From The National Institute On Alcohol Abuse and Alcoholism

Sixty percent of U.S. women have at least one drink a year. Among women who drink, 13 percent have more than seven drinks per week. For women, this level of drinking is above the recommended limits published in the Dietary Guidelines for Americans, which are issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services.

The Dietary Guidelines define moderate drinking as no more than one drink a day for women and no more than two drinks a day for men. The Dietary Guidelines point out that drinking more than one drink per day for women can increase the risk for motor vehicle crashes, other injuries, high blood pressure, stroke, violence, suicide, and certain types of cancer.

Why are lower levels of drinking recommended for women than for men? Because women are at greater risk than men for developing alcohol-related problems. Alcohol passes through the digestive tract and is dispersed in the water in the body. The more water available, the more diluted the alcohol. As a rule, men weigh more than women, and, pound for pound, women have less water in their bodies than men. Therefore, a woman's brain and other organs are exposed to more alcohol and to more of the toxic byproducts that result when the body breaks down and eliminates alcohol.

Drinking more than seven drinks per week increases a woman's chances of abusing or becoming dependent on alcohol. Even women who drink fewer than seven drinks a week are at increased risk of developing alcohol abuse or dependence if they occasionally have four or more drinks on any given day.

Heavy Drinking

An estimated 5.3 million women in the United States drink in a way that threatens their health, safety, and general well-being. A strong case can be made that heavy drinking is more risky for women than men:

• Heavy drinking increases a woman's risk of becoming a victim of violence and sexual assault.
• Drinking over the long term is more likely to damage a woman's health than a man's, even if the woman has been drinking less alcohol or for a shorter length of time than the man.
• Fewer women than men drink. However, among the heaviest drinkers, women equal or surpass men in the number of problems that result from their drinking. For example, female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics, including deaths from suicides, alcohol-related accidents, heart disease and stroke, and liver cirrhosis.

The health effects of alcohol abuse and alcoholism are serious. Some specific health problems include:

• Alcoholic liver disease: Women are more likely than men to develop alcoholic hepatitis (liver inflammation) and to die from cirrhosis.
• Brain disease: Most alcoholics have some loss of mental function, reduced brain size, and changes in the function of brain cells. Research suggests that women are more vulnerable than men to alcohol-induced brain damage.
• Cancer: Many studies report that heavy drinking increases the risk of breast cancer. Alcohol also is linked to cancers of the digestive tract and of the head and neck (the risk is especially high in smokers who also drink heavily).
• Heart disease: Chronic heavy drinking is a leading cause of cardiovascular disease. Among heavy drinkers, men and women have similar rates of alcohol-related heart disease, even though women drink less alcohol over a lifetime than men.

Finally, many alcoholics smoke; smoking in itself can cause serious long-term health consequences.

Alcohol in Women's Lives

Despite the fact that drinking is illegal for anyone under the age of 21, the reality is that many adolescent girls drink. Research shows that about 39 percent of 9th grade girls — usually about 14 years old — report drinking in the past month. (This rate is slightly less than that for 9th grade boys.) Even more alarming is the fact that about 21 percent of these same young girls report having had five or more drinks on a single occasion during the previous month.

Young women in their twenties and early thirties are more likely to drink than older women. No one factor predicts whether a woman will have problems with alcohol, or at what age she is most at risk. However, there are some life experiences that seem to make it more likely that women will have drinking problems.

Heavy drinking and drinking problems among White women are most common in younger age groups. Among African American women, however, drinking problems are more common in middle age than youth. A woman's ethnic origins — and the extent to which she adopts the attitudes of mainstream vs. her native culture — influence how and when she will drink. Hispanic women who are more "mainstream" are more likely to drink and to drink heavily (that is, to drink at least once a week and to have five or more drinks at one time).

Research suggests that women who have trouble with their closest relationships tend to drink more than other women. Heavy drinking is more common among women who have never married, are living unmarried with a partner, or are divorced or separated. (The effect of divorce on a woman's later drinking may depend on whether she is already drinking heavily in her marriage.) A woman whose husband drinks heavily is more likely than other women to drink too much.

Many studies have found that women who suffered childhood sexual abuse are more likely to have drinking problems.

Depression is closely linked to heavy drinking in women, and women who drink at home alone are more likely than others to have later drinking problems.

Stress is a common theme in women's lives. Research confirms that one of the reasons people drink is to help them cope with stress. However, it is not clear just how stress may lead to problem drinking. Heavy drinking by itself causes stress in a job and family. Many factors, including family history, shape how much a woman will use alcohol to cope with stress. A woman's past and usual drinking habits are important. Different people have different expectations about the effect of alcohol on stress. How a woman handles stress, and the support she has to manage it, also may affect whether she uses alcohol in response to stress.

Aging seems to reduce the body's ability to adapt to alcohol. Older adults reach higher blood levels of alcohol even when drinking the same amount as younger people. This is because, with aging, the amount of water in the body is reduced and alcohol becomes more concentrated. But even at the same blood alcohol level, older adults may feel some of the effects of alcohol more strongly than younger people. Alcohol problems among older people often are mistaken for other aging-related conditions. As a result, alcohol problems may be missed and untreated by health care providers, especially in older women.

An Individual Decision

A woman's genetic makeup shapes how quickly she feels the effects of alcohol, how pleasant drinking is for her, and how drinking alcohol over the long term will affect her health, even the chances that she could have problems with alcohol. A family history of alcohol problems, a woman's risk of illnesses like heart disease and breast cancer, medications she is taking, and age are among the factors for each woman to weigh in deciding when, how much, and how often to drink.

What Are Alcohol Abuse and Alcoholism?

Alcohol abuse is a pattern of drinking that is harmful to the drinker or others. The following situations, occurring repeatedly in a 12-month period, would be indicators of alcohol abuse:

• Missing work or skipping child care responsibilities because of drinking
• Drinking in situations that are dangerous, such as before or while driving
• Being arrested for driving under the influence of alcohol or for hurting someone while drunk
• Continuing to drink even though there are ongoing alcohol-related tensions with friends and family.

Alcoholism or alcohol dependence is a disease. It is chronic, or lifelong, and it can be both progressive and life threatening. Alcoholism is based in the brain. Alcohol's short-term effects on the brain are what cause someone to feel high, relaxed, or sleepy after drinking.

In some people, alcohol's long-term effects can change the way the brain reacts to alcohol, so that the urge to drink can be as compelling as the hunger for food. Both a person's genetic makeup and his or her environment contribute to the risk for alcoholism. The following are some of the typical characteristics of alcoholism:

• Craving: a strong need, or compulsion, to drink
• Loss of control: the inability to stop drinking once a person has begun
• Physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness and anxiety, when alcohol use is stopped after a period of heavy drinking
• Tolerance: the need for increasing amounts of alcohol to get "high."

How Do You Know if You Have a Problem?

Answering the following four questions can help you find out if you or someone close to you has a drinking problem.

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

One "yes" answer suggests a possible alcohol problem. If you responded "yes" to more than one question, it is very likely that you have a problem with alcohol. In either case, it is important that you see your health care provider right away to discuss your responses to these questions.

Even if you answered "no" to all of the above questions, if you are having drinking-related problems with your job, relationships, health, or with the law, you should still seek help.

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