Ann Dowsett Johnston, author of Drink: The Intimate Relationship Between Women and Alcohol, is the CEO of Pine River Foundation. Co-founder of the National Roundtable on Girls, Women and Alcohol, she is also an award-winning journalist and a founding member of Faces and Voices of Recovery. A wonderful woman who has privileged us by writing this piece for MarchFifteen – a must read. A provocation. A great starter to the year. Your comments are most welcome.
To Your Health
By: Ann Dowsett Johnston
Flying to London recently in business class, I was just settling down to some serious work when the flight attendant offered me a glass of port with my cheese course. “No thanks, I have work to do,” I explained. She grimaced. “Lots of people drink while they work.” As she poured a glass for the neighbouring woman, laboring over a spreadsheet with a glass of wine, I thought: that used to be me. Six years ago, I would have said “yes” to the wine, and “yes” to the port. My exit from the plane might have been a little fuzzy, but I would have seen it as my right to have a glass or two to decompress, to relax, to reward myself for hard work—and to celebrate having used my airline points for a business-class seat.
Before I put a stop to my almost nightly wine habit and headed off to rehab, it wasn’t uncommon for me to drink an extra glass over an evening of work. I was a high-functioning professional in her fifties, a woman who used wine to cope with the stresses of “leaning in.” Leaning in was fun, but it took its toll. Leaning back was the hard part. For that, I used Pinot Grigio: my means of downshifting, decompressing from the demands of the day, prepping for the demands of the evening.
For many years, this strategy worked: a glass or two of chilled white wine while chopping vegetables, overseeing homework and finishing a little work before bed. It helped unhitch my shoulders from my earlobes. It worked, when it was one or two glasses, period. But this was before I hit menopause and a particularly bad bout of depression and empty-nest syndrome. Then two became three. At the very end, three became four.
In other words, it worked until it didn’t.
And as it turns out, I am not the only one who has used alcohol as a means to manage a more than full plate. When I did the research for my bestselling book Drink: The Intimate Relationship Between Women and Alcohol, I learned that I was just one of many, one of countless women around the globe, wrestling with the same demons. In fact, I may be the poster girl for the modern alcoholic: a well-educated, high-functioning, high-bottom woman, using alcohol to manage the stress of a complex world.
Pre-eminent American researcher Professor Sharon Wilsnack believes we are now witnessing a “global epidemic” in women’s drinking. Four years ago, Katherine Keyes, a post-doctoral fellow at Columbia University, reviewed 31 international studies of generational and gender differences in alcohol consumption and mortality. Her conclusion? Those like me, born after the Second World War, are more likely to binge-drink and develop alcohol-use disorders than their older counterparts.
Keyes gets specific: “Those born between 1978 and 1983 are the weekend warriors, drinking to black out. In that age group, there is a reduction in male drinking, and a sharp increase for women.” Meanwhile, women who are in their forties and fifties have a very high risk in terms of heavy drinking and weekly drinking. “We’re not saying, ‘Put down the sherry and go back to the kitchen,’” says Keyes. “But when we see these steep increases, you wonder if we are going to see a larger burden of disease for women.”
There is no doubt. Risky alcohol consumption is associated with more than 200 diseases and cancers; it is connected to 15 per cent of breast cancer cases. Canada’s low-risk drinking guidelines state that women should consume no more than 10 drinks a week, taking days off from alcohol and rarely drinking more than two alcoholic beverages on any given day.
For many women, this is challenging. We live in an alcogenic culture, where a glass of red wine is seen as the next best thing to Vitamin D. Walk into most social gatherings and the first thing you’re asked is, “Red or white?” We live in a culture where knowing your wines is a mark of sophistication. And thanks to media reports in the past few years, we have happily absorbed the news that drinking has its health benefits. If one glass is good for you, a double dose can’t do much harm, can it? Actually, a double dose may have real drawbacks; Canadian researcher Tim Stockwell suggests that the largest health benefit comes from having one drink every two days.
Meanwhile, we have witnessed the “pinking” of the drinking market, the feminisation of the LCBO. Witness Girls’ Night Out wines and Mommyjuice, Skinnygirl products and girly “alcopops”: Mike’s Hard Lemonade and Smirnoff Ice. These aren’t manly drinks.
Some of this is product drive; some is entitlement. Women drink because they can. Women need a break. They feel they deserve a break. And if drinking is about escape, it is also about empowerment. “Those in high-status occupations,” says Keyes, “working in male-dominated environments, have an increased risk of alcohol-use disorders.” In fact, the one protective factor for women is what Keyes calls “low-status occupations”. “As gender role traditionality has decreased,” she goes on, “the gender gap in substance abuse has decreased as well. And the trajectory for female alcohol abuse now outpaces that of men.” In fact, women with a university degree are almost twice as likely to drink daily as those without.
Which raises a simple question: why are we aware of the dangers related to trans fats and tanning beds, yet blinkered when is comes to the more serious side-effects associated with our favourite drug? Two years ago, a study in the respected journal Addiction challenged the broadly accepted assumption that a daily glass of red wine offers protection against heart disease. The protective association varies by gender, with higher risk for morbidity and mortality in women.
I don’t want to be a killjoy, but alcohol is a carcinogen: the risks of drinking far outweigh the protective factors. Politically, we are equal. But when it comes to alcohol, men and women are different metabolically and hormonally. There is no doubt: this has implications for tolerance and physical impacts in the long run. Women’s vulnerabilities start with the simple fact that, on average, they have more body fat than men. Since body fat contains little water, there is less to dilute the alcohol consumed. In addition, women have a lower level of a key metabolizing enzyme, alcohol dehydrogenase, which helps the body break down and eliminate alcohol. As a result, a larger proportion of what women drink enters the bloodstream. Furthermore, fluctuating hormone levels mean that the intoxicating effects of alcohol set in faster when estrogen levels are high.
The list goes on. Women’s chemistry means they become dependent on alcohol much faster than men. Other consequences, including cognitive deficits and liver disease, all occur earlier in women, with significantly shorter exposure to alcohol. Women who consume four or more alcoholic beverages a day quadruple their risk of dying from heart disease. Heavy drinkers of both genders run the risk of a fatal hemorrhagic stroke, but the odds are five times higher for women.
I am no prohibitionist. Far from it. But I think it’s time we jumpstarted an adult conversation about our drinking: what it means to us as individuals and as a whole. Each and every one of us needs to be well-educated on our own risks, and observant of our own behaviour. Are you drinking to relax and reward, or to numb? Are you drinking within the low-risk drinking guidelines, or above?
Alcohol has become the modern women’s steroid, enabling her to do the heavy lifting in an increasingly complex world, and the consequences are profound.
My advice? Keep a drinking diary. Ensure you have options to that second nightly glass of wine. Practice good self-care–extreme self-care. And if you or a loved one have a problem, see your doctor. Speak to a friend. Read my book. Believe me: you are not alone.