Red or white? It's the first thing you're asked when you walk into a party. Booze is everywhere, and women are now a big part of the drinking culture. Is that a problem? Well, yeah, says writer Ann Dowsett Johnston who wrote about her own struggles with the bottle within the pages of her new book, Drink: The Intimate Relationship Between Women and Alcohol.
Intimate it is. "Men go to sports bars and drink with friends. Women tend to drink alone, to medicate difficult feelings like sadness, loneliness, depression and grief," Johnston told me. It starts with young women who drink to combat the social anxiety they feel when they go on a date. Women like her (writer, editor, speaker, university VP, daughter, partner, Halloween costume-maker -- she's had many roles) try to have it all. And why shouldn't they -- except that when they do they do it all, too.
"Has alcohol become the modern woman's steroid, enabling her to do the heavy lifting necessary in an endlessly complex world?" she asks. Good question. "Is it the escape valve women need, in the midst of a major social revolution still unfolding?" Maybe.
Although the seasoned writer's personal story is a compelling one that's honest and full of heart, Drink, is much more than "quit lit" -- the kind of drinking memoirs made famous by Caroline Knapp's Drinking: A Love Story. In fact, Johnston's new book will resonate with any woman who asks herself if she drinks too much -- and, according to the author, that means a lot of us.
For example, women with a university degree are almost twice as likely to drink daily as those without. Recent results from Statistics Canada's Canadian Community Health Survey suggest nearly 30 per cent more women engage in risky drinking (that's having five or more drinks a sitting, once or more a month) than 10 years ago. Binge drinking is part of university life today, a Centre for Disease Control study notes that female binge drinking is under-recognized and that almost 14-million American girls and women binge drink about three times a month.
Why girls and women drink is a question that Johnston explores fully. For young women, she says, alcohol has become a kind of "rite of passage and a sense of entitlement. It's like, I drink because I can do what the guys do."
The link between alcohol and romance should not be underestimated: A date without a glass of wine, a wedding without champagne? Never! Romancing the glass includes shopping for designer crystal patterns, and drinking that midnight brandy with a lover is a reminder of classic movie romances like Audrey Hepburn and Albert Finney in Two for the Road.
Johnston explores the feminization of alcohol culture: Alco-pops, those premixed drinks that groom younger drinkers for the heavier stuff later on; marketing strategies to target women with wines that have cute names like Girls' Night Out and Skinnygirl Vodka; and pretty pastel tote bags that look like they came from Martha Stewart's workshop.
"You have a role that industry has played and a role that emancipation has played where women say I am going to be a lawyer, raise and family, and do everything a man does," she says, recalling her own long professional career and life as a single mother, "sipping wine while I chopped up veggies. My drinking was fine for many years -- until it wasn't."
Alcoholism is a progressive disease. On average it takes 12 years of problem drinking to get to a breaking point. But Johnston needed no intervention: She took herself off to rehab and has been sober five years.
One of the reasons she wrote the book was to address the stigma that surrounds alcoholism: "If you're a sophisticated person, you know your wines and you know how to handle your alcohol. We expect that and we don't look kindly upon anyone who gets into trouble. I grew up with a lot of silence around alcohol."
Now, years sober, people still ask her if she wouldn't like "just one" drink: "I don't lie and say I'm on a prescription or something. I say no thank you, I have a problem with alcohol. It's only by standing up that we may see some change."
Johnston believes we need to have the same kind of discussion around women and alcohol that we have had around tobacco use. Alcohol ups the risk of breast and colon cancer, for instance. One Australian study reported that 47 per cent of pregnant women consumed alcohol. Many women in her book attest to the link between alcohol and depression. In Britain, young women in their 30s are presenting with end-stage liver disease, she says: "That used to be an old man's disease."
But back to the stigma: She was advised by a colleague not to admit to alcoholism in print if she ever wanted to work again. Addiction needs its own anti-stigma campaign, she says. When interviewing women drinkers for this book, she asked each whether they'd rather be known as a depressive or an alcoholic. "None said alcoholic," said Johnston. "To a person they felt the stigma was too overwhelming."
According to <a href="http://www.cdc.gov/vitalsigns/BingeDrinkingfemale/#Introduction" target="_blank">Centers for Disease Control and Prevention estimates</a> released earlier this year, nearly 14 million women in the U.S. binge drink roughly three times a month. For women, binge drinking is defined as having four or more drinks in a single period, but most women average six drinks per binge. Women with a household incomes above $75,000 are more likely to binge, as are women age 18 to 34 and in high school. According to the CDC, 1 in 5 teenage girls binge drink, a behavior that poses serious health risks, including unintentional injuries, alcohol poisoning, liver disease and stroke, among others.
Women's bodies tolerate alcohol differently than men's for reasons that are not yet fully understood, <a href="http://www.slate.com/articles/health_and_science/explainer/2012/10/moderate_drinking_definition_of_two_drinks_per_day_for_a_man_and_one_for.html" target="_blank">Slate explains</a>. It may be that the hormone estrogen interacts with alcohol in a way that increases the risk for liver problems, Slate says, or it could be due to differences in stomach enzymes. Plus, as the <a href="http://pubs.niaaa.nih.gov/publications/womensfact/womensfact.htm" target="_blank">National Institute on Alcohol Abuse and Alcoholism (NIAAA) points out</a>, women's bodies have less water per pound than men's. If a man and woman who weigh the same amount drink the same amount of alcohol, the woman will likely have a higher blood alcohol concentration, because alcohol disperses in water and her body has less.
Largely <em>because</em> women's bodies tolerate alcohol differently than men's, they're more likely to be at risk for alcohol-related problems. Those risks include specific health diseases and conditions, such as liver disease, heart disease and breast cancer, as well as alcohol dependence. <a href="http://pubs.niaaa.nih.gov/publications/womensfact/womensfact.htm" target="_blank">The NIAAA defines</a> the "low-risk" drinking limit as no more than seven drinks per week for women, and no more than three drinks in any one sitting. For men, it's no more than 14 drinks per week, and four drinks in any one day.
As <a href="http://www.huffingtonpost.com/2013/08/09/women-alcohol-treatment-seek-men_n_3734023.html" target="_blank">HuffPost's Amanda Chan</a> previously reported, a new study released earlier this summer, which included more than 500 males and females, found that women who abuse alcohol tend to seek out help four to five years earlier than their male counterparts. Why that is, isn't exactly clear at this point, although in a statement, Rosemary Fama (a senior research scientist at Stanford University, who did not work on the study) hypothesized that women may attach less social stigma to drinking problems than men, and therefore may be more likely to report theirs, <a href="http://www.nlm.nih.gov/medlineplus/news/fullstory_139629.html" target="_blank">according to HealthDay</a>.
A new book "<a href="http://www.huffingtonpost.com/2013/08/20/expecting-better-emily-oster_n_3780541.html" target="_blank">Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong and What You really Need To Know</a>" has made waves for challenging many of the beliefs women and their doctors have long held, among them, that drinking during pregnancy is strictly off limits. Occasional drinking may not pose any danger, concludes author Emily Oster, an economist who was inspired to analyze the existing scientific literature when she became pregnant. But the fact remains that no amount of alcohol during pregnancy has been proven to be safe. In other words, there exists no clearly defined threshold at which experts can say alcohol consumption is safe, which is why most advise simply avoiding it altogether.
"The use of alcohol is clearly linked to an increased risk of developing breast cancer," the <a href="http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors" target="_blank">American Cancer Society</a> warns -- and that risk increases with the more alcohol a woman consumes. For example, a woman who sips only one drink a day has a very small increase in overall risk, the ACS explains, whereas a woman who has up to five drinks a day has roughly one-and-a-half times the risk of a woman who doesn't drink at all. That said, drinking is hardly the only risk factor for the disease -- there are many others that contribute, including a woman's lifestyle and her genes.
A German study published last year concluded that alcohol dependence is <em>twice</em> as deadly for women as for men. The death rate for alcohol-dependent women was four times that of a sample of comparable, non-addicted, 18- to 64-year-old women, but only double for men. While the "why" is unclear, the research is in line with other studies suggesting the effect of alcohol on women is "particularly harsh," CASAColumbia's vice president and director of policy research and analysis <a href="http://www.huffingtonpost.com/2012/10/17/women-alcohol-dependence-death_n_1973713.html" target="_blank">told HuffPost.</a>
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