Opinion

Female Alcohol Consumption Is On the Rise and Here's Why

Women and alcohol
Bottles of fruit-flavoured and low-alcohol soju at a pub in Seoul, South Korea, September 9, 2015. The gender gap in term of alcohol consumption is closing. Kim Hong-Ji/REUTERS

If any one of us were to attend a social event today, we would expect women to be as likely to be drinking as men—and even excessive drinking among females would be unlikely to attract attention. This is hardly surprising given the rapid social and economic changes of the past 100 years. But does scientific data support these observations, and does increased prevalence of drinking among women translate into increased harmful drinking?

Historically, men have been far more likely to drink alcohol than women. However, the drinking landscape seems to be shifting, with rates of alcohol use converging among men and women born in more recent times.

Population surveys provide short-term snapshots of these changing patterns. The Australian National Drug Strategy Household Survey 2013 found, for example, that while males were more likely to drink than females and twice as likely to drink in ways that would put them at risk of harm, the rate of drinking among younger males between 2010 and 2013 had fallen significantly without a corresponding drop among females.

In a bid to quantify this closing gender gap in alcohol use over an extended time period, we pooled data from 68 studies in 36 countries with a total sample size of more than 4 million men and women going back 100 years. We were able to map drinking rates in males and females across the entire period from as early as 1891 right up to the year 2000 and everything in between.

The results were illuminating.

We grouped data according to three broad definitions: any alcohol use (in other words, being a drinker or not), problematic alcohol use (for instance, binge or heavy episodic drinking) and alcohol-related harms (negative consequences as a result of drinking, such as accidents, injuries or a diagnosis of an alcohol use disorder).

What we found was that the gap between the sexes has narrowed over time. Among people born in the early 1900s, men were more than two times more likely than women to drink, three times more likely to drink problematically and three-and-a-half times more likely to experience alcohol-related harm. Among those born in the late 1900s, the differences had all but disappeared. This means that by the end of the last century, men and women were drinking at almost the same rate.

We didn’t map out men’s and women’s drinking patterns separately. However, of the 42 studies that showed converging alcohol use, most reported that this was driven by increases in the rates of female drinking. Some studies even reported data suggesting that women may, in fact, be drinking at higher rates and in more harmful ways than their male counterparts. These studies mostly studied cohorts born after 1981.

Scientifically, it is important that we look at the data in terms of years of birth rather than age so we can distinguish whether the effect is based on when they were born rather than on their age at the time they are surveyed. This allowed us to track whether drinking rates change in all women over a specific time period, independent of how drinking rates change in individual women as they age. This is particularly important when tracking women’s drinking because of the additional complications and risks of drinking during childbearing years and while pregnant.

So, what has driven these changes in the last 100 years?

We don’t have a definitive answer to that question, and our study did not set out to specifically answer that question. However, in many countries around the world we have seen substantial developments in broader social, cultural and economic factors for women and increasingly accepting societal norms around female drinking. It is likely that sex differences in alcohol use are linked to these wider societal changes. Most people would argue that these changes have been predominantly positive. However, increased exposure to alcohol for women also means increased exposure to the risks associated with drinking too much.

If we are to formulate effective preventative and public health responses to these changes, it will be important to drill down more specifically to cause and effect. For example, have marketing efforts directed towards young women, including in the digital sphere, as well as the creation of drinks specifically designed for young women, been particularly effective and with unintended long-term consequences? If that proves to be the case, and if young women’s patterns of harmful drinking continue into their late 20s, 30s and beyond, then we need to shape our prevention programs in schools appropriately.

Health-wise, the closing of the gender gap is significant. We know that women drinking excessively develop more medical problems than males. Sex-related biological factors include differences in alcohol pharmacokinetics (the way the body processes alcohol) and differences in its impact on brain function and on sex hormones. Women metabolize alcohol differently to men, resulting in higher blood alcohol concentrations in women that tend to persist for longer.

Studies also suggest there are significant differences in the way in which alcohol affects different parts of the brain in men and women—accounting for possibly more aggressive behaviour in men but reduced inhibition in females, which could for example lead to risky sexual behaviors. Worryingly, studies have found that loss in brain volume brought about by long-term heavy alcohol use develops more quickly in women compared with men. This could be associated with a higher rate of psychiatric conditions induced by drinking, which, coupled in some countries with judgemental sociocultural views around women drinking, could increase the negative consequences for women.

Another controversial finding is that alcohol appears to have different effects on sex hormones in males and females. In females, alcohol consumption is associated with increases in both male and female sex hormones, affecting mood and behavior and a faster rate of progression towards alcoholism. There is evidence that women feel intoxicated more quickly than men, encouraging them to consume larger amounts of alcohol.

More work needs to be done verifying that the mental and physical effects of drinking are more severe in women. Our finding that the gender gap between male and female drinking is closing makes the need for such studies even more urgent.

The sooner we structure our education campaigns as well as our prevention, early intervention and treatment programs around this finding, the better our community response to harmful alcohol use will be. We need to ensure that education campaigns addressing the harms of alcohol use are designed to appeal to both men and women. We need to target young men and women before drinking patterns are entrenched and deliver high-quality prevention and early intervention programs. We also need to reduce the attitudinal and structural barriers that get in the way of women seeking treatment for alcohol-related problems.

This is by no means the end of the story. In fact, we are really only in the middle of this story. Many of the men and women who are contributing to these changing drinking patterns are only now in their 20s or 30s. We need to keep tracking population trends in drinking as these cohorts age into their 40s, 50s and beyond.

This study is available online here.

Associate Professor Tim Slade, Dr Cath Chapman, Dr Wendy Swift and Professor Maree Teesson are academic researchers at the National Drug and Alcohol Research Centre, University of New South Wales, Australia. More information on their research can be found here and on Twitter.

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