"Alcohol use disorder" is on the rise among young women. Experts explain why.
Photo: Getty/ Luisa Sancelean / EyeEm
From brunch get-togethers to first dates to holiday parties, it's undeniable that alcohol plays a central role in our social lives. And although many of us know the health benefits of drinking less (Ed Sheeran lost 50 pounds just by cutting out beer), most people are reluctant to stop drinking for more than a month (lookin' at you Dry January!).
But the repercussions of heavy drinking go far beyond packing on some extra pounds: The number of young people (age 25 to 34) dying from liver disease and cirrhosis is rapidly increasing, according to a new study published in BMJ—and alcoholic cirrhosis is the primary driver behind this fatal increase. This trend goes hand-in-hand with the fact that alcoholism is on the rise and that it's fast-growing in women, particularly among young women.
If this is news to you, we're here to answer some crucial questions, like who exactly is at risk, what's behind the shift, and what alcohol-related behaviors should you watch out for.
What the Stats Say
A recent study published in JAMA Psychiatry looked at alcohol use in the U.S. from 2001 to 2002 and from 2012 to 2013, and found that one adult in eight in the U.S. meets the criteria for alcohol use disorder, aka alcoholism. The study looked at people who exhibited signs of either alcohol abuse or alcohol dependence, both of which contribute to meeting the diagnostic criteria for alcoholism. (If you're curious what qualifies as alcohol abuse or dependence, you can get all the details via the National Institutes of Health.)
That's pretty surprising in itself, but here's the real shocker: Among adults under age 30, one in four meet the criteria. That's an astonishing number. One of the groups that saw the largest increase in use between 2001 and 2013? Women. And it's not just the statistics that are telling this story. Treatment providers are seeing an increase in female patients, too—particularly young ones. "I've seen a steady rise," says Charlynn Ruan, Ph.D., a Los Angeles–based clinical psychologist and founder of Thrive Psychology LA. "I work mostly with women, and alcohol use is a big issue with my college-age and early career clients."
The habit is lasting far beyond college, though. "The latest research points towards a spike in alcohol consumption in the young adult age group, from about 25 to 34," says Joseph Galati, M.D., a Houston-based hepatologist who specializes in caring for patients with liver disease. "Some have tied it to the economic downturn 10 years ago, while others may point towards an improved economic outlook and disposable income to spend on entertainment and alcohol consumption. In my own practice, I've seen an increase in binge drinking on weekends, which does carry negative effects. The majority of young people really do not understand the inherent dangers of alcohol consumption, binging, and the difference in liver toxicity between men and women."
It's true: Alcohol affects women's bodies differently from men's, according to the National Institute on Alcohol Abuse and Alcoholism. Women become intoxicated faster and process alcohol differently. Plus, heavy drinking (that means eight or more drinks per week, according to the CDC) can potentially increase the risk for certain diseases, notably breast cancer and brain disease.
Though not all people who engage in binge drinking are alcoholics, research indicates that college-age women are more likely to exceed recommended drinking guidelines than college-age men. And FYI, to be considered "alcoholic," a person needs to meet the criteria for either alcohol abuse or alcohol dependence—meaning that either they're experiencing negative life consequences because of their drinking or they crave alcohol on a regular basis. And while it's still true that men are more likely than women to become alcoholics (the current stats show that 4.5 percent of men in the U.S. qualify as alcoholic while just 2.5 percent of women do, although both of these numbers have likely grown since this research was conducted), there's lower awareness around the serious issues women face related to alcoholism, experts say. "At the first sign of a problem women need to take notice, as women's substance use tends to progress more quickly from first use to addiction than in men," says Patricia O'Gorman, Ph.D., a clinical psychologist and author.
What's Behind the Rise
Most often, women learn alcohol-related behaviors in college—or even in high school. That was the case for Emily, a 25-year old who got sober at age 21. "My first sip of alcohol without my parents' permission was at age 15," she says. It started as a rarity, then developed into something more—drinking and behaving recklessly—by her junior and senior years of high school. "This continued for three years until right after my 21st birthday. I was one of those alcoholics who took no time to let it manifest into full-blown addiction—going from 0 to 90 in less than a minute."
Experts say Emily's experience isn't uncommon, and it's partially thanks to the images young people are exposed to. "We live in a society where alcohol is heavily advertised as a social elixir to help ease you into new situations, relax, and have a good time," says O'Gorman. With so many images of alcohol and its "benefits," it's easy to understand how young people develop positive associations with the stuff. Just look at the fake Instagram account created to raise awareness about alcoholism, which garnered 68,000 followers in just two months. An ad agency put together the account, which featured a cool-looking young woman with not-so-obvious alcohol featured in every post, for their addiction recovery client, and easily proved their point that not only does alcohol use in young people often go unnoticed, but people like seeing glamourized images of alcohol.
As for why more women are drinking than ever, experts say there are several factors at play. "One is that societal expectations and cultural norms have changed," says Jennifer Wider, M.D., a women's health expert. The recent study in JAMA Psychiatry pointed out that as more women enter the workforce due to increases in occupational and education options, their level of alcohol consumption may increase as well." While there's no definitive research on why this is exactly, it's likely due to a variety of factors, such as women and men experiencing similar levels of work-related stress, or the desire to "keep up" with social drinking in the office.
Lastly, there's the fact that young women especially aren't generally known to be "at risk" for alcohol abuse, which can make it harder to recognize. "I wish people knew that age is not a factor in determining whether or not you could be an alcoholic," Emily says. "I told myself for years that I was too young to be an alcoholic and that I was just having fun like every other high schooler, college kid, (you fill in the blank)." From current addicts to those in recovery, it's important to know that people of all genders and in all age groups are at risk. "The stereotype of 12-step meetings being fully populated by middle-aged men is just that—a stereotype."
Signs of Alcoholism
Alcoholism isn't always obvious, especially in people who generally have their lives "together." "A person can be sober all week, then drink to extreme excess on the weekend," notes Ruan. "On the other end of the spectrum, a woman might get buzzed every night, but never binge. The key distinction is how her drinking impacts her functioning, relationships, and health." If any of these areas suffer and efforts to cut back on drinking aren't working, there may be an issue that needs to be addressed.
"I didn't drink every day," says Katy, a 32-year-old who has been sober for four years. "I was always a binge drinker. I'd go days or weeks without, but when I did partake, controlling the amount I consumed was never possible. I was never able to stop drinking once I started, especially in a party situation," she says. This is actually pretty common, according to O'Gorman, and for many, it makes recognizing the issue difficult. "Addiction has to do with the effect the drug has on you, more so than how often you use it, and this speaks to the biology of abuse and addiction," she explains. "If you only drink once a year but can't control how much you drink and can't remember what you did, then you have a problem."
So what should you do if you have concerns about your drinking? "Talk to your primary care doctor or a psychiatrist or counselor," suggests Thomas Franklin, M.D., medical director of The Retreat at Sheppard Pratt. "Many times just a few sessions of counseling will help greatly. For more serious alcohol use disorders, there are many levels of care available from outpatient through longer-term residential treatment that have good outcomes for those that can take it seriously. Alcoholics Anonymous (AA) meetings work for many people, too." Plus, with more people in the public eye opening up about their sobriety or their struggled to stay sober (Demi Lovato among them) and more research being done on alcoholism's prevalence and what causes it, the future is more than hopeful.