The
room is slowly filling up with women who have come to this obligatory meeting
about the harmful effects of alcohol on women. Verna, a short, stout woman of
45 years, is standing at the front of the room with a bright smile on her round
face welcoming everyone in. She has
spent most of her life in health education, and she enjoys meeting with these
women, hoping that they may take into account some of the things she is going
to tell them this evening. She knows
there are some women out there who will not want her help, and her efforts are
wasted on them. However, she knows that
not all is lost and what she does is important.
Verna: Hello everybody! Tonight
we are going to have a discussion about the effects of alcoholism on
women. I want this to be informal, and
I would like to answer as many questions as you have about women and alcohol
abuse. I'll try to answer as best I
can. (She notices a woman in the back
of the room examining her fingernails and then rolling her eyes; she tries not
to let it bother her and continues.) So
how is everybody this evening?
Josephine: (Jokingly) I don't know about anybody else, but I sure could use
a drink!
Laughter
is heard throughout the room.
Verna: Well, tonight I am here to give you some reasons not to
have that drink. Chronic alcohol abuse
causes more physical damage faster in women than in men. Women who are alcoholics have death rates 50
to 100 percent higher than those of male alcoholics. Furthermore, a greater percentage of female alcoholics die of
suicide, alcohol-related accidents, circulatory disorders, and cirrhosis of the
liver.
Janis: 50 to 100 percent?! That is crazy!
Verna: The first question I want to address is how is alcohol affecting
Native Women? Among Native American
women, there are high rates of fetal alcohol syndrome (FAS) and of alcohol
related diseases, such as cirrhosis of the liver. One in four deaths among Native American women is caused by
alcohol-related cirrhosis. This figure
is 37 times higher than the rate among white women. Much of the research out there is about men. However, researchers are beginning to
realize there is a large contrast between the way men and women drink.
Margie: When I think about
alcoholism and the people that I know who are alcoholics, I think of men. Is this true that more men are alcoholics?
Verna: It’s true. Women don't drink as heavily as men do. And they are less likely to have the
alcohol-related problems and dependence symptoms as men. But that gender gap is closing; furthermore,
in some tribes alcohol abuse is increasing at astounding rates among
women. And when we talk about chronic
alcohol abuse, women are right up there with the men having as many or even
more problems due to their drinking.
What kinds of differences do you think exist between men and women?
Margie: Men are probably more reckless when it comes to their drinking; I
bet they get in a lot more accidents.
Verna: Although women are less likely than men to drive after drinking
and to be involved in fatal alcohol-related crashes, women have a higher
relative risk of driver fatality than men at similar blood alcohol
concentrations. Laboratory studies of the effects of alcohol on responding to
visual cues and other tasks suggest that there may be gender differences in how
alcohol affects the performance of driving tasks. In other words, alcohol’s may be more damaging to a woman’s
performance behind the wheel.
Clara: Are there any differences
between men and women and their likelihood of entering treatment?
Vena: Women usually enter treatment sooner after they begin to
experience drinking-related problems.
Research indicates that alcoholic women in treatment have had more
health problems sooner into their abuse of alcohol compared to men. This means that the health threats due to
drinking are more prevalent and occur in women more frequently. Did you know that women tend to get drunk by
less alcohol than men? Why is it that?
Josephine: Because they are beefier!
Verna: Actually you are sort of on
the right track. One explanation is
that women tend to weigh less than men.
In other words, they have lower total body water content than men of the
same size. When a person takes a drink
of alcohol it disperses throughout the body in the same concentration inside
and outside cells. Since women usually
have less body water, they have more concentrated levels of alcohol in their
blood after drinking the same amount as a man of the same weight. Check out this table comparing blood-alcohol
concentrations for men and women:
(TABLE) On average a woman’s blood alcohol content will be approximately
30 % higher than a man who drank the same amount.
Clara: So that explains why those
guys are still going strong at the end of the forty-nine, while I’m in the car
passed out. Even though we started out
matching each other drink for drink.
What about that one thing? I think it is like an enzyme or something, I
heard about it somewhere.
Verna: Yes, you are right there is a second reason that your guy-friends
are still staggering around after you have called it a night is due to the
enzyme, alcohol dehydrogenase. The
purpose of alcohol dehydrogenase is to break down alcohol in the stomach. Women produce less of this enzyme as
compared to men and this enzyme is almost absent in alcoholic women. Since women don't have the same amount of
this enzyme, a woman who ingests the same number of drinks as a man of
comparable size will get much drunker faster.
(Verna scans the faces of the women to see if they are getting the
point).
Several women are
leaning forward, listening intently.
Verna: (Continuing) The reason for
this is that more alcohol is circulated through the woman's body since she does
not have as much of the enzyme to break down the alcohol that she is drinking.
And the third reason is due to hormone levels, which may play a role in how
fast a woman gets drunk. A woman may
have higher blood alcohol concentrations at certain times during her menstrual
cycle.
Janis: So I have a question for
you Verna, why do Indian women have such high rates of cirrhosis? Didn't you say one in four?
Verna: Much of the research
findings have indicated that women are much more susceptible to the damage that
alcohol ravages on the body. Women will develop alcoholic liver diseases, such
as cirrhosis and hepatitis, much more quickly due to heavy drinking and by
drinking less alcohol than men. If you
compare heavy drinking men and women you will find that more women die of
cirrhosis than men. Why do you think
that is?
Mary: Does it have to do with what you were just explaining? That enzyme and because they get drunk
faster?
Verna: You are absolutely right.
Possible answers are similar to the reasons why women get drunk faster
than men. Body weight differences as
well as the levels of the enzyme alcohol dehydrogenase contribute to increase
in liver damage. Research has also
implicated that the combined effects of estrogens, female sex hormones, and
alcohol may increase liver damage.
Clara: This may be a silly
question but I have heard about cirrhosis and alcoholic hepatitis but I really
don't know what each one is.
Verna: No question is silly. I am sorry I didn’t explain sooner. Cirrhosis is the last stage of liver disease
associated with chronic heavy use of alcohol during which liver cells die and
damage is permanent. Alcoholic
hepatitis is a condition resulting from prolonged use of alcohol in which the
liver is inflamed. It, too, can result in death. (Link to General
physiology). Drinking takes a heavy
toll on our bodies. Other health problems a woman will encounter if she chooses
to drink excessive amounts of alcohol are:
increased risk of heart disease, liver disease,
ulcers, reproductive problems, osteoporosis, pancreatitis,
memory loss, several digestive-tract cancers, and other
illnesses associated with alcohol abuse.
(Link to physiology) The Centers for Disease Control have reported that
women who are in the "late stages" of alcoholism develop
hypertension, anemia, and malnutrition faster than alcoholic men.
Josephine: I thought alcohol is good for your heart.
Verna: Well not in excess, such as in alcoholics. Among heavy drinkers research shows that
there are similar incidences of alcohol associated heart muscle disease,
cardiomyopathy, for both men and women.
This is in spite of the fact that women have a 60 percent lower lifetime
alcohol use.
Mary: What about the brain? I know alcohol does brain damage, what is
the bad news for women?
Verna: Women are probably more likely to have alcohol-induced brain
damage as well. In one study, a
researcher used MRI scans of the brain and found a section of the brain that
was significantly smaller in alcoholic women as compared to non-alcoholic women
and alcoholic men. Furthermore, in the
American Journal of Psychiatry, research done by Dr. Daniel W. Hommer at the
National Institute on Alcohol Abuse and Alcoholism, compared the brain volumes
of male and female alcoholics to healthy study participants and found the
alcoholic men showed brain shrinkage as compared to the healthy men. However the difference between alcoholic
women and non-alcoholic women’s brains was even greater. On average, alcoholic women showed an 11 %
smaller brain volume than healthy women.
The shrinkage probably reflects the killing off of brain cells,
according to Hommer.
Mary: I have heard that alcohol
can cause breast cancer. Is this true?
Verna: That is right, research has indicated that when a woman drinks alcohol she increases her risk of developing breast cancer. The Journal of the American Medical Association did a study that concluded women's risk of breast cancer increases with the amount of alcohol regularly consumed. So, drinking moderately or not at all can reduce your chances of developing breast cancer. According to the study, women have a 41 percent higher chance than nondrinkers of developing breast cancer if they drink from two to five alcoholic drinks per day.
Margie: What about the health
risks to older women who drink? I bet it is even worse for us!
Verna: Yes, you are right, the health risks are even greater for older
women. Women are more likely than men
to start drinking heavily later in life, and many times their alcohol abuse
goes undiagnosed.
Josephine: Wow, I didn't know that booze did all these things to me!
Verna: Wait, there is more! Women who drink heavily are also doing
damage to their reproductive system, which leads to problems with
fertility. Some problems that occur are
painful menstruation, heavy flow, premenstrual discomfort, and irregular or
absent cycles. These symptoms can cause
problems with a woman's fertility.
Janis: I know several women who
are heavy drinkers, and they got pregnant.
Verna: If a woman does get
pregnant, it is important that she realize the consequences her chronic
alcoholism will have on her child. When
a woman downs a bottle of beer or any other alcoholic beverage, the alcohol
enters her bloodstream and then is transferred to her baby's blood stream. Since the baby is in a critical stage in its
development, by consuming alcohol, the mother is risking a miscarriage or
possibly fetal alcohol syndrome or Fetal Alcohol Effects birth defects,
which are irreversible (Link to FAS). I hope you don’t feel overwhelmed by this
information. Just try to think it over
and maybe it will give some support to your decision to quit drinking. If there are no more questions, I'll let you
guys go. Thank you for all your
questions.
Clara: Thank you Verna, man, this was really informative!
Josephine
and Janis: Yeah, thanks.
Mary: Thanks, Verna. I learned
a lot today.
Verna smiles as they all
file out of the room. What a
interesting group of women, she thinks to herself. Even the woman who was
rolling her eyes at first, got into the discussion. Verna knows some of them will not make it and will be back again
and again, but hopefully she has made a difference in at least one of their
lives. Her prayers will be with these
women on their quest for sobriety.
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