(1) Head of Department of Standardisation and Quality Assessment of Medical Care of the State Health Agency of the Republic of Komi ‘Republican Medical Information and Analytical Center’, MD Sciences
(2) Doctor of the Highest Qualification Category of the State Health Agency of the Republic of Komi ‘Consultative Diagnostic Center of the Republic of Komi’
* Corresponding author Email: firstname.lastname@example.org
In today’s society, social alcoholism is growing in the female population. It causes symptoms and affects their consumption behaviour of alcoholic beverages. The habit of close relatives, especially that of their husband, friends and close associates, has a decisive influence on the model of female behaviour. The features of everyday behaviour of women who use alcohol can be used as potential markers of alcoholism. This article highlights the malignancy and severity of alcoholism in women compared with men.
Every woman should be informed about alcoholism as a disease leading to inevitable premature death.
In a social institution, such as a family, both men and women indulge in binge drinking. If the number of women suffering from alcoholic diseases was rare at the beginning of the 20th century, it would be exceptional and not typical of the society as a whole, where the ratio of drinking men and women was estimated at 1:12. But now, with the ratio of drinking men and women being 1:5, under 12%–17% of women patients are being referred to Russian psychiatrists. According to official statistics, in Russia, the ratio of women suffering from alcohol dependence has increased from 11.3% to 15.8%. While the Scandinavians and Americans believe their number is not less than 30%, with the British, about half of all patients suffer from alcoholism[1,2,3]. This article discusses the features of alcoholism in women.
The authors have referenced some of their own studies in this review. These referenced studies have been conducted in accordance with the Declaration of Helsinki (1964), and the protocols of these studies have been approved by the relevant ethics committees related to the institution in which they were performed. All human subjects in these referenced studies gave informed consent to participate in these studies.
The most painful aspect of female alcoholism is rapid rejuvenation. According to the clinical and statistical studies of Academician G.V. Morozov and Professor A.K. Kachaev, 82% of women with alcoholism began to systematically use alcohol before the age of 30 years. According to other sources, 46.9% start below 20 years and 55.0% start between 16 and 21 years. Young girls and women typically start drinking under the influence of family or peers. Older women start drinking due to various unfavourable factors of life such as drinking husband, loss of loved ones or family break-ups. Another important factor is the easy availability of alcohol—more than half of the alcoholic patients work in catering, services or trade[4,5,6].
There is a popular saying: “When the husband drinks, half of the house is burning, when the wife drinks, the whole house is on fire.” In fact, female alcoholism brings a lot of trouble—disabled children are born, the family is destroyed, the woman turns dishevelled and falls morally. Female alcoholism causes the so-called habitual drunkenness—drinking at home and away, while on holidays and on weekdays, on all sorts of occasions and for no reason. Its peculiarity lies in the fact that addiction to alcohol is formed faster in women than in men. Very soon, it becomes irresistible, yet painful. Unlike men, women have a far indifferent attitude towards alcoholism from others (e.g. friends, relatives, family members and co-workers), so men are by all means able to hide their attraction to alcohol. And as a result, men are better able to seek treatment in the later stages of the disease. Another fact is that the younger a woman starts drinking, the greater the risk of alcohol-induced disease and the quicker it affects[7,8,9].
Women, in contrast to men, are pulled into alcoholism on emotional and psychological basis. Even when it is taken in small amounts, alcohol affects the neurotransmitter system, thus promoting a sense of relaxation, sedation and euphoria. This is the effect related to most cases involving women and alcohol—a chance to relax and forget about their problems. With a more flexible mind, women expertly balance between the activation of the brain with alcohol and depression between doses.
The reasons for female alcoholism are as follows:1. Physical
• The smaller the amount of muscle mass, the stronger the intoxication
• The lower the water content in the body, the higher the concentration of alcohol in the blood
• Increased absorption of ethanol (influenced by the hormonal features of the female body)
• Lower doses required to achieve the antidepressant effect—the illusion of drinking safely
• Personal and public evaluation of social factors—the woman is forced to behave in a manner appropriate to her role in the family and society, often shouldering an excessive burden. For example, display of weakness is considered wrong in today’s society, and to meet this requirement, a woman looks for easy ways to relax.
• Drinking habit is often hidden in women, since the reaction to women drinking is often hostile. This is exacerbated during stress since they face the additional burden of hiding their addiction, and this leads to more consumption of alcohol.
• Emotional predisposition of women to relieve stress without involving outsiders. Hence, they only gather with close girlfriends over a “cup of tea”, but do not visit the doctor.
The key elements of female alcoholism include deepening of the voice and the appearance of signs of premature aging. Female alcoholism develops in patients with negative qualities such as rudeness, aggressiveness and deceit. Under the influence of alcoholic beverages, the female body is destroyed faster than that of a man. The effects of alcoholism are harder felt by women. Due to the influence of alcohol, a number of problems arise in the central nervous system, including personality changes and severe mental disorders. That is why, among former alcoholics, more females had reported for substance abuse and got admitted into psychiatric clinics[11,12,13].
The female body is more vulnerable to the toxic effects of alcohol in connection with the well-known cyclical activities related to changes in the concentration of sex hormones in the blood. This in turn affects the emotional background and metabolic processes. In the male body, there is 10% more water, so women need a lower dose of alcohol for the development pattern of intoxication. The influence of alcoholism on monthly cycles increases the intensity of craving for alcohol.
Compared to men, lesser water content in a woman’s body and lower body weight leads to the fact that the ceteris paribus blood rises to a higher concentration of alcohol. During premenstrual syndrome, when women experience tension, irritability and anxiety, alcohol is better absorbed in the stomach, which leads to high toxicity at the end of the menstrual cycle. The monthly menstrual tension also predisposes to the consumption of alcohol. Women predominate men in binging by 82%. The very attraction to alcohol is different in women; “atrophy” of logical components is the ideological platform (arguments, reflection, doubt, etc.). Often, the attraction has an impulsive character.
A woman addicted to alcohol shows noticeable changes when compared to others. Her manners and behaviour become more cheeky. Her appearance is careless and sloppy, she has a rough voice, the skin becomes loose, she loses femininity and attractiveness, and shows signs of premature aging. She has a lost sense of modesty, is dull and sometimes loses instinct of motherhood, love of children, the need to care for her loved ones and to take care of the family. Drinking women lose professional status, are less interested in the results of their work and are in conflict with the interests of society.
Alcohol causes great damage to women’s health. They stand at a higher risk of cirrhosis of the liver than men. Alcoholism in women is accompanied by the development of diseases of the heart and blood vessels in 55.0% of patients and of the liver and biliary tract in 37.5% of patients. Compared to men, drinking women are five times more likely to suffer gepatoholetsistitah and three times more likely to suffer from hypertension (in non-drinkers, the rates are 2 and 1.5 times, respectively).
Diseases of the cardiovascular system due to the influence of alcohol occur much more frequently in women than in men. The use of alcohol and its damaging effects on the brain lead to gradual changes in a woman, leading to mental deterioration. Passion for alcoholic beverages violates the sexual function of women, particularly frigidity. On this basis, often there are conflicts between couples ending in divorce. In addition, women who drink have marked disorders of the ovaries, leading to disruption of the menstrual cycle, early menopause and infertility. There is a growing risk of spontaneous abortion. However, the worst result of alcoholism is the birth of children with physical and mental defects. The laws of Ancient Rome forbade young people under 30 years of age from drinking alcohol—the best period for childbearing. Greeks believed that the god of fire, Hephaestus, was born lame, because Zeus was in a state of intoxication during conception. In Ancient Greece, the bride and groom were forbidden from drinking wine on their wedding day. A similar prohibition has existed in Russia. In France, weak children born to alcoholics are called, “Children of a Merry Evening” and “Children of Sunday”. It is often believed that in a drunken conception, the man is to be blamed most. Research by many scientists has revealed that no less responsibility lies with the woman. Within an hour after drinking, even in moderation, alcohol can be found in a woman’s ovaries[17,18].
Severe consequences—toxicosis, miscarriage, premature birth and death of a child in the first month of life—are observed in cases where the mother drinks alcohol during pregnancy. There are physiological changes in the body of the mother who drinks alcohol in violation of the conditions required for the proper development of the foetus. Alcohol easily crosses the placental barrier and has a strong deleterious effect on the foetus. It can even kill the human embryo. Alcohol affects foetal development in various stages of pregnancy differently. The most dangerous period is the first nine weeks, when the main organs of the future child are formed. The foetal brain is most susceptible to the action of alcohol, especially the structures defining the future intellectual and emotional activity and the ability to learn.
Alcohol consumed by the mother proves much more dangerous for the offspring than that of the father. According to US researchers, all those children, who were born of mothers who drank alcohol during pregnancy, were detected to have some type of deviation from the norm. The most common were mental retardation, rickets, various skull deformations, congenital heart disease, abnormalities of joints with limitation of movement and abnormalities in the development of the external genitalia. At birth, these children have a mass of 30% and growth of up to 20% less than normal. In the future, they continue to lag behind in development compared to their peers. Alcohol lowers the body’s defences in pregnant women and increases its susceptibility to adverse environmental factors. Often, there is a marked increase in blood pressure and renal failure, which further aggravate the course and outcome of labour.
Currently, specialists frequently come across a combination of particular types of birth defects and shortcomings in the intellectual and physical development in children born to women who consume alcohol. This pathology manifests in the form of small eye slits, short upturned nose with a sunken bridge of the nose and hypoplasia of the lower jaw. In recent years, paediatricians are faced with yet another dire consequence of alcoholism—chronic alcohol-induced foetus being exposed to the toxic effects of alcohol in the uterus. At the time of birth, this baby is terminally ill as a result of the complete absence of the cerebral cortex. Nothing can help children with such disorders[20,21].
Children born to women who drink alcohol during pregnancy are more likely than their peers to suffer from colds and infectious diseases; they are often restless, irritable, disobedient, moody and tearful; they have a sleep disorder, stuttering and bedwetting habits and they talk in their sleep. At school, these children tend to perform poorly and are undisciplined. In order to avoid such consequences, women should completely eliminate alcohol from their lives. Of drinking women, one in three women is not able to breastfeed, which adversely affects the child’s body. Alcohol, consumed in any dose, moves very rapidly into the milk of lactating women causing disorders of the nervous system of the child, mental problems and diseases of the digestive system, cardiovascular system and lungs and inhibiting brain development. There is a perception that beer helps to increase the amount of milk in the mother during breastfeeding. This is a dangerous misconception.
A woman in a state of intoxication can easily start casual sex, a constant companion in sexually transmitted diseases. Women, who have symptoms of sexually transmitted diseases, would try to hide the disease and delay treatment of medical venereal diseases. They try self-medication, which often leads to infertility or adversely affects the growth of the foetus. Sexually transmitted diseases are a severe price to pay for the use of alcoholic beverages.
A man’s attitude to alcohol is formed in early childhood. Families, especially mothers, play a leading role in creating a healthy, anti-alcoholic climate in the family. It is known that in families where the parents drink, children take to drinking more frequently. Teenagers drink in roughly equal measures as that of their drinking fathers. Teenagers whose mothers drink alcohol are 1.5 to 2 times more likely to consume alcohol than teenagers who have non-drinking mothers. Very often, the knowledge of drinking comes in children through the direct involvement of parents. Research studies reveal that of all avid drinkers, who began to drink before 15 years of age, about 39% of them were attached to alcoholic parents. The body’s defence systems of children and teenagers are much weaker than that of adults. Conditioned reflexes, in relation to craving for alcohol, are formed faster and fade away slowly. Even small amounts of alcohol can cause severe poisoning in children and adolescents. It is necessary to cultivate a negative attitude to alcohol in children that would stay with them all through their life. Maxim Gorky wrote that it is necessary for a mother to make every effort to eradicate drunkenness in her family so that the harmful effects do not ruin the children’s lives.
A woman’s attitude to alcohol is appreciably affected by the behaviour of close relatives, especially that of her husband and friends. According to the observations of scientists, 94% of relatives and friends of alcoholic women do not drink alcohol. In the presence of relatives and friends who drink, only 11% of women do not consume alcoholic beverages. In families where the husband often drinks, 22% of women are drinkers.
Men are often the culprits for familiarising women with alcoholic beverages. Often, this is done deliberately for personal gain. The woman in the family is always an active opponent of drunkenness. By conniving the woman into drinking, men eliminate the obstacles to their addiction. Much also depends on the circumstances of the woman’s life, her circle of friends and interests. Most alcoholic women, for various reasons, do not create a family; they are single or divorced. The study of psychological and socio–psychological factors that lead to craving for alcoholic beverages found that it is more satisfying by believing in yourself. Reasons that push a woman to the path of alcoholism are conflicts in the family and at work, depressed mood, creativity and life’s setbacks, financial independence and the desire for emancipation. Women tend to misunderstand the meaning of “emancipation”, believing that alcoholism makes them, “on par with men”. The bitter consequences of such errors soon show up.
Scientists have come to the conclusion that in many ways alcoholism is more malignant in women than in men. The rate at which alcohol-induced diseases begin after the onset of alcohol use is as follows: in men, it begins on an average of 7–9 years and in women, in 3–4 years (by episodic drinking, constant drinking, binge drinking and constant drinking)!
Clinical manifestations of the disease in women are not only growing faster, but often have more severe consequences. First of all, the master of the disease syndrome—craving for alcohol—can be extremely intense, often stubbornly defying health effects and is easily revived under the influence of a variety of reasons. In women, it is often in the form of extreme mental deterioration, manifested with apparent opposition to the truth about herself, hiding alcoholism, hysteria, impulsiveness, rudeness, scandalous, duplicity and insincerity. But for stubbornness, frivolous, or, on the contrary, defiant angry rejection of the treatment is usually hidden alcoholism peculiar phenomenon misrecognition disease, called ‘anosognosia of alcoholism’. Recent research (using data from statistics) reveals one of the most significant differences between male and female alcoholics—women under the influence of alcohol are more often affected by emotional trauma and develop depressive disorders[23,24].
What can and should alert a woman or her family in terms of potential alcohol abuse?
1. Daily (or slightly less) need for the removal of stress with alcohol—usually beer or wine. The more often a woman drinks, the more quickly she develops tolerance to low doses of alcohol and this reduces the severity of antidepressant action. It leads to higher levels of alcohol use, but in large doses, alcohol inhibits the production of pleasure hormones, so she would keep increasing the doses. Alcohol dependence in women usually begins with beer alcoholism—a bottle of beer after work and martini with her friends in a café.
2. Attempts to hide cravings (or addiction has been formed) to alcohol.
3. Lack of insight into the behaviour of the period of intoxication.
4. Excuses and trying to find a more or less acceptable reason for drinking.
When at least one of these symptoms is presented, you must immediately take precautionary measures and seek medical attention.
There are four stages to modern drug and alcohol abuse: prodromal (zero), first, second and third. The psychiatric and clinical signs of dependence, frequency and amount of alcohol consumed are the factors on which the stage of alcoholism is determined. The system contains a total of three points: (1) People who do not drink alcohol at all (or who drink extremely rare in microdoses), (2) People who consume alcohol in moderate amounts and (3) People who abuse alcohol (with varying degrees of alcohol).
In the developing stages, women usually begin with minimal dependence on alcohol and increase in small doses up to a total loss of self-control, leading to the collapse of the individuals and the development of somatic disorders.
The first stage is when the dependence on alcohol begins. The person loses control over the dose, and is popularly called, “do not know the rules”. Intoxication, usually expressed, accompanies each episode of drinking. At this time, there are no neuropsychiatry disorders, to keep in check at least the minimum criticality. Yet, women understand the severity of the situation, and are able to tell themselves, “I drink too much!”
The second stage is characterized by the appearance of withdrawal symptoms of hangover. There are significant changes in the body, which shows an increased tolerance to ethanol. At this stage, a larger dose is required to get the usual intoxication. The higher the dose of alcohol, the more is the acetaldehyde poisoning and the more difficult the effects of intoxication become. It is at this stage that the typical appearance of puffy face, eye slits and swollen lips appear, and hormonal changes and rapidly melting fat tissue begin.
The third stage is related to almost everything from emotions to physiological functions. A typical feature of the third stage is binging. Typically, people suffering from chronic alcoholism begin to drink alcohol during adolescence or early adulthood. Accordingly, after 35–40 years of age, their body no longer copes with the load, which often leads to death.
The main diagnostic signs of alcohol dependence are:
• Lack of response, even vomiting on using large amount of alcoholic beverages
• Lack of self-control and a sense of proportion relative to the amount of alcohol consumed
• Drunken syndrome
• Permanent hangover
• Retrograde amnesia—memory impairment (relative events leading to drunkenness)
Every woman should be informed about alcoholism as a disease leading to inevitable premature death. They need to face the enemy.
The authors are grateful to all the anonymous referees for their support and valuable advice and helpful comments.
All authors contributed to the conception, design, and preparation of the manuscript, as well as read and approved the final manuscript.
All authors abide by the Association for Medical Ethics (AME) ethical rules of disclosure.