“I love a stage,” Sandy told me. I was doing research for a chapter on college women, for my book on women and alcohol, and she was explaining why she had liked to binge drink from ages 15 to 18. She had binged on weekends, she said, to blow off steam. One night, during her freshman year, she ran drunkenly onto a highway and was hit by a truck going 35 miles an hour. Miraculously, she was not badly hurt.
In a way, Sandy was lucky to have had the accident. Her family was shocked into recognition of her alcohol problems before they developed into genuine dependence. Her father had the money (and the will) to send her to an inpatient treatment facility. When I interviewed her, Sandy had been sober for seven years -- but it hadn’t been easy. At the treatment facility, she had been the only young person and hated it. She hadn’t been able to relate to the older women’s stories of hiding bottles and being afraid to appear in public. In the second week of the program, a counselor told her: “These women have been drinking for years. You have problems, red flags for alcoholism in your future. When you listen to these stories, I want you to think, ‘This hasn’t happened to me. Yet.’”
The counselor told Sandy she should never drink again, and Sandy bawled. Not even on her wedding night? Her 21st birthday? New Year’s Eve?
Binge drinking in college used to be associated primarily with males, but a 1997 survey of 116 four-year colleges, conducted by researchers at Harvard University, found that 39 percent of women and 49 percent of men had binged in the two previous weeks. The percentages for women were higher for sorority members, especially if they lived in Greek houses. Now, several studies reported this year indicate a further increase in the percentage of college women drinking. The downside of changing gender norms seems to be that the convention of moderation in drinking among women is disappearing.
Today, many girls and young women associate drinking (and smoking) with independence, glamour, and the kind of power once reserved for men. “Get in touch with your masculine side,” goes one recent advertisement for bourbon. In my interviews, young people of both sexes reported admiring a woman who could drink like a man; heavy drinking, said one male respondent, was “a badge of honor.” “Equal rights, equal pay -- and equally drunk,” as a magazine intoned a few years ago.
To date, it has been hard to get a clear, overall picture of women and alcohol, since large national surveys are rare and expensive. (That, however, may soon change: The National Institute on Alcohol Abuse and Alcoholism is conducting a major survey of 48,000 people from a broad geographical base and will be able to compare the results to baseline studies from 1992.)
Most studies of alcoholism rates among women cite the ratio of male to female alcoholism as anywhere from 6:1 to 2:1 (most recent surveys tending toward the latter). Some observers even play down alarm about women and alcohol, saying periodic concern about the topic has surfaced from time to time throughout U.S. history and primarily reflects our anxiety about women’s changing roles. They point to headlines like two that appeared not too long ago in British newspapers: “Career Mothers Driven to Drink” and “Success Drives a Girl to Drink -- Lonely High Fliers Can’t Share Stress.”
But there is strong, if indirect, evidence that cultural and social changes are bringing about a shift in the way women drink. While it is true that large differences in the way men and women drink still persist, it is also true that women are working in much greater numbers; that women who work are less likely to abstain from alcohol, and more likely to drink heavily; and that, generally speaking, alcohol-related problems in any population increase as consumption increases. That correlation holds true across many cultures. We also know that, at two drinks a day, a woman’s health risks increase significantly.
Whatever the statistics on alcoholism among women eventually show, the changes in drinking habits among girls and young women are undeniable. Today, girls are 15 times more likely to begin using alcohol and drugs by age 15 than their mothers were and four times more likely to begin drinking by 16. (An alarming factor, since -- among whites, not among blacks -- getting drunk at an early age is a very strong predictor of problem drinking and multiple addictions.) Thirty years ago, women typically began drinking later in life than men, and that may have partly explained the higher number of male alcoholics.
Now that girls and boys take their first drink at roughly the same early age, some researchers predict an upsurge in the number of women who will become dependent on alcohol. Certainly adolescence is a high-risk time for developing behaviors that lead to addiction, and an early start with alcohol extends the risk. A survey on alcohol published in January 1998 found that more than 40 percent of respondents who began drinking before age 15 became dependent on alcohol at some later point in their lives, compared with 24.5 percent of those who began drinking at 17, and 10 percent of those who began at 21 or 22.
Doctors, clinicians, and researchers have been taken by surprise by the lowering of the age of abuse. They describe girls arriving for treatment with their backpacks loaded with needles and drug paraphernalia in one pouch, and a worn stuffed animal in the other. At the same time, the older girls and young women who come for treatment often seem childlike, since alcohol and drugs can suspend emotional development.
The day I interviewed the manager of the Chemical Dependency Unit at Hazelden Center for Youth and Families, she had just done an intake assessment of a 21-year-old woman and mistaken her age: “I thought she was 14!” the clinician said. “She told me, ‘I’m just a little girl who likes to play.’ And she was -- she had a bouncy, young walk, she wore sparkly makeup like young teens do; her hair and clothes were like a kid’s; and she told me that she loves to blow bubbles. She’d been using alcohol since she was 11, and inside, she’s still 11.”
For young women, there are additional issues. Those who drink are often proud of having less-conservative attitudes about gender roles than their peers. But if they cross the line into alcohol dependence, they are in for some nasty surprises: The equality with which they drank will not accompany them.
To start, there are physiological differences in the way alcohol affects women and men. Even when a woman and a man weigh the same, the woman gets high on less alcohol, and she gets addicted more easily. She more quickly develops such physical complications as liver disease, high blood pressure, and hepatitis. (For instance: A woman’s risk of liver cirrhosis begins at only two drinks a day; a man’s risk begins at four to six drinks a day.) In sobriety, a woman’s damaged organs take longer to repair themselves. If she has four or more drinks a day, some studies show that she is also up to 40 percent more likely to get breast cancer than women who don’t drink.
We’ve all heard about how alcohol may protect against heart disease, but most people don’t seem to know that, in women, that protection applies only after menopause, and peaks at one drink a day.
But physiology is perhaps the smallest part of women’s increased vulnerability. Women are also tremendously stigmatized by alcoholism. The recovering women I interviewed repeatedly told me so, but none more explicitly than Sonja, 17 years sober at the age of 58 and conducting group therapy with recovering alcoholics in Houston: “A drunk man with a lampshade on his head is cute,” said Sonja, “but a drunk woman is a slut and a whore and a piece of trash. I don’t know if it will ever really change.”
Indeed, despite changes in ideas about gender, college women today are still vulnerable to the double standard. “Women sometimes work really hard to be one of the boys,” Gabrielle Lucke, director of health resources at the Dartmouth College Health Service, told me. “But the women know they are sexually vulnerable and, when something bad happens, they feel the shame of being a drunk woman.” It bears remembering that, on many college campuses around the country, a woman’s Sunday-morning walk home from a fraternity house is still referred to as “the walk of shame.”
Men, of course, are not spared the shame of alcoholism, but studies repeatedly find that alcoholic women, having internalized society’s contempt, suffer even worse anxiety, guilt, and depression than alcoholic men, and they have lower self-esteem.
One stunning fact says it all: Female alcoholics are as much as twice as likely to die as male alcoholics in the same age group -- even as male alcoholics die at three times the rate of men in the general population. That is due partly to higher accident rates, victimization, and physiological vulnerability among women, although suicide is also a factor. Generally, women attempt suicide more often than men, but men more often complete their suicides; but among alcoholics, women actually have a higher rate of successful suicide. Young women are particularly vulnerable: Teenage girls who drink more than five times a month are almost six times more likely to attempt suicide than those who never drink.
While their male counterparts get in trouble with authority when they drink, girls with alcohol problems more often turn their aggression against themselves, and they are more likely to be victimized by others. As one alcohol counselor told me: “Boys break things, and girls get broken.” Similarly, young men with alcohol problems are more likely to come to the attention of college counseling centers. Says Ms. Lucke, “I’m not going to hear about the woman who gets really drunk and beats up five people -- the man will do that and then get kicked into our system.”
Our prejudices about alcoholism make it harder for us to recognize its symptoms when we see them in women, and harder for afflicted women to reach out. Kirsten, age 22 and seven months sober when I met her in Minneapolis, described herself as “the angel of the family, the total model child.” Her family had been so convinced of her saintliness that no one had guessed she had drunk every single day of her college career. No one suspected, even afterward, when she added drugs to her repertoire; started passing out at work; crashed her car; or when she fell down a flight of steps, cracked her head, and went into a two-month coma.
So many of the girls, female college students, and young women I spoke with were trying desperately to make themselves into the ideal daughters they thought their parents wanted -- by studying, dieting, and being good. They turned their anger on their bodies when their needs weren’t met, pretending to be happy when they were wilting inside. Alcohol, for a while, eased the sense that there was something wrong that they couldn’t fix.
While we are encouraged, these days, to think of alcoholism as a thing in itself -- not a symptom but the primary problem -- I believe that such an approach does not do justice to the complex nature of addiction. Social, cultural, and psychological contexts are crucial in the development of alcohol problems. Consider the accompanying problems of women dependent on alcohol: often eating disorders, a history of sexual abuse; more often than men, a depression that preceded their drinking. The pain in their lives has everything to do with what it means to be female in our culture.
During Theo’s junior year at an Ivy League college, she realized that alcohol was so woven into her life that she couldn’t study unless she was also drinking. “I’d sit down with a six-pack of beer and my books,” she told me. “At the fifth beer, I’d put the books away and go out and party.”
When I spoke to Theo, who graduated last spring, I at first thought she fit what I’ve come to call the “white male model” -- happy and successful until alcohol got in the way. But after interviewing scores of young women, I came to realize that Theo would have stories underneath the stories. First, the humiliating sexual experiences -- the men who had sex with her when she was too drunk to protest. Then the binge eating, the overzealous dieting, and the man who served as a “substitute addiction” during her first try at sobriety.
Further back, before Theo made friends with alcohol, there was a depression that began at age 10 and a father who drank, whom Theo was “very, very afraid of.” When Theo got sober during her senior year, she had to face the anger, the fear, and the anxiety that alcohol had helped allay. She cut her course load in half, started counseling, joined Alcoholics Anonymous, and spent a lot of time hiking in the woods.
Girls who rely on alcohol -- even if they never become dependent on it -- may delay the day of reckoning. The challenges of life are not likely to be confronted as long as alcohol smooths the way. Alcohol “works” in the beginning: It can make you feel pretty, funny, happy. It can make you feel like part of a group, ease your anxiety or depression, banish devastating memories of abuse; it can make you less inhibited about sex. It can make you feel warm and cozy toward your boyfriend even when you’re angry; it soothes your heartbreak when you’ve broken up. It can also be a vehicle for rebellion: no more the perfect daughter, perfect student, perfect girl.
In fact, the “rebellion” of drinking almost always reinforces the status quo. In the lives of adult women, the irony is blatant: Stephie, for instance, drank to show her husband he couldn’t control her, yet she couldn’t walk away from him, because her drinking meant that he would get custody of the kids. Among college-age women, I saw a more-subtle dynamic, often in relation to their sexual choices. Many described drinking to loosen up for sex, to feel “liberated” -- they drank, and they acted on their sexual desires.
In reality, they couldn’t always tell when they were acting to please themselves and when they were responding to pressure from men or their peers. Each sexual encounter facilitated by alcohol chipped away at their self-confidence. If sex is not a girl’s choice, if she does it because she is drunk, and she isn’t even sure she wants sex at all, what happens to her sense of personal power? If she is not consciously making a decision, she has little opportunity to take responsibility. She begins to feel like a victim, unaware of the freedom she does have to direct her own behavior and make choices.
Most of us worry -- with good reason -- about the biggest risks to young women who abuse alcohol: accidents, vulnerability to sexual assault and other violence, the potential for addiction.
Those are real threats. But this other kind of harm, though not so visible, is equally real. When a girl relies on alcohol to get her through her teenage years, she misses the adolescent learning curve, the time for developing healthy strategies for managing mood swings and for developing skills that lead to a sense of competence and independence. Of course she can catch up, but that doesn’t happen magically. It takes hard work, at a time of life when she may feel she ought to know better.
At college health centers, too often struggling young women are put into mixed-gender drug and alcohol groups, where they are less likely to address their feelings of shame, sexual experiences, and histories of abuse. The women are frequently outnumbered by young men, and so the groups often fail to discuss the connections to eating disorders, depression, and unhealthy relationships.
And problems are often missed. Yonna McShane, director of health education at Middlebury College, told me, for example, that she doubts female students at many colleges are often asked whether an unwanted pregnancy was alcohol-related. “And what happens when a woman comes in with a sexually transmitted disease?” She left the question hanging. Because women are less likely than men to come in directly with alcohol problems, their health-care providers need to have a higher index of suspicion.
In addition, colleges need to do a better job of identifying and assisting the growing number of incoming students who already have an addiction. Kristina’s story is all too familiar. She got sober in high school but lost her counselor and peer-support group with graduation and started drinking again. In college, socializing centered on binge drinking and casual sex (or so it seemed to Kristina).
It seems to me enormously ironic that, for today’s young women, alcohol has come to symbolize power and choice and independence -- the very qualities that, in excess, it most undermines.
I emphasize that phrase “in excess” -- because, when we talk about women’s vulnerability to alcohol problems, it is important to remember the positive aspects of changing gender norms around alcohol. Of course women should have the freedom men have to drink! Of course we must abhor the special stigma against women with drinking problems! Ultimately, what we want for young women is not just their safety and their health, but the opportunity to grow emotionally and intellectually, and to take creative risks and responsibilities. If they can coolly and objectively assess the role of alcohol in their lives, and take responsibility for whether, when, and how much they drink, they will be several steps ahead of many adults.
Devon Jersild is the author of Happy Hours: Alcohol in a Woman’s Life (HarperCollins, 2001).
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