ALCOHOL

A Women’s Health Issue

U . S . D E PA RT M E NT O F H E A LT H A N D H U M A N S E RV ICE S

Na tion a l Instit ut e s of H e a lt h

Na tiona l I n sti tut e on Alcoh ol Abus e and Alcoh olism
This booklet is the result of a collaboration between two components 

of the National Institutes of Health (NIH): the Office of Research on 

Women’s Health, Office of the Director, and the National Institute 

on Alcohol Abuse and Alcoholism. NIH is the lead Federal agency for 

biomedical research. 

(Photographs of people appearing in this booklet are for illustrative purposes only. These photographs are copyrighted and may not 

be reproduced without written permission. For information, contact the National Institute on Alcohol Abuse and Alcoholism.) 
ALCOHOL
 

A Women’s Health Issue 

Table of Contents 

Women and Drinking 2
 

Alcohol in Women’s Lives: Safe Drinking Over a Lifetime 8
 

Women and Problem Drinking 13
 

Research Directions 16
 

Getting Help and More Information 18
 

Additional Reading 20
 

1 
Women and Drinking 

Exercise, diet, hormones, and stress: keeping up with 

all the health issues facing women is a challenge. 

Alcohol presents yet another health challenge for women. Even in small 

amounts, alcohol affects women differently than men. In some ways, 

heavy drinking is much more risky for women than it is for men. 

With any health issue, accurate information is key. There are times and 

ways to drink that are safer than others. Every woman is different. No 

amount of drinking is 100 percent safe, 100 percent of the time, for 

every woman. With this in mind, it’s important to know how alcohol can 

affect a woman’s health and safety. 

How Much Is Too Much? 

Sixty percent of U.S. women have at least one drink a year. Among 

women who drink, 13 percent have more than seven drinks per week. 

For women, this level of drinking is above the recommended limits 

published in the Dietary Guidelines for Americans, which are issued jointly by 

the U.S. Department of Agriculture and the U.S. Department of Health 

and Human Services. (The Dietary Guidelines can be viewed online at 

www.nutrition.gov.) 

The Dietary Guidelines define moderate drinking as no more than one drink 

a day for women and no more than two drinks a day for men. 

The Dietary Guidelines point out that drinking more than one drink per 

day for women can increase the risk for motor vehicle crashes, other 

2 
 

 

What is a drink? A standard drink is: 

One 12-ounce bottle of beer or wine cooler 

One 5-ounce glass of wine 

1.5 ounces of 80-proof distilled spirits 

Keep in mind that the alcohol content of 

different types of beer, wine, and distilled 

spirits can vary quite substantially. 

injuries, high blood pressure, stroke, violence, suicide, and certain types 

of cancer. 

Some people should not drink at all, including: 

■ Anyone under age 21 

■ People of any age who are unable to restrict their drinking to 

moderate levels 

■ Women who may become pregnant or who are pregnant 

■ People who plan to drive, operate machinery, or take part in other 

activities that require attention, skill, or coordination 

■ People taking prescription or over-the-counter medications that can 

interact with alcohol. 

Why are lower levels of drinking recommended for women than for men? 

Because women are at greater risk than men for developing alcoholrelated problems. Alcohol passes through the digestive tract and is dispersed 

in the water in the body. The more water available, the more diluted the 

alcohol. As a rule, men weigh more than women, and, pound for pound, 

women have less water in their bodies than men. Therefore, a woman’s brain 

and other organs are exposed to more alcohol and to more of the toxic 

byproducts that result when the body breaks down and eliminates alcohol. 

3 
Moderate Drinking: Benefits and Risks 

Moderate drinking can have short- and long-term health effects, both 

positive and negative: 

■ Benefits 

Heart disease: Once thought of as a threat mainly to men, heart disease 

also is the leading killer of women in the United States. Drinking 

moderately may lower the risk for coronary heart disease, mainly 

among women over age 55. However, there are other factors that 

reduce the risk of heart disease, including a healthy diet, exercise, 

not smoking, and keeping a healthy weight. Moderate drinking 

provides little, if any, net health benefit for younger people. 

(Heavy drinking can actually damage the heart.) 

■ Risks 

Drinking and driving: It doesn’t take much alcohol to impair a person’s 

ability to drive. The chances of being killed in a single-vehicle crash 

are increased at a blood alcohol level that a 140-lb. woman would 

reach after having one drink on an empty stomach. 

Medication interactions: Alcohol can interact with a wide variety of 

medicines, both prescription and over-the-counter. Alcohol can 

reduce the effectiveness of some medications, and it can combine 

with other medications to cause or increase side effects. Alcohol can 

interact with medicines used to treat conditions as varied as heart 

and blood vessel disease, digestive problems, and diabetes. In 

particular, alcohol can increase the sedative effects of any medication 

that causes drowsiness, including cough and cold medicines and 

drugs for anxiety and depression. When taking any medication, 

read package labels and warnings carefully. 

4 
 

Breast cancer: Research suggests that as little as one drink per day can 

slightly raise the risk of breast cancer in some women, especially 

those who are postmenopausal or have a family history of breast 

cancer. It is not possible, however, to predict how alcohol will affect 

the risk for breast cancer in any one woman. 

Fetal Alcohol Syndrome: Drinking by a pregnant woman can harm her 

unborn baby, and may result in a set of birth defects called fetal 

alcohol syndrome (FAS). 

Fetal Alcohol Syndrome 

Fetal alcohol syndrome (FAS) is the most common known 

preventable cause of mental impairment. Babies with FAS 

have distinctive changes in their facial features and they 

may be born small. The brain damage that occurs with 

FAS can result in lifelong problems with learning, memory, 

attention, and problem solving. These alcohol-related 

changes in the brain may be present even in babies whose 

appearance and growth are not affected. It is not known 

if there is any safe drinking level during pregnancy; nor 

is there any stage of pregnancy in which drinking—at any 

level—is known to be risk free. If a woman is pregnant, or 

wants to become pregnant, she should not drink alcohol. 

Even if she is pregnant and already has consumed alcohol, 

it is important to stop drinking for the rest of her 

pregnancy. Stopping can reduce the chances that her 

child might be harmed by alcohol. 

5 
Another risk of drinking is that a woman may at some point abuse alcohol 

or become alcoholic (alcohol dependent). Drinking four or more drinks 

on any given day OR drinking eight or more drinks in a typical week 

increases a woman’s risk of developing alcohol abuse or dependence. 

The ability to drink a man—or 

anyone—under the table is not a 

plus: it is a red flag. Research has 

shown that drinkers who are able 

to handle a lot of alcohol all at 

once are at higher—not lower— 

risk of developing problems, such 

as dependence on alcohol. 

Heavy Drinking 

An estimated 5.3 million women in the United States drink in a way that 

threatens their health, safety, and general well-being. A strong case can 

be made that heavy drinking is more risky for women than men: 

■ Heavy drinking increases a woman’s risk of becoming a victim of violence and sexual assault. 

■ Drinking over the long term is more likely to damage a woman’s health than a man’s, even 

if the woman has been drinking less alcohol or for a shorter length of time than the man. 

6 
The health effects of alcohol abuse and alcoholism are serious. Some 

specific health problems include: 

■ Alcoholic liver disease: Women are more likely than men to develop 

alcoholic hepatitis (liver inflammation) and to die from cirrhosis. 

■ Brain disease: Most alcoholics have some loss of mental function, reduced 

brain size, and changes in the function of brain cells. Research 

suggests that women are more vulnerable than men to alcoholinduced brain damage. 

■ Cancer: Many studies report that heavy drinking increases the risk of 

breast cancer. Alcohol also is linked to cancers of the digestive track 

and of the head and neck (the risk is especially high in smokers who 

also drink heavily). 

■ Heart disease: Chronic heavy drinking is a leading cause of cardiovascular 

disease. Among heavy drinkers, women are more susceptible to alcoholrelated heart disease, even though women drink less alcohol over a 

lifetime than men. 

Finally, many alcoholics smoke; smoking in itself can cause serious longterm health consequences. 

7 
Alcohol in Women’s Lives: 

Safe Drinking Over a Lifetime 

The pressures to drink more than what is safe—and the 

consequences—change as the roles that mark a 

woman’s life span change. Knowing the signs that 

drinking may be a problem instead of a pleasure 

can help women who choose to drink do so without harm to themselves or others. 

Adolescence 

Despite the fact that drinking is illegal for anyone under the age of 21, 

the reality is that many adolescent girls drink. Research shows that about 

37 percent of 9th grade girls—usually about 14 years old—report drinking 

in the past month. (This rate is slightly more than that for 9th grade 

boys.) Even more alarming is the fact that about 17 percent of these same 

young girls report having had five or more drinks on a single occasion 

during the previous month. 

Consequences of Unsafe Drinking 

■ Drinking under age 21 is illegal in every State. 

■ Drunk driving is one of the leading causes of teen death. 

■ Drinking makes young women more vulnerable to sexual assault and 

unsafe and unplanned sex. On college campuses, assaults, unwanted 

sexual advances, and unplanned and unsafe sex are all more likely 

among students who drink heavily on occasion—for men, five drinks 

in a row, for women, four. In general, when a woman drinks to 

excess she is more likely to be a target of violence or sexual assault. 

■ Young people who begin drinking before age 15 have a 40-percent 

higher risk of developing alcohol abuse or alcoholism some time in 

their lives than those who wait until age 21 to begin drinking. This 

increased risk is the same for young girls as it is for boys. 

8 
Alcohol’s Appeal for Teens. Among the reasons teens give most often for 

drinking are to have a good time, to experiment, and to relax or relieve 

tension. Peer pressure can encourage drinking. Teens who grow up with 

parents who support, watch over, and talk with them are less likely to 

drink than their peers. 

Staying Away From Alcohol. Young women under age 21 should not drink 

alcohol. Among the most important things parents can do is to talk 

frankly with their daughters about not drinking alcohol. 

Women in Young and Middle Adulthood 

Young women in their twenties and early thirties are more likely to drink 

than older women. No one factor predicts whether a woman will have 

problems with alcohol, or at what age she is most at risk. However, there 

are some life experiences that seem to make it more likely that women 

will have drinking problems. 

Heavy drinking and drinking problems 

among White women are most common in 

younger age groups. Among African American 

women, however, drinking problems are 

more common in middle age than youth. 

A woman’s ethnic origins—and the extent to 

which she adopts the attitudes of mainstream 

vs. her native culture—influence how and 

when she will drink. Hispanic women who are 

more “mainstream” are more likely to drink 

and to drink heavily (that is, to drink at least 

once a week and to have five or more drinks 

at one time). 

9 
Research suggests that women who have trouble with their closest relationships tend to drink more than other women. Heavy drinking is more 

common among women who have never married, are living unmarried 

with a partner, or are divorced or separated. (The effect of divorce on a 

woman’s later drinking may depend on whether she is already drinking 

heavily in her marriage.) A woman whose husband drinks heavily is more 

likely than other women to drink too much. 

Many studies have found that women who suffered childhood sexual 

abuse are more likely to have drinking problems. 

Depression is closely linked to heavy drinking in women, and women who 

drink at home alone are more likely than others to have later drinking 

problems. 

Stress and Drinking 

Stress is a common theme in women’s lives. Research 

confirms that one of the reasons people drink is to 

help them cope with stress. However, it is not clear 

just how stress may lead to problem drinking. Heavy 

drinking by itself causes stress in a job and family. 

Many factors, including family history, shape how 

much a woman will use alcohol to cope with stress. 

A woman’s past and usual drinking habits are 

important. Different people have different 

expectations about the effect of alcohol on stress. 

How a woman handles stress, and the support she 

has to manage it, also may affect whether she uses 

alcohol in response to stress. 

10 
Consequences of Unsafe Drinking 

■ The number of female drivers involved in alcohol-related fatal traffic 

crashes is going up, even as the number of male drivers involved in 

such crashes has decreased. This trend may reflect the increasing 

number of women who drive themselves, even after drinking, as 

opposed to riding as a passenger. 

■ Long-term health problems from heavy drinking include liver, heart, 

and brain disease; suppression of the immune system; and cancer. 

■ Because women are more likely to become pregnant in their twenties 

and thirties, this age group faces the greatest risk of having babies 

with the growth and mental impairments of fetal alcohol syndrome, 

which is caused by drinking during pregnancy. 

Older Women 

As they grow older, fewer women drink. At the same time, research suggests 

that people born in recent decades are more likely to drink—throughout 

life—than people born in the early 1900s. Elderly patients are admitted 

to hospitals about as often for alcohol-related causes as for heart attacks. 

Older women may be especially sensitive to the stigma of being alcoholic, 

and therefore hesitate to admit if they have a drinking problem. 

Consequences of Unsafe Drinking 

■ Older women, more than any other group, use medications that can 

affect mood and thought, such as those for anxiety and depression. 

These “psychoactive” medications can interact with alcohol in harmful ways. 

11 
■ Research suggests that women may be more likely to develop or to
 

show alcohol problems later in life, compared with men. 


Age and Alcohol. Aging seems to reduce the body’s ability to adapt to alcohol. 

Older adults reach higher blood levels of alcohol even when drinking the 

same amount as younger people. This is because, with aging, the amount 

of water in the body is reduced and alcohol becomes more concentrated. 

But even at the same blood alcohol level, older adults may feel some of 

the effects of alcohol more strongly than younger people. 

Alcohol problems among older people often are mistaken for other agingrelated conditions. As a result, alcohol problems may be missed and 

untreated by health care providers, especially in older women. 

Staying Well. Older women need to be aware that alcohol will “go to their 

head” more quickly than when they were younger. Also, caregivers need 

to know that alcohol may be the cause of problems assumed to result from 

age, such as depression, sleeping problems, eating poorly, heart failure, 

and frequent falls. 

The National Institute on Alcohol Abuse and Alcoholism recommends 

that people ages 65 and older limit their consumption of alcohol to one 

drink per day. 

An important point is that older people with alcohol problems respond 

to treatment as well as younger people. Those with shorter histories of 

problem drinking do better in treatment than those with long-term 

drinking problems. 

12 
 

Women and Problem Drinking 

Fewer women than men drink. However, among 

the heaviest drinkers, women equal or surpass 

men in the number of problems that result from 

their drinking. For example, female alcoholics 

have death rates 50 to 100 percent higher than 

those of male alcoholics, including deaths from 

suicides, alcohol-related accidents, heart disease 

and stroke, and liver cirrhosis. 

An Individual Decision 

A woman’s genetic makeup shapes how quickly she feels the effects of 

alcohol, how pleasant drinking is for her, and how drinking alcohol over 

the long term will affect her health, even the chances that she could have 

problems with alcohol. A family history of alcohol problems, a woman’s 

risk of illnesses like heart disease and breast cancer, medications she is 

taking, and age are among the factors for each woman to weigh in deciding 

when, how much, and how often to drink. 

What Are Alcohol Abuse and Alcoholism? 

Alcohol abuse is a pattern of drinking that is harmful to the drinker or 

others. The following situations, occurring repeatedly in a 12-month 

period, would be indicators of alcohol abuse: 

■ Missing work or skipping child care responsibilities because of drinking 

■ Drinking in situations that are dangerous, such as before or while driving 

■ Being arrested for driving under the influence of alcohol or for 

hurting someone while drunk 

■ Continuing to drink even though there are ongoing alcohol-


related tensions with friends and family.
 

Alcoholism or alcohol dependence is a disease. It is chronic, or lifelong, and it can be both progressive and life threatening. Alcoholism 

13 
is based in the brain. Alcohol’s short-term effects on the brain are 

what cause someone to feel high, relaxed, or sleepy after drinking. 

In some people, alcohol’s long-term effects can change the way the 

brain reacts to alcohol, so that the urge to drink can be as compelling 

as the hunger for food. Both a person’s genetic makeup and his or 

her environment contribute to the risk for alcoholism. The following 

are some of the typical characteristics of alcoholism: 

■ Craving: a strong need, or compulsion, to drink 

■ Loss of control: the inability to stop drinking once a person has begun 

■ Physical dependence: withdrawal symptoms, such as nausea, sweating, 

shakiness, and anxiety, when alcohol use is stopped after a period 

of heavy drinking 

■ Tolerance: the need for increasing amounts of alcohol to get “high.” 

Know the Risks 

Research suggests that a woman is more likely to drink excessively if she has any of 

the following: 

■ Parents and siblings (or other blood relatives) with alcohol problems 

■ A partner who drinks heavily 

■ The ability to “hold her liquor” more than others 

■ A history of depression 

■ A history of childhood physical or sexual abuse. 

The presence of any of these factors is a good reason to be especially 

careful with drinking. 

14 
How Do You Know if You Have a Problem? 

Answering the following four questions can help you find out if you or 

someone close to you has a drinking problem. 

■ Have you ever felt you should cut down on your drinking? 

■ Have people annoyed you by criticizing your drinking? 

■ Have you ever felt bad or guilty about your drinking? 

■ Have you ever had a drink first thing in the morning to steady your 

nerves or to get rid of a hangover? 

One “yes” answer suggests a possible alcohol problem. If you responded 

“yes” to more than one question, it is very likely that you have a problem 

with alcohol. In either case, it is important that you see your health care 

provider right away to discuss your responses to these questions. 

Even if you answered “no” to all of the above questions, if you are having 

drinking-related problems with your job, relationships, health, or with 

the law, you should still seek help. 

Treatment for Alcohol Problems 

Treatment for an alcohol problem depends on its severity. Women who 

have alcohol problems but who are not yet alcohol dependent may be 

able to stop or reduce their drinking with minimal help. Routine doctor 

visits are an ideal time to discuss alcohol use and its potential problems. 

Health care providers can help a woman take a good hard look at what 

effect alcohol is having on her life and can give advice on ways to stop 

drinking or to cut down. 

15 
Research Directions 

The National Institute on Alcohol Abuse and 

Alcoholism (NIAAA), a component of the 

National Institutes of Health (NIH), supports 

about 90 percent of the Nation’s research on 

alcohol use and its effects. The goal of this 

research is to better understand the causes and 

consequences of alcohol abuse and addiction, 

and to find new ways to prevent and treat 

alcohol problems. 

Finding out what makes some women drink too much is the first step to 

preventing alcohol problems in women. Scientists are studying the role 

of genetics and family environment in increasing or decreasing the risk 

of alcohol problems. They also are studying other features of a woman’s 

life, such as the type of job she has; whether she combines family and work; 

life changes like marriage, divorce, and the birth and departure of children; 

infertility; relationship and sexual problems; and ethnic background. 

Scientists want to know why women in general seem to develop longterm health problems from drinking more quickly than men. Researchers 

are examining issues like alcohol and breast cancer in women, and the 

extent to which alcohol may lower the risk of heart disease, and possibly 

osteoporosis, in some women. 

Finally, research is helping determine how to identify women who may be 

at risk for alcohol problems, and to ensure that treatment will be effective. 

16 
The Office of Research on Women’s Health (ORWH) serves as the focal 

point for women’s health research at NIH. ORWH works in a variety of 

ways to encourage and support researchers to find answers to questions 

about diseases and conditions that affect women and how to keep women 

healthy, and to establish a research agenda for the future. ORWH 

encourages women of all racial and ethnic backgrounds to participate in 

clinical studies to help increase knowledge of the health of women of all 

cultures, and to understand the health-related similarities and differences 

between women and men. The office also provides opportunities and 

support for the advancement of women in biomedical careers. 

17 
Getting Help and

More Information 

Alcoholics Anonymous (AA) World Services 

Internet address: www.aa.org 

Phone: 212–870–3400 

Makes referrals to local AA groups and provides informational materials on the AA program. 

Many cities and towns also have a local AA office listed in the telephone book. 

Al-Anon Family Group Headquarters 

Internet address: www.al-anon.alateen.org
 

For locations of Al-Anon or Alateen meetings worldwide, call
 

888–4AL–ANON (888–425–2666), Monday through Friday, 


8 a.m.–6 p.m. (EST)
 

For free informational materials, call 757–563–1600, 


Monday through Friday, 8 a.m.–6 p.m.
 

Makes referrals to local Al-Anon groups, which are support groups for spouses and other 

significant adults in an alcoholic person’s life. Also makes referrals to Alateen groups, which 

offer support to children of alcoholics. 

National Association for Children of Alcoholics (NACoA) 

Internet address: www.nacoa.net 

E-mail: nacoa@nacoa.org 

Phone: 888–554–COAS or 301–468–0985 

Works on behalf of children of alcohol- and drug-dependent parents. 

18 
 

National Clearinghouse for Alcohol and Drug Information (NCADI) 

Internet address: www.ncadi.samhsa.gov 

Phone: 800–729–6686 

Provides alcohol and drug abuse information produced by the Substance Abuse and Mental 

Health Services Administration, U.S. Department of Health and Human Services. 

National Council on Alcoholism and Drug Dependence (NCADD) 

Internet address: www.ncadd.org
 

Phone: 800–NCA–CALL (800–622–2255)
 

Provides telephone numbers of local NCADD affiliates (who can provide information on local 

treatment resources) and educational materials on alcoholism. 

National Institute on Alcohol Abuse and Alcoholism (NIAAA) 

5635 Fishers Lane, MSC 9304 

Bethesda, Maryland 20892–9304 

Internet address: www.niaaa.nih.gov 

Phone: 301–443–3860 

Offers a free 12-minute video, Alcohol: A Woman’s Health Issue,profiling women recovering 

from alcohol problems and describing the health consequences of heavy drinking in women. 

Other publications also are available from NIAAA and feature information on a wide variety of 

topics, including fetal alcohol syndrome, the dangers of mixing alcohol with medications, family 

history of alcoholism, and preventing underage drinking. See "Additional Reading," on page 

20, for information on ordering NIAAA materials. 

Substance Abuse Treatment Facility Locator 

Internet address: www.findtreatment.samhsa.gov 

Phone: 800–662–HELP (800–662–4357) 

Offers alcohol and drug information and treatment referral assistance. (This service is provided 

by the Substance Abuse and Mental Health Services Administration, U.S. Department of 

Health and Human Services.) 

19 
Additional Reading 

A Family History of Alcoholism: Are You at Risk?—offers easy-to-read information 

for anyone who is concerned about a family history of alcoholism. 

English version: NIH Publication Number 03–5340; Spanish version: 

NIH Publication Number 04–5340–S. 

Drinking and Your Pregnancy—explains how drinking can hurt a developing 

baby, the problems that children born with fetal alcohol syndrome have, 

how to stop drinking, and where to go for help. English version: NIH 

Publication Number 96–4101; Spanish version: NIH Publication 

Number 97–4102. 

Make a Difference: Talk to Your Child About Alcohol—offers guidance to parents 

and caregivers of young people ages 10 to 14 on preventing underage 

drinking. English version: NIH Publication Number 06–4314; Spanish 

version: NIH Publication Number 06–4314–S. 

Tips for Cutting Down on Drinking—offers a checklist for reducing drinking, 

including setting goals and keeping track, tips for handling the urge 

to drink, and learning how to say “no” to alcohol. English and 

Spanish versions: excerpted from NIH Publication Number 07-3769. 

To order, write to: National Institute on Alcohol Abuse and Alcoholism, 

Publications Distribution Center, P.O. Box 10686, Rockville, MD 

20849–0686. The full text of all of the above publications is available 

on NIAAA’s Web site (www.niaaa.nih.gov). 

20 
For more information on 

alcohol abuse and alcoholism, 

go to www.niaaa.nih.gov. 

For more information on 

women’s health research, go 

to http://orwh.od.nih.gov. 
U.S . DEPART ME NT OF HEALT H AND HU MAN SERVIC ES

Na ti ona l I nsti tut e s of He a lth

Na tio n a l Instit ut e on A lcohol Ab us e an d A lcoholi sm

NIH Publi c a tion No. 0 3–4956

Re v is ed 2008