Comment: Women are drinking more and dying because of it

By Lisa Jarvis / Bloomberg Opinion

New data show that more U.S. women are dying from alcohol than ever before. Public health authorities need to adopt more effective strategies to help women realize when their drinking is a problem. Considering the many marketing messages pushing a “rosé all day” lifestyle, that campaign will be an uphill battle.

But exposing the dangers of drinking will save lives. A recent analysis of data from the Centers for Disease Control and Prevention found that alcohol-related deaths among women increased by nearly 15 percent per year between 2018 and 2020. The pandemic potentially exacerbated the trend, with overall alcohol-related deaths in the U.S. rising precipitously in spring 2020 and continuing to rise through 2021, the most recent data available.

“If you go back to 1990, there were five times as many men who had alcohol use disorder than women; now it’s two times,” says George Koob, director of the National Institute on Alcohol Abuse and Alcoholism. Men’s drinking has declined, while women are drinking more. “The gender differences are converging.” The trend starts early: College-age women now surpass their male counterparts in binge drinking, Koob says.

Those habits used to get curtailed when women married and had children — people are known to drink less during the life transitions of marriage and parenthood — but with more women delaying or forgoing both, the heavy-drinking behavior persists longer. According to a recent study, delayed motherhood is one of the factors creating a larger group of women at risk of alcohol abuse disorder.

Women at the top of the socioeconomic spectrum appear to be driving the change. “Increases in alcohol consumption and binge drinking are concentrated among the highest levels of education, highest level of family income and occupations that are considered more prestigious,” says Columbia University epidemiologist Katherine Keyes, who authored the study.

And it’s possible that marriage and parenthood no longer act as sufficient buffers against excessive consumption. Much ink has been spilled over the #winemom phenomenon. Researchers suspected the years-long proliferation of memes about moms drinking to numb their stress might be helping to drive a fundamental shift in the acceptability of drinking.

Unpacking why women are drinking more should shape public health experts’ strategy for reversing the trend. Certainly, the pervasive signals that drinking is part of being a successful, carefree person — those omnipresent “Live Laugh Wine” signs — don’t help. Neither does the sudden influx of beverages like hard seltzers and canned cocktails that seem tailored to women.

The marketing push to sell women alcohol is eerily similar to the tobacco industry’s push of Virginia Slims — and the brand’s famous “You’ve come a long way, baby” slogan — which resulted in a marked rise in rates of smoking among women, says Dawn Sugarman, a research psychologist in the division of alcohol, drugs and addiction at McLean Hospital.

Given women’s higher rates of anxiety and depression, the natural question is whether they are drinking more to cope. While some data suggests that plays a role, data emerging from Keyes’s lab suggests that there’s more going on. In surveys where people are asked to give their reasons for drinking, the biggest change she’s seeing is more women saying they’re drinking to have fun.

That suggests public health authorities need to make women more aware of the health consequences of high-risk drinking patterns. Women’s bodies have less water (which can dilute the alcohol), more fat (which can retain it), and lower levels of a metabolic enzyme (which breaks it down before it gets into the bloodstream). “There’s a faster progression to alcohol use disorder than men, and women are more vulnerable to hangovers, liver inflammation, cardiovascular disease and even certain cancers,” Koob says.

That’s quite a list.

Yet few women seem to be aware that they could suffer greater health harms than men after consuming lower amounts of alcohol. Sugarman says many women tell her they had no idea. “These are women in treatment, and many have been in and out of treatment multiple times. And they’ve never heard about it,” she says.

Doctors must do a better job of screening women and highlighting those risks. Primary care providers are on the front line of identifying a brewing problem, and yet one large study showed that they are far less likely to probe women than men over their drinking habits.

And the way they pose their questions about drinking matters, too, Sugarman says. A physician might bring his or her own biases into the exam room, resulting in an approach that closes off conversation. Sugarman recalls a doctor once asking her, “You don’t drink alcohol, do you? And the answer to that is no, right?”

Providers should press beyond the question of, “How many drinks do you have each week?” to offer some information on the heightened health consequences for women, and perhaps explain the benefits of forgoing the extra drinks, Koob says. And primary care screenings should also more often translate into referrals for help.

Just like holding a slim cigarette was never truly a sign of women’s progress, neither is holding a glass of rosé. Public health agencies would do well to remind women what happened the last time we let marketing agencies shape our notion of modern women: Lung cancer rates skyrocketed and women died.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.