Women and Alcoholism: A Biopsychosocial Perspective and Treatment Approaches

Due to a complex blend of biological and psychosocial factors related to female alcohol abuse that we detail in this article, women present for treatment with a unique set of issues and challenges that must be addressed in order to foster the most supportive atmosphere for their recovery. As of 1994, Grant, Bergman, Glenn, Errico, and King identified 4 million American women aged 18 years or older as alcoholics or problem drinkers. Women for Sobriety, devoted since 1976 to education, outreach, and treatment for the female alcoholic, estimated the number of female alcoholics to be between 5 and 7 million (Kirkpatrick, 1990). BIOLOGICAL FACTORS A number of biological realities combine to lead to severe organic damage at a more rapid rate in alcohol consumption for women as compared with men. According to Wilsnack, Wilsnack, and Miller-Strumhofel (1994), a woman's susceptibility to the physiological consequences of alcohol abuse is higher than that of a man's. Among the reasons for the difference is the way men's and women's bodies respond to alcohol (Deal & Galaver, 1994). These circumstances can be partly explained by the fact that alcohol is more soluble in water than in fat (Deal & Galaver, 1994). The fact that women's bodies contain more fatty tissue proportionately than do men's bodies means that the same quantity of alcohol consumed by both a man and a woman of equal size will result in a higher blood alcohol level for the woman. In addition, women have been shown to produce less alcohol dehydrogenase, which is the stomach enzyme that breaks down alcohol. The consequence of this enzymatic differential is that women break down less alcohol in the digestive process and, thus, again will show a higher blood alcohol concentration than men (Deal & Galaver, 1994). In fact, according to Deal and Galaver, "the hypothesis of increased absolute bioavailability of alcohol in women is supported by scientists who believe women are more susceptible to liver disease, as well as those who believe men and women are at equal risk for developing the disease" (p. 190). Various studies reported since 1977 (e.g., Krasner, Davis, Portmann, & Williams, 1977; Peres, Gavallero, Brugera, Torres, & Robes, 1986) have shown that the risk for developing cirrhosis is higher in women than in men who consume equal amounts of alcohol. Although the risk for cirrhosis increases with increasing alcohol consumption for both genders, both sets of data support the hypothesis that women are more susceptible to alcohol-induced cirrhosis than are men at each consumption level (Deal & Galaver, 1994, p. 191). In addition, Deal and Galaver have hypothesized that women's increased susceptibility to alcohol-induced liver disease is not the only factor in women's development of cirrhosis. Gender-specific mechanisms may also be at work, according to Deal and Galaver. In populations of those who continued to drink alcohol after being diagnosed with alcoholic hepatitis, more women than men progressed to the more severe form of liver disease, cirrhosis. Among those in the group who stopped drinking after being diagnosed with alcoholic hepatitis, more women than men died or progressed to cirrhosis more rapidly. Clearly the female alcoholic seems to be at increased risk of death or permanent disability compared with her male counterpart (Deal & Galaver, 1994). Another area of increased vulnerability for the alcoholic woman concerns the damage done to cognitive functioning as a result of long-term alcohol abuse. According to Nixon (1994), when four domains of neurocognitive functioning--verbal skills, visual-spatial performance, verbal memory, and set-shifting flexibility--were measured, alcoholics of both genders performed more poorly than did nondrinking controls. What was both significant and relevant to the current discussion was that women alcoholics reported shorter durations of consumption and smaller quantities of alcohol consumed when compared with men. …