Women and Their Complicated Relationship With Alcohol

New research shows that too many women are drinking too much—and it's often habit (wine o'clock), not addiction, that's to blame. Here's a look at our current (complicated) relationship with alcohol, and how to make it a healthy one.

Photo by Jamie Chung

I Drink to Unwind.

Dinner isn't made yet, but the sink is already full of dishes. There are bills to pay, and as my buzzing phone has just reminded me, I have e-mails to answer and more work to tackle after the kids go to bed. I grab the open bottle of wine in the fridge, pour myself a glass—and suddenly feel like I've just hit the pause button on an otherwise never-ending day.

Sound familiar? "Drinking makes many women feel like we can do the heavy lifting in an ever evolving, complex world," says Ann Dowsett Johnston, the Toronto-based author of Drink: The Intimate Relationship Between Women and Alcohol. "There's this feeling of "I'm doing it all—why shouldn't I have something for myself?" "

Two-thirds of American women consume alcohol regularly (having at least one drink within the past week), with most citing wine as their beverage of choice, according to a 2013 Gallup poll. That number has stayed fairly constant over the past two decades, but something more significant has changed: An increasing number of us are overimbibing. Almost 25 percent of women drink heavily (four or more drinks at once or more than eight drinks in a week) some of the time, according to a 2014 study from the Centers for Disease Control and Prevention (CDC). And heavy or "binge" drinking (consuming four drinks or more per occasion) rose 18.9 percent among women between 2005 and 2012, whereas men saw an increase of 7.3 percent during that same period.

"Drinking and drinking problems have increased in every generation of women born after World War II, including boomers, Gen Xers, and millennials," says Katherine M. Keyes, Ph.D., an assistant professor of epidemiology at Columbia University. Women in their early 20s are most at risk, but undergraduates at keg parties are hardly the only ones overdoing it. Affluent, fit adults over the age of 50 may be particularly prone to heavy drinking, according to a 2015 study published in the medical journal BMJ. "Higher socioeconomic status is associated with a higher risk of alcohol abuse in men and women," says Keyes. Many people, regardless of income, associate drinking with glamour and prestige. (Think Scott and Zelda Fitzgerald or the Jolie-Pitts, producing their own wine.) But it may be that those with more income and leisure are more prone to (and accepting of) heavier drinking.

Why We Drink

Television shows like Sex and the City and the Real Housewives franchises and Amy Schumer and her fishbowl-size wineglasses make getting drunk seem, well, perfectly normal. But it wasn't so long ago that most girls didn't go wild. "When a woman drinks," wrote novelist Marguerite Duras, a self-described alcoholic, a quarter century ago, "it's as if an animal were drinking, or a child. Alcoholism is scandalous in a woman.… It's a slur on the divine in our nature."

Today heavy drinking is not only accepted—it's expected. Maybe that's because it has come to represent a badge of female empowerment. "I thought drinking was shorthand for being a socially liberated female," says Sarah Hepola, the Dallas-based author of the best-selling book Blackout: Remembering the Things I Drank to Forget. "Like many women, I felt like I had value when I could throw back drinks and keep up with the boys."

Marketing has played a role, too. Take a look around a liquor store and you'll see shelves filled with margarita-flavored malt beverages, berry-flavored vodkas, and wines with names like Cupcake and Mommy's Time Out. Such female-friendly products didn't exist even 20 years ago, says Johnston, "but the beverage industries realized women had money to spend on alcohol." Hence, a new "gateway" industry was born—one that enticed women to drink.

Then there's the stress factor. "Women today are under incredible pressure in the workplace and at home—perhaps more so than at any other time in history," says Harris Stratyner, Ph.D., the regional clinical vice president of Caron Treatment Centers of New York City. "With added pressure comes an added desire to self-medicate."

Many professional women can't shake the feeling that to make strides—particularly in fields that are male-dominated, like law and finance—they have to take part in the culture. "We drink to fit in and keep up with our peers," notes Deidra Roach, M.D., a project officer in the Division of Treatment and Recovery Research of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in Rockville, Maryland. And the more we work, the more we drink: Women who log more than 48 hours at the office each week are the most likely to drink heavily, according to another 2015 study published in BMJ. "I used to work 50 to 70 hours a week, and I often put in the night shift with a bottle of wine or two," says Hepola, who is now sober. "As a high-achieving female, I didn't know how to relieve stress except through drinking."

This Is Your Body On Booze

Alcohol has long enjoyed a health halo, thanks to the much touted Mediterranean diet and Champagne-enthusing books such as French Women Don't Get Fat. It's true that many studies have linked roughly a drink a day to a reduced risk of heart disease, a lower body mass index, and even a longer life. The result: a widely held belief that alcohol is teeming with health benefits. "I've had patients proudly tell me that they have at least a glass of red wine daily," says Nieca Goldberg, M.D., the medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center, in Manhattan. "The antioxidants in alcohol appear to increase levels of good HDL cholesterol, but drinking isn't the best way to improve cholesterol—exercising is." Not to mention the fact that too much alcohol raises blood pressure and weakens the heart muscle.

And studies show only a correlation between alcohol and wellness—not that alcohol itself is beneficial, says William C. Kerr, Ph.D., a senior scientist and the center associate director at the Alcohol Research Group at the Public Health Institute, in Emeryville, California. "It may be that people who drink moderately also eat moderately or have higher incomes and therefore better access to health care," says Kerr. "If you don't drink, you certainly shouldn't start with the assumption that you're going to improve your health."

That's especially true if the bartender keeps pouring. Anything beyond moderation inverts the health equation. After just a few drinks a week, your odds of developing breast and other cancers begins to rise, as does your risk of injury. Anything beyond eight drinks a week can increase the risk of heart disease, depression, sleep disorders, and other issues. (Each extra daily drink increases your risk of breast cancer by roughly 7 percent, according to a 2002 study published in British Journal of Cancer.)

Most people don't think of alcohol as a drug, but it is. On an annual basis, American men and women use it at more than five times the rate at which they use illegal drugs. Worse, women are uniquely vulnerable to alcohol's ill effects. Alcohol is water-soluble, and women's bodies are made up of 52 percent water, compared with men's 61 percent, says John Whyte, M.D., an internist at Kaiser Permanente, in Washington, D.C. As a result, "a man's body automatically dilutes alcohol more than yours will, even if you have the same body weight," says Whyte.

Also, women are usually smaller-framed and have lower levels of alcohol dehydrogenase, an enzyme that breaks down alcohol in the stomach. The result: "Women get drunker easier and faster than men," says Howard Monsour Jr., M.D., the chief of hepatology at Houston Methodist Hospital, in Texas. Alcohol lingers longer in our bodies, where it has more opportunity to cause cellular damage. It also raises estrogen levels, "which may be part of the reason even moderate drinking elevates breast cancer risk," says Goldberg. Then there's your liver, which eliminates poisons from your body. Whether you're drinking beer or bourbon, the liver ultimately treats alcohol like a poison. That's why it bears the brunt of drinking's damage, even if you're not overdoing it. "You don't have to get drunk to develop liver disease," says Monsour, who adds that 20 to 25 percent of all women are genetically susceptible to cirrhosis and liver cancer. If you're one of them, he says, "even two drinks daily may put you at risk." (If you have a family history of these problems or you have hepatitis, you'll want to be particularly careful, says Monsour.)

And when your head hurts on the morning after, remember that acetaminophen—the over-the-counter kind or as an ingredient in certain prescription drugs—increases the risk of acute liver damage when taken with alcohol. Try ibuprofen instead, and ask your pharmacist or physician about other medications.

Alas, even indulging at the office holiday party can put your health at risk. "A single episode of binge drinking can reduce immune response, making you more susceptible to viruses and bacteria," says Gyongyi Szabo, M.D., Ph.D., the vice chair of the department of medicine at the University of Massachusetts Medical School, in Worcester. "Binge drinking can upset the balance of gut bacteria and make the intestinal wall leaky, so to speak, which can cause GI problems and increase inflammation in the liver and elsewhere." Call it unfair, but once again this happens to a greater extent to women than to men.

Developing A Healthy Habit

If you tend to have a glass (or three) of wine every evening, it may be habit rather than addiction. Only 1 in 10 people who drink excessively fits the criteria for alcohol dependence (often referred to as "alcoholism," though many experts no longer use this word), according to the 2014 CDC study. "Humans like to repeat things that feel good," explains Michael Levy, Ph.D., a psychologist with North Shore Medical Center, in Salem, Massachusetts, and the author of Take Control of Your Drinking…and You May Not Have to Quit. "Drinking too much is often a subtle phenomenon. You get used to it one drink at a time—until suddenly it's your way in the world."

Is it better to drink moderately or not at all? Experts disagree. Although many studies show that moderate drinkers might live longer and have better overall health, "there are no proven benefits and many, many potential risks," says Kerr. If you have tested positive for the BRCA1 or BRCA2 breast cancer genes or have a family history of breast cancer or liver disease, talk to your doctor about drinking. You should also avoid alcohol if you've suffered from alcohol dependence or an addiction to prescription or illegal drugs in the past.

If you choose to drink, don't do so for your health, but rather with your health in mind. One drink a day is an ideal average, but you can have a second—or even a third on occasion—provided you scale back during the rest of the week, according to the NIAAA. The organization divides drinking into two categories:

  • Low-risk drinking is no more than three drinks in a single day and no more than seven drinks in a week for a woman.
  • At-risk or heavy drinking is drinking more than either the single-day limit or the weekly limit.

Check the label before you pour. The percentage of alcohol in wines and beers can vary. For example, one bottle of red wine may contain 12 percent alcohol, while another contains 15 percent or more. If you opt for a higher-alcohol drink, simply drink less of it.

If You Suspect You Drink Too Much And Want To Curb Your Habit, Decide How Much You'll Drink Before You Start

" "I'm going to cut back" is too vague," says Levy. "But "I will have two glasses on each weekend night, but not during the week" gives you a map of how to behave." He advises taking at least three days a week off, both to give your body a break and to get your mind used to not expecting a drink every night. That's especially important if you often overimbibe, says Levy. And don't drink in situations when you usually tend to overdo it. If you regularly get smashed at stressful family events, say, swap the Sauvignon for club soda.

It's helpful to keep a log of your drinking and to tell friends and family that you're setting limits for yourself so that they don't talk you into having "just one more."

Finally—And Even Though It's Obvious, It's Important—Don't Hesitate To Get Help

If you can't stick to your self-imposed alcohol guidelines for two to three months, it might be a sign that you don't have control of your drinking and could benefit from treatment. "There's still a stigma surrounding alcohol treatment, especially for women," says Keyes. "But there are many treatment options, and those administered by qualified addiction professionals have the greatest demonstrated efficacy."

The most recent version of Diagnostic and Statistical Manual of Mental Disorders (the guide mental-health professionals use to make psychological diagnoses) replaces the two conditions "alcohol abuse" and the more severe "alcohol dependence" with "alcohol-use disorder," which describes a moderate to severe range of dependence. "Most people only experience alcohol disorders for a set period of time," says Keyes.

Research shows that behavioral treatment—especially cognitive behavioral therapy, which teaches you to identify problematic thoughts in order to change your behavior—is particularly effective. Groups such as Alcoholics Anonymous (aa.org) and Moderation Management (moderation.org) and prescription medications that reduce the urge to drink can also be effective, either together or alone. Talk to your physician, or learn about treatment options at niaaa.nih.gov. (Go to "Publications & Multimedia," then look under "Brochures and Fact Sheets.")