Jasmine Charbonier’s heavy drinking started in college. By her early thirties, she was downing up to eight tequila cocktails daily, several days each week. Last year she tried to quit and was surprised when she plummeted into withdrawal.
New research shows that while men are still more likely to die from an alcohol-related disease, the gap is narrowing. The rise in deaths results from an unfortunate gender equality: Women now raise their glass almost as frequently as men. A recent government survey found 49 percent of women drank in the prior month, compared to 55 percent of men. Women in their thirties and forties, in particular, are now drinking more than male counterparts.
Unlike hard drugs, alcohol is generally viewed as a less dangerous way to destress and reduce inhibitions for women, says Dhruti Patel, a specialist in addiction psychiatry at the University of Miami Miller School of Medicine. “It’s legal, readily available, and not so taboo in society, so women feel less worry drinking,” she says.
That was certainly the case for Charbonier. “I was the friend on vacation having mimosas at 8 A.M.,” says Charbonier, a 35-year-old fundraising specialist, entrepreneur, and blogger, in Tampa, Florida. Drinking made nights out and travel more fun, enabling her to meet new people and dance without inhibition. Last year, she temporarily gave up alcohol to lose a few pounds and was startled by the withdrawal symptoms: intense cravings, heightened anxiety, and periodic hand tremors. “I was completely shocked,” she says. “I didn’t think I had an addiction until then.”
Different bodies, stronger effects
Cute terms like mommy juice or liquid courage belie the reality that even small amounts of wine, beer, or cocktails endanger health. Last year, the global nonprofit World Heart Federation challenged the widely held notion that a daily glass of red wine is good for you. Any amount increases the risk for heart disease, stroke, and aneurysms, the group stated.
Even when consuming the same amount of alcohol as men, women are more susceptible to its negative effects. Experts point to women’s body composition, which has more fatty tissue and less water than men of similar weight, leading to higher and more persistent blood-alcohol concentration. Women also have fewer enzymes that metabolize alcohol. And their hormonal fluctuations are thought to play a role in how quickly alcohol breaks down.
Moreover, women who drink develop a greater number of medical problems, and at much lower alcohol levels, than men. Women who consume less than two drinks a day increase their risk of death from any cause, according to an analysis published in March.
While more men die from alcohol use than women, the recent study published in JAMA Network Open found the gap is shrinking. Annual alcohol-related deaths in the United States were relatively stable for both sexes until 2007, after which they increased a few percentage points for each.
Starting in 2018, the numbers jumped dramatically. Women’s deaths began rising 15 percent annually, versus a 12.5 percent increase for men.
This finding is not unexpected, says Ibraheem Karaye, assistant professor of population health at Hofstra University in Hempstead, New York, and the study’s coauthor. “It’s logical that we would see these sex differences in alcohol-related deaths considering the literature has been showing that the gap in consumption has been narrowing and complications in women are rising,” he says. A portion of the stark increase may also be attributable to the opioid epidemic, since people tend to abuse more than one substance simultaneously, he says.
Deaths from alcohol can occur swiftly, such as the sudden heart or liver failure of alcohol poisoning, or the car accidents, falls, or drownings after drinking too much.
But most of the deaths reflect the toll from longer-term consumption, Karaye says, including from its eventual impact on the liver, the pancreas, or heart.
Drinking can also lead to breast cancer, where lifetime risk rises as much as 9 percent even with one daily drink (each additional glass boosts rates further), and to disturbances to the immune system, which can increase infections and decrease wound and post-operative healing. Fertility problems and early menopause are also tied to alcohol. And of course, women who drink while pregnant put their children at risk of physical, mental, and behavioral problems.
Alternatives to alcohol
Some 29.5 million Americans are thought to have an alcohol use disorder. But women who have a problem are less likely to seek help than men. Seven percent of men but just four percent of women are diagnosed annually.
One reason may be that women don’t always recognize how much they’re drinking, Patel says. An official serving of wine is just five ounces, but today’s large stemware often holds 10 ounces or more. When two people polish off a bottle over dinner, they’ve each had two-and-a-half servings.
Federal guidelines recommend that women who want to drink consume no more than one serving a day (two for men). But from a health perspective, less—or none—is a better target, Patel suggests.
Reducing consumption starts with replacing alcohol in social situations. Charbonier now does water shots when her friends down tequila. Ordering sparkling water, a soft drink, or mocktail with dinner or at happy hour gives a person a glass to hold when others do, Patel says. She also recommends telling friends and family you are no longer drinking.
Those who frequently rely on alcohol to manage stress or who regularly experience symptoms of overconsumption—such as lethargy or foggy thinking—should talk to their primary care physician, Patel says. A doctor may recommend seeing a therapist to learn alternative stress-management techniques or joining a support group such as Alcoholics Anonymous.
Or it might involve a referral to a psychiatrist, who can prescribe craving-reducing medicines such as naltrexone, disulfiram, and acamprosate. As Karaye’s study notes, though, these drugs—like many others—have primarily been studied in men, so it is uncertain how much they improve the health or mortality of women.
Several novel treatments are also on the horizon. When the psychedelic drug psilocybin (the active ingredient in magic mushrooms) was administered twice along with psychotherapy, it significantly lowered heavy drinking days in people with alcohol use disorder. And in June, researchers reported that rats given the new weight-loss drug semaglutide (aka Wagovy) reduced their desire to imbibe.
Charbonier was able to quit on her own, motivated by how much physically and mentally healthier she feels. Her insomnia is gone, replaced by nightly sleeps that are deep and refreshing. Her skin is clearer, her mood less volatile, and her work life is flourishing. “Alcohol suppressed my creativity and contributed to limiting beliefs I no longer have,” she says.
And stepping away from the bar may have another effect, as the JAMA Network Open research shows: It could be saving her life.