Alcohol use disorder and binge drinking is on the rise among middle-aged women in the last decade, and clinicians need to be more aware of this condition in their clients, an expert said here.
The gap in alcohol use between men and women is narrowing, with binge-drinking and alcohol use disorder increasing more rapidly among middle-aged women, and clinicians may fail to properly identify women with alcohol problems, said Connie Newman, MD, of New York University School of Medicine in New York City.
“Alcohol use disorder is one of the most underdiagnosed and undertreated conditions we have today,” she said at a talk at the North American Menopause Society annual meeting. “We need to screen women to identify alcohol use disorder and at-risk drinking, so they can be treated earlier or referred to a specialist.”
Newman shared some sobering statistics, noting that rates of alcohol use disorder increased 84% among women from 2001-2002 compared with 2012-2013. From 2006-2014, she cited data indicating women, ages 55-64, posted the highest increases in frequency of visits to the emergency department for acute alcohol consumption.
Why the increase in this population specifically? Newman shared some hypotheses, including from a qualitative survey of middle-aged women. Reasons for frequent drinking among women, ages 45-54, included the “belief that alcohol causes relaxation,” and among women ages ≥55, “alcohol is the remedy for a stressful week.”
Risk factors for women for alcohol use disorder include family history of alcohol use disorder, anxiety, smoking, relational factors, and a spouse with alcohol use disorder.
“We need to challenge the belief alcohol is an important means of reducing stress, highlight healthy alternatives to stress management, and educate about the long-term effects of alcohol,” Newman said.
Indeed, Newman discussed the potential for women to experience adverse health consequences related to alcohol, especially as women are more susceptible to the effects of alcohol at the equivalent consumption of men due to lower body water and higher body fat, as well as relatively lower amounts of alcohol dehydrogenase, or enzymes that break down alcohol, compared with men.
In comparison to men, women had a higher risk for a number of conditions related to alcohol, such as alcoholic hepatitis, hemorrhagic stroke, and heart disease. Newman also cited a study of 1.2 million women in the UK (mean age), and followed for about seven years, who experienced a 12% increase in relative risk of breast cancer per 10 g of alcohol per day (or the equivalent of one drink per day). This study also found moderate amounts of alcohol consumption in middle-aged women can also contribute to higher risks of larynx, oral cavity, liver, esophagus, and rectum cancers, she said.
However, Newman noted that while women are less likely to use formal treatment centers, they have better outcomes in women-only treatment centers. Instead, they are more likely to seek treatment in primary care and mental health settings.
This is why catching women through screening is so important, Newman said. She shared two validated screening tools, the 10-question AUDIT (Alcohol Use Disorders Identification Test) and the four-question CAGE survey.
In addition to treatment centers, treatment for alcohol use disorder includes behavioural interventions, 12-step programs like Alcoholics Anonymous, and even some pharmacotherapy options, such as naltrexone.
But women with alcohol use disorder face a number of barriers to treatment, including financial circumstances, trauma, childcare responsibilities, and social stigma. Newman emphasized the importance of treating alcohol use disorder as a “chronic disease with a biological basis,” not a “moral failing.”
“We need to reduce the stigma associated with excessive drinking,” Newman said. “If we reduce stigma, perhaps our patients will seek care.”
