SPECIAL CONSIDERATIONS FOR WOMEN

SPECIAL CONSIDERATIONS FOR WOMEN

DIFFERENT SENSITIVITY

Alcohol does not treat all people equally, and there are some big differ­ences between the effects of alcohol on women and on men. As women have taken a more visible role in our society, they have found more free­dom (and perhaps more encouragement) to drink. Consequently, drink­ing is on the rise among women in general. Surveys indicate that the percentage of women who drink alcohol has increased from 45 to 66 per­cent over the past forty years and that as many as 5 percent of women are heavy drinkers.

Women's bodies differ from men's bodies in a number of ways that make them react differently to alcohol. For one, women are generally smaller than men, and their bodies have a larger percentage of fat, which causes them to develop higher blood alcohol concentrations than men after drinking similar amounts of alcohol. There is also a chemical called alcohol dehydrogenase (ADH) that breaks down some of the alcohol in the stomach before it gets absorbed into the blood. Women under 40 years of age appear to have less of this in their stomachs, so, compared to men, more of the alcohol they drink gets absorbed into the blood. In fact, after a given dose of alcohol, a woman may achieve a blood alcohol level 25 to 30 percent higher than a man. Women should know that they will likely be considerably more impaired than their male companions if they drink comparable amounts of alcohol.

HEALTH EFFECTS

Women who drink are at significantly greater risk for liver damage than men even if they drink less alcohol or drink for a shorter period of time. This increased risk has been reported for women who drink from one and a half to three drinks of alcohol per day and may be due to the differences in the way a woman's body eliminates alcohol.

The pancreas, too, is more likely to be damaged by alcohol in women. The cells of the pancreas make chemicals that are used for digestion. When alcohol damages the pancreas cells, the digestive chemicals begin to leak out and can actually begin to digest the pancreas itself. Although this hap­pens in both women and men, women tend to develop the disease sooner.

Women are also more likely than men to develop high blood pressure due to drinking alcohol. High blood pressure is one of the major causes of

heart attack and stroke. Women who have two to three alcoholic drinks per day have a 40 percent greater risk of developing high blood pressure. The good news is that this additional risk diminishes when the woman stops drinking. Still, for women who drink even moderate amounts of alcohol, the increased risk of high blood pressure is substantial.

The risk of breast cancer is also increased in women who drink. The minimum amount of drinking that it takes to increase breast cancer risk has not been established. However, there is solid evidence that even as few as one to two drinks per day can increase a woman's risk of breast cancer. And it does not take much more drinking to push the risk up consider­ably higher. For example, one analysis indicated that women who had two to four drinks per day increased their breast cancer risk by 41 percent while another showed that women who drank three or more drinks per day on average suffered a 69 percent higher risk of getting breast cancer.

Finally, women appear to be more sensitive to the effects of chronic alcohol drinking on brain function and seem to be more likely to show deficits in cognitive function.

SOCIAL AND PSYCHOLOGICAL ISSUES

Despite the increased acceptance of drinking by women during the past several decades, a number of studies have shown that women who drink a lot meet with more disapproval of their drinking than do men. In addi­tion, the divorce rate for alcoholic women is higher than for alcoholic men. This suggests that women are less likely to leave relationships with alcoholic men than the reverse.

It is also clear that women who drink heavily are at a much higher risk for domestic violence and sexual assault than other women. One particu­larly compelling study of more than 3,000 college women found that the more alcohol a woman consumed, the higher her chances were of being sexually victimized. This might occur because a woman impaired by alcohol may have more trouble accurately interpreting a man's behavior as threatening or resisting unwanted sexual advances.

ALCOHOL AND SEX

Anyone who has ever watched a commercial for beer can tell you that your sex life will improve considerably with drinking. The truth of the

matter is that most of the effects of alcohol on sexual functioning are bad. Of course, a person may feel more suave and sexy after drinking, and he may more easily convince himself that his sexual prowess is unparalleled. But all too often the mind makes a promise that the body cant keep after a night of heavy drinking. Men, in particular, should consider the mean­ing of the term "brewer's droop."

As many as 40 to 90 percent of chronic male drinkers (depending on the study) report reduced sex drive. Chronic drinkers show reduced capacity for penile erection, decreased semen production, and lower sperm counts. In fact, in alcoholic men the testes may actually shrink (a fact generally not presented in beer commercials). In extreme cases of chronic heavy alcohol abuse among men, a feminization syndrome can develop, which involves a loss of body hair and the development of breast tissue. Although these effects are most often seen in men who drink heav­ily over a prolonged period, some sexual and reproductive functions are impaired even by lesser intake. For example, evidence is accumulating that consuming two to three drinks per day may decrease sperm counts.

RISK FACTORS FOR ALCOHOL ADDICTION

RISK FACTORS FOR ALCOHOL ADDICTION

Anyone can become dependent on alcohol. Continued exposure to alco­hol changes  brain in ways that produce dependence. Although there are large differences in individuals' risk for dependency and addiction, any person who puts enough alcohol into his brain over a long enough time will become physically dependent on the drug. Putting aside for a moment the risk factors that have been identified for alcohol dependence, the numbers generally show that the chances of a man becoming addicted to alcohol increase markedly if he drinks more than about three to four drinks per day. For women, the number of drinks is about three. Another consistent finding is that people who become addicted to alcohol are often those who report that they drink to relieve their emotional or social diffi­culties. In other words, if someone drinks to self-medicate—to block out emotional or social problems—he is especially likely to become addicted. But self-medication simply cannot account for all of the alcohol addiction in the world, and the big question remains: Why do some people choose to drink enough to get addicted?

GENETIC FACTORS

Much of the evidence that genetic factors may lead to alcohol dependence has come from studies on twins and children of alcoholics who were adopted at birth and raised by nonalcoholic adoptive parents. Studies like these allow researchers to begin to tease apart the separate influences of nature and nurture in the development of alcohol addiction. At present it seems clear that the basis of alcoholism is partly genetic but that genetic factors alone cannot account for the development of the disease. The real value of the nature versus nurture studies so far is that they have identi­fied certain traits, or markers, that run in families and predispose people to alcohol dependence. Thus, they help to identify individuals who may be at risk for developing alcohol problems. If a person knows that he is at more risk than normal for this disease, then he can make better decisions about drinking.

It is very clear that alcoholism, like diabetes, runs in families. With no family history of alcoholism, the risk of developing alcohol abuse problems is about 10 percent for men and 5 percent for women. How­ever, the risk nearly doubles if there is a family history of alcohol prob­lems. For example, for women who have a first-degree relative (child, sibling, or parent) who is an alcoholic, the chances rise from 5 percent to 10 percent. For men with a first-degree relative who is an alcoholic, the risk goes from 10 percent to 20 percent. So, for both men and women, the risk is doubled. The risk goes to 30 percent for men and 15 percent for women who have both a first-degree relative and a second- (e.g., uncle, aunt, grandparent) or third-degree relative (e.g., cousin, great-grandparent) who is an alcoholic. So, being the child of an alco­holic increases the risk of developing alcohol abuse problems, but boys are at considerably more risk than girls.

It is important to know that these family studies do not conclusively demonstrate a genetic basis for alcoholism. It is likely that factors other than biological ones, such as being raised by an alcoholic parent, also contribute to drinking behavior. A number of studies show that being raised in a family in which alcohol is abused increases a child's chances of becoming alcohol dependent.

A SPECIAL RISK FOR MEN

Although genetic influences significantly affect the risk of alcoholism in both men and women, these influences appear to be particularly powerful in men. A number of studies compare the sons of alcoholic fathers with sons of nonalcoholic fathers. In general, it appears that the sons of alco­holic fathers are less impaired by alcohol than those of nonalcoholic fathers. However, early in the drinking session (when the pleasurable effects of alcohol prevail), the sons of alcoholics appear to be more affected by alcohol than others. This difference suggests that sons of alcoholic fathers may have a more powerful experience of the pleasurable effects of alcohol and a less powerful experience of the impairing effects of alcohol than other men, creating a setup for these men to continue drinking over time and making them more susceptible to addiction.

In addition, a specific type of alcoholism seems to occur mostly in men. This is called Type II alcoholism and is characterized by an onset of drinking problems in adolescence, aggressive behavior, trouble with the law, and the use of other drugs. Type II alcoholism is considered to be very strongly influenced by genetics. Type 1 alcoholism is more common and less severe than Type II alcoholism, occurs in both men and women, and begins in adulthood. Men with fathers or brothers who show signs of Type IT alcoholism should be particularly careful about alcohol use.

HOW TO SPOT A PROBLEM DRINKER

flealtfficare practitioners use several simple screening tests to assess whether an individual may have an alcohol problem. Before describing them, though, we must make two cautionary notes. First, a diagnosis of alcohol abuse, alcohol dependency, or alcoholism can only truly be made by a health pro­fessional trained specifically in addiction. These are very complex medical and psychological states, and no simple screening tool is adequate to make a foolproof assessment. Second, it sometimes does considerably more harm than good to confront a friend or relative with the impression that she may have a drinking problem. Although a concerned person may have the best of intentions and may be acting out of true concern, the other person may simply feel accused and withdraw from the very help being offered. The screening tests we describe in what follows are often used in doctors' offices and clinics as a first indication that there might be a problem.

The most widely used screening test is called the CAGE:

·   Have you ever felt the need to Cut down on your drinking?

·   Have you ever felt Annoyed by someone criticizing your drinking?

·   Have you ever felt Guilty about your drinking?

·  Have you ever felt the need for an Eye-opener (a drink at the begin­ning of the day)?

If the person gives two or more positive responses to these questions, there is a good chance that she has some degree of an alcohol problem. But remember that screening tests are, by their nature, imperfect. For example, it is easy to imagine that a person with a history of heavy drink‑

ing might answer yes to all of the questions, even if she hadn't had a drink for years.

Another screening test, which has proven particularly useful with women, is called the TWEAK:

·      Tolerance: How many drinks does it take to make you high?

·   Worried: Have close friends or relatives worried or complained about your drinking?

·  Eye-opener: Do you sometimes take a drink in the morning to wake up?

·        Amnesia (memory loss): Has a friend or family member ever told you

things you said or did while you were drinking that you could not remember?

·   (K)Cut: Do you sometimes feel the need to cut down on your drinking?

This test is scored differently from the CAGE, but a positive score of

three or more is considered to indicate that the person likely has a drinking problem.

One final word of caution regarding these screening techniques: they all rely on one critical component (which is not always so reliable)--the person's own responses. There are any number of reasons why a person might not respond fully accurately. Therefore, while these screening tools may be useful as a first-pass indicator of a possible problem, they must not be used in isolation to form impressions about a person.