Alcohol and Women

Much of our knowledge of alcoholism has been gathered from studies conducted with a
predominance of male subjects. Recent studies involving more female subjects reveal
that drinking differs between men and women. Studies in the general population
indicate that fewer women than men drink. It is estimated that of the 15.1 million
alcohol-abusing or alcohol-dependent individuals in the United States, approximately
4.6 million (nearly one-third) are women (1).

On the whole, women who drink consume less alcohol and have fewer alcohol-related
problems and dependence symptoms than men (2,3), yet among the heaviest drinkers,
women equal or surpass men in the number of problems that result from their drinking
(3).

Drinking behavior differs with the age, life role, and marital status of women. In general,
a woman's drinking resembles that of her husband, siblings, or close friends (3).
Whereas younger women (aged 18-34) report higher rates of drinking-related problems
than do older women (3,4), the incidence of alcohol dependence is greater among
middle-aged women (aged 35-49) (5).

Contrary to popular belief, women who have multiple roles (e.g., married women who
work outside the home) may have lower rates of alcohol problems than women who do
not have multiple roles (6). In fact, role deprivation (e.g., loss of role as wife, mother, or
worker) may increase a woman's risk for abusing alcohol (7).

Women who have never married or who are divorced or separated are more likely to
drink heavily and experience alcohol-related problems than women who are married or
widowed. Unmarried women living with a partner are more likely still to engage in
heavy drinking and to develop drinking problems.

Environmental Factors

Heath and colleagues (8) studied drinking behavior among a select sample of female
twins to identify possible environmental factors that may modulate drinking behavior.
They reported that, among women, marital status appears to modify the effects of
genetic factors that influence drinking habits. Marriage or a marriage-like relationship
lessens the effect of an inherited liability for drinking.

Several researchers have explored whether drinking patterns and alcohol-related

problems vary among women of different racial or ethnic groups. Black women (46
percent) are more likely to abstain from alcohol than white women (34 percent) (9,10).
Further, although it is commonly assumed that a larger proportion of black women
drink heavily, researchers have disproved this assumption:

Equal proportions of black and white women drink heavily (3,9). Black women report

1
fewer alcohol-related personal and social problems than white women, yet a greater
proportion of black women experience alcohol-related health problems (11).

Data from self-report surveys suggest that Hispanic women are infrequent drinkers or
abstainers (12,13), but this may change as they enter new social and work arenas. Gilbert
(14) found that reports of abstention are greater among Hispanic women who have
immigrated to the United States; reports of moderate or heavy drinking are greater
among younger, American-born Hispanic women.

Greater Physiological Impairment

The interval between onset of drinking-related problems and entry into treatment
appears to be shorter for women than for men (15,16). Moreover, studies of women
alcoholics in treatment suggest that they often experience greater physiological
impairment earlier in their drinking careers, despite having consumed less alcohol than
men (17,18). These findings suggest that the development of consequences associated
with heavy drinking may be accelerated or "telescoped" in women.

In addition to these many psych osocial and epidemiological differences, the sexes also
experience different physiological effects of alcohol. Women become intoxicated after
drinking smaller quantities of alcohol than are needed to produce intoxication in men
(19). Three possible mechanisms may explain this response.

First, women have lower total body water content than men of comparable size. After
alcohol is consumed, it diffuses uniformly into all body water, both inside and outside
cells. Because of their smaller quantity of body water, women achieve higher
concentrations of alcohol in their blood than men after drinking equivalent amounts of
alcohol. More simply, blood alcohol concentration in women may be likened to the
result of dropping the same quantity of alcohol into a smaller pail of water.

Second, diminished activity of alcohol dehydrogenase (the primary enzyme involved in

the metabolism of alcohol) in the stomach also may contribute to the gender-related
differences in blood alcohol concentrations and a woman's heightened vulnerability to
the physiological consequences of drinking. Julkunen and colleagues (20) demonstrated
in rats that a substantial amount of alcohol is metabolized by gastric alcohol
dehydrogenase in the stomach before it enters the systemic circulation.

Chronic Alcohol Abuse

This "first-pass metabolism" of alcohol decreases the availability of alcohol to the

system. Frezza and colleagues (21) reported that, because of diminished activity of
gastric alcohol dehydrogenase, first-pass metabolism was decreased in women
compared with men and was virtually nonexistent in alcoholic women.

2
Third, fluctuations in gonadal hormone levels during the menstrual cycle may affect the
rate of alcohol metabolism, making a woman more susceptible to elevated blood alcohol
concentrations at different points in the cycle. Research findings to date, however, have
been inconsistent (22,23,24).

Chronic alcohol abuse exacts a greater physical toll on women than on men. Female
alcoholics have death rates 50 to 100 percent higher than those of male alcoholics.
Further, a greater percentage of female alcoholics die from suicides, alcohol-related
accidents, circulatory disorders, and cirrhosis of the liver (25).

Increasing evidence suggests that the detrimental effects of alcohol on the liver are more
severe for women than for men. Women develop alcoholic liver disease, particularly
alcoholic cirrhosis and hepatitis, after a comparatively shorter period of heavy drinking
and at a lower level of daily drinking than men (26,27). Proportionately more alcoholic
women die from cirrhosis than do alcoholic men (28).

Heightened Vulnerability

The exact mechanisms that underlie women's heightened vulnerability to alcohol-

induced liver damage are unclear. Differences in body weight and fluid content between
men and women may be contributing factors (29). In addition, Johnson and Williams
(30) suggested that the combined effect of estrogens and alcohol may augment liver
damage. Finally, alcoholic women may be more susceptible to liver damage because of
the diminished activity of gastric alcohol dehydrogenase in first-pass metabolism (21).

Drinking also may be associated with an increased risk for breast cancer. After reviewing
epidemiological data on alcohol consumption and the incidence of breast cancer,
Longnecker and colleagues (31) reported that risk increases when a woman consumes 1
ounce or more of absolute alcohol daily. Increased risk appears to be related directly to
the effects of alcohol (32).

Moreover, risk for breast cancer and lower levels of alcohol consumption are weakly
associated. Data from other studies (33), however, do not concur with these findings,
suggesting that more research is needed to explore the relationship between drinking
and breast cancer.

Menstrual disorders (e.g., painful menstruation, heavy flow, premenstrual discomfort,

and irregular or absent cycles) have been associated with chronic heavy drinking
(34,35). These disorders can have adverse effects on fertility (36). Further, continued
drinking may lead to early menopause (37,38).

3
Barriers to Treatment

Animal studies have provided data that replicate the findings of studies in humans to
determine the effects of chronic alcohol consumption on female reproductive function.
Studies in rodents and monkeys demonstrated that prolonged alcohol exposure disrupts
estrus regularity and increases the incidence of ovulatory failure (39,40,41).

Researchers have begun to examine whether women and men require distinct treatment
approaches. It has been suggested that women alcoholics may encounter different
conditions that facilitate or discourage their entry into treatment.

Women represent 25.4 percent of alcoholism clients in traditional treatment centers in

the United States (42). Although it appears that they comprise a small proportion of the
treatment population (25 percent women compared with 75 percent men), the
proportion of female alcoholics to male alcoholics in treatment is similar to the
proportion of all female alcoholics to male alcoholics (30 percent women to 70 percent
men).

In addition, women drinkers pursue avenues other than traditional alcoholism

programs, such as psychiatric services or personal physicians, for treatment (43).

Treatment Outcomes

Women alcoholics may encounter motivators and barriers to seeking treatment that
differ from those encountered by men. Women are more likely to seek treatment
because of family problems (44), and they often are encouraged by parents or children
to pursue therapy. Men usually are encouraged to pursue therapy by their wives.

Fewer women than men reach treatment through the criminal justice system or through
employee assistance programs (45). Lack of child care is one of the most frequently
reported barriers to treatment for alcoholic women (46).

Sokolow and colleagues (47) attempted to compare treatment outcome between men
and women and reported that, among those who completed treatment, abstinence was
slightly higher among women than among men. Women had a higher abstinence rate if
treated in a medically oriented alcoholism facility, whereas the abstinence rate was
higher for men treated in a peer group-oriented facility.

Treatment outcome was better for women treated in a facility with a smaller proportion
of female clients and better for men in a facility with a larger proportion of female
clients. This study provided preliminary data on gender-specific treatment outcome;
however, the trials were not controlled. Although the question of whether women should
have separate treatment opportunities is an important one, the supporting evidence still
has not been found.

4
Alcohol and Women--A Commentary by NIAAA Director Enoch Gordis, M.D.

The extent of women's participation in alcoholism treatment appears to equal roughly

the prevalence of alcohol-related problems among women. Even so, some women may
face barriers that limit access to treatment. Limited financial resources may be one
barrier. For example, many women do not have access to the employer-paid alcoholism
treatment provided by larger industries, where men tend to predominate in the work
force. Child-care concerns and the fear that an identified alcohol problem will cause the
loss of dependent children also may create barriers to treatment. With regard to
treatment, many questions remain to be answered by research, including whether
specialized treatment in a women-only program is more effective than treatment in a
mixed-gender setting.

Previous concerns about a lack of women as research subjects in alcohol studies are
beginning to be addressed. However, there have been recent charges that alcohol
research on women is discriminatory (48,49). Research on fetal alcohol and drug effects
and the fear of discriminatory actions, such as imprisoning pregnant women solely
because of their addiction, is central to this controversy. The issue of fetal effects and
how to prevent and treat them will not go away simply because discriminatory policies
have been suggested. The challenge for alcohol research will be how both sexes can
benefit from the fruits of science.

Women's Brains More Damaged by Alcohol

Brain Atrophy Develops Faster in Women

Computer imaging technology has shown that women develop alcohol-related brain
damage more readily than men in studies conducted at the University of Heidelberg and
Stanford University School of Medicine.

Women appear to be more vulnerable to chronic drinking than men are. Yet few studies
have looked at gender differences in alcohol's effects on the brain. A study in the May
2005 issue of Alcoholism: Clinical & Experimental Research addresses this gap in
research, using computed tomography (CT) to examine brain atrophy in the brains of
alcoholic men and women.

The findings support and build upon a prior hypothesis that women develop alcohol-
related brain damage more readily than men.

"Telescoping" is a term that refers to the later onset and possibly accelerated negative
effects that chronic alcohol consumption may have on the brain's structural and
functional systems in women.

"Epidemiological studies have demonstrated gender differences in alcohol-consumption

behavior and the course of alcohol dependence," said said Karl Mann, full professor in

5
the department for addictive behavior and addiction medicine at the University of
Heidelberg and first author of the study. "Women typically start to drink later in life,
consume less per occasion and are, in general, less likely to develop alcohol dependence.
One could reason that women are less affected by alcohol. But there is, in fact, evidence
for a faster progression of the developmental events leading to dependence among
female alcoholics and an earlier onset of adverse consequences of alcoholism. This
suggests that women may be more vulnerable to chronic alcohol consumption."

Gender-Specific Differences

For this study, researchers examined 158 subjects: 76 women (42 patients, 34 healthy
"controls"), and 82 age-matched men (34 patients, 48 healthy "controls"). All of the
alcoholics were recruited from a six-week inpatient treatment program, and met
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition and
International Classification of Diseases 10 criteria for alcohol dependence.

Control subjects were recruited by advertisement. CT scans were performed twice

among the patients – at the beginning and end of their six-week program – and once
among the controls.

Results confirm gender-specific differences in the onset of alcohol dependence.

Faster Development of Dependence

"We were able to confirm the telescoping course of alcohol dependence in women," said
Mann, "meaning faster progression of the developmental events leading to dependence
among female alcoholics and an earlier onset of adverse consequences."

Results also show that brain atrophy seems to develop faster in women.

"We confirmed greater brain atrophy in alcoholic women and men compared to healthy
controls," said Mann. "Furthermore, the women developed equal brain-volume
reductions as the men after a significantly shorter period of alcohol dependence than the
men. These results corroborate previous studies that have found other gender-related
consequences of alcohol, such as cognitive deficits, alcoholic cardiomyopathy, myopathy
of skeletal muscle, and alcoholic liver disease - all of which occur earlier in women than
in men despite a significantly shorter exposure to alcohol."

Telescoping Effect

"The higher depression index in alcoholic women than men was also of interest," added
Edith Sullivan, a professor in the department of psychiatry and behavioral sciences at
Stanford University School of Medicine, "and may actually serve as a useful trigger to
family members that 'something is wrong' with the affected individual.

6
The good news is that abstinence seems to partially reverse the brain atrophy, for both
genders.

"Because of the 'telescoping' effect," said Mann, "early diagnosis and early prevention
are even more important for women with alcohol problems than for men. Despite the
fact that men, in general, drink more alcohol and are more likely to develop alcohol
dependence, it is those women who consume alcohol who probably develop alcohol
dependence and adverse consequences more readily than men."

Women, Girls and Drugs: Facts & Figures

Overview

A three-year study on women and young girls (ages 8–22) from the National Center on
Addiction and Substance Abuse (CASA) at Columbia University revealed that girls and
young women use substances for reasons different than boys and young men. The study
also found that the signals and situations of higher risk are different and that girls and
young women are more vulnerable to abuse and addiction: they get hooked faster and
suffer the consequences sooner than boys and young men.1

In 2007, lifetime, past year, and past month drug use rates were lower for women than
for men.2 Women accounted for 32.3% of the nationwide admissions to treatment
during 2007.3

Extent of Use

According to the 2008 National Survey on Drug Use and Health (NSDUH),
approximately 42.9% of women ages 12 or older reported using an illicit drug at some
point in their lives. Approximately 12.2% of females ages 12 and older reported past year
use of an illicit drug and 6.3% reported past month use of an illicit drug. 4

The rate of substance dependence or abuse for males aged 12 or older in 2008 was
nearly twice as high as the rate for females (11.5% vs. 6.4%). Among youths aged 12 to
17, however, the rate of substance dependence or abuse was higher among females than
males (8.2% vs. 7.0%).5

According to the Centers for Disease Control and Prevention (CDC), approximately
34.5% of female high school students surveyed nationwide in 2007 used marijuana
during their lifetime. This is down from 35.9% in 2005 and 37.6% in 2003. Inhalant
abuse among surveyed high school females has increased from 11.4% in 2003, to 13.5%
in 2005 and 14.3% in 2007.6

7
Percent of High School Females Reporting Drug Use, 2003–2007

Drug Type 2003 2005 2007

Lifetime marijuana 37.6% 35.9% 34.5%
Current marijuana 19.3 18.2 17.0
Lifetime cocaine 7.7 6.8 6.5
Current cocaine 3.5 2.8 2.5
Lifetime inhalant 11.4 13.5 14.3
Lifetime heroin 2.0 1.4 1.6
Lifetime 6.8 6.0 4.1
methamphetamine
Lifetime Ecstasy 10.4 5.3 4.8
Lifetime Steroid 5.3 3.2 2.7

According to data from the Bureau of Justice Statistics, approximately 59.3% of State
and 47.6% of Federal female prisoners surveyed in 2004 indicated that they used drugs
in the month before their offense. Additionally, approximately 60.2% of State and 42.8%
of Federal female prisoners surveyed in 2004 met drug dependence or abuse criteria.7

Health Effects

A National Vital Statistics Report found that 38,396 persons died of drug-induced
causes in 2006. Of the drug-induced deaths, 13,889 were females. Drug-induced deaths
include deaths from dependent and nondependent use of drugs (legal and illegal use)
and poisoning from medically prescribed and other drugs. It excludes unintentional
injuries, homicides, and other causes indirectly related to drug use. Also excluded are
newborn deaths due to mother's drug use.8

The Drug Abuse Warning Network (DAWN) collects data on drug-related visits to
emergency departments (ED) nationwide. In 2006, there were 1,742,887 drug related
ED episodes. The rates of ED visits involving cocaine, marijuana, and heroin were
higher for males than females, but the rates for stimulants did not differ by gender
during 2006. 9

Number of Female ED Drug Mentions, 2006

Drug Type Mentions

Cocaine 194,121
Heroin 59,744
Marijuana 95,478

8
Stimulants 38,930
MDMA (ecstasy) 5,915
LSD 705
PCP 6,661
All illicit drugs 326,846

The impact of drug use and addiction can be far reaching. Cardiovascular disease,
stroke, cancer, HIV/AIDS, hepatitis, and lung disease can all be affected by drug abuse.
Some of these effects occur when drugs are used at high doses or after prolonged use,
while some may occur after just one use. Drug abuse not only weakens the immune
system but is also linked to risky behaviors like needle sharing and unsafe sex. The
combination greatly increases the likelihood of acquiring HIV-AIDS, hepatitis and many
other infectious diseases.10

The U.S. Department of Health and Human Services manual, A Guide to the Clinical
Care of Women with HIV/AIDS, addresses the primary care needs unique to women
infected with HIV infection and provides information specifically about substance abuse
among these women. Also see the National Institutes of Health's AIDSinfo site on
General Information for Women to learn more about the prevention, treatment, and
impact of HIV/AIDS on females.

Effects on Pregnancy

Alcohol and drug use by pregnant women is a public health problem with potentially
severe consequences. Combined data from the 2002 to 2007 National Surveys on Drug
Use and Health shows that past month alcohol use was highest among women who were
not pregnant and did not have children living in the household (63.0%) and lowest for
women in the second and third trimesters (7.8 and 6.2%, respectively). Similar patters
were seen among women for marijuana, cigarette and binge alcohol use.11

Research has shown that babies born to women who used marijuana during their
pregnancies display altered responses to visual stimuli, increased tremulousness, and a
high-pitched cry, which may indicate problems with neurological development.12 Heroin
abuse during pregnancy and its many associated environmental factors (e.g., lack of
prenatal care) have been associated with adverse consequences including low birth
weight, an important risk factor for later developmental delay.13 Knowledge of the effects
of methamphetamine during pregnancy is limited. However, the few human studies that
exist on the subject have shown increased rates of premature delivery, placental
abruption, fetal growth retardation, and heart and brain abnormalities. These studies,
though, are difficult to interpret due to methodological issues, such as small sample size
and maternal use of other drugs.14

The National Institute on Drug Abuse has created a Prenatal Effects page to focus on the
impact that a mother's drug use can have on the developing fetus.

9
Treatment

Of the approximately 1.8 million admissions to drug/alcohol treatment in the U.S.

during 2007, 32.3% were female. For 18% of the female admissions in 2007, alcohol
only was the primary substance of abuse. Fifteen percent involved alcohol along with a
secondary drug.15

Female Admissions by Primary Substance, 2007

Drug Type % of Total

Alcohol 18%
Alcohol with secondary drug 15
Heroin 13.2
Other opiates 7.2
Cocaine-smoked 12.1
Cocaine-other route 4.0
Marijuana 13.0
Meth./amphetamine 11.1
Other stimulants 0.1
Tranquilizers 0.9
Sedatives 0.4
Hallucinogens 0.1
PCP 0.2
Inhalants 0.1
Other/none specified 4.8

According to the Substance Abuse and Mental Health Services Administration's

(SAMHSA) 2007 National Survey of Substance Abuse Treatment Services (N-SSATS),
which presents data from more than 13,000 facilities, approximately 32% of the
facilities offered special programs or groups for adult women and 14% offered programs
or groups for pregnant or postpartum women.16

SAMHSA offers a Treatment Facility Locator service to aid in identifying treatment

programs throughout the country. Using the Treatment Facility Locator site, individuals
can search for programs/facilities in their area and can also identify facilities that offer
special programs for females. This information can also be obtained by calling 800-662-
HELP (4357).

10
Arrests & Sentencing

According to the Federal Bureau of Investigation's Uniform Crime Reporting Program,

during 2007, there were a total of 1,033,203 state and local arrests for drug abuse
violations in the United States where gender information was available. Of these drug
abuse violation arrests, 199,262 involved females.17

In FY 2004, the U.S. Marshals Service arrested and booked 19,434 female suspects for
Federal offenses, representing 13.8% of the total arrests made by this agency. Of the U.S.
Marshals Service arrestees booked on drug offense charges, 14.5% were female. Also in
FY 2004, the Drug Enforcement Administration (DEA) arrested 4,285 females,
representing 15.6% of all DEA arrests. Approximately 1,188 of the female DEA arrests in
FY 2004 involved methamphetamine.18

Females Arrested by the DEA, by Type of Drug, FY 2004

Drug Category Total arrested

Powdered cocaine 898
Crack cocaine 494
Marijuana 737
Methamphetamine 1,188
Opiates 401
Other or non-drug 567

From October 1, 2002 to September 30, 2003, there were 9,127 female offenders
convicted of a Federal offense. Approximately 82.3% of the female offenders convicted
of felony drug offenses in FY 2003 were sentenced to incarceration. On September 30,
2003, there were 10,493 female offenders in Federal prison. Females accounted for
8.0% of the Federal prisoners serving time for drug offenses.19

At yearend 2005, there were approximately 88,200 sentenced female prisoners under
State jurisdiction. Approximately 28.7% of incarcerated females were sentenced for drug
offenses compared to 18.9% of incarcerated males.20

During FY 2008, there were 25,332 Federal defendants whose gender was reported to
the U.S. Sentencing Commission who were charged with a drug offense. Approximately
12.3% of these defendants were female. For 17.4% of the female defendants,
methamphetamine was the type of drug involved in the case.21

Females Sentenced for Drug Offenses, by Type of Drug, FY 2008

11
Drug Category Total sentenced
Powder cocaine 573
Crack cocaine 567
Heroin 206
Marijuana 817
Methamphetamine 755
Other 191
Total 3,109

A Bureau of Justice Statistics (BJS) report found that about half of women offenders
confined in State prisons had been using alcohol, drugs, or both at the time of the
offense for which they had been incarcerated. About 6 in 10 women in State prison
described themselves as using drugs in the month before the offense and 5 in 10
described themselves as a daily user of drugs. Nearly 1 in 3 women serving time in State
prisons said they had committed the offense which brought them to prison in order to
obtain money to support their need for drugs.22

A report from the Office of Juvenile Justice and Delinquency Prevention (OJJDP), that
summarized research on female gangs, states that drug offenses are among the most
common offenses committed by female gang members. In Los Angeles County, an
analysis of lifetime arrest records of female gang members revealed that drug offenses
were the most frequent cause for arrest. A special tabulation from Chicago showed that
between 1993 and 1996, either drug offenses or violent offenses were the most common
cause for arrest of female gang members.23

DRUGS AND PREGNANCY

A Double Danger

When a woman becomes pregnant, it is very important for her to lead a healthy life: to
eat plenty of nourishing food, get plenty of rest, and exercise regularly. It is also vital
that she avoid anything that might harm her or her baby-to-be. It is especially important
to give up alcohol, cigarettes, and drugs.

For a pregnant woman, drug abuse is doubly dangerous. First, drugs may harm her own
health, interfering with her ability to support the pregnancy. Second, some drugs can
directly impair prenatal development.

Which Drugs are Dangerous?

Virtually all illegal drugs, such as heroin and cocaine, pose dangers to a pregnant
woman. Legal substances, such as alcohol and tobacco, are also dangerous, and even
medical drugs, both prescription and over-the-counter, can be harmful. For her own

12
health and the health of her baby-to-be, a woman should avoid all of them as much as
possible, from the time she first plans to become pregnant or learns that she is pregnant.

Drugs and the Stages of Pregnancy

Some drugs can be harmful when used at any time during pregnancy; others, however,
are particularly damaging at specific stages.

The stage of organ formation

Most of the body organs and systems of the baby-to-be are formed within the first ten
weeks or so of pregnancy (calculated from the date of the last menstrual period). During
this stage, some drugs—and alcohol in particular—can cause malformations of such
parts of the developing fetus as the heart, the limbs, and the facial features.

The stage of prenatal growth

After about the tenth week, the fetus should grow rapidly in weight and size. At this
stage, certain drugs may damage organs that are still developing, such as the eyes, as
well as the nervous system. Continuing drug use also increases the risk of miscarriage
and premature delivery. But the greatest danger drugs pose at this stage is their
potential to interfere with normal growth. Intrauterine growth retardation (IUGR) is
likely to result in a low-birthweight baby—a baby born too early, too small, or both.
Low-birthweight babies require special care and run a much higher risk of severe health
problems or even death.

The stage of birth

Some drugs can be especially harmful at the end of pregnancy. They may make delivery
more difficult or dangerous, or they may create health problems for the newborn baby.

Alcohol

Alcohol is one of the most dangerous drugs for pregnant women, especially in the early
weeks. In the mother’s body, alcohol breaks down chemically to a cell-damaging
compound that is readily absorbed by the fetus. Heavy drinking during early pregnancy
greatly increases the risk of a cluster of birth defects known as fetal alcohol syndrome.
This cluster includes a small skull (microcephaly), abnormal facial features, and heart
defects, often accompanied by impeded growth and mental retardation. Heavy drinking
in later pregnancy may also impede growth.

It is not known whether light to moderate drinking can produce these effects. However,
even if the risk is low, the stakes are very high. Medical experts agree that a woman
should avoid alcohol entirely when she decides to become pregnant, or at least when the
first signs of pregnancy appear. Even such mild beverages as beer and wine coolers
should be off limits.

13
Tobacco

Smoking during pregnancy appears to raise the risk of miscarriage or premature labor.
But the primary danger is hindered fetal growth. Nicotine depresses the appetite at a
time when a woman should be gaining weight, and smoking reduces the ability of the
lungs to absorb oxygen. The fetus, deprived of sufficient nourishment and oxygen, may
not grow as fast or as much as it should.

Cocaine & Methamphetamine

Cocaine (including crack) and methamphetamine (speed, or ice) are powerful

stimulants of the central nervous system. They suppress the mother’s appetite and exert
other drastic forces on her body, causing the blood vessels to constrict, the heart to beat
faster, and the blood pressure to soar. The growth of the fetus may be hindered, and
there are higher risks of miscarriage, premature labor, and a condition called abruptio
placentae (the partial separation of the placenta from the uterus wall, causing bleeding).

If these drugs are taken late in pregnancy, the baby may be born drug dependent and
suffer withdrawal symptoms, such as tremors, sleeplessness, muscle spasms, and
sucking difficulties. Some experts believe learning difficulties may later develop.

Heroin & Other Narcotics

Heavy narcotics use increases the danger of premature birth with such accompanying
problems for the infant as low birthweight, breathing difficulties, low blood sugar
(hypoglycemia), and bleeding within the head (intracranial hemorrhage).

The babies of narcotics-dependent mothers are often born dependent themselves and
suffer withdrawal symptoms, such as irritability, vomiting and diarrhea, and joint
stiffness.

Women who inject narcotics may become infected with the HIV virus from dirty needles
and may subsequently develop AIDS. HIV-infected women obviously run a high risk of
passing the virus on to their babies.

Inhalants

At least one inhaled substance has been clearly connected with birth defects. The
organic solvent toluene, widely used in paints and glues, appears to cause
malformations like those produced by alcohol (which is itself an organic solvent). It is
possible that all organic solvents may cause birth defects.

PCP

PCP (phencyclidine, or angel dust) taken late in pregnancy can cause newborns to have
withdrawal symptoms, such as lethargy alternating with tremors.

14
Marijuana

Studies of marijuana use by pregnant women are inconclusive, because marijuana is

often used with other drugs, such as tobacco and alcohol. Like them, it is associated with
premature birth and low-birthweight babies.

Medications

Many medications have side effects that are potentially harmful during pregnancy, but
their benefits may outweigh their risks. A woman should consult her doctor or midwife
before taking any drug, even one sold over the counter. Below are a few examples of
medical drugs that must be used with extreme caution or avoided altogether.

• Isotretinoin (Accutane) and etretinate (Tegison) are used to treat chronic acne
and psoriasis. They may cause chronic malformations during the stage of organ
development.
• Anticonvulsants, such as phenytoin (Dilantin) and carbamezapine (Tegretol), are
used to prevent epileptic seizures. They are associated with defects of the heart
and face, as well as mental retardation.
• Antimigraine drugs, such as ergotamine and methysergide, are used to head off
migraine attacks but raise the risk of premature labor.
• Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs)
interfere with blood clotting and increase the risk of uncontrolled bleeding for
both mother and baby. Toward the end of pregnancy, they hinder production of
the hormones that stimulate labor, so that labor may be dangerously delayed or
extended.
• Anticoagulant drugs based on coumarin are used in the treatment of heart
disease and stroke, to slow blood clotting. Taken during early pregnancy, they are
associated with facial malformations and mental retardation. Later on they raise
the risk of uncontrolled bleeding.

Alcohol a Greater Risk for Women

Health Problems Are Not the Only Risks

She wakes up groggy with a tremendous hangover, then makes a startling discovery. She
is not in her own room, not in her own bed, and not alone.

Oh, no! I'm in bed with a man! How did I get here? I don't remember. Did I
we have sex? We must have! Did he use protection? Could I be pregnant?
Could I have a sexually transmitted disease?

How did this happen? Everybody else was drinking and apparently having a good time.
She was not drinking any more or less than her companion, and he seemed to be in
control. How did she get so out of it?

15
The simple answer is women get drunk a lot faster than men. Even allowing for
differences in body weight, a woman will attain a higher blood alcohol concentration
than a man from the same amount of alcohol. This may be because women have lower
levels of Alcohol Dehydrogenase (ADH), an enzyme involved in the metabolism of
alcohol.

The end result was, while her date was drinking right along with her, he was simply not
getting as drunk -- while she was drinking herself into a blackout -- and later he took
advatange of the situation. It is a scene that has been played millions of times.

Other Risk Factors

Getting drunker quicker is not the only risk for women who drink to excess. Women are
not only more sensitive to alcohol, may become addicted sooner, may develop alcohol-
related problems more quickly, and many die younger than men with similar drinking
problems.

Women usually have drinking patterns similar to those of their husband or lover and
their friends. But because of the biological make-up of their bodies, develop alcohol-
related diseases sooner, according to a study by the National Center on Addiction and
Substance Abuse at Columbia University.

Plus there is growing evidence that women are at an especially high risk for the health
and social problems caused by alcohol, tobacco, and other drugs, compared to their mail
counterparts.

Growing Problem

Recent studies have indicated an increase of alcohol and substance abuse problems in
the general female population. More women are drinking to deal with stress, according
to health experts in a National Opinion Poll. More young professional females are
drinking more after work , while mothers with small children are drinking more
frequently at home.

Now that more women are in the work force, they have come out in the open with their
drinking. A quarter of women questioned in the poll admitted having an alcoholic drink
every day, with the same number drinking more heavily on weekends.

Women are also beginning to drink more early in life. In the early 1960's, among girls,
about seven percent of the new users of alcohol were between the ages of 10-14. By the
early 1990's, that percentage had increased to 31 percent. On top of this, girls today are
15 times more likely than their mother to begin using illegal drugs by age 15.

Other Factors

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Women first caught up to men in cigarette smoking in the mid-1970s and their rate of
lung cancer soared. Now, according to a new study by the Center on Addiction and
Substance Abuse, women are catching up to men in the consumption of alcohol and the
use of drugs.

To make matters worse, treatment of substance abuse in women lags behind because the
female anatomy is more complex and they face greater social stigma that hinders
treatment. Only 14% of women who need treatment get it, according to the Betty Ford
Center.

Alcoholism and Women – Contributing Factors

Estimates state that there are nearly 5 million alcohol-dependent women in the United
States alone. It’s important to stress that alcoholism is a very complex disease that
typically has more than one cause/contributing factor. How these causes and factors
come together in each person is wholly unique to that individual.

Hormonal: For many women alcohol abuse begins with hormonal changes, typically
during perimenopause. As the body changes, it creates stress and emotional trauma
that’s among the causes of alcoholism in women.

Alcohol Processing: Men do not get drunk as quickly as women, because a woman’s
body doesn’t process alcohol the same way. More alcohol goes into a female’s blood,
which may in turn become one of the causes of alcoholism in women. Additionally,
studies reveal that men don’t become addicted as quickly as women.

Self Medication: Depression and other emotional issues contribute to alcoholism in

women, particularly those who binge drink (4 or more drinks in under 2 hours). Quite
simply, some women use alcohol to offset negative feelings (some of which may have
other physical causes that go undiscovered because of the self-medicating with alcohol).

Genetics: As with men, a woman with family members who were alcoholics has a
stronger chance of becoming an alcoholic herself.

Stress & Environment: Women are prone to heavier drinking when they’re under stress,
or when factors in their environment cause anxiety, nervousness, insecurity, and self
doubt. For example, unmarried women are more likely to become dependent than
married or widowed women. Stress and environmental factors alone will not cause a
woman to become an alcoholic, but drinking as a result of either can cause more stress
(and lead to alcohol abuse).

Alcoholism and Women: Health Issues

Premature Menopause: We know that perimenopause is one of the causes of alcoholism

in women. And if a woman begins heavy drinking during this time it could shorten the

17
time until complete menopause by up to 5 years. Additionally it may increase the
intensity of hot flashes and sleeplessness associated with this period in life.

Cancer Risk: Alcohol has been linked to an increase risk of breast cancer in menopausal
women by as much as 50%

Calcium Loss: Menopausal women already loose a lot of calcium, but alcohol
consumption increases this, which in turn exasperates the risk of osteoporosis.

Other Health Issues: In addition, women who drink heavily increase their chances of
getting heart disease, memory loss, and having reproductive difficulties. Studies of
alcoholism and women show that women alcoholics have more health risks then men
who drink heavily.

Pregnancy:

A woman who drinks during pregnancy (and/or while nursing) passes along that alcohol
content directly to her fetus. This may result in birth defects or Fetal Alcohol Spectrum
Disorder, a condition that can impact the child mentally, physically, and emotionally.

Conclusion: Alcoholism and Women

There is no question that drinking can have serious impacts on a woman’s life. Women
who drink heavily face numerous potential illnesses and issues, far more so than men
who drink the same amount. There is help out there from a variety of support services,
your personal physician and this website.

Women and Alcoholism

When it comes to women and alcoholism, gender plays a distinct role. Women are far
more vulnerable to the consequences of alcoholism than men, according to a report on
the Effects of Alcohol on Women published by the U.S. Department of Health and
Human Services.

The incidence of women who die of alcohol-related deaths such as motor vehicle
crashes, accidents, and suicide is double that of their male counterparts who are alcohol
dependent.

Women are also more susceptible to illnesses included heart-related problems, liver
disease and brain damage.

Heavy drinking also fosters menstrual problems, infertility, early menopause, and
problems with bone health.

Moreover, chronic alcohol consumption at heavy levels puts women at greater risk of

18
exposing themselves to sexual assault and other violence. With intoxication, people are
more likely to have unprotected sex and expose themselves to sexually transmitted
diseases.

Different Effects Compared to Men

Body makeup and chemistry are the reasons why chronic drinking affects women
differently than men. Since a woman’s body has less water and a higher concentration of
fat than a typical man, alcohol is less diluted and reaches the bloodstream faster than
with men.

This allows women to more quickly feel the effects of the alcohol at greater levels of
intoxication. In addition, women may become more easily intoxicated during their
menstrual cycle.

Pregnancy and Alcohol

When a pregnant woman consumes alcohol in any quantity, it is passed to the fetus
through the bloodstream and inhibits the development of the unborn child. Women who
are pregnant or who are trying to conceive should avoid all alcohol or risk harming the
fetus.

Unborn children exposed to alcohol in vitro may experience irreversible physical,

mental, behavioral, and/or learning disabilities they will live with for the rest of their
lives. In addition, women who are nursing must avoid alcohol because it can pass
through breast milk to the baby.

Women should always evaluate the consequences of drinking and the impact
consumption will have on their bodies, as well as those of their unborn children.

The Facts About Men vs. Women and Alcoholism

Alcoholism has devastating effects on a person’s health and personal life, no matter
what sex they are. Studies show, however, that the risk factors that lead to alcoholism
and the consequences of alcohol abuse differ among men and women.

At Casa Palmera, we understand that men and women face different hurdles in
alcoholism treatment because their addictions to alcohol are based on very different
physical, physiological, social and environmental factors. Here are the facts about
alcoholism in men vs. women and what we can do to help.

Men vs. Women and Alcoholism: The Rate of Alcoholism

* Alcoholism is more than twice as common among men as women.

19
* Men are more at risk for abusing or becoming dependent on alcohol than women.

* The consequences associated with heavy drinking are accelerated in women vs. men.
For example, a man may be a heavy drinker for 20 to 30 years and have moderate
problems, while a woman can be a heavy drinker for only five years and show moderate
to severe problems.

* Women are more at risk for developing a drinking problem later in life. They are also
at greater risk for alcohol-related health problems as they get older due their physiology.
Younger women (aged 18-34) have higher rates of drinking-related problems than older
women do, but the rates of alcohol dependence are greater among middle-aged women
(aged 35-49).

* Chronic alcohol abuse takes a greater physical toll on women than on men. Women
alcoholics have death rates 50 to 100 percent higher than men alcoholics. Women
alcoholics also have a higher percentage of death due to alcohol-related injuries,
suicides, circulatory disorders and cirrhosis of the liver.

Men vs. Women and Alcoholism: How Alcohol is Metabolized

* Women typically have less body mass and less water content in their bodies than men.
Body water diffuses alcohol content as it’s digested, which means women have a higher
concentration of alcohol in their blood stream when they drink. This not only causes
women to become more impaired from drinking, but also exposes their brains and other
organs to more alcohol before it’s broken down. This plays a role in the short- and long-
term effects of alcohol on women.

Men vs. Women and Alcoholism: Alcoholic Health Issues

* Alcohol-induced liver diseases such as cirrhosis and hepatitis develop more quickly in
women than in men, and more alcoholic women die from cirrhosis than do alcoholic
men.

* Women who consume alcohol are more at risk for developing cancer than men.
Excessive alcohol consumption has also been shown to increase the risk of several
digestive-tract cancers in women.

* Women in the late stages of develop hypertension, anemia and malnutrition much
quicker than alcoholic men. They are also at risk for developing depression, sleeping
problems and are more at risk for personal injury. These risks are especially prevalent in
older women.

* Excessive alcohol use can cause men to have difficulty getting and maintaining
erections, difficulty ejaculating, reduced sexual desire, increased sexual aggression, and
infertility.

20
* Studies show that men are more likely than women to take risks during periods of
excessive drinking, further increasing their risk of injury or death. In fact, men
consistently have higher rates of alcohol-related deaths and hospitalizations than
women.

* Drinking makes symptoms of depression and anxiety worse. Studies show that men
are more likely than women to commit suicide, and that the majority of men who
commit suicide consumed alcohol before doing so.

Men vs. Women and Alcoholism: Treatment

At Casa Palmera, we believe that alcoholism is more than just a physical problem. We
recognize the need for mental and spiritual recovery and strive to treat our residents’
entire well-being. We also understand that men and women face unique hurdles in
treatment and will tailor a treatment program to your specific needs. Our focus on
individualized alcohol treatment helps make Casa Palmera a valuable, rare and life
changing experience.

Consequences of Drug Abuse and Dependency in Women

Although proportionately more men use and abuse drugs, drug abuse and dependency
pose significant problems for women. Studies show that women are more vulnerable
than men to
alcohol-related organ damage and trauma resulting from traffic accidents and violence.
[19]
Research has also shown that women's abuse or problem use of alcohol or other
drugs is a risk factor for a number of adverse health and social consequences, including
criminal activities, mental health disorders, unprotected intercourse, sexually
transmitted diseases and HIV infection, unintended pregnancies, poor birth outcomes,
and child abuse and neglect.[18]

For example, one study[18] found that adult women who had used any illicit drug in the
previous year were six times as likely as women who had not used drugs to have been
arrested in that same year and four times as likely to have committed any criminal
activity in that year. Adult men had a similar relationship between previous-year illicit
drug use and criminal activity; however, those who had used any illicit drug in the
previous year were only three times as likely as those who had not used drugs to have
been arrested in that same year. This suggests that the association between drug use and
crime is stronger for women than for men. Similar patterns were found among
adolescents, suggesting that the association between drug use and crime is stronger for
girls than boys.

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Consequences of Alcohol Use in Women
Differences in the way women absorb and metabolize alcohol may increase their
vulnerability to alcohol-related problems. Drugs that are lipophilic (such as marijuana)
tend to accumulate in the fatty tissues. Drugs that are hydrophilic (such as alcohol)
concentrate in blood and muscle. On average, men are larger and have more muscle
mass and therefore more body water per pound than women. Thus, because women
have less body water than men of similar body weight, they are subject to higher blood
concentrations of alcohol after drinking equivalent amounts of alcohol.[20] Furthermore,
women appear to have less capacity than men to oxidize alcohol in their stomachs due to
diminished activity of gastric alcohol dehydrogenase, an alcohol-metabolizing enzyme.
[21]
As a result, women may be more vulnerable to the physiologic consequences of
drinking.

Fluctuations in gonadal hormone levels during the menstrual cycle may also affect the
rate of alcohol metabolism, making women more susceptible to elevated blood alcohol
concentrations at different points in the cycle. Research findings to date, however, have
been inconsistent. Menstrual disorders have been associated with chronic heavy
drinking.[22] Furthermore, continued drinking may lead to early menopause.[23]

The detrimental effects of alcohol on the liver seem to be more severe in women than in
men. Women develop alcoholic liver disease, particularly alcoholic cirrhosis and
hepatitis, after a comparatively shorter period of heavy drinking and at a lower level of
daily drinking than do men.[24] Proportionately more alcoholic women die from cirrhosis
than do alcoholic men.[25] Animal research suggests that women's greater susceptibility
to alcohol-related liver damage may be linked to physiologic effects of the female
reproductive hormone estrogen.[26]

These and other studies of women alcoholics in treatment suggest that they often
experience greater physiologic impairment earlier in their drinking careers, despite
having consumed less alcohol than men.[27] These findings suggest that the development
of consequences associated with heavy drinking may be accelerated or "telescoped" in
women. Female alcoholics also have death rates 50% to 100% higher than those of male
alcoholics; a greater percentage of female alcoholics die from suicide, alcohol-related
accidents, circulatory disorders, and cirrhosis of the liver.[28]

Alcoholic women also seem to have an increased sensitivity to alcohol-induced brain

damage, such as deficits in cognitive psychosocial performance[29] and brain volume
shrinkage.[30] In addition, researchers using magnetic resonance imaging have found

22
that the corpus callosum region of the brain -- which is involved in coordinating
multiple brain functions -- was significantly smaller among alcoholic women when
compared with nonalcoholic women and alcoholic men. The differences remained
significant after adjustment for head size.[31]

The association between breast cancer and alcohol consumption is under debate.
Numerous studies have reported that
[32]
moderate-to-heavy alcohol use somewhat increases the risk for breast cancer. One
recent study, however, found that light consumption of alcohol (up to one drink per day,
the maximum reported by most women in the study) is not associated with an increase
in breast cancer risk.[33]

Although women are less likely than men to view drinking and driving as acceptable
behavior,[34] less likely than men to drive after drinking,[35] and less likely to be involved
in fatal alcohol-related crashes,[36] women have a higher relative risk of fatal driver
injury than men at similar blood alcohol concentrations.[37] Laboratory studies suggest
that there may be gender differences in how alcohol affects the performance of driving
tasks.[38]

Women also appear to be more vulnerable than men to domestic violence as an adverse
consequence of alcohol abuse or dependency.[39] Preliminary data from one study
showed that 90% of women in drug treatment had experienced severe violence from a
partner during their lifetimes.[40] Although the findings do not indicate that partner
violence is necessarily a consequence of drug use or vice versa, the two realities -- drugs
and victimization -- are clearly interrelated.

Finally, a neglected segment of the drug-abusing population consists of mature adults,

those older than 59 years of age, most of whom (58%) are women. Pharmacists are likely
familiar with older clients who confuse their medications and/or instructions or who
take prescription drugs with small amounts of alcohol. Yet the problem may be even
more severe. One study estimates that
3 million of the nearly 10 million alcohol-dependent individuals in the United States are
more than 60 years of age.[41] Another report has found that of the 25.6 million
American women older than 59 years of age, 4.4 million (or 17%) are addicted to
nicotine, some 1.8 million (7%) abuse alcohol, and about 2.8 million (11%) abuse
psychoactive drugs.[42] In fact, today's mature woman is more likely to be hospitalized
for drug-abuse-related problems than for a heart attack.[42]

23
In postmenopausal women, moderate alcohol consumption (one drink or less per day)
may actually increase estrogen levels by stimulating the adrenal glands to increase the
conversion of androgens into estrogen.[43] This estrogen-enhancing effect of alcohol may
serve in a protective capacity for chronic conditions
associated with postmenopausal estrogen deficiency, such as heart disease and
osteoporosis. However, one of the most serious medical consequences of alcoholism is
liver cirrhosis, and the combined effects of alcohol and cirrhosis in postmenopausal
women remain unclear. Long-term heavy drinking in women with alcoholic cirrhosis
has been shown to cause severe disruptions in reproductive hormone levels.[43]

24