Why Alcohol Affects Women More than Men

June 25, 2018

It used to be that men were the outsized alcohol drinkers in Western society – perhaps best depicted in popular culture by Don Draper’s Mad Men cronies, who swilled from office stashes of brown liquor, knocked back three-martini lunches and imbibed Old Fashioneds in an after-work pub culture where few women dared tread.

But epidemiologists have noted that the rise of marketing alcohol to women and the changing of gender roles have gradually shifted the booze imbalance. Overall, men are still almost twice as likely as women to binge drink. But that isn’t true for younger people, specifically. In fact, women born between 1991 and 2000 now drink just as much as their male counterparts – and their drinking rates could eventually surpass them.

Women are increasingly suffering from the ill effects of alcohol, too. National data show that the cirrhosis death rate shot up by 57% among women aged 45-64 from 2000-2015 in the US, compared to 21% among men. And it rose 18% in women aged 25-44, despite decreasing by 10% among their male peers. Adult women’s visits to hospital emergency departments for overdosing on alcohol also are rising sharply. And risky drinking patterns are escalating among women in particular.

But the problem isn’t just that women are drinking more. Researchers are finding that women’s bodies are affected differently by alcohol than men’s bodies – for reasons that go beyond mere size.

Scientists have discovered that women produce smaller quantities of an enzyme called alcohol dehydrogenase (ADH), which is released in the liver and breaks down alcohol in the body.

Meanwhile, fat retains alcohol, while water helps disperse it. So thanks to their naturally higher levels of body fat and lower levels of body water, women experience an even more dramatic physiological response to alcohol.

“That vulnerability is why we see increases in medical problems in women with alcohol-use disorders, compared to men,” says Dawn Sugarman, a psychology professor at Harvard Medical School and addiction psychologist at McLean Hospital in Belmont, Massachusetts. (Find out more about how different bodies react to alcohol differently in our recent story Why do only some people get blackout drunk?)

Women who drink excessively also tend to develop addiction and other medical issues more quickly than men. It’s a phenomenon called ‘telescoping’: women with alcohol struggles tend to start drinking later in life than men, but it takes them much less time to develop alcohol addiction. Women are also faster to experience liver disease and damage to their hearts and nerves.

Many of these gender-based differences in alcohol’s effects on the body weren’t discovered until recent decades. The earliest study on gender-based differences in ADH, for example, was published in 1990.

In fact, almost all clinical studies on alcohol were done entirely on men until the 1990s. This was partly because scientists were encouraged to eliminate as many variables as possible that might influence an experiment’s results – one of which was gender. And because alcoholism was assumed to be a mostly male problem, no-one wondered what not studying women and alcoholism might miss.

That changed when government institutions like the US National Institutes of Health mandated that women and minorities had to be included as clinical research subjects, and critical gender gaps in medical research began to be addressed.

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