Book Review (Part Three): Women Under the Influence

Rehab and the Working Mother

According to Columbia University’s National Center on Addiction and Substance Abuse, more than 2.5 million women abuse or are dependent on illegal drugs. Women are almost 50 per cent more likely to be prescribed a narcotic or sedative, and teenage girls are more likely than teenage boys to abuse prescription drugs, with dramatic increases among 12 to 17 year old girls.

Statistics cited in Women Under the Influence, produced by the Center, show that while women convicted of drug-related offenses represent the fastest growing subset of America’s prison population, their representation in the drug rehab community has not kept pace. Fully three-fourths of these incarcerated women are mothers, and that fact is at the heart of the difficulties women face when they seek treatment.

Put simply, millions of women who need treatment for addiction to alcohol and illegal drugs do not receive it. This has been true throughout American history. Women were not admitted to meetings during the formative years of Alcoholics Anonymous (AA), and there is evidence that the 19th Century practice of performing hysterectomies on alcoholic women as a last resort quietly persisted until the 1950s.

AA soon opened its doors to women, who now comprise roughly one third of its membership. But when it comes to rehab centers, the treatment gap has not closed: “For women with small children, lack of childcare is a serious obstacle to seeking treatment…. For some women, fear of losing their children to the child custody system upon admission that they have a problem makes them apprehensive about entering treatment.”

Moreover, there are no universal standards of training, practice or accountability among the nation’s treatment providers, and women face differing approaches to their needs for child care, pediatric services, transportation, and the like. While older women have treatment needs that differ from girls and pregnant women, very few treatment centers offer programs designed specifically for older females.

If treatment is to become noticeably more effective for addicted women, “it must be readily available, tailored to fit the needs of the individual patient, and part of a comprehensive program that addresses associated medical, psychological, social, and economic needs…. Appropriate, research-based, and effective prevention efforts tailored specifically to the unique needs of girls and women are in desperately short supply.”

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Book Review (Part Two): "Women Under the Influence"

The Rise of the Binge Grrls

“Women get drunk faster, become addicted more quickly, and develop alcohol-related diseases—such as hypertension and liver, brain and heart damage—more rapidly than men.” --The National Center on Addiction and Substance Abuse at Columbia University


Today, about one out of every four American girls has had one or more alcoholic drinks by the age of 13, according to “Women Under the Influence,” a book by Columbia’s National Center on Addiction and Substance Abuse. In the 1960s, only 7 percent of girls reported having consumed alcohol by that age.

80 per cent of college women living in sororities engage in regular bouts of binge drinking, compared to 35 per cent of non-sorority college women. While most women are moderate drinkers, the Center estimates that at least six million girls and women meet the DSM-IV criteria for alcohol abuse and dependence.

When it comes to alcohol, the study turned a few common assumptions upside down. For example, the more education a woman has had, the more likely she is to be a drinker. Surveys indicate that 36 per cent of women with less than a high school education drink alcohol, compared to 60 percent of women who attended college. White adult women are more likely to be drinkers than African-American, Hispanic, or Asian-American women. And while men traditionally drink more than women, women are fast closing that gender gap. Among high school seniors, the percentage gap between heavy-drinking boys and heavy-drinking girls was 23 percent in 1975. By 2003, the difference was only 12 percent, and among very young teenagers, girls have closed the gender gap completely. In addition, older women have higher rates of late-onset (over age 60) alcohol abuse than men.

Teenage girls whose mothers drank regularly during pregnancy are six times more likely to report alcohol use than girls whose mothers did not drink. Whatever the cause, or most likely causes, no such maternal relationship has been demonstrated for teenage boys of drinking mothers. And—bearing in mind that such estimates are fraught with peril—the Center concludes that genetic factors account for as much as 66 percent of the risk for alcohol dependence in women. As evidence, women who are alcoholics are somewhat more likely that male alcoholics to come from a family with a history of alcohol abuse.

Women metabolize alcohol differently than men do. With less water and more fatty tissue in their bodies, blood alcohol levels are higher for women than for men, given the same number of drinks. After two beers, women are more likely than men to exceed legal levels of alcohol in the bloodstream. Women get drunk faster and have heavier hangovers, and the reason may stem from differences in ADH enzyme activity in breaking down alcohol into its byproducts. (More research is needed.) Female alcoholics also develop liver diseases like cirrhosis more frequently than alcohol-abusing men, and at lower levels of alcohol intake.

From the sociocultural point of view, women are targeted heavily in alcohol advertising, primarily through promotion of the idea that alcohol will relax sexual inhibitions and improve communication with men. Alcohol advertising has increasingly zeroed in on selling beer to women—“beer’s lost drinkers,” as one brewery spokesman put it. Only about 20 per cent of women currently drink beer regularly. Ironically, the alcohol industry’s official code of ethics forbade the use of women in alcohol ads until 1958. And as recently as 2003, the Code of Responsible Practices of the Distilled Spirits Council of the United States specifically prohibited any ads or marketing materials that “degrade the image, form or status of women…”

All of the foregoing pales in comparison to the potential for damage among pregnant women who drink. The fact that alcohol is dangerous to fetal development is not a recent discovery. Aristotle pointed out that “Foolish drunken or harebrain women for the most part bring forth children like unto themselves.” While warning signs on alcohol containers and tavern doors have become a common sight, the study group estimates that about 10 percent of pregnant women still drink. (That number is quite likely higher, given the reluctance of patients to accurately report their alcohol intake). “Drinking during pregnancy,” according to the Center, “is the single greatest preventable cause of mental retardation” in America today. Indeed, the number of birth defects caused by alcohol in one year exceeds the total number of recorded thalidomide births.

Tragically, “As many as 60 percent of pregnant women who drink do not discover their condition until after the first trimester.” In addition to the well-known Fetal Alcohol Syndrome (FAS), there is also a range of other neurobehavioral deficits to the fetus associated with drinking during early pregnancy. Pregnant women who drink heavily suffer three times the normal risk of miscarriages and stillbirths. In fact, to this day, no safe level of alcohol intake during pregnancy has been established. The American Academy of Pediatrics continues to advise women who are pregnant or thinking of becoming pregnant to abstain for alcohol completely.

Part Two of Three

Women Under the Influence--purchase info

Book Review (Part 1): "Women Under the Influence"

Women and Cigarettes: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

“Compared to boys and men, girls and women become addicted to alcohol, nicotine, and illegal and prescription drugs at lower levels of use and in shorter periods of time, develop substance-related diseases like lung cancer more quickly, suffer more severe brain damage from alcohol and drugs like Ecstasy, and often pay the ultimate price sooner. Yet 92 per cent of women in need of treatment for alcohol and drug problems do not receive it. Stigma, shame, and ignorance hide the scope of the problem and the severity of the consequences.”

--Joseph A. Califano, Jr.

“Women Under the Influence,” with a Foreword by former Health, Education and Welfare Secretary Joseph Califano, appeared in print last year, but is well worth a second look. The result of studies undertaken at Columbia University’s National Center on Addiction and Substance Abuse, and collectively written by that group, “Women Under the Influence” gathers together a decade’s worth of research on the gender differences researchers have thus far been able to identify in the addict population.

The same genetic and biological mechanisms that predispose certain men toward alcoholism and other forms of drug addiction do the same in women. Young women with family histories of alcoholism will, like Pavlov’s dogs, salivate more intensely at the sight of alcohol than women from families without addiction histories. Studies of female twins also confirm the behavioral link between major depressive disorder and substance abuse. Women who have suffered from major depression are three to six times more likely to suffer from alcoholism than those who have not. Despite these and other commonalities, however, women and men often follow different arcs of addiction on a drug-by-drug basis.

We begin with cigarettes, since it is with nicotine that women have lately shown the ability to achieve a grisly parity, or in some cases even outdo men in the damage done by nicotine. About one American woman out of five smokes. While rates of lung cancer in men have been slowly declining since 1980, the number of women with lung cancer has increased 600 percent over the past 70 years. More women now die of lung cancer than the combined fatalities from breast cancer, ovarian cancer, and uterine cancer. As Antonia C. Novella, former U.S. Surgeon General, put it: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

80 per cent of female smokers began smoking before the age of 18, and women did not begin smoking in large numbers until the late 1940s, thus producing a delayed epidemic of lung cancer in women. To make matters worse, the Columbia group concluded that “At the same level of exposure to tobacco smoke, women have a greater risk of developing lung cancer than men.” Up to three times more likely, according to some studies. Moreover, women who smoke more than 20 cigarettes a day face an 80 per cent greater risk of developing breast cancer, compared to non-smoking women.

Women who smoke heavily have four times as many heart attacks as non-smoking women. Add in oral contraceptives, and the risk of heart attack increases by 1,000 percent.

Women who smoke have more respiratory disorders. Wheezing rates are consistently higher for women than for men, at all age levels. Women smokers develop more crow’s feet around the eyes than men who smoke. Female pack-a-day smokers suffer a steady accretion of bone density and a concomitant increase in rates of osteoporosis. And the fact that nicotine is an effective appetite suppressant is an open secret, as a couple of generations of chain-smoking supermodels have demonstrated.

Cigarette companies are increasingly placing their bets abroad, among a new generation of young women in countries like China, where authorities estimate that as many as 20 million Chinese women have taken up smoking over the past ten years. In “Lung cancer in U.S. women: A contemporary epidemic,” published in the Journal of the American Medical Association (JAMA 291(14):1767), J.D. Patel et. al. suggest that “Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today.”

The silver lining, if there is one, is that a majority of women still choose not to smoke.

Women Under the Influence--purchase info

End of Part One.