How Women Drink: Epidemiology of Women's Drinking and Problem Drinking.

Gender is a strong predictor of drinking behavior. According to a 1990 national survey of drinking by American adults (Midanik and Clark 1992), men are more likely than women to drink at all (71 percent of men and 59 percent of women drink any alcohol) and are more likely than women to be heavy drinkers (21 percent of men and 6 percent of women have two or more drinks(1) daily).Data from 39 longitudinal surveys(2) in 15 countries have confirmed these gender differences. In every country and every age group, men drink larger quantities, drink more frequently, and report more drinking-related problems(3) than women (Fillmore et al. 1991). However, women's drinking behavior can vary significantly among countries and within a country over time.The gender differences in drinking and heavy drinking rates are paralleled by gender differences in the prevalence of the clinical diagnoses of alcohol abuse and alcohol dependence. (The terms "alcohol abuse" and "alcohol dependence" are used as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [American Psychiatric Association 1994].) In all studies conducted, more men than women were diagnosed with these disorders, but the male-to-female prevalence ratios vary considerably among studies. For instance, Kessler and colleagues (1994) found three times more alcohol-abusing and alcohol-dependent men than women, whereas Robins and colleagues (1988) reported male:female ratios ranging from 4:1 to 8:1. These differences in ratios are due in part to interview questions in some surveys that emphasize drinking behavior or drinking problems more common in men; however, why the male-to-female prevalence ratios are so variable across studies remains to be determined.The lower rates of alcohol use and abuse among women than among men do not mean that women's drinking behavior is socially inconsequential and need not be studied in detail. On the contrary, research on women's drinking is important for at least three reasons. First, until the 1970's, alcohol research of all forms-epidemiological, clinical, and experimental-either excluded women entirely or focused disproportionally on men. And although research on women and alcohol has increased substantially since then, significant gaps in knowledge still exist (see Gomberg and Nirenberg 1993; Wilsnack and Beckman 1984).Second, the biomedical and other consequences of women's alcohol use may be greater than their lower consumption levels seem to imply. For example, as a rule, a woman's susceptibility to the physiological consequences of alcohol abuse is higher than a man's. Women reach higher blood alcohol concentrations than men from the same weight-adjusted levels of consumption and may develop liver disorders after lower levels of regular alcohol consumption and earlier in their drinking careers than men (e.g., Hill in press; for more information, see sidebar by Deal and Gavaler, pp. 189-191).Third, understanding more about women's drinking can increase knowledge about the factors that influence drinking behavior and drinking-related problems more generally. Trying to understand why women as a group drink less than men, but also why some women drink more than other women, can help to clarify how gender and gender roles (i.e., social expectations about how women and men should behave) affect the drinking behavior of both women and men.In this article, we review general trends in women's alcohol consumption over the last 20 years and present data from a l0-year longitudinal study conducted between 1981 and 1991. We describe the influences of some demographic variables on women's drinking and identify personal and social risk factors for problem drinking.(4) Finally, we suggest implications for prevention of alcohol problems and make some recommendations for future research on women's drinking.TRENDS IN WOMEN'S DRINKINGNot only have drinking patterns among women varied across different periods in history, but society's concern about women's drinking has varied even more (Fillmore 1984). …