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Women Now Drink As Much As Men — Not So Much For Pleasure, But To Cope

By the time Victoria Cooper enrolled in an alcohol treatment program in 2018, she was "drinking for survival," not pleasure, she says — multiple vodka shots in the morning, at lunchtime and beyond. In the treatment program, she saw other women in their 20s struggling with alcohol and other drugs. "It was the first time in a very long time that I had not felt alone," she says.
By the time Victoria Cooper enrolled in an alcohol treatment program in 2018, she was "drinking for survival," not pleasure, she says — multiple vodka shots in the morning, at lunchtime and beyond. In the treatment program, she saw other women in their 20s struggling with alcohol and other drugs. "It was the first time in a very long time that I had not felt alone," she says.

Victoria Cooper thought her drinking habits in college were just like everyone else's. Shots at parties. Beers while bowling. Sure, she got more refills than some and missed classes while nursing hangovers, but she couldn't have a problem, she thought.

"Because of what my picture of alcoholism was — old men who brown-bagged it in a parking lot — I thought I was fine," says Cooper, now sober and living in Chapel Hill, N.C.

That common image of who is affected by alcohol disorders, echoed throughout pop culture, was misleading over a decade ago when Cooper was in college. And it's even less representative today.

For nearly a century, women have been closing the gender gap in alcohol consumption, binge-drinking and alcohol use disorder. What was previously a 3-1 ratio for risky drinking habits in men versus women is closer to 1-to-1 globally, a 2016 analysis of several dozen studies suggested.

And the latest U.S. data from 2019 shows that women in their teens and early 20s reported drinking and getting drunk at higher rates than their male peers — in some cases for the first time since researchers began measuring such behavior.

This trend parallels the rise in mental health concerns among young women, and researchers worry that the long-term effects of the COVID-19 pandemic could amplify both patterns.

"It's not only that we're seeing women drinking more, but that they're really being affected by this physically and mental health-wise," says Dawn Sugarman, a research psychologist at McLean Hospital in Massachusetts, who has studied addiction in women.

Research shows women suffer health consequences of alcohol — liver disease, heart disease and cancer — more quickly than men and even with lower levels of consumption.

Perhaps most concerning is that the rising gender equality in alcohol use doesn't extend to the recognition or treatment of alcohol disorders, Sugarman says. So even as some women drink more, they're often less likely to get the help they need.

In Cooper's case, drinking eventually led her to drop out of college at the University of North Carolina at Chapel Hill. She moved back home and was soon taking a shot or two of vodka each morning before heading to the office for her finance job, followed by two more drinks at lunch.

When she tried to quit on her own, she was quickly pulled back by the disease.

"That's when I got scared, when I tried to not drink and only made it two days," says Cooper, now 30. "I was drinking for survival, basically."

Drinking to cope

Although the gender gap in alcohol consumption is narrowing among all ages, the reasons differ. For people over 26, women are increasing their alcohol consumption faster than men. Among teens and young adults, however, there's an overall decline in drinking. The decline is simply slower for women.

That may sound like progress, says Aaron White, a senior scientific adviser at the National Institute on Alcohol Abuse and Alcoholism. But it may indicate larger underlying issues.

"We have a real concern that while there might be fewer people drinking, many of those who are drinking might be doing so specifically to try to cope," White says. "And that is problematic."

Research suggests that people who drink to cope — as opposed to drinking for pleasure — have a higher risk of developing alcohol use disorder. And while every individual's reasons for drinking are different, studies have found that women are more likely to drink to cope than men.

In Cooper's teenage years, alcohol helped her overcome social anxiety, she says. Then she was sexually assaulted, and a new pattern emerged. Drink to deal with trauma. Experience new trauma while drinking. Repeat. "It's hard to get out of that cycle of shame, drinking and abuse," Cooper says.

Women are statistically more likely to experience childhood abuse or sexual assault than men. In recent years, studies have found rates of depression, anxiety, eating disorders and suicide are climbing among teenage and young adult women. That could be driving their alcohol use, White says

And the layers of stress, isolation and trauma from COVID-19 could make things worse.

One study that looked at alcohol's effects on college students early in the pandemic found increased alcohol use among those who reported higher levels of stress and anxiety. And several studies found women were more likely to report rises in drinking during the pandemic, especially if they experienced increased stress.

"For us to address issues with alcohol, we also need to address these pervasive issues with mental health," White says. "They are all related."

What's more, despite alcohol's temporary calming properties, it can actually increase anxiety and depression, research suggests; some studies show it may lead to depression more quickly in women than in men.

When Gillian Tietz began drinking in graduate school, she found a glass of wine helped ease her stress. But as soon as the glass emptied, her concerns worsened. Within a year, she began drinking daily and couldn't sleep. Anxiety kept her up at night, she says, and she started having suicidal thoughts.

It was only when Tietz took a brief reprieve from alcohol that she noticed the connection. Suddenly, the suicidal thoughts stopped.

"That made the decision to quit really powerful," says Tietz, 30, who now hosts a podcast called Sober Powered. "I knew exactly what alcohol did to me."

Rising risks: From hangovers to cancer

Until the 1990s, most research on alcohol focused on men. Now, as women approach parity in drinking habits, scientists are uncovering more about the unequal damage that alcohol causes to their bodies.

Women generally have less body water, which dissolves alcohol, than men of the same weight. That means the same number of drinks leads them to have higher concentrations of alcohol in the blood, and their body tissues are exposed to more alcohol per drink.

The result? "From less years of alcohol use, women are getting sicker faster," says Sugarman, of McLean Hospital.

They're at greater risk for hangovers, blackouts, liver disease, alcohol-induced cardiovascular diseases and certain cancers. One study found alcohol-related visits to the emergency room from 2006 to 2014 increased 70% for women, compared with 58% for men. Another paper reported that the rate of alcohol-related cirrhosis from 2009 to 2015 rose 50% for women, compared with 30% for men.

Yet when it comes to prevention and treatment of alcohol-related health issues, "that message is not really getting out there," Sugarman says.

As part of a research study, Sugarman and her colleagues gave women struggling with alcohol use information on how alcohol affects women differently from men. Some participants had been in detox 20 times yet had never heard this information, Sugarman says.

Research from Sugarman's colleagues found that women with alcohol use disorder had better outcomes when they were in women-only treatment groups, which included a focus on mental health and trauma, as well as education about gender-specific elements of addiction.

Cooper says enrolling in a 90-day residential treatment program in 2018 drastically changed her own perception of who is affected by addiction. She found herself surrounded by other women in their 20s who also struggled with alcohol and other drugs. "It was the first time in a very long time that I had not felt alone," she says.

In 2019, she returned to UNC-Chapel Hill and finished her degree in women's and gender studies, even completing a capstone project on the links among sexual violence, trauma and addiction.

Although Cooper says 12-step programs have helped her stay sober for 3 1/2 years now, a downside to those efforts is that they are often male dominated: educational materials written by men, advice geared toward men, examples about men.

Cooper plans to return to school this fall for a master's degree in social work, with the goal of working to change those gender disparities in the field.

Kaiser Health News is a national, editorially independent newsroom and program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente. Copyright 2021 Kaiser Health News. To see more, visit Kaiser Health News.

Transcript:

AILSA CHANG, HOST:

Alcohol consumption rose sharply in the U.S. during the pandemic. I'm sure none of us are surprised to hear that. Heavy drinking among women especially soared. It's a trend that was already happening for years before COVID-19, and the latest data shows that young women and teenage girls drink at higher rates than their male peers. Aneri Pattani of Kaiser Health News has been covering the rise of alcohol use and abuse among women. She joins us now.

Welcome.

ANERI PATTANI: Thanks for having me.

CHANG: So just to start, what do we know about why people drink? I'm curious if we're seeing some differences between, like, why men drink and why women drink.

PATTANI: So it's hard to pinpoint for any specific individual why they drink, but research shows on a general level, men are more likely to drink for pleasure or for enjoyment. And women more often drink to cope with things like stress or anxiety.

CHANG: Interesting.

PATTANI: And that can be concerning because people who drink to cope, research shows, are more likely to develop an alcohol use disorder.

CHANG: Well, I mean, this pandemic has been stressful and anxious for basically everybody, right? So does the increase of drinking to cope suggest to you that women suffer more from stress and anxiety than, say, men do?

PATTANI: Yeah. So certainly, you know, increase in drinking during the pandemic has been reported. But this is something that predated the pandemic, right? Drinking to cope, a lot of researchers say, could be the reason why we're seeing this shrinking gap between men and women and the amount they drink. Especially when it comes to teen and young adult women, reports of anxiety, depression, eating disorders, suicide - all of those have been rising pretty quickly. And so a lot of researchers are saying if we want to address the fact that women are drinking more, we might need to be looking at these underlying mental health issues.

CHANG: Right. Well, just to speak on a strictly physical level, how does heavy alcohol use affect women versus men?

PATTANI: Women's bodies have less water than men's, even when you're talking about two people of the same weight. So that means with the same number of drinks, women reach higher levels of alcohol in their blood more quickly, and their body tissues are exposed to more alcohol per drink. The result of that is that they get sicker faster from alcohol...

CHANG: Yeah.

PATTANI: And that means your shorter-term things like blackouts but also longer-term effects like liver disease, cancer or developing alcohol use disorder.

CHANG: Well, now that we know that women are drinking about the same amount as men are, have resources for alcoholism, like treatment programs and such, adapted to that new reality?

PATTANI: Not quite - I mean, even as women are drinking more, they're not necessarily getting more treatment. A lot of people I spoke with said things like, you know, that stereotypical image of someone who's affected by alcohol is still a man, so that means it's often harder to recognize problematic drinking in women. And even if it is recognized, treatment centers and recovery programs like 12Step are heavily male, right? A lot of men are participants. A lot of men lead those sessions. And that can be uncomfortable for some women, especially if they've experienced sexual violence or trauma. So there are starting to be some programs that are - treatment programs that are women-centered. And there is some research that shows those are more effective, but it's early on.

CHANG: That is a Aneri Pattani. She is a reporter at Kaiser Health News.

Thank you so much for joining us today.

PATTANI: Thank you. Transcript provided by NPR, Copyright NPR.