By Gretchen Cook
Sunday, July 6, 2003
Long overlooked by researchers, the subject of female alcoholism is now attracting greater attention as women face some higher risks from the disease and can have a harder time finding appropriate treatment.
(WOMENSENEWS)--The day she won a prized fellowship from her university, Jean Kirkpatrick went out on a drunk--a decade-long binge that led to terrifying blackouts, a hit-and-run car accident, an attempted suicide and a psychiatric ward. When she finally fought her way out of her alcoholic nightmare, Kirkpatrick recognized it was anxiety about her success that had triggered it.
"We alcoholic women know anxiety. And sometimes we have used alcohol and pills to make it go away," Kirkpatrick, a sociology professor, wrote in a booklet for the Women for Sobriety, Inc., a recovery group she founded in Pennsylvania.
That was back in 1976. It wasn't until March this year that women, anxiety and alcoholism were scientifically linked by the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md., the world's foremost medical alcohol research center. Until recently, alcohol research focused overwhelmingly on men, just as society has generally stereotyped alcoholics as the guy curled up with his bottle on Skid Row.
The sobering facts for women, however, are that more than one-third of the country's 15.1 million alcoholics are women and that proportion is growing fast, according to the institute's spokesperson Anne Bradley. She says that increased work pressures as well as more social acceptance of women drinkers are two factors contributing to the rise in alcoholism among women.
The institute's latest findings also show that women can suffer more damage--including to the liver and brain--from alcohol's effects than do men. In separate, but related findings, alcohol-abusing women have also been shown to be more susceptible to trauma resulting from traffic accidents and interpersonal violence and are more likely to commit suicide.
So why have women drinkers been so overlooked? Bradley explains that potential risks to reproductive systems prevented researchers from using female subjects. The stigma of alcholism also discourages women from joining studies or entering treatment programs, where they can be observed.
Recovery experts often note that while drinking has traditionally almost been a rite of passage for men, it has been considered "unladylike," and that female alcoholics suffered harsher judgments from themselves and society. It's only in the past decade that the institute has added women to their subject pools. But the alarming findings have prompted them to push hard now for more gender balance.
"Because women suffer to a far greater extent than men makes us newly vigilant to the subject of women and alcohol," says Bradley.
But progress has been slow, according to recovery advocate Susan Rook. She believes a reason for that is the overwhelmingly male management of alcohol research and recovery programs.
"There's a natural inclination to have a one-size-fits-all box to put people in, and up until now that box has been defined by men," says Rook, a former CNN anchor and recovering alcoholic.
Lower body weight has long been blamed for womens' low alcohol tolerance, with the assumption being that women just got drunker on less. But one of the most critical recent findings by the institute, issued in a December 1999 report, was that women absorb and metabolize alcohol differently from men and generally achieve higher concentrations of alcohol in the blood after drinking equivalent amounts. This makes women more susceptible to cirrhosis of the liver and brain damage and therefore more in need of early intervention than men.
The discovery of women's different reaction to alcohol also has a psychological impact, says Rook. "When I found out that my body treated alcohol differently, it made it easier for me to accept my alcoholism. It made it more like a real condition than a moral failing, and it helped me understand why I could get caught up in alcohol so quickly," she says.
The new gender-specific studies also suggest the need for more treatment alternatives. Women are far less likely than men to seek help for treating their addiction. Lack of child care is one of the most frequently cited barriers for women who need inpatient programs or daily attendance at recovery meetings. Women also often find public exposure of their alcoholism more daunting than do men, says Rook, and private doctors or counselors are options open only to those who can afford it.
The most widely available free alternative is the 12-step Alcoholics Anonymous program. But Kirkpatrick and others suggest that women may be less likely to benefit from AA than men, and argue it can even be counterproductive for some women drinkers.
AA was developed by men in large part for men. The program's "Big Book" was written in 1939 and is a reflection of the times. It includes a chapter "To Wives," which presumes traditional gender roles, and though AA denies any religious leanings, the "Big Book" refers to God throughout and uses the pronoun "He."
Kirkpatrick also says AA's First Step, "We admitted we were powerless over alcohol," sends a destructive message to many women who turn to alcohol to overcome a sense of powerlessness. She also argues that the Fourth Step of taking a "fearless and moral inventory" compounds, for many women, the shame of the disease.
Tracey Deschaine, a nurse anesthetist who has worked in recovery centers, agrees. "Women have known all along they're powerless, that's part of the reason they fall victim to drugs or alcohol. They need to be told they have power inside them to get well," she says. "And in the Fourth Step," she continues, "you have to go out and emotionally flog yourself. Nobody has to tell women to flog themselves. They do it all the time."
Additionally, about one-half of all sexual-assault victims report that they were drinking alcohol at the time of their attack. Women may be reluctant to discuss that trauma in gender-mixed AA meetings and require additional counseling to help cope misplaced guilt and shame.
Nonethless, courts and employers have long required AA attendance as part of sentencing or work reinstatement. Those orders have been challenged on the grounds that AA's religious content puts it in violation of the First Amendment's separation of church and state. Kirkpatrick and others also argue that women should be allowed to seek alternative recovery programs.
However, few other options are widely available. Women for Sobriety, Inc. in Quakertown, Pa.,--to which "Dear Abby" has recently begun referring female readers of the newspaper advice column--and Rational Recovery Systems, Inc., of Lotus, Calif., are two abstinence-only alternatives, but the need far outstrips the meetings the groups have organized.
The National Institute on Alcohol Abuse and Alcoholism's inpatient treatment requires AA attendance. Bradley acknowledges that while AA "is helpful to some and not to others," she stresses "the 12-step approach has helped many millions of alcoholics over the years."
And because AA is free, it is sometimes the only game in town. Rook notes that with the dramatic drop in federal spending and insurance coverage for treatment since the 1970s, there's little reason to discuss how treatment programs can be improved.
"We're getting all of this fabulous research, which is wonderful," she says, "but if people can't get treatment of any kind, then treatment falls into the category of caffiene-free diet Coke--why bother?"
Gretchen Cook is a freelance writer in Washington, D.C.
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National Institute on Alcohol Abuse and Alcoholism:
NIAAA's Alert on Women's Vulnerability to Alcohol: