It’s no surprise to anyone that drinking has increased dramatically as a result of the pandemic. As a pattern, drinking increases with any extreme stressor, and recent market research shows that alcohol sales went up by 55% during the pandemic’s peak.
This increased alcohol use has been particularly notable among women. Though even before 2020, women were beginning to drink more. What many may not realize is that women tend to have worse outcomes from increased drinking — worse outcomes in health issues, psychological consequences, and progression to an alcohol use disorder.
As a recovering alcoholic, former nurse, and middle-aged woman, this topic hits home for me. When I quit drinking five years ago, what made sobriety challenging in part was constantly being bombarded by ads that encourage drinking. In the last decade, we’ve seen a boom in alcohol marketing that specifically targets women. The “mommy wine culture” in particular encourages women to “take care of themselves” by drinking. This feels particularly absurd given that alcohol does anything but take care of one’s health needs. In fact, for women, the health consequences can be devastating.
Women’s drinking: The numbers and the impact
Research shows that women are more likely to drink in excess with increased stress. And, of course, stress has been at an all-time high. One pandemic study showed that stress was the number one reason for women’s increased alcohol intake. In another study of pandemic drinking, 80% of participants reported consuming alcohol at least 10 days in one month, 36.1% reported binge-drinking, and 7% reported extreme binge-drinking during the shutdown. In this study, binge-drinking was classified as drinking more than four drinks on one occasion for a woman and more than five drinks for a man. Extreme binge-drinking refers to binge-drinking 10 or more times in a month.
Increased drinking is especially evident in women 30 years of age and older in the U.S. Research also indicates that women over 60 are binge-drinking more often. A nationwide study showed that between 2006 and 2014, emergency room visits due to excessive alcohol rose by 61.6%, with a staggering 272% increase in related costs. Another study showed that between 1993 and 2010, alcohol-related hospital diagnoses increased by 90% for women 45–64 years of age (versus 30% for men of the same age). In a look at alcohol-related liver issues, one study shows that between 2000 and 2015, rates of alcohol-related liver issues for women increased by 85%.
What do we know about how alcohol impacts women specifically?
One study on women and alcohol shows that women react more to alcohol because of lower amounts of water and muscle mass in their body and higher amounts of estrogen. Dr. Joseph Volpicelli, an addiction medicine specialist, confirms this. He also points to the fact that women have higher estrogen levels as an important part of the puzzle in alcohol addiction.
Volpicelli explains that because women have large fluctuations in estrogen, it makes the effects of alcohol more pronounced. Estrogen enhances a sense of well-being, and since alcohol also increases blood estrogen concentration, the effects of alcohol may be more pleasurable for women, says Volpicelli. One study shows a definite increase in alcohol craving for women when estrogen levels are dropping. In his practice, he notices that women have more alcohol cravings postpartum once estrogen levels drop.
Volpicelli also notes that the withdrawal process is more pronounced for women due to changing estrogen levels. A drop in estrogen levels has a highly irritating effect on the nervous system in women, which explains many premenstrual symptoms. This can compound the effects of alcohol withdrawal, especially if estrogen levels are naturally dropping at the same time.
A literature review published in 2020 in the Alcohol Research journal shows that alcohol impacts a woman’s cognitive capacity more acutely than it does a man’s. Also, it appears that binge-drinking and repeated withdrawals have more long-term negative consequences for women.
Heavy drinking is defined as more than seven drinks per week for women, and binge-drinking is defined as more than four drinks on one occasion. Moderate drinking, of course, is anything more than zero and less than the numbers for heavy and binge drinking. However, evidence shows that moderate drinking may also be problematic for womendepending on issues such as age, health background, medications, nutritional status, drug use, family history, menstrual issues, mental health issues, and amount and frequency of alcohol intake.
In my case, I experienced worsening health issues due to alcohol use in my late thirties and early forties when my estrogen levels were fluctuating more wildly. My hangovers produced harsher neurological symptoms, I had worsening chronic pain, and my menstrual symptoms became unmanageable. At the time, I had no idea that the combination of changing estrogen levels and heavy alcohol use was causing me harm.
Volpicelli explains that since alcohol increases estrogen, the fluctuations of this hormone are more pronounced in women who drink. Simultaneously, this process makes women more prone to severe withdrawal symptoms like Delirium Tremens — a syndrome marked by psychosis, high blood pressure, and seizures. More severe withdrawal translates to needing more alcohol to steady the nervous system. Mild withdrawal symptoms like anxiety, insomnia, and headache also tend to be worse, making women more likely to continue drinking to offset these symptoms.
Why women turn to alcohol
For a long time, men were more prone to alcohol addiction than women. However, more recent research shows that men’s and women’s global addiction rates are converging. One study of birth cohorts and alcohol use shows that younger women (under 30) are more likely to drink now compared to women of older generations.
The study also shows a closing gap between men and women with regard to alcohol use. Other research shows that binge-drinking is increasing among women 60 years and older. Although women turn to alcohol for similar reasons as men, there are a few unique issues to consider related to emotional stress, chronic pain, and changing roles.
Geri-Lynn Utter, PsyD, a clinical psychologist and addiction educator, says that women are more likely to feel the emotional impact of stress and thus are more likely to self-medicate. She says that women are also more likely to sufferfrom severe PTSD due to past trauma, another factor related to addiction rates.
Utter also works with women who have co-occurring mental health and addiction issues. Unfortunately, having a mental health disorder makes the prevalence of addiction much more likely. She says that women who have experienced abuse, rape, and domestic violence are more prone to having both mental health and addiction issues.
Given that the pandemic may activate previous PTSD and that women are more likely to have concurrent substance abuse and mental health issues, the moment we’re in presents a particularly potent climate for women at risk of addiction.
A 2020 review about alcohol’s effect on women’s cognition and nervous system found that women have more chronic pain issues and thus are more likely to turn to alcohol to self-medicate. Initially, drinking can seem like a useful way to decrease chronic pain, but in fact, it activates a vicious cycle as more alcohol is needed to get pain relief over time. With increased use, alcohol actually causes more pain due to a rebound effect in the nervous system. This can lead to heavy drinking and a disturbing comfort around mixing alcohol with pain medication, which can prove deadly.
Over the past few decades, women have been fighting for equal pay and more equality in familial and socioeconomic endeavors. On top of working full time, many women also care for older adults and dependent children. They’re also more likely to be responsible for daily household chores. It seems women have gained more of a foothold in their working lives, yet still have less pay and more responsibility at home. This has led to more stress and emotional upheaval, which correlate to alcohol use and abuse.
How alcohol affects women
There are four main areas where alcohol affects women more severely and differently than men.
1. Estrogen levels
As discussed, estrogen is a major factor in women’s alcohol addiction issues. Contrary to popular belief, estrogen impacts various body systems, not just reproduction. In fact, men also have estrogen that plays a role in their reproductive, urinary, musculoskeletal, immune, and nervous systems. However, estrogen levels are much higher in women, and the fluctuating nature of estrogen can be highly irritating to the body.
Alcohol increases circulating estrogens in both men and women. For women, this has a harsh effect on the nervous system and immune function. Studies show that women who drink excessively are more likely to have breast cancer, liver issues, mental health problems, and neurological deterioration. All of this can be traced back to alcohol’s heightened effect on estrogen. Lastly, as we’ve discussed, the interaction between alcohol and estrogen can induce further cravings for alcoholin women. Not only does this impact the nervous system, but also other body systems where estrogen plays a role.
2. The nervous system and brain aging
One study shows that women who abuse alcohol are more likely to have cognitive and neurological deterioration. This is due to the interplay of estrogen and the unique makeup of women’s nervous systems. Alcohol has a more severe effect on the inhibitory and excitatory parts of women’s nervous system. Women are more likely to feel “drunk” faster than men and are also more susceptible to dangerous hangovers.
Although some of this may be common knowledge, most people don’t understand that heavy drinking and repeated withdrawals in women are much more dangerous than they are for men. Over time, women’s brains are more likely to age faster with heavy drinking. Studies show that women experience more cognitive decline and brain atrophy with heavier and longer alcohol use.
3. Increased prevalence of dangerous health issues
Women are more likely to develop dangerous health issues such as neuroimmune dysfunction, liver disease, strokes, breast cancer, cardiovascular disease, worsened menstrual and menopause issues, and hypertension due to alcohol use. Some of these health issues are increased even with moderate drinking. Studies show that alcohol use can also impact fertility levels and cause spontaneous miscarriage and fetal alcohol syndrome for women in childbearing years.
4. Mortality rate
One study shows that drinking significantly increases mortality for women for any and all causes. The study looked at all-cause mortality for over 2 million participants — half of whom were women. Another study shows that women have an increased mortality rate from heavy drinking due to indirect issues like mental health, injuries, and assault. This is why it is strongly recommended that women stick to safe drinking guidelines.
Reason for caution
In the past several decades, drinking has increased dramatically among women putting them at risk for dangerous outcomes from mild drinking, heavy drinking, and repeated alcohol withdrawals. Low body mass, less water, and higher estrogen levels all make alcohol more irritating for a woman’s body. This becomes especially problematic given that alcohol also increases circulating blood estrogens.
Most of us know that the safe drinking guidelines suggest that women consume less alcohol than men, but many don’t know why.
Issues like PTSD, mental health issues, massive stress loads, and chronic pain may prompt women to drink more. And if women were stressed before, many may feel absolutely overwhelmed now, as a result of the pandemic. Though the impetus to reach for a drink is certainly understandable, the domino effect of a pattern of continued reaching poses a significant health risk to women, in particular.