The Woman I Was Drank The Woman I Was May Drink Again
Why alcohol affects women more than men
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More and more women are addicted to booze – but their needs have largely been ignored by the medical establishment.
Their levels of body fat, alcohol dehydrogenase and water mean that women respond differently to alcohol than men (Credit: Getty Images)
Women who drink to excess develop damage to their liver, hearts and nerves faster than their male counterparts (Credit: Getty Images)
Many of these gender-based differences in alcohol's effects on the body weren't discovered until recent decades. The earliest study on gender-based differences in ADH, for example, was published in 1990.
In fact, almost all clinical studies on alcohol were done entirely on men until the 1990s. This was partly because scientists were encouraged to eliminate as many variables as possible that might influence an experiment's results – one of which was gender. And because alcoholism was assumed to be a mostly male problem, no-one wondered what not studying women and alcoholism might miss.
That changed when government institutions like the US National Institutes of Health mandated that women and minorities had to be included as clinical research subjects, and critical gender gaps in medical research began to be addressed.
"People just didn't think about women," says Sharon Wilsnack, a psychiatry and behavioural science professor at the University of North Dakota's School of Medicine and Health Sciences. "To the extent that they did, they just assumed, well, you could study men and it could apply to women."
Until the 1990s, almost all clinical studies on alcohol were done entirely on men (Credit: Getty Images)
For her PhD at Harvard University in the early 1970s, Wilsnack wrote her graduate dissertation about women and alcohol; her literature review then yielded only seven studies at Harvard's Widener Library. With her husband, a sociologist, Wilsnack went on to lead the first long-term national study on women's drinking habits. Among their many findings was the discovery that women who abuse alcohol often have been sexually abused as children, a gender difference that has since been deemed as crucial in helping women with addiction.
Gender-based alcohol research since then has turned up a variety of other sex-specific results.
By the 2000s, brain scans of alcoholics seemed to show that women's brains are more sensitive to alcohol than men's. But Marlene Oscar-Berman, an anatomy and neuropsychology professor at Boston University Medical School, has found a twist.
When her team looked at the brains of long-term drinkers, they noticed that alcoholic men had smaller 'reward centres' than their male counterparts. This area of the brain, made up of parts of the limbic system and frontal cortex is tied to motivation; it is key for making decisions and even for basic survival. But in alcoholic women, the reward centers were larger than in the non-alcoholic women – implying that their brains were less damaged than their male counterparts.
"That blew us out of the water," Oscar-Berman says. "Our findings are somewhat counter to the general idea that women have been more susceptible to alcohol damage in the brain than men." Scientists don't yet understand what might be causing these differences.
Women drink for different reasons than men do (Credit: Getty Images)
Findings like these show the importance of gender-specific studies on alcohol and addiction, says Sugarman. She points to recent research showing that alcohol-addicted women have better outcomes when they're in women-only treatment groups that also educate them about the gender-specific elements of their addiction and women's motivations for drinking. Perhaps unsurprisingly, those motivations are different from men's. Research shows that women's drinking is tied to quelling emotional pain, while men's drinking is more linked to social pressure.
"Some women had been in [alcohol] treatment five, six, 10 times before, and were saying things like, 'This is information I never heard before,' and 'I never heard that I'm more susceptible to alcohol than men, or that these substances affect me differently,'" says Sugarman.
Because of these differing motivations for drinking, their biological vulnerabilities and especially because of the link between women's alcoholism and histories of trauma, it's worth exploring how women's alcohol treatment needs may be different from men's. For example, women who have survived sexual assault may not feel safe entering the standard therapy group for alcohol treatment, where the gender breakdown can skew up to 70% male. For these women, hearing the stories of other women and knowing that they're not alone has shown to be beneficial to their recovery.
Above all, say experts, the days of assuming that the research on men and alcohol can simply be applied to women should be long gone.
This story is part of the Health Gap , a special series about how men and women experience the medical system – and their own health – in starkly different ways.
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Source: https://www.bbc.com/future/article/20180618-why-alcohol-affects-women-more-than-men
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