Nearly four million American women under the age of 30 have alcohol problems, and they are less likely than their male counterparts to seek treatment, according to a University of Miami alcohol researcher, the lead author of a study published today in the Journal of the American Medical Association.
Female problem drinkers are prone to menstrual and fertility problems, and their risky behavior while intoxicated can lead to HIV infection from unsafe sex or death or injury from driving under the influence, said Barbara Mason, who heads the Division of Substance Abuse at the UM School of Medicine.
There is also a stronger link between depression and problem drinking in women than in men, she said.
“Depressed alcoholic women are more likely to commit suicide than depressed alcoholic men,” said Mason, who advocates treating depression along with the alcohol problem.
The statistics were compiled from a nationwide survey that began in 1992, sponsored by the National Institute on Alcohol Abuse and Alcoholism. The survey used face-to-face interviews with 42,862 Americans chosen to ensure that all segments of the U.S. population - by age, sex and ethnicity - were represented.
Mason said it appears that women are gaining on men in abuse of alcohol or alcohol dependence, but further study is needed to prove there is a trend.
“The male-to-female ratio for alcoholism had been 3 to 1, but the survey indicates the gender gap may be closing. It’s more like 2 to 1 now,” Mason said.
Ten percent of young adult women were identified by the survey as having alcohol problems - either abuse or alcohol dependence as defined in the DSM-IV, the American Psychiatric Association’s manual of mental disorders, Mason said.
Alcohol abuse is defined in the manual by absences from school or work, job performance problems, neglect of child-care or household responsibilities because of drinking or the after-effects of drinking, or using alcohol in physically hazardous circumstances, such as driving a vehicle.
Alcohol dependence is characterized by the development of withdrawal symptoms within 12 hours of ceasing alcohol intake, or the compulsive use of alcohol - devoting substantial periods of time to obtaining and consuming alcohol.
“Women in the younger age groups are particularly influenced by their peers and drinking seems to be a part of socializing for many people in that age group,” Mason said. Having a spouse or live-in boyfriend who is a heavy drinker increases the risk that a woman will also abuse alcohol, she said.
“I think young people tend to use alcohol in a more dangerous way, because they think they’re immortal,” she said.
Women may avoid seeking treatment because of fear they may lose dependent children if the problem is revealed, or because they can not arrange care for their children while in treatment, she said.
Women become intoxicated after drinking smaller amounts than men, and intoxication can cause impaired judgment which may lead to unprotected sex and the risk of HIV and other sexually transmitted diseases. Alcohol also makes women more vulnerable to violence. The risk of being assaulted increases along with drinking, Mason said.
Women alcoholics have a higher death rate than men who are alcohol-dependent. Their physiological makeup allows potentially deadly liver diseases such as hepatitis and cirrhosis to develop after a shorter period and at a lower level of alcohol abuse than in men, Mason said.
Treating depression in women problem drinkers can increase their likelihood of staying sober, she said.
In one study of 71 patients with alcohol dependence, Mason identified 28 patients as having clinical depression. Half of them were given an antidepressant along with their alcohol rehabilitation program, and the other half got a placebo.
The results were striking - 82 percent of patients who got the antidepressant drug were lifted out of their depression and remained abstinent from alcohol longer than people who received the placebo.
Mason said some alcohol treatment programs have been reluctant to prescribe a drug to a recovering alcoholic, because they see it as exchanging one addiction for another.
“But this is a very important finding and I really hope it changes the way the alcoholism treatment community views treatment,” she said.
Dr. David Lewis, a professor of medicine at Brown University, Providence, R.I., and a member of the board of the American Society of Addiction Medicine, said he is not surprised that women are catching up with men as abusers of alcohol.
“It’s not a surprise that it may be kind of an emerging trend, particularly as women’s roles change,” he said. “But women have been under-served by treatment programs and many factors have kept women out of treatment programs.”
Lewis said primary care doctors need to be more diligent about screening for alcohol problems among their patients, women as well as men.
“Drinking problems are really common. Screening should be routine, mainstream medicine,” he said. But most studies show that less than half of primary care doctors look for alcohol problems or try to get their patients treatment, he said.
“Any treatment is a lot better than no treatment,” he said. “Treatment works.”
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