Crossing the Line: Women and Alcoholism
A Slippery Slope
Kate Levine* would be the first to tell you that she likes to drink. She likes it a lot. "I sort of fixate on it," admits the fortysomething New York City consultant and mother of three. "Nothing relaxes me and makes me feel good like a drink." But she is quick to add, "I don't consider myself an alcoholic." She drinks only on weekends and rarely more than three glasses of wine. "I don't binge, binge, binge until I get drunk," she says. "I drink until I get to that place where I have a buzz going." Although she believes she is firmly on the safe side of the line where drinking shifts from pleasurable to problematic, some experts would argue that she has crossed it.
Levine acknowledges that she looks forward to the weekends, when she allows herself to drink, and that she can't limit herself to just one glass of wine. "These may be red flags," says Sharon Chambers, executive director of Residence XII. "Given the right kind of stress, her drinking could swing out of control."
And given their greater physiological sensitivity to alcohol, women are apt to move more quickly across the continuum from moderate drinking to problem drinking to the addiction of alcoholism. This is especially true for women with a family history of alcohol abuse, who, for unknown reasons, seem to be even more vulnerable to the disease than similar men.
But DNA is not destiny; lifestyle counts, too. You can be hardwired for addiction but won't develop a problem if you don't drink to excess. Nor are you off the hook merely by not being genetically predisposed. "Anyone who drinks enough can become alcohol-dependent," cautions Dr. Blume.
The question, of course, is what is "enough"? At what point does drinking for relaxation veer into problem drinking? Experts agree that you can't put a number on it. Having more than one drink a day doesn't mean a woman has a problem or is developing one. But it increases the odds. "Your body will develop a tolerance to a certain amount of alcohol," notes Stephanie Brown, PhD, director of the Addictions Institute, in Menlo Park, California. To get the desired buzz, you'll need to drink more.
At that point, a two- or three-drink habit may become customary. If a woman's life enters a high-stress zone, she may add another glass or fill the one she already has to the brim. "It's a slippery slope," says Chambers.
Binge drinking -- which is defined as four drinks in one sitting for a woman and five for a man -- can also prime the pump, even if such episodes are rare. (They are increasingly common on college campuses.) According to a 2004 NIAAA report, the risk for alcohol abuse or dependence jumps dramatically for women who exceed three drinks per occasion.
To determine whether her drinking has crossed the line, a woman has to assess the impact that alcohol is having on her life. Is it taking on a more important role? Instead of a movie, for example, does she prefer a party where she can relax with a drink in her hand? Even if there is no physical craving, "this could be the beginning of a psychological preoccupation," says Chambers.
If drinking is causing tangible problems, of course, the signs are inescapable. "Generally, if women experience negative consequences from their drinking -- problems with driving, their job, at home, or with the law -- and continue to drink anyway, that's considered abusive drinking," says Foster.
The line between problem drinking and out-and-out addiction is similarly blurry. In fact, some experts believe there is no line -- that the problem drinker is showing symptoms of addiction, a physical dependency characterized by craving for a drink, a loss of control once drinking, an ever-higher tolerance and withdrawal symptoms when drinking is stopped. "Once a woman is physically dependent, she isn't just drinking for pleasure," observes Dr. Randall. "She's drinking to avoid the withdrawal, the hangover, and the pain."
Levine has not experienced any negative effects from her drinking. But she concedes that "if I drink too much, my husband feels as though I argue with him without provocation in a way I wouldn't otherwise." And her weekends-only rule is flexible. Not long ago she was suffering from pain in her neck and decided to treat it with alcohol, even though it was the middle of the week. She and her husband went to a bar, where she had a shot and a pint of beer. She later drank another beer over pizza. "I got home and fell asleep on the couch," she says. "I felt guilty but the crick in my neck was gone. It was therapeutic."
Like Levine, many women use alcohol to treat their aches and pains, especially emotional ones. "Women more than men drink to self-medicate negative feelings," says Dr. Wilsnack. "That's a fairly common pattern and in my view one of the most important warning signs. Why you drink is as important as how much you drink." (Some experts say that males, by contrast, are more likely to drink out of a sensation-seeking urge.)
The sad irony is that drinking to alleviate depression or to shake off sexual inhibitions -- both common reasons that women reach for the bottle -- can have the opposite effect. "Alcohol is not an antidepressant. If anything, it makes depression worse," says Dr. Blume. And while booze may make a woman feel freer sexually, alcohol decreases sexual pleasure. "The more you drink, the less responsive you are," she says.
*Individual's name has been changed at her request.