Women and Alcohol – The Lily Livers

“Sober is the New Black”, “Mind Your Drink”, “The Sober Diaries”, “The Sober Revolution”, “Drunk Mom”, “Mindful Drinking”, “The Unexpected Joy of Being Sober”, “Glass Half Full”, “Girl Walks Out of a Bar: A Memoir”, are all recent books about alcohol, but specifically about women and alcohol. The catchy titles hide the pain behind alcohol abuse and the courage and fortitude it takes to become sober. We have made problem drinking more respectable and now use the term “alcohol use disorder” rather than alcoholism, respecting the fact that this is a mental health disorder having a complexity of sociobiological risk factors.

Web-based groups to support women through alcohol cessation are sprouting all over the net and have equally clever titles – Soberistas, Club Soda, Hip Sobriety, Sober Evolution, Sexy Sobriety, This Naked Mind, Living Sober, One Year No Beer and Smart Recovery. (1)

Clever titles for a sobering issue – women and alcohol just don’t mix well together, but stopping can be hard because drinking alcohol for many women is not just about socialisation, but to help them cope, to fit in, to get through the day.

While I am all for gender equity, alcohol use is one area in which we women should not strive for equality. It is not what the suffragettes fought for. Women’s brains and bodies are harmed by alcohol even more than men are, and recent studies have shown that there is no safe level of alcohol use, for women or for men.

A recent study published in the Lancet, using data from 195 countries, found that alcohol use is a leading risk factor for global disease burden and causes substantial health loss. It found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. (2)

Women get drunker quicker, our livers are more readily inflamed and we get brain damage at lower doses than men. Women are generally smaller than men, and have less total body water and more total body fat. Blood alcohol levels rise more quickly and are elevated longer, so that even if a man and a woman drink the same amount, the harmful effects of alcohol will show up sooner and last for longer in a woman.

There has historically been a difference in alcohol use between men and women – men drink more, binge more, drive under the influence more and are more often involved in alcohol induced violence – but women are catching up on all fronts and the gender gap is closing.

The Australian Bureau of Statistics shows that from 2001 to 2011, risky alcohol use in women increased from 8% to 10% of the population.

The 2016 National Drug Strategy Household Survey showed that while overall there is a trend towards lower levels of risky alcohol consumption, driven in particular by a reduction in the number of young people drinking, for the first time more women in their 50s were exceeding the lifetime risk guidelines for alcohol consumption than those aged 18-24, i.e. mothers are overtaking their daughters when it comes to risky drinking. (3)

“Boozy boomers are defying trends” said one headline noting that alcohol use in the over 45 age group exceeds that of younger women, and older women are a part of the population we may not be regularly screening.(4)

This is a group where excess drinking may be hidden like my lovely mother-in-law who steadily drank her gin and tonics until in her nineties (“The sun is over the yard arm Jane” – and I could not keep up) or my eighty-year-old nursing home patient who said she had a nip of whiskey each night, but the nip was more a tumbler full. Unlike the falling numbers of risky drinking across the Australian population in general, in my generation of women risky drinking is increasing.

While drinking less than their mothers’ generation, risky drinking in young women is rapidly catching up with the levels reported in young men, putting girls from as young as high school at risk.

While those over 70 years old are most likely to drink every day, for young people the danger is binge drinking. Outer regional and remote areas, as well as lower socioeconomic areas have higher levels of alcohol consumption. International comparisons of alcohol consumption are gauged by annual sales, and for Australia this was higher than the average across 34 OECD countries. (5)

Personally, I was a late starter, becoming a social drinker who thought she was a whole lot of fun. I was protected somewhat by having days off drinking when I was on call, in retrospect one of the few advantages of being on call so frequently. I would never have said I had a drinking problem and readily stopped when I started to react with a severely drippy nose and headaches – not a pretty picture when attempting to look sophisticated! None the less when I was diagnosed with breast cancer I had to face the fact that alcohol could have contributed. An American study suggests that 15% of breast cancers are attributable to alcohol use. (6)

When considering that 1 in 8 Australian women will have a diagnosis of breast cancer over a lifetime, these numbers are alarming. Women are beginning to ask, “Why were we not told?” but we all know the risks of drink-driving, liver disease and the social impacts of alcohol. Little can be more sobering than seeing little children damaged by foetal alcohol syndrome, the most common preventable cause of mental impairment. We have moved a long way from when my mother was advised by the doctor to drink Guinness to keep her iron levels up – which she dutifully did while holding her nose.

It can be hard to resist the social pressure of not drinking and unpleasant to be considered “boring” and sometimes difficult to live life without the relief of having a drink, but as the many who have let alcohol go have discovered, life can still be joyful and somehow there is more space, more honesty and more self-love, more room to truly nurture the beautiful beings we are. There may be a period of discomfort when we feel all the things we were choosing to numb by having a drink instead, but if we are sober, we are more able to deal with them, so that we can truly heal, not just put them off for another day. If sober is the new black, if not drinking becomes trendy, then women will feel freer to support themselves and each other to make the choice to live alcohol free, truly free.

References:

1. https://www.smh.com.au/national/hi-sobriety-our-changing-relationship-with-alcohol-20180813-p4zx5r.html
2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31571-X/fulltext
3. https://www.smh.com.au/healthcare/drug-and-alcohol-use-less-common-among-young-people-more-common-in-middle-age-20170531-gwhgcw.html
4. https://www.smh.com.au/healthcare/boozy-baby-boomers-alcohol-drink-women-20180816-p4zxx4.html
5. https://www.aihw.gov.au/reports/biomedical-risk-factors/risk-factors-to-health/contents/risk-factors-and-disease-burden
6. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.301199