Women and Alcohol

Women and Alcohol: By Mary Ellen Hettinger
A montage of America’s women alcoholics might include photos of the following nameless faces.
* The 64-year-old grandmother who takes her 11-year-old granddaughter bar hopping at night;

* College roommates who “get blottoed” regularly, binge-drinking on Friday afternoon, then waking on Sunday at dawn with no memory of how they got home or what they did for two days;
* The pillar of the community and volunteer extraordinaire who drinks alone every night when her husband’s out of town;
* The 76-year-old widow who started having a little nip with dinner, and now combines her daily gin and tonics with powerful prescription painkillers;
* The new kid in town who waters down bottles of booze in the liquor cabinet to hide her drinking. (The 12-year-old found that alcohol and Hawaiian Punch makes her feel less shy, and now that her new stepfather has “started messin’ around” with her, she drinks every day.)
These are just a few examples of the nation’s 4.6 million alcohol-abusing or alcohol-dependent female faces.
More often than not, women who abuse alcohol don’t fit the stereotype or profile of a “lost-weekend lush” or “bag lady,” and their addictions remain hidden from family, friends and even physicians. It’s their “little secret.” The majority of women most likely to drink heavily (defined as sixty or more drinks a month) are either affluent with annual incomes above $75,000, or those who live in poverty, with incomes less than $15,000 a year. These women are not just “lonely housewives”: Working women are 67 percent more likely to abuse alcohol than are homemakers.

Women are drinking more

Why? As the recent World Health Organization’s European Charter on Alcohol noted, alcohol’s social acceptance, a greater presence of women in the workforce, easy access to alcohol — even in supermarkets — and advertising targeting young women may influence women to imbibe more. Here are some more sobering statistics about women over 59 from a 1998 report, “Under the Rug: Substance Abuse and the Mature Woman”, from the Center on Addiction and Substance Abuse at Columbia University:

* One in five women abuses alcohol or drugs at some point in her life, compared with one in three men.
* Almost 70 percent of women in treatment were sexually abused as children (compared with 12 percent of men in treatment).
* Only 1 percent of physicians recognizes the early signs of alcohol abuse in mature women.
* Only 14 percent of women who need treatment for alcohol and drug abuse get treatment.

Sheila B. Blume, MD, a psychiatrist who has dealt with addictions since 1962, now semi-retired, cites research done at Johns Hopkins Hospital, Baltimore, years ago, in which participants in the study were screened for alcohol. “It was surprising how much [alcoholism] they picked up,” says Dr. Blume. “Often the least likely looking people, people who didn’t fit the stereotype, were found to have alcohol problems. Doctors and family members often don’t believe a woman is an alcoholic. “We have this image of women where we see them as ‘fallen’ if they drink,” Blume tells Professional Counselor. “But this denial, or looking down at women who drink, makes them more prone to being victimized: through physical abuse, sex abuse and rape, or crime.”

The link between alcoholism and depression

Long-time stigmas attached to having a drinking problem or being a part of the mental-health system keeps many from seeking the help they need.
“Often, depression and alcohol go together,” says Blume. “If the mental- health system screens aggressively, this combination is found. In many, many women, depression follows drinking. Many suffer from both. One scenario is a woman who becomes an alcoholic then is depressed. In the other scenario, she suffers from depression first, often in her late teens, and then she self-medicates her recurring depressions with alcohol. Alcohol is a depressant. It numbs them.
“The first thing a woman with primary depression and an alcohol problem has to do is stop drinking,” says Blume. “Since most anti-depressant medications are prescribed by primary-care physicians, if the underlying alcoholism is missed the depression doesn’t get better, despite the drugs.” Blume explains that drugs such as Xanax combined with alcohol create a dangerous chemical mix and can lead to the woman developing a secondary dependence on the drug.

Alcohol and the mature woman

As part of their extensive study, CASA conducted a survey of primary-care physicians who treat many women over 59. When presented with the
“classic symptoms of alcohol abuse” in a mature woman, only 1 percent of them considered a diagnosis of substance abuse. Most (more than 80 percent) diagnosed the woman as suffering from depression, “which might lead to prescriptions for sedating psychoactive drugs, a potentially deadly mix with alcohol,” the report warned. (Adding insult to injury, even physicians who suspect alcohol abuse may not take it seriously. The report revealed that 37 percent of physicians surveyed agreed with this statement: “Many physicians fail to address problem drinking among mature patients because they believe drinking is one of the last few pleasures left for the elderly.”)

Depression often goes unrecognized by caregivers as well.

“In rehab, 40 to 50 percent of care providers miss the diagnosis of depression,” says Claudia A. Blackburn, MS, who has a private practice in Lancaster, Pennsylvania, and does training in the addictions field specializing in gender and trauma.
“They tend not to focus on it, tend to treat the addiction first, according to the male model of substance-abuse treatment,” Blackburn says. “This is a big mistake in dealing with women. They need to be treated for depression to avoid relapse. They need treatment focused on skills to manage depression and trauma-related feelings.”

Women’s needs are different

“Women need a very careful evaluation and treatment, since their disease is different from men’s,” Blume continues. “They don’t come in and hand you their history. There is a very high history of childhood abuse — physical and sexual — among women, and often they do better in an all- women’s group and with a woman therapist. “Not that they need a different kind of treatment, just a (therapist with a) sensitivity and knowledge about what to look for and how to approach them. Highly confrontational approaches such as those used for drug addiction are not good for women, who are already feeling shame and powerlessness. They need hope and techniques to teach them how to live without alcohol. “But you don’t have to be a woman to successfully treat a woman” says Blume. “You do have to know a lot about women to treat women.” The comprehensive and groundbreaking CASA study, a 180-page
analysis of more than 1,700 research papers, books, studies and surveys, notes that 69 percent of women receiving treatment for alcohol abuse were sexually abused as children, compared with 12 percent of men in treatment. Blume notes, “Our major thinking in society is based on a fallacy: that alcohol is a sexual stimulant. The date rape drug is alcohol, and our culture assumes that if a woman drinks she wants sex. This isn’t true, it actually decreases sexual arousal in women, but since ancient times, we’ve believed this. “In a University of Georgia study based on a true story of a rape, students were given four versions to consider. In one, the rapist was drunk. In another, the victim was drunk, and in another both the rapist and victim were drunk. In the last scenario, no one was drunk. Female and male students deemed the rapist in the first scenario ‘less responsible’ because he was drunk, and the victim in the second scenario ‘more responsible’ because she was drunk. “As the World Health Organization’s European Charter on Alcohol puts it, “Women may be particularly likely to be the victims of another person’s drinking.”

Treatment

Wayside House, an all-female, intensive multi-level treatment center is now in its 28th year in Delray Beach, Florida. It’s set up to treat 23 residents, and treatment is offered on a long-term, outpatient and aftercare basis to about 50 clients.
Carolyn Tardiff, CAP, is the executive director. “We provide care regardless of a woman’s ability to pay,” she says, “as long as they fit the criteria for admission and are motivated to get sober. “Most are upset at having to come here, but we work keeping Wayside’s homelike, nurturing feel. It was started by a doctor who was a recovering alcoholic, Susan B. Anthony, PhD, a grandniece of the historical figure. She helped a lot of women.” Wayside depends on some state and county money, is contracted through a local mental-health center and has a dedicated board of determined supporters who hold major fund-raisers each year.
There are also support groups for family members of these women, including children and spouses, and parenting classes are available. “These families have been devastated by these women’s disease and need help too,” Tardiff says. Once a month, on “anniversary night,” former clients celebrate one year or more of sobriety with an all-out party. Family and friends attend, along with other alumni of Wayside, and the women speak. At a recent night, one woman was celebrating her 17th year of staying sober. “They all tell their stories,” Tardiff says, “and it’s very emotional. These women are staying straight despite having to deal with other issues, from death to breast cancer. The room is packed. “We all get teary as, one by one, they say how grateful they are and how Wayside saved their lives. Many of these women were not familiar with being cared for until they came here. They tell newer residents, “Don’t run away, stick it out!’ It’s wonderful to see the difference.” Although “sadly, there are not that many places exclusively for women,” Tardiff believes all-female treatment communities are a real boon. “I’ve done my own experiments in co-ed programs in more than 20 years in the field, and women definitely change when men are around,” Tardiff says. “It doesn’t matter if it’s a hunky fellow addict, an administrator or an elderly, grubby, groundskeeper, women of all ages change posture and behavior regardless of the male’s attractiveness when he passes by. “I’ve seen so many ‘detox love affairs’ that are disastrous. A woman needs to learn about herself from the inside out, then to learn to choose healthier relationships. They need a place to be safe for awhile. They’re sick and need time to heal.”
An important part of treatment is connecting to their spirituality, Tardiff believes. “From point of admission through aftercare, they’re taken to AA and NA meetings. But they have to be accountable, not dependent on us. The focus of aftercare is relapse prevention.”

Alcohol’s physical effects vary by gender

Blume notes that all the early research on the effects of alcohol was done on men. But recent studies have shown there are many differences in the way alcohol affects women. “Physically, women are more sensitive to alcohol,” says Blume, who lives in Sayville, New York, and who ran addiction services for years at South Oaks Hospital. She is also a clinical professor of psychiatry at the State University of New York at Stony Brook. The symptoms or presentation of alcoholism also vary, according to the CASA report: “Alcoholism in men often is detected because of alcohol- related arrests, drunken driving, financial problems and job impairment. “But female alcoholics more often experience less obvious symptoms such as depression, anxiety and family conflicts.”
Although both male and female alcoholics say they drink “to escape life’s pressures,” women more often report feeling powerless and inadequate even before problem drinking, the report noted. Physical tolerance for alcohol falls with age, and women have a lower tolerance level for alcohol than men to begin with.
Post-menopausal women who drink may fall and break their hips. They also increase their risk of cancer, heart attack, diabetes, stroke and kidney failure. Also, combining alcohol and sedating drugs increases the risk of car crashes. Women also develop liver cirrhosis “sooner and from drinking less alcohol” than men, the report shows, as well as hepatitis. And, compared to women over 65 who die of natural causes, those who had at least three drinks a day were nine times likelier to commit suicide. “Chronic alcohol abuse exacts a greater physical toll on women than on men,” the National Institute on Alcohol Abuse and Alcoholism reported in their 1990 Alcohol Alert on Alcohol and Women. “Female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics . . . a greater percentage die from suicides, alcohol-related accidents, circulatory disorders and cirrhosis of the liver.” One in five women abuses alcohol or drugs at sometime in her life, compared with one in three men. Women get drunk faster than men of comparable size for several reasons, including lower total body water content and different metabolic rates. They become addicted sooner and develop related diseases earlier than men. Female alcoholics are up to twice as likely to die as same-age male alcoholics.

Pregnancy and alcohol

Because they get drunk faster on less alcohol, pregnant women who drink even moderately put their unborn infants at risk of fetal alcohol syndrome
(FAS), Anuppa Caleekal, BA, MSC, noted in a report on this topic. Major damage can occur to the fetus in the early weeks of the first trimester when a woman may be unaware that she is pregnant. FAS can lead to growth retardation, central nervous system damage (including “permanent and irreversible brain damage,” learning disabilities, memory and attention deficits and hyperactivity) and physical abnormalities. Also, women tend to seek treatment for their alcoholism “at much later stages of the disease than men,” recovery book author Rokelle Lerner writes. Ominously, statistics on alcohol consumption among pregnant and childbearing-aged American women from 1991 to 1995 revealed a 4 percent jump, from 12.4 percent to 16.3 percent, in numbers of women who drink while pregnant.You don’t have to be a woman to pass your addiction across the generations: “Children of alcoholics have an altered brain chemistry which may increase their chances of becoming addicted,” the recent U.S. Longitudinal Alcohol Epidemiologic Survey said.

Alcohol abuse at all ages

Females are using alcohol and other drugs at earlier ages. “Girls are fifteen times more likely than their mothers to begin using illegal drugs by age 15,” the CASA report revealed. Plus, teen girls who drink more than five times a month are five times more likely to have sex than girls who don’t drink and they are one-third less likely to use a condom. College women who drink “report many of the same adverse consequences related to drinking as do men,” according to Catalyst, a publication of the Higher Education Center for Alcohol and Other Drug Prevention, including hangovers, missing classes and social problems.
Sexual assault and rape are also closely linked to alcohol use by both partners, “and are often a major reason why women drop out of college.” Even more frightening, research by Henry Wechsler, PhD, reported in Catalyst shows that approximately 40 percent of female college students are “binge drinkers.” This is defined as having had four or more drinks on one occasion within the past 14 days. Listen up, sisters: Sorority women are at special risk; 80 percent fit the classification, he says. Reasons given by females for drinking on campus included being “cool,” helping with stress, using it for “courage” and to dull inhibitions.
One young woman said she drank to hang out with the guys, while another female student said that “men use alcohol to promote sex, and the women use it to approach men.” As with the young teens studied, Wesley Perkins, PhD, said women who start drinking early in college are “more likely to drink excessively after college and with more frequent adverse consequences.” Another gender difference in regards to abusing alcohol is the subsets of populations using it: lesbians, children of alcoholics and women with eating disorders. And, as Rokelle Lerner points out in “Women’s Issues in Recovery,” those dealing with concurrent eating disorders and alcohol addictions face a double whammy. Women are also more likely to be persuaded to abuse substances by their partners than men are, a study of heroin addicts found. Thirty-three percent of female addicts said men influenced their decision to use, while only 2 percent of men said a woman influenced them. Blackburn notes, “I approach women’s addictions from the onset of
picking up alcohol or any other chemical. Their initial reason for picking up alcohol and their route of introduction to it is different from boys. When we follow these women all the way through relapse, we see how their initial introduction leads to relapse later. “Preteen boys often start using because of their peer group, whereas adolescent girls often pick it up in a relationship or through a sibling. The dynamics that are laid down at this point are the same triggers for relapse later on, in the majority of cases,” Blackburn says. “She starts drinking with a boyfriend at 12, by 40 is in active addiction, she goes through a rehab or intensive outpatient program. The greater the risk to her relationship, the greater the chance of relapse due to a relationship event.
“Women are also most likely to relapse within six months of trauma or their first major depression. Even if they’ve never used before, women often pick up a chemical then. Alcohol is the number-one choice. When we trace their pattern through relapse, we see it’s based on trauma- related events.
“The same trigger sets them off, from a foundation that was laid 20, 30 years before. This is true in women much more so than men.”

Barriers to recovery

Once they do seek treatment, women have more challenges to getting and staying sober than men, Lerner adds. An abusive relationship or living situation, working at a menial job where there is no EAP to help financially, or no help with childcare, can be real barriers to recovery.
According to literature from the Center for Substance Abuse Treatment in Washington, D.C., alcoholic/addicted women need to address 14 primary issues in treatment and recovery:
* low self-esteem
* powerlessness
* sexism
* family-of-origin issues
* unhealthy relationships
* violence
* incest
* rape
* sexuality
* recreation
* grief and loss
* parenting
* vision for the future
* life planning
Because of the nature of this disease, recovery is never easy. Although many of the stories told at anniversary night at Wayside House have happy endings, many don’t, and relapse prevention is an ongoing effort. Part of the problem is intrinsic to addictions, denial: among the drinkers, family members, employers, physicians, and healthcare providers. “Many studies show that even brief interventions . . . in a primary-care setting are very helpful,” according to a 1996 Josiah Macy, Jr. Foundation conference. However, “most physicians have not been trained to diagnose alcohol problems or refer patients for treatment.” Their panel of 45 experts concluded that residents in the fields of family practice, internal medicine, obstetrics-gynecology and pediatrics should be trained in the basics of substance abuse. Even when substance abuse is noted, physicians reported that one-fifth of their referrals of mature, adult patients to substance-abuse counseling or treatment were denied by managed-care organizations or insurance companies.

Treatment needs to address underlying issues

And again, women are more likely to have another component such as depression or anxiety or an abusive living situation complicating their addiction. If these issues aren’t addressed, recovery isn’t as likely. Blume and Blackburn each believe that if underlying depression isn’t recognized or treated along with the alcoholism, relapse is highly likely. A study of 670 women receiving treatment for substance abuse at the Women’s Addiction Foundation, an intensive therapeutic environment targeting the special needs of women in recovery, in Winnipeg, Canada, showed that 75 percent had experienced physical and sexual abuse. Sixty-three percent had been physically abused as children, and 78 percent had experienced physically abusive relationships with men.
Nonprofit groups such as Women for Sobriety, Inc. (WFS) of Quakertown, Pennsylvania, aim to tackle addiction issues specific to females, even linking women across the country via online chat rooms. Many other recovery groups have a presence in cyberspace as well as in street- corner churches or meeting halls, but only a few are for women only. At the University of Miami School of Medicine, Barbara Mason is conducting studies of combination treatments to help people stay sober. One study focuses on alcoholics who suffer from depression. The associate professor in the department of psychiatry and behavioral sciences says she’s studying the anti-drinking drug naltrexone in combination with the antidepressant Zoloft to help those who are also depressed. Addictions among women over 60 leave “millions of children without grandmothers and children without mothers. We saddle others with the avoidable burden of caring for an ailing parent . . . these tragedies are readily preventable,” said former Secretary of Health, Education and Welfare and CASA president Joseph A. Califano, Jr.
“Because alcohol remains the drug of choice for most people, the harm caused by alcohol far outweighs anything done by illegal drugs,” the recent U.S. National Longitudinal Alcohol Epidemiologic Survey concluded. When all is said and done about women and their abuse of alcohol, it seems clear to many professionals in the field, that it is time for women’s big “little secret” to be revealed and time for the stigma surrounding addiction and mental illness to be dissolved.
Mary Ellen Hettinger is a freelance writer in Coral Springs, Florida.