A group text message buzzes through around lunchtime on Friday with the red wine emoji and a question mark. The response is a resounding thumbs up, followed by a flurry of arranging to make it happen. One friend is having a tough time at work. Another is going through a rough patch in her relationship. As for me, it’s been another busy week trying to do it all—meet writing deadlines, ferry my kids to school and activities, and spend some time with my husband. As one friend texts: “We’ve earned it!” Not that we need an excuse.
We meet at the tapas bar after work and quickly pour out one bottle of wine and all our worries. After that, we “need” the second bottle. The third bottle is probably a bad idea, but one friend offers to put it on her tab—it would be rude to refuse, right? We’re a Sex in the City caricature in Blundstones rather than Blahniks. In fact, we came of drinking age when the series launched in 1998 with a clear message: booze makes life more beautiful. When it’s time to leave the bar, we’ve had three bottles of wine between the four of us—that’s nearly four glasses each and double the amount recommended by Canada’s Low-Risk Alcohol Drinking Guidelines, which stipulate no more than two drinks a day (three on special occasions) and no more than 10 a week.
About three-quarters of Canadian women consume alcohol; more than 30 percent exceed the low-risk guidelines and nearly half are heavy drinkers, meaning that they put back four or more drinks on one occasion at least once a month. All this overindulging can have grave consequences. According to chief public health officer Theresa Tam’s 2018 report on the state of public health in Canada, women are increasingly drinking themselves into long-term illness and even death.
The rate of women who have died from conditions attributed to alcohol increased by 26 percent from 2001 to 2017, compared with a roughly five percent increase for men. Not only that, more than 25,000 women were hospitalized in 2016–17 due to alcohol, a three percent jump over the previous year and more than triple the increase for men, according to research by the Canadian Institute for Health Information. Men have higher rates of drinking and hospitalizations overall, but underage girls are more likely than boys to end up in the hospital entirely due to alcohol, a worrisome trend as experts say early drinking habits set the course for life.
“What is really concerning is the rising rates of risky drinking among women. The gap is actually closing between men and women,” Tam says. “People need to be more aware of the harms that are caused by alcohol. It can have significant impacts on individual health physically and mentally, it can harm one’s family and it has a huge societal cost.”
The health impacts of drinking
You’ve probably heard that red wine is good for your heart, but what’s less well known is how many chronic and deadly diseases alcohol is associated with (including cardiovascular conditions), and that women are more vulnerable to the effects of alcohol than men. Alcohol is solely to blame for some 25 conditions—such as alcoholic hepatitis and alcoholic liver disease—and is a factor in many more, including hypertension, depression and several digestive diseases.
Alcohol is a carcinogen and, according to some studies, even having as little as one drink a day over the long term can increase your chances of getting at least eight types of cancer, including liver, colon and breast cancer. One in eight women develops breast cancer in her lifetime; studies have found that between four and 10 percent of all breast cancers are caused by alcohol, and when your daily average goes up by one drink, your chances of getting the disease increase by seven to 10 percent. In Canada, between 250 and 500 women die every year due to breast cancer caused by alcohol, but according to a 2011 study from the Canadian Partnership Against Cancer, only 33 percent are aware of the cancer-alcohol connection.
If some of this is news to you, you’re not alone. “I think that Canadians are generally not aware of all the risks associated with [even moderate] alcohol consumption,” says Tam. “A lot of the current messaging is promoting consumption and even some of the perceived benefits of drinking rather than increasing awareness about risk and harm.”
It’s easy to see why. Several studies have found that light drinking reduces your risk of diabetes and stroke and heart disease caused by low blood supply. However, research has also found that when you drink over a certain amount, your risk for these same diseases actually increases. Tim Stockwell, director of University of Victoria’s Canadian Institute for Substance Use Research (CISUR), has done several papers examining the purported benefits of booze, and he has bad news for drinkers: “The idea that moderate drinking is actually good for you is getting weaker.”
Most of the research on the health impacts of alcohol is observational, Stockwell says, meaning that researchers looked at the correlation between alcohol use and health outcomes. As a result, there’s a lot of potential for bias and misinterpretations. For example, when it comes to the theory that moderate drinking confers health benefits, drinkers are often compared to nondrinkers, who often don’t consume alcohol due to medication for chronic health issues, so are less healthy in general. “The lifetime abstainers are systematically different from the moderate drinkers who cut the fat off their meat, eat more vegetables, exercise daily and have a higher income,” Stockwell explains, adding that it will likely take a couple more decades of research before there’s scientific consensus on the purported health benefits of moderate drinking.
“People get very frustrated: a study says it’s good, a study says it’s bad,” he says. “A lot of the studies that say it’s good have industry funding behind them, and they have a vested interest in people believing that it’s true.” Case in point: as part of a study, Stockwell and his colleagues worked with the Yukon Liquor Corporation to put labels on liquor bottles warning that alcohol can cause breast and colon cancer, but the labels were promptly peeled off after the industry threatened the corporation with legal action, despite overwhelming public support.
Why drinking is riskier for women
Women have the most to lose from being kept in the dark about the health risks of alcohol because their physiology makes them more prone to some alcohol-related conditions. In addition to weighing less than men on average, women also have more fat in their bodies and less water. Fat slows down the absorption of alcohol and makes it take longer to wear off, and water dilutes alcohol. Even if a man and a women of the same weight drink the same amount of alcohol, the woman’s blood-alcohol level will be higher. Alcohol also stays in women’s bodies longer because they have lower levels of the enzyme that breaks it down.
When women exceed the limits set in the low-risk drinking guidelines, their risk for stroke is at least double that of men who exceed their limit. Women are more susceptible to alcohol-related heart disease and more likely to develop alcoholic hepatitis and die from cirrhosis. There’s also some evidence that women are more vulnerable to alcohol-induced brain damage, which can make it hard to remember things and make decisions.
It’s clear that problematic drinking is no longer only defined by starting the day with an eyeopener, and ending it by blacking out. Alcohol use disorder occurs on a spectrum, and signs include having a hard time stopping after that third glass of wine, forgetting what happened after a night of drinking and feeing guilty the next morning. To find out if you’re in the danger zone, google the Alcohol Use Disorders Identification Test.
Men have long had higher rates of alcohol use disorder, but women are catching up. Surveys in the 1980s found that men were five times as likely as women to have alcohol use disorder, but now they’re only three times as likely. In a phenomenon dubbed “telescoping,” women have been found to become dependent on alcohol and enter treatment at a faster rate than men and with more severe symptoms.
“I don’t think a lot of girls and young women are told about the differing ways their bodies process alcohol,” says Nancy Poole, director of the Centre of Excellence for Women’s Health in Vancouver. “I think because of that, they may drink at levels more commonly done by boys and men, and it’s not a level playing field. It’s not sexist, it’s science.”
The appeal of alcohol to women
We drink to celebrate. We drink to relax. We drink to forget. And these days, women have plenty of reasons to do all three. While researchers don’t know exactly why women are drinking more, social, economic and cultural factors all likely play a role. Women continue to make gains in the workplace but often don’t have the necessary supports to make family life run smoothly, and absorb guilt when things go off the rails. Most women also grapple with household inequity, taking on much more emotional labour when their partners are men. We lean in at work, we’re dolphin moms at home and we’re totally burnt out. So we turn to alcohol.
Ann Dowsett Johnston, author of Drink: The Intimate Relationship Between Women and Alcohol, knows this all too well. With that book’s publication in 2013, she painted a vivid picture of today’s modern alcoholic: female, well-educated, professional and high functioning. “Women are racing in from a busy day at the office, having to put dinner on the table, and it’s easier to pour yourself a glass of wine than get to a yoga class,” she says. “We see alcohol as a reward for our busy lives, and we’re self-medicating to deal with stress. As women progress in so many ways in our culture, it is the one thing that is going deeply sideways.”
Indigenous women have higher rates of risky drinking due to intergenerational trauma stemming from colonization and the residential school system, and women in the LGBTQ2 community also drink more, often due to trauma and experiences of stigma and discrimination, which can lead to mental health issues. Institutional and societal changes are needed to better support these women, according to Tam.
The problem with drinking to relieve stress or anxiety is that it only works in the short term and the next day you’re likely to feel even worse. When you drink, your nervous system goes into defensive mode in an attempt to counteract the effects of alcohol, Stockwell explains. After the alcohol wears off, it takes a while for your nervous system to calm down, leading to a higher baseline level of anxiety. Not only that, drinking disrupts your sleep, which can negatively affect your mental health. “It’s a losing battle: the more you drink to fend off the anxiety, the stronger the anxiety becomes,” Stockwell says. “Once you start drinking to relieve those symptoms, the more you do it and your tolerance increases and you need more alcohol. That’s when you’re seriously on the path to developing a major drinking problem.”
It doesn’t help that alcohol is everywhere—the farmers market, the movie theatre, the grocery store and even the school fundraiser—and women are being bombarded with messages and products carefully crafted to appeal just to them. There are wines with names like Mommy’s Time Out and Girls’ Night Out and products that prey on women’s vulnerabilities, such as Skinnygirl Cocktails, which allow you to get wasted without wasting calories. Alcohol companies have even co-opted the breast cancer awareness campaign, pink-washing their products to boost sales. One company stamped a pink ribbon on a bottle of rosé and pledged to donate a dollar to a cancer foundation for every wine selfie tweeted.
“It’s surround-sound messaging that this is how you relax, this is how you reward, this is how you celebrate,” says Dowsett Johnston, who is now studying to be a psychotherapist focusing on women with addictions. “There’s [also] a real sense, one that I shared for many years, that drinking is glamorous. Know your wines, you’re affluent. Know your vodkas, you’re hip. Know your coolers, you’re young.”
As much as we like to think we’re immune to marketing, research shows that it’s associated with drinking initiation by previous non-drinkers and increased frequency of drinking, particularly among women. Advertising has effectively normalized drinking among women and made it more socially acceptable. Wine has become an expectation at gatherings like book clubs and clothing exchanges, and drinking cider from adult sippy cups at playdates in the park is common practice among my friends. “For the last few decades, alcohol companies have been well aware that there’s an untapped market for women and they’ve been successful in encouraging more drinking,” says Stockwell. “I think that’s a large part of the explanation for the observed differences in harms.”
Women are also more economically independent today, and people with higher incomes consume more alcohol. However, Canadians with the lowest incomes are twice as likely to be hospitalized for alcohol-related conditions as those with the highest incomes, possibly due to other factors that affect their health like stress, poor diet and physical inactivity. People living in poverty also have limited social supports and fewer resources to cope, making it difficult for those with alcohol use disorder to get the help they need. “This is what we call the alcohol paradox,” Tam says.
Unfortunately, when women do develop drinking problems, they’re less likely than men to seek treatment and face more gender-related barriers, such as childcare responsibilities, social stigma and a lack of programs that address their mental health needs. Women are also less likely to think they need help. “Women are seen as caregivers, not care receivers,” says Tam, adding that there’s a need for more women-centred education and treatment.
At the Centre of Excellence for Women’s Health, Poole and her colleagues are working with service providers across the country in a variety of areas—midwifery, sexual health, violence against women and girls’ empowerment, for instance—to help them start positive and nonjudgmental conversations with girls and women about alcohol use. Service providers are encouraged to explore how sex and gender relate to alcohol use and harm, and take an approach that is culturally safe and trauma informed. The goal is to get service providers and women more comfortable with talking about alcohol. “People have so much shame and guilt about their alcohol use and really find it hard to talk about and accept help,” Poole says. “We’re trying to break through that first level of resistance and start a relationship that will be the basis for real change.”
How to make healthy changes
If this is all hitting close to home and you feel it’s time to make some changes, Stockwell suggest starting by keeping a record of how much you drink (there are several apps for this) and knowing what a standard drink is. You might be surprised to see that a home pour of wine is often two to three drinks. He also recommends staying well within the low-risk drinking guidelines—not drinking up to them—and practicing not having a drink in situations where you normally would. “You can learn a bad habit and you can also unlearn it, but it becomes harder and harder the further you go down that path,” he says.
Poole urges women to also take some time for introspection. “I think the most important thing is that women think about their relationship to alcohol,” she says. “That they’re consciously asking themselves, how does alcohol fit in my life, where do I want to be five years from now, and is my current level of use going to interfere with that?”
As for me, I’ve made a few small but significant changes since looking into this subject. I’ve started keeping track of my drinks and sticking to the low-risk drinking guidelines. I’ve stopped making the beef stew that calls for half a cup of red wine, which gave me an excuse to open a bottle and have a few sneaky glasses throughout the week. And as I was standing in the Australian wine section at the liquor store, looking for the perfect bottle of sauvignon blanc to thank my friend for watching my kids all day, I decided to do something radical. I went to the tea shop to find the perfect blend instead: Mother’s Little Helper, which promises to help you “release stress and anxiety the natural way … to take the edge off your 24/7 reality.” Until the 24/7 reality for women changes, it will have to do.