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October 6, 2020 10:54 am
National Institute on Alcohol Abuse and Alcoholism No. 46 December 1999
Are Women More Vulnerable to Alcohol's Effects?
Women appear to be more vulnerable than men to many adverse consequences of alcohol use. Women achieve higher concentrations of alcohol in the blood and become more impaired than men after drinking equivalent amounts of alcohol. Research also suggests that women are more susceptible than men to alcohol-related organ damage and to trauma resulting from traffic crashes and interpersonal violence. This Alcohol Alert examines gender differences in alcohol's effects and considers some factors that may place women at risk for alcohol-related problems.
Prevalence of Women's Drinking
Household surveys indicate that alcohol use is more prevalent among men than women in the United States (1,2). In one survey, 34 percent of women reported consuming at least 12 standard drinks1 during the previous year compared with 56 percent of men (1). Among drinkers surveyed, 10 percent of women and 22 percent of men consumed two or more drinks per day on average (1). Men are also more likely than women to become alcohol dependent (3).2
Women's drinking is most common between ages 26 and 34 and among women who are divorced or separated (2). Binge drinking (i.e., consumption of five or more drinks per occasion on 5 or more days in the past month) is most common among women ages 18 to 25 (2). Among racial groups, women's drinking is more prevalent among whites, although black women are more likely to drink heavily (1).
Metabolism
Women absorb and metabolize alcohol differently than men. In general, women have less body water than men of similar body weight, so that women achieve higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol (5,6). In addition, women appear to eliminate alcohol from the blood faster than men. This finding may be explained by women's higher liver volume per unit lean body mass (7,8), because alcohol is metabolized almost entirely in the liver (9).
Consequences of Alcohol Use
Research suggests that women are more vulnerable than men to alcohol-related organ damage, trauma, and legal and interpersonal difficulties.
Liver Damage. Compared with men, women develop alcohol-induced liver disease over a shorter period of time and after consuming less alcohol (10,11). In addition, women are more likely than men to develop alcoholic hepatitis and to die from cirrhosis (12). Animal research suggests that women's increased risk for liver damage may be linked to physiological effects of the female reproductive hormone estrogen (13).
Brain Damage. Views of the brain obtained by magnetic resonance imaging (MRI) suggest that women may be more vulnerable than men to alcohol-induced brain damage. Using MRI, researchers found that a brain region involved in coordinating multiple brain functions was significantly smaller among alcoholic women compared with both nonalcoholic women and alcoholic men. These differences remained significant after measurements were adjusted for head size (14). Conversely, a study measuring metabolic energy utilization in selected brain regions found a significant difference between alcoholic and nonalcoholic men but no significant difference between alcoholic and nonalcoholic women (15). These results are not consistent with a greater vulnerability to alcoholic brain damage in women. However, the female alcoholics reported less severe alcohol use compared with the male alcoholics studied (15).
Heart Disease. Men and women who consume one or two alcoholic drinks per day have a lower death rate from coronary heart disease (e.g., heart attacks) than do heavier drinkers and abstainers, as discussed in Alcohol Alert No. 45, "Alcohol and Coronary Heart Disease" (16). Among heavier drinkers, research shows similar rates of alcohol-associated heart muscle disease (i.e., cardiomyopathy) for both men and women, despite women's 60 percent lower lifetime alcohol use (17).
Breast Cancer. Many studies report that moderate to heavy alcohol consumption increases the risk for breast cancer (18), although one recent study found no increased breast cancer risk associated with consumption of up to one drink per day, the maximum drinking level reported by most women (19).
Violent Victimization. A survey of female college students found a significant relationship between the amount of alcohol the women reported drinking each week and their experiences of sexual victimization (20). Another study found that female high school students who used alcohol in the past year were more likely than nondrinking students to be the victims of dating violence (e.g., shoving, kicking, or punching) (21).
A history of heavy premarital drinking by both partners has been found to predict first-year aggression among newlyweds (22). In some studies, problem drinking by wives has been linked to husband-to-wife aggression regardless of the husbands' drinking levels (23).
Traffic Crashes. Although women are less likely than men to drive after drinking (1,24) and to be involved in fatal alcohol-related crashes (25), women have a higher relative risk of driver fatality than men at similar blood alcohol concentrations (26). Laboratory studies of the effects of alcohol on responding to visual cues and other tasks suggest that there may be gender differences in how alcohol affects the performance of driving tasks (27).
Women's lower rates of drinking and driving may be attributed to their lower tendency toward risk taking compared with men (28,29). Women are also less likely to view drinking and driving as acceptable behavior. In a 1990 national household survey, 17 percent of women, compared with 27 percent of men, agreed that it was acceptable for a person to drink one or two drinks before driving (30). Nevertheless, the proportion of female drivers involved in fatal crashes is increasing. In 1996, 16 percent of all drivers involved in alcohol-related fatal crashes were women, compared with 13 percent in 1986 and 12 percent in 1980 (25).
Risk Factors for Women's Alcohol Use
Factors that may increase women's risk for alcohol abuse or dependence include genetic influences, early initiation of drinking, and victimization.
Genetic Factors. The relative contribution of genetic factors to women's risk for alcoholism has been debated. A survey of 2,163 female twins revealed greater similarity between identical twins compared with fraternal twins on measures of alcohol consumption (31). Similar studies including more than 12,000 twin pairs from the general population have confirmed that among both male and female twin pairs, identical twins are more likely than fraternal twins to have similar rates of alcohol dependence, alcohol abuse, and heavy alcohol consumption (32,33).
Studies of women who had been adopted at birth have shown a significant association between alcoholism in adoptees and their biological parents (34). In addition, antisocial personality (e.g., aggressiveness) in biological parents may predict alcoholism in both male and female adoptees (35). However, potential interactions between genetic and environmental influences require further study.
Using laboratory animals, researchers are currently attempting to identify gender-specific genetic factors whose interactions might contribute to differential sensitivity to alcohol's effects (36).
Age of Initiating Drinking. Results of a large nationwide survey show that more than 40 percent of persons who initiated drinking before age 15 were diagnosed as alcohol dependent at some point in their lives (37). Rates of lifetime dependence declined to approximately 10 percent among those who began drinking at age 20 or older. The annual rate of this decline was similar for both genders (37). Although in the past women generally started drinking at later ages than men, more recent survey data show that this difference has nearly disappeared (2).
Victimization. Using data collected in a large general population survey, Wilsnack and colleagues (38) found that women who reported being sexually abused in childhood were more likely than other women to have experienced alcohol-related problems (e.g., family discord or household accidents) and to have one or more symptoms of alcohol dependence. Another study found that women in alcoholism treatment were significantly more likely to report childhood sexual abuse and father-to-daughter verbal aggression or physical violence compared with women in the general population (39).
Widom and colleagues (40) reached a different conclusion from that of Miller and colleagues. Instead of relying on women's recall of their pasts, Widom and colleagues consulted court records to identify cases of childhood physical or sexual abuse. These researchers found that for women, a history of childhood neglect, but not abuse, significantly predicted the number of alcohol-related symptoms experienced, independent of parental alcohol or other drug (AOD) problems, childhood poverty, race, and age.
Physical abuse during adulthood has also been associated with women's alcohol use and related problems. One study found that significantly more women undergoing alcoholism treatment experienced severe partner violence (e.g., kicking, punching, or threatening with a weapon) compared with other women in the community. In addition, among women in the community group, those with AOD-related problems reported significantly higher rates of severe partner violence than women without such problems. Although the findings indicate that partner violence and AOD problems co-occur among women, the data do not indicate whether the association is causal (41).
October 7, 2020 1:19 pm
I am not much of a drinker I never have been I don't think I ever will be, I have nothing against alcohol its just not really for me. I have been around people who get black out drunk for fun, although I'm not sure whats so fun about waking up with a pounding headache and vomiting everywhere but who knows. The instances I have been around drunk people before and the effect the alcohol has on their abilities to function as a normal human is insane. It just does not interest me at all, not to mention the disease that can come with alcohol if you have an addictive personality or if you use alcohol as a depressant. It can cause liver and heart damage, you can get alcohol poisoning, and depending on the percentage of alcohol in the beverage it can shred your stomach lining because of how acidic it is. There is nothing wrong with alcohol there are lots of fun cute drinks lol it is just always best to be safe and I never mind being the sober DD out of my friends.
January 5, 2021 1:05 pm
My family has a huge history with alcohol abuse. It's mostly the men, but there are a few women who have struggled as well. Growing up I have been told that I have to be careful about my alcohol consumption because I have that addiction gene that almost everyone in my family has. However, I look at alcoholism as a disease that can be cured. I've seen family members be cured of their alcoholism and I've also seen it destroy those who could not heal.
January 5, 2021 11:57 pm
There is no history of alcohol abuse in my family, we just have one black sheep that had a drug problem. Although its not in my family directly, I have close friends that have lost their lives because of alcohol. Since graduating high school, too many of my old friends either lost their lives or practically ruined theirs due to alcohol. After having my son, I like a glass of wine every now and then but thats about it. Taking care of a baby and being hungover is not fun.
Topic starter
January 12, 2021 11:07 am
Members of my family also have issues with suing too much alcohol Amanda. I was always with family that drank and some to access. It is no good to be hungover. Women absorb and metabolize alcohol much different that men. Women have higher concentrations of alcohol in their blood when drinking the same as men. Women have less of an enzyme to breakdown alcohol before it enters the blood
January 19, 2021 9:06 pm
This was interesting to read, as I guess I always assumed that males have more stake in alcoholism. But i suppose it would make sense that women do not have to drink as much to mentally negate the fact that they are, in fact, drinking to excess. I know in my college years, having a few beers or glasses of wine regularly didn't seem to add up to much because weren't blackout drunk, but in hindsight, we were intoxicated for longer periods of time with more consecutive days. All I know now is that I absolutely can't handle that anymore. I'm half asleep after one glass of white wine.
January 19, 2021 9:10 pm
@amandamooreiectskin-com My extended family has always been in the bar/restaurant business, so we definitely have had experience with family members regularly drinking in excess, but in hindsight, grandmas two glasses a wine-every night really added up too. But i absolutely agree, I watched my best friend experience multiple blackouts, DWI's, and nights in the drunk tank consciously make the decision to identify his alcoholism and dependency as problems and get the help he wanted. He'll be a year sober in a few weeks and I'm beyond grateful to not have lost my friend.
July 25, 2021 10:10 pm
There is definitely a lot of information here I didn't know. It makes me think about the safe alcohol serving course I took and how casually it mentioned the different effects of alcohol of men versus women. It only mentioned how it generally takes women less drinks to become drunk. It's concerning to hear that other symptoms of actively being drunk can be different or more sever for women. Makes me wonder how much of a difference this information would make for women to know before they ever started drinking. Although I definitely do enjoy the occasional drink, I've also always been very aware of my family's history of alcoholism and to keep my drinking habits in check because of this.
Topic starter
August 1, 2021 10:36 am
I learned the metabolism of alcohol by women is faster than men so it takes less to be drunk. It is also a fact that an alcoholic that is recovering and relapses returns to active drinking the same amount as when they stopped. It is a devil that has to be watched all the time.
August 4, 2021 10:16 am
i have a few family members that have a history with alcoholism and watching them have to try and beat that disease on top of other health problems that have stemmed from their alcohol abuse has influenced me to this day. i watch how much i drink and i generally only like to drink in the house because i feel like being in a familiar environment and staying there cancels out a lot of situational dangers that alcohol can enhance
August 4, 2021 10:17 am
@amandamooreiectskin-com i agree amanda this is something that most people can beat, ive seen family members become sober and live healthy sober lives after being stuck in that cycle for 10+ years
August 18, 2021 3:16 pm
Unfortunately, I have personally witnessed the devastating affects of alcohol abuse in my family. Alcohol affects the mind, body, and spirit. Although i feel anyone can fall victim to alcohol abuse, it is surprising to hear that it affects women more than men. Most people who abuse drugs and alcohol often suffer from something psychological such as depression, anxiety, or trauma. I am a person who learns their lessons through experience so I always remind myself of who I want to become and what actions will bring me closer to that person to keep me from traveling down the wrong path.
This post was modified 3 years ago by Haley Keeth
August 18, 2021 3:26 pm
I also learned some new information from this article. I think it would be very beneficial for individuals, especially women, to know about these studies and facts at a young age. I think it's very wise of you to take what you learned from your past experiences and apply them into your life!
October 8, 2021 8:53 pm
@amandamooreiectskin-com alcoholism also runs in my family! Although I don't have an addictive personality when I used to drink alot I noticed that I could handle my liquor in a way that most people couldn't even tell when I was drunk. Which is scary!
October 22, 2021 11:21 pm
I was in a relationship with an addict for about two years, and i can say it was the hardest relationship ive ever been in. Going into it i thought i knew what i was getting myself into but i was completely wrong. I thought addition was a choice, something that could be cut on and off but i was extremely wrong. Its a disease. I attended NA meetings and AA meetings , although they werent for me they were very eye opening. These people wanted to be clean so bad, theyd go to 3 meetings a day by choice in order to do so. I remember the first conversation i had with my ex about getting married was, would he toast with me, in my head its only one glass of champagne right? wrong. One leads to another which leads to another. I wish young adults my age would understand the velosity of addiction and not use to words " im an alcoholic" as a joke, like its cute or glorified.
October 22, 2021 11:27 pm
@gabriellemrasiectskin-com I enjoy drinking from time to time with friends but i totally agree with the drinking to blackout is not for me. I dont like feeling out of control of my own body and why someone would want to drink until theyre physically sick is beyond me.
October 22, 2021 11:30 pm
As a former bartender , is important to be able to recognize alcohol abuse. Theres a difference between going out with your friends every once and a while verses having regulars who come in every night to get black out drunk. Being able to say no and cut someone off takes alot of confidence but atleast you can stop it at the source. I used to think that cutting someone off was like the worst thing, im ruining their night, but in reality theyre about to ruin their own night or god forbid someone else's night, or life.
October 24, 2021 7:29 pm
I have always enjoyed having a drink however when I was younger I would go out and drink to purposely black out and not forget. I have a history of alcoholism and addiction in my family so it's easier for me to drink more than someone else and not seem drunk. Alcoholism is something that isn't talked about as a disease because it's such a social thing to do. It's more accepted because you can go out and have a drink with friends and you can use it to celebrate so people don't look at it as something that is a problem. Sadly I have many friends who drink pretty excessively and don't really see they have a problem because it's what they do after work with friends so it doesn't seem "so bad". One of my friends from home has liver damage and another friend has jaundice so it's really sad to see. Women definitely get a buzz on way faster than a man does for the most part.
Topic starter
February 5, 2022 1:49 pm
My family has a history of alcoholism. My brother and I are both recovering alcohics. I used to drink all the time and finally realized I needed help. This led me to rehab 2 times each for 30 days. I will never be able to drink again as 1 is too many and 10 is not enough
June 21, 2023 7:54 pm
My family has a history of drinking problems. Mainly on my fathers side of the family. After Hurricane Irene in August 2011, my father along with 2 of his cousins were driving drunk, just riding around looking at all the damage around town. They lived in Rodanthe which is basically a tiny sand bar, the tiniest rain storm flood half the town. They were driving down to a broken down bridge, and ended up crashing into a trailer with no headlights. My dad was in the passenger seat and instantly passed away.
July 4, 2023 1:39 pm
alcohol is so frequent and is something that people use to celebrate events, and that's what makes it so unfortunate for recovering alcoholics, it makes it harder to quit when everyone around you is drinking it. Reaching out to family, friends, and avoiding alcohol related events and people at all costs is challenging but can be easier with the right people in your life.
July 4, 2023 1:42 pm
@abigailcochraneiectskin-com that is a good trait as a bartender to look out for people's safety in the long run
