Alcohol Abuse In Women

Introduction

• Description: Alcohol abuse and other substance use disorders are significant, underdiagnosed health problems for women and carry high costs for individuals and society. Compared with men, alcohol abuse by women has a disproportionate effect on their health and lives, including reproductive function and pregnancy outcomes. The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use for healthy women as more than three drinks per occasion ( Box 21.1 ), more than seven drinks per week, or any amount of drinking for women who are pregnant or at risk of pregnancy. Moderate drinking is defined as one drink per day, but 50% of binge drinking occurs among otherwise moderate drinkers.

  Box 21.1

  Standard Drink

  One standard drink is equal to 15 mL of pure ethanol

  • Beer or wine cooler: 12 oz

  • Table wine: 5 oz (25-oz bottle = 5 drinks)

  • Malt liquor: 8–9 oz (12-oz can = 1.5 drink)

  • 80-Proof spirits: 1.5 oz (a mixed drink may contain 1–3 or more drinks)

• Prevalence: Alcohol use disorders are the most prevalent of all substance use disorders worldwide: American Indian and Alaska Native women (13.7%), White non-Hispanic women (5.6%), Black non-Hispanic women (3.5%), and Hispanic or Latino women (3.8%). Over 25% of individuals aged 18–24 years report binge drinking. Among women aged 18–34 years who binge drink, 31.4% report drinking eight or more drinks per occasion. Alcohol-related mortality is the third leading cause of preventable death for women in the United States.

• Predominant Age: Not age specific, most common from teens to early 30s.

• Genetics: Estimated 50% of the vulnerabilities related to alcohol use disorder are genetic.

Etiology And Pathogenesis

• Causes: Excessive and frequent use of alcohol.

• Risk Factors: Male gender, age 18–29, Native American and White ethnicity, significant disability, other substance use disorder, mood disorder (eg, major depression, bipolar disorder), personality disorder (eg, borderline or antisocial personality). (Higher than average rates of alcohol use disorder also have been reported among transgender populations.)

Clinical Characteristics

Diagnostic Approach