Addiction Research and Theory

April 2010; 18(2): 119–121

Editorial – Drinking and women’s health: Time for action

LUCINDA BURNS

National Drug and Alcohol Research Centre, University of New South Wales, New South Wales,

2052, Australia

(Received 14 December 2009; accepted 17 December 2009)

Some individuals are more prone to problematic alcohol use and associated harms than

others. This is due to a complex range of factors including biology, genetics, age, culture,

socio-economic factors, mental health, family substance use, poor early nurturance and peer

influence to name but a few. Whilst these factors interact in a variable manner, the single

most consistent predictor of alcohol consumption identified in the international literature is

gender: men are more likely to consume alcohol than women; male drinkers consume larger

quantities of alcohol than female drinkers and male drinkers experience more behavioural

problems related to their drinking than their female counterparts.

The cross-national consistency of these findings suggests biology plays a major role.

In particular, body size and distribution of fat and water, differences in the rate of alcohol

absorption, sensitivity of key brain neurotransmitters and hormonal influences have all been

identified as factors that differentiate between patterns of alcohol consumption by males and

females (Wilsnack et al. 2000; Devaud and Prendergast 2009). However, the wide variation

in the prevalence of drinking by gender suggests that cultural influences are also critical.

For example, whilst 97% of men and 94% of women in Denmark are current drinkers, this

compares to just 37% of men and 3% of women in the state of Karnataka, India (Wilsnack

et al. 2009).

Biology and culture are therefore both significant in determining patterns of alcohol

consumption by gender, whereas biology is relatively constant. Cultural variability often

reflects societal roles, and these change over time. In ancient Roman times, for example,

alcohol consumption by women was banned and punishable by death in the belief that

Correspondence: Lucy Burns, MPH, PhD, Grad Cert Health Policy, Senior Lecturer, National Drug and Alcohol Research Centre,

University of New South Wales, New South Wales 2052, Australia. E-mail: l.burns@unsw.edu.au

ISSN 1606-6359 print/ISSN 1476-7392 online � 2010 Informa Healthcare Ltd.

DOI: 10.3109/16066350903569656

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consumption would lead to wanton sexual behaviour. During the US temperance movement

of the late nineteenth and early twentieth century, sobriety was linked to women being pure,

honourable and feminine, whilst sobriety in men on the other hand was associated with

powerlessness and impotence (Martin 2008). Research in the 1970s and 1980s identified

Fetal Alcohol Syndrome in babies born to women who drank large amounts of alcohol

during pregnancy and concern moved to the impact on the foetus and child.

The focus has now moved on to reflect the complexity of the roles women now fill. In

contemporary society, the options available to women have increased as a result of

heightened educational opportunities and an expanded role in the paid workforce. For many

women this has meant maintaining the role of primary care giver to dependent children and

ageing family members, in addition to longer and more demanding positions within the paid

workforce. This has also involved entry to public domains including careers and leisure time

pursuits traditionally dominated by men.

These changes have been reflected in a convergence in patterns of alcohol consumption by

men and women; as their roles have become more similar, so do the patterns of alcohol

consumption. Of note is an increase in binge drinking by young women in a number of

countries where the degree of modernization of the country is high and gender inequality is

low (Bloomfield et al. 2006; Rahav et al. 2006; Kuntsche et al. 2009). Younger women in

these countries now drink more alcohol in any one sitting than ever before (Lyons and

Willott 2008), whilst middle-aged women drink more frequently (Clemens et al. 2007).

Other research suggests the multiple roles women now fill can lead to conflict and high levels

of stress, conflict, poor physical and mental health and resultant heavy drinking (Frone et al.

1994; Kuntsche et al. 2009)

Given the changing patterns of alcohol consumption by women, together with the fact that

women experience a telescoping effect in alcohol related harms, (i.e. they present with more

severe health concerns in a shorter time from drinking initiation to problematic use than

their male counterparts), it is clear that we are at a time when increasing attention must be

paid to the way gender influences both the prevention and treatment of alcohol-related

problems. Whilst a complex relationship has been shown to exist between alcohol

consumption and health service utilisation research to date has focused largely on how

past and present patterns of alcohol consumption will determine this. Gender has yet to be

addressed adequately in this analysis despite early work suggesting a differential pattern of

service use by gender.

This set of three papers addresses this deficit by providing crucial answers as to how

gender is associated with distinct attitudes and behaviours and, in turn, how these influence

the drinking patterns and health care utilisation. Each of the papers draws on data from a

survey of 7884 respondents with oversampling of women to ensure their needs are

adequately reflected. Paper one in the series examines the way confounding factors influence

the relationship between gender, alcohol consumption and health. The authors clearly

demonstrate the need to take gender into account by demonstrating that women are more

likely to cope with stress by drinking and that gender differences become more apparent

when heavy drinking is examined, which reflected in poorer general and mental health for

women in comparison with their male counterparts.

Paper two examines the use of preventive health care services and the way attitudes and

patterns of alcohol consumption dictate these. Importantly, in this paper the authors find

only minimal support for the association between patterns of alcohol consumption and

willingness to seek preventive services and suggests that alcohol consumption covaries with

other health-related practices and attitudes that are more strongly related to the use of

120 L. Burns

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preventive care. These include enabling factors such as the level of income and the presence

of co-payments.

Paper three extends this work further by examining the association between patterns of

alcohol consumption and use of health services. In doing so, the authors use the previous

survey methods but importantly also add a qualitative component that asks about

health-related practices among individuals with a range of different alcohol consumption

practices. In concordance with some previous work the authors find that former drinkers

used more services and lifelong abstainers used fewer services in comparison to light

drinkers, whereas drinking at high levels was predictive of fewer specialty outpatient visits

and more specialist addiction medicine visits. Notably, they also show that, whilst women

were less likely to have visits to emergency departments or addiction medicine, they were

more likely to engage in more primary health care visits. Overall, the authors suggest it is not

heavier drinking that affects a person’s willingness to seek health care services but rather

hazardous drinking and drinking-related problems that initiate the use of services.

Taken together this series of papers gives us important new insights into how gender

influences patterns of alcohol consumption and the use of both preventive and health care

services in the contemporary society. Given the importance of the findings, I am sure these

papers will have wide ranging appeal to readers from many different disciplines, including

those involved in developing policy, undertaking research and health care practitioners alike.

References

Bloomfield K, Grittner U, Kramer S, Gmel G. 2006. Social inequalities in alcohol consumption and

alcohol-related problems in the study countries of the EU concerted action ’gender, culture and alcohol

problems: A multi-national study. Alcohol and Alcoholism Supplement 41:126–136.

Clemens S, Matthews S, Young A, Powers J. 2007. Alcohol consumption of Australian women: Results from the

Australian Longitudinal Study on Women’s Health. Drug and Alcohol Review 26:525–535.

Devaud L, Prendergast M. 2009. Introduction to the special issue of alcohol and alcoholism on sex/gender

differences in responses to alcohol. Alcohol and Alcoholism 44:533–534.

Frone MR, Cooper ML, Russell M. 1994. Stressful life events, gender, and substance use: An application of Tobit

regression. Psychology of Addictive Behaviors 8:59–69.

Kuntsche S, Knibble RA, Gmel G. 2009. Social roles and alcohol consumption: A study of 10 industrialised

countries. Social Science and Medicine 66:1263–70.

Lyons AC, Willott SA. 2008. Alcohol consumption, gender identities and women’s changing social positions.

Sex Roles 59:694–712.

Martin SC. 2008. Devil of the domestic sphere: Temperance, Gender, and middle-class ideology, 1800–1860.

DeKalb: Northern Illinois University Press.

Rahav G, Wilsnack R, Bloomfield K, Gmel G, Kuntsche S. 2006. The influence of societal level factors on men’s

and women’s alcohol consumption and alcohol problems. Alcohol & Alcoholism 41:47–55.

Wilsnack R, Wilsnak S, Kristjanson N, Vogeltanz-Holm N, Gmel G. 2009. Gender and alcohol consumption:

Patterns from the multinational GENACTS project. Addiction 104:1487–1500.

Wilsnack RW, Vogeltanz ND, Wilsnack SC, Harris TR. 2000. Gender differences in alcohol consumption and

adverse drinking consequences: Cross-cultural patterns. Addiction 95:251–265.

Drinking and women’s health 121

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