Why alcohol affects women more than men

It used to be that men were the outsized alcohol drinkers in Western
society – perhaps best depicted in popular culture by Don Draper’s Mad Men
cronies, who swilled from office stashes of brown liquor, knocked back
three-martini lunches and imbibed Old Fashioneds in an after-work pub
culture where few women dared tread.

But epidemiologists have noted that the rise of marketing alcohol to women
and the changing of gender roles have gradually shifted the booze
imbalance. Overall, men are still almost twice as likely as women to binge
drink. But that isn’t true for younger people, specifically. In fact, women
born between 1991 and 2000 now drink just as much as their male
counterparts – and their drinking rates could eventually surpass them.

Women are increasingly suffering from the ill effects of alcohol, too.
National data show that the cirrhosis death rate shot up by 57% among women
aged 45-64 from 2000-2015 in the US, compared to 21% among men. And it rose
18% in women aged 25-44, despite decreasing by 10% among their male peers.
Adult women’s visits to hospital emergency departments for overdosing on
alcohol also are rising sharply. And risky drinking patterns are escalating
among women in particular. But the problem isn’t just that women are
drinking more. Researchers are finding that women’s bodies are affected
differently by alcohol than men’s bodies – for reasons that go beyond mere
size. Scientists have discovered that women produce smaller quantities of
an enzyme called alcohol dehydrogenase (ADH), which is released in the
liver and breaks down alcohol in the body.

Meanwhile, fat retains alcohol, while water helps disperse it. So thanks to
their naturally higher levels of body fat and lower levels of body water,
women experience an even more dramatic physiological response to alcohol.

“That vulnerability is why we see increases in medical problems in women
with alcohol-use disorders, compared to men,” says Dawn Sugarman, a
psychology professor at Harvard Medical School and addiction psychologist
at McLean Hospital in Belmont, Massachusetts.

Women who drink excessively also tend to develop addiction and other
medical issues more quickly than men. It’s a phenomenon called
‘telescoping’: women with alcohol struggles tend to start drinking later in
life than men, but it takes them much less time to develop alcohol
addiction. Women are also faster to experience liver disease and damage to
their hearts and nerves. any of these gender-based differences in alcohol’s
effects on the body weren’t discovered until recent decades. The earliest
study on gender-based differences in ADH, for example, was published in
1990.

In fact, almost all clinical studies on alcohol were done entirely on men
until the 1990s. This was partly because scientists were encouraged to
eliminate as many variables as possible that might influence an
experiment’s results – one of which was gender. And because alcoholism was
assumed to be a mostly male problem, no-one wondered what not studying
women and alcoholism might miss.

That changed when government institutions like the US National Institutes
of Health mandated that women and minorities had to be included as clinical
research subjects, and critical gender gaps in medical research began to be
addressed.

“People just didn’t think about women,” says Sharon Wilsnack, a psychiatry
and behavioural science professor at the University of North Dakota’s
School of Medicine and Health Sciences. “To the extent that they did, they
just assumed, well, you could study men and it could apply to women.” For
her PhD at Harvard University in the early 1970s, Wilsnack wrote her
graduate dissertation about women and alcohol; her literature review then
yielded only seven studies at Harvard’s Widener Library. With her husband,
a sociologist, Wilsnack went on to lead the first long-term national study
on women’s drinking habits. Among their many findings was the discovery
that women who abuse alcohol often have been sexually abused as children, a
gender difference that has since been deemed as crucial in helping women
with addiction.

Gender-based alcohol research since then has turned up a variety of other
sex-specific results.

By the 2000s, brain scans of alcoholics seemed to show that women’s brains
are more sensitive to alcohol than men’s. But Marlene Oscar-Berman, an
anatomy and neuropsychology professor at Boston University Medical School,
has found a twist.

When her team looked at the brains of long-term drinkers, they noticed that
alcoholic men had smaller ‘reward centres’ than their male counterparts.
This area of the brain, made up of parts of the limbic system and frontal
cortex is tied to motivation; it is key for making decisions and even for
basic survival. But in alcoholic women, the reward centers were larger than
in the non-alcoholic women – implying that their brains were less damaged
than their male counterparts.

“That blew us out of the water,” Oscar-Berman says. “Our findings are
somewhat counter to the general idea that women have been more susceptible
to alcohol damage in the brain than men.” Scientists don’t yet understand
what might be causing these differences.

Findings like these show the importance of gender-specific studies on
alcohol and addiction, says Sugarman. She points to recent research showing
that alcohol-addicted women have better outcomes when they’re in women-only
treatment groups that also educate them about the gender-specific elements
of their addiction and women’s motivations for drinking. Perhaps
unsurprisingly, those motivations are different from men’s. Research shows
that women’s drinking is tied to quelling emotional pain, while men’s
drinking is more linked to social pressure.

“Some women had been in [alcohol] treatment five, six, 10 times before, and
were saying things like, ‘This is information I never heard before,’ and ‘I
never heard that I’m more susceptible to alcohol than men, or that these
substances affect me differently,’” says Sugarman.

Because of these differing motivations for drinking, their biological
vulnerabilities and especially because of the link between women’s
alcoholism and histories of trauma, it’s worth exploring how women’s
alcohol treatment needs may be different from men’s. For example, women who
have survived sexual assault may not feel safe entering the standard
therapy group for alcohol treatment, where the gender breakdown can skew up
to 70% male. For these women, hearing the stories of other women and
knowing that they’re not alone has shown to be beneficial to their recovery.

Above all, say experts, the days of assuming that the research on men and
alcohol can simply be applied to women should be long gone.

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