from suicides, alcohol-related accidents, heart disease, stroke and liver disease.
• Heavy drinking increases the risk that a woman will be sexually assaulted or become a victim of violence.

A study by researchers at the University of Michigan School of Public Health and Washington University looked at more than 400 people during a 15-year period to study the long-term effects of alcohol. It found that women who drank heavily reported more difficulty in everyday tasks such as climbing stairs, carrying groceries or taking care of family members, than men did.

"On most of the measures, the women were more seriously disabled than the men," says Kyle Grazier, Ph.D., professor in the department of health management and policy at the University of Michigan and lead author of the study. The study was presented at the First World Congress on Women and Mental Health in Berlin.

Study subjects were divided into three groups: those who were alcoholics throughout the whole period, those who were alcoholics at the beginning of the study and those who were not alcoholics. Women were adversely affected by alcohol whether they had been drinking heavily for 20 years or had stopped drinking in the past five years. Alcohol affected the time they spent at work or social activities and, in general, compromised their health more than men.

"It's very consistent with what other researchers have reported about alcohol having a more accelerated course toward negative effects in women," says Kathleen Bucholz, Ph.D., who worked on the study with Grazier and is a professor of psychiatry at Washington University School of Medicine in St. Louis.

Different reactions

Other research has indeed shown that women react to alcohol differently than men in many ways. They tend to get intoxicated quicker, even when taking into account the difference in body weight. According to a NIAAA report, women absorb and metabolize alcohol differently than men. Because they have less body water than men of the same weight, their blood alcohol concentrations are higher after drinking equivalent amounts. After having one drink on an empty stomach, a 140-pound woman has a greater chance of being killed in a single-vehicle car accident crash.

What's more, women are more vulnerable to alcohol-related organ damage.

• Women who are heavy drinkers are more likely than men to develop hepatitis and die from cirrhosis.
• Research suggests that women are more vulnerable than men to alcohol-induced brain damage.
• Some research shows that even one drink per day can slightly raise the risk of breast cancer in women, especially in those with a family history of the disease. Alcohol also has been linked to cancers of the digestive tract and of the head and neck.
• Alcohol abuse is a leading cause of cardiovascular disease. Heavy drinking women and men have similar rates of alcohol-related heart disease, even though the women consume less alcohol.

There may be other factors that tie in with how alcohol affects women versus men. Women who are alcohol-dependent tend to be using other drugs as well, which could impair their health, according to Carol Boyd, Ph.D., a researcher from the Substance Abuse Research Center at the University of Michigan.

Boyd has conducted studies of college students and their drinking habits and has found that, "When young women drink too much, the consequences are quite notable." They have more trouble with their grades and miss more classes than their male counterparts, she said. According to the NIAAA report, there is a relationship between how much female college students drink and the incidence of sexual victimization and dating violence.

How much is too much?

The NIAAA estimates that 5.3 million women in the United States drink in a way that threatens their health, safety, and general well-being.

But what constitutes alcohol abuse as opposed to moderate drinking? According to the NIAAA, moderate alcohol use is one drink per day for women, two for men. One drink is equal to a 5-ounce glass of wine, 12 ounces of beer or 1.5 ounces of hard liquor. In the U.S., 60 percent of women have at least one drink a year. Of that number, 13 percent have more than seven drinks per week.If a woman has more than seven drinks per week or more than four on a given day, she is more likely to develop an alcohol dependency.

Boyd has her own rule about how to tell if you're drinking too much. She calls it the 0-1-2-3 rule and uses it to help women gauge if they're close to the line of alcohol abuse.

Her 0-1-2-3 rule is this:

• You should not drink if you're pregnant or have a medical condition that will be made worse by drinking.
• Never have more than one drink an hour.
• Never drink two days in a row.
• Never have more than three drinks in a 24-hour period.

There is some leeway in the 0-1-2-3 rule, Boyd says. It's true that drinking moderately may lower a woman's risk for coronary heart disease, especially if she is over age 55. But because it's easy for women who drink every day to slip into drinking too much, she advises caution. "If women drink every day, they need to acknowledge it and watch it," she says.

Women also can ask themselves certain questions to determine if they may have a drinking problem. According to Boyd, if you answer "yes" to two or more of the following, it's a red flag:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt guilty about your drinking?
• Have you ever had an eye-opener, a drink first thing in the morning to steady your nerves?

Other questions might include whether other people have complained about your drinking and whether you have to drink more now than you used to for the same effects. People with more than two positive answers should be prepared to take the next step. "They would need to see somebody about the fact that they possibly have a problem," says Boyd.

Sources:

School of Public Health, University of Michigan

Substance Abuse Research Center, University of Michigan

Department of Psychiatry, Washington University, St. Louis

National Institute on Alcohol Abuse and Alcoholism

National Women's Health Information Center

This article was reviewed and updated June 2007.