Excerpts

Her Best-Kept Secret 1 Lush Solid statistics on women's drinking habits are hard to come by. In part, that's because all measures of potentially illicit behavior--sex, drugs, alcohol--are subject to the inherent inaccuracies of self-reporting. ("How many drinks a week?" "I don't know, Doc--maybe three or four.") There's also the historic indifference of the mostly male research community to focusing on gender differences in the science of disease. In recent years, however, a critical mass of credible studies have emerged that quantify the anecdotal evidence I had glimpsed in Portland and New York. The findings are incontrovertible. By every quantitative measure, women are drinking more. They're being charged more often with drunk driving, they're more frequently measured with high concentrations of alcohol in their bloodstreams at the scene of car accidents, and they're more often treated in emergency rooms for being dangerously intoxicated. In the past decade, record numbers of women have sought treatment for alcohol abuse. And, in perhaps the most undeniable statistic of all, they are the consumers whose purchases are fueling steady growth in the sales of wine. Meanwhile, men's drinking, arrests for drunk driving, and alcohol purchases are flat, or even falling. Contrary to the impression fostered by reality shows and Gossip Girl, young women alone are not responsible for these statistics. There are plenty of girls going wild on the nation's college campuses, but there is an even more striking trend of women in their thirties, forties, and fifties who are getting through their days of work, and nights with teething toddlers, trying teenagers, or sick parents, by hitting the bottle. The risky habits of young women are well documented in articles, graphic memoirs, and cautionary TV specials. But their stories are more than just sad tales, or the school nurse's hyperbole: They are a serious public health concern. A national analysis of hospitalizations for alcohol overdose found that the rate of young females age eighteen to twenty-four jumped 50 percent between 1999 and 2008. In the same period, the rate for young men rose only 8 percent. The most alarming statistic was the sharp rise in the number of young women who turned up at hospitals having OD'd on both drugs and alcohol: That number more than doubled. Among young men, it stayed the same. These data are part of a broader cultural shift in which drinking by women is seen as a proud rite of passage--or, at least, nothing to hide. I once shared a train ride with a loquacious college student who told me she was "practicing drinking" in advance of her planned spring break in Mexico. "It was my mom's idea, after I got sick over Christmas break from mixing rum with beer," she explained. "She doesn't want me making a fool of myself in Cabo, so we're working on getting my tolerance up." Nothing like a little mother-daughter bonding--especially when gals with hollow legs get such respect. In 2011, students at Rutgers University chose Jersey Shore's Snooki as a guest speaker on campus. The reality TV star--whose on-camera antics included blackout falls, an arrest for drunken and disorderly conduct, and the admission that she had often gotten so intoxicated she had woken up in garbage cans--was paid thirty-two thousand dollars for her talk. That was two thousand dollars more than writer Toni Morrison received for giving the school's commencement address six weeks later. Who needs guidance from a Nobel Prize winner when you can get advice like Snooki's? "Study hard," she told the crowd, "but party harder." Middle-aged women aren't pounding shots or slurping tequila out of each other's belly buttons, but they, too, are drinking more than at any time in recent history. Their habits are different from those of their younger sisters. Their beverage of choice, after all, is wine, and their venue is less likely to be public. In fact, the middle-class female predilection for wine seems like it's just a jolly hobby for time-stretched mothers. There are T-shirts with a spilled wineglass and the shorthand plea, "Not so loud, I had book club last night." Nearly 650,000 women follow "Moms Who Need Wine" on Facebook, and another 131,000 women are fans of the group called "OMG, I So Need a Glass of Wine or I'm Gonna Sell My Kids." And the wine-swilling mom pops up as a cultural trope, from the highbrow to the mass market. In Jonathan Franzen's Freedom, Patty Berglund shuffles out for the morning papers every day with the "Chardonnay Splotch," the ruddy face of heavy drinkers. Nic, the driven doctor played by Annette Bening in The Kids Are All Right, downs her red wine a little too eagerly for her partner's taste. "You know what, Jules? I like my wine! Okay? So fucking sue me!" In the film Smashed, Kate, the fresh-faced first-grade teacher, wets her bed, throws up in front of her students, and drunkenly steals wine from a convenience store before she sobers up and leaves her drinking-buddy husband. Courteney Cox's Cougar Town character pours her daily red wine into giant vessels she calls Big Joe, Big Carl, and Big Lou. When Big Joe breaks, she holds a memorial service for its shards, tearfully recalling, "He was always there for me when I needed him." And drinking wine is so linked to the women of Real Housewives shows that three of the women it made famous--Bethenny Frankel, Ramona Singer, and Teresa Giudice--introduced their own brands. In 2010, Gallup pollsters reported that nearly two-thirds of all American women drank regularly, a higher percentage than any other time in twenty-five years. Like many other studies around the world, Gallup found that drinking habits correlated directly with socioeconomic status. The more educated and well off a woman is, the more likely she is to imbibe. Catholics, atheists, agnostics, and those who identified themselves as non-Christians were also far more likely to drink than churchgoing Protestants. White women are more likely to drink than women of other racial backgrounds, but that is changing, too. An analysis of the drinking habits of eighty-five thousand Americans between the early 1990s and the early 2000s found that the percentage of women who classified themselves as regular drinkers rose across the board. The number of white women drinkers increased 24 percent; Hispanics, 33 percent; and black women, 42 percent. (American Indian women were not included in this study. Because of the isolation of many Native American communities and the devastating role alcohol often plays in them, researchers typically study tribal alcohol use separately. Asian women were also not included; of all ethnic groups, they drink the least, perhaps because of a genetic intolerance that creates an uncomfortable flushing of the face and chest.) Women are the wine industry's most enthusiastic customers. Despite the recession (or perhaps because of it), wine consumption in the U.S. continued to grow between the years 2009 and 2012, according to wine industry analysts. Not all that wine is being decorously sipped. In 2012, the Centers for Disease Control and Prevention released a study that found 13 percent of American women binge drink regularly, about half the rate of men. Researchers define binge drinking as more than four drinks in two hours for women, and five drinks in two hours for men. We often hear about binge-drinking youths, but adult women aren't far behind: The CDC found that while more college-age women binge drink, the frequency of binge drinking among women ages forty-five and older is about the same as it is for younger females, about once a week. The average number of drinks downed per binge is six. No surprise, then, that the number of women arrested for drunk driving rose nearly 30 percent in the nine years between 1998 and 2007. In California alone, between 1994 and 2009, that number doubled, going from 10.6 percent of all drivers to 21.2 percent. Women over forty had among the highest rates of arrest. There is evidence that alcohol dependence among women is also rising precipitously. Two large national surveys of drinking habits, conducted in 1991 and 1992, and again in 2001 and 2002, found that women born between 1954 and 1963 had an 80 percent greater chance of developing dependence on alcohol than women who were born between 1944 and 1953. For men of those generations, the rate stayed flat. The topic of women and alcohol is a relatively new one in academic research, with only a handful of experts around the country. Sharon Wilsnack, a distinguished professor of clinical neuroscience at the University of North Dakota School of Medicine and Health Sciences, became one of its pioneers as a graduate student at Harvard in the early 1970s. Though she has published hundreds of academic papers about women and alcohol, she is perhaps best known for the longitudinal studies of women's drinking she began conducting with her husband, sociologist Richard Wilsnack, in the early 1980s. Since then, the Wilsnacks have directed and analyzed in-depth, face-to-face interviews about drinking habits with more than eleven hundred women ages twenty-one to sixty-nine. In the most recent evaluations of the study completed in 2002, Wilsnack noticed a startling shift: a substantial increase in the number and ways in which women reported intoxication. While the stigma of female drunkenness has faded since the first study in the early 1980s, Wilsnack is struck by the openness with which women today describe their drinking habits. She wasn't at all surprised by the frank talk of my train partner, since she hears similar anecdotes at the lectures she gives on college campuses. "There is a pattern of intentional drinking, with a whole plan behind it," she says. "Drinking on an empty stomach; predrinking before going to a party or a bar; learning to do straight shots. They are very aware of their drinking, and how to manipulate it for maximum effect." Wilsnack was struck by another new finding. In the early 1980s, one in ten women answered yes to the question: "Are you concerned about your drinking?" In 2002, it was one in five. That corresponds with what Rick Grucza, an epidemiologist at Washington University in St. Louis, found in his research on the generational shift of female alcohol dependence. Because it's unlikely that anyone could accurately remember how much they drank the previous decade, Grucza compared how people in the same age groups responded to questions about their consumption in two national surveys, the first conducted in 1991-1992, and then ten years later. What he found among women was especially striking. When Grucza and his colleagues compared the two surveys, they saw a flattening in consumption among younger and older men. The opposite was true for women. "More women were drinking, and among those women, more women were becoming dependent," Grucza told me. Grucza is a young guy, in his midforties, with a salt-and-pepper goatee and a wry midwestern wit. He also partakes--"I enjoy it," he told me--and steers clear of moralizing. He is careful not to place a value judgment on the behavioral narrowing of the gender gap. For Grucza, the issue is how alcohol disproportionately harms women. Women of childbearing age are incessantly warned that alcohol poses a danger to the developing fetus, but nobody talks much about why women in general are more vulnerable to alcohol's toxic effects, too. They absorb more alcohol into their bloodstream than men because they have a higher percentage of body fat, and a lower percentage of water. Fat cells retain alcohol, but water dilutes it, so women drinking the same amount as men their size and weight become intoxicated more quickly than the men. Males also have more of the enzyme alcohol dehydrogenase that breaks down alcohol before it enters the bloodstream. This may be one reason alcohol-related liver and brain damage appears more quickly in heavy-drinking women than men. Alcohol-dependent women have death rates 50 to 100 percent higher than those of alcohol-dependent men, including those from suicide, liver cirrhosis, and alcohol-related accidents. Increasingly, inebriated women get behind the wheel and careen into inanimate objects and other drivers. The tabloid photos of smashed starlets crashing their cars reflect a lot more than just celebrity culture: They're part of a gruesome wider trend. In California, the number of young women responsible for alcohol-related accidents jumped 116 percent between 1998 and 2007. It rose as well among young men, but only by 39 percent. While the number of U.S. drunk-driving deaths fell between 2001 and 2010, from 12,233 to 9,694, the number of female drivers responsible for them rose by 15 percent. One way to measure the changes in women's drinking habits is in the frequency with which they seek help. Between 1992 and 2007, the number of middle-aged women who checked into rehab nearly tripled. That's especially telling: Disappearing for a month or more is difficult for anyone, but it's especially tricky for women who have children at home. •  •  • When it comes to alcohol treatment, there's growing evidence that women are different as well. The antidote most commonly recommended to problem drinkers in America--Alcoholics Anonymous--is particularly ill-suited to women. A.A.'s twelve-step approach instructs drinkers to surrender their egos to a higher power, but it doesn't take a gender-studies expert to know that women who drink too much aren't necessarily suffering from an excess of hubris. The A.A. approach, developed by men, for men, in the 1930s, is widely endorsed by our medical and judicial systems and used by the vast majority of all treatment facilities in this country. No doubt it has helped many people to a saner life. But an increasing number of Americans, from addictions researchers to ex-A.A. group leaders disturbed by some of the group's practices, are challenging its toehold in U.S. society. They are frustrated with the fact that many doctors, educators, and the general public remain unaware of (or insist on ignoring) the numerous scientific advances in the treatment of alcohol disorders. Just as middle-aged women's drinking has been overlooked, so, too, has the success of recent evidence-based treatments, methods whose efficacy has been determined by rigorous scientific studies. A.A., a faith-based group whose philandering, LSD-tripping cofounder, Bill Wilson, has achieved the status of a demigod, remains embedded in public minds as the best approach. This tension over how to treat women who abuse alcohol is a new phenomenon, but the figure of boozy broads has deep roots in American history. In fact, the notion of the woman as the sober member of the household, the teetotaling mom, is relatively recent. Women who traveled from England on the Mayflower downed beer just like the male passengers, and women who trudged along on the Oregon Trail nipped from their whiskey jugs alongside the menfolk. How could they not? There was no safe drinking water, and when food supplies got low, alcohol had to fill in for calories' sake alone. Over time, however, women became leaders of the temperance movement, and by the early twentieth century, female imbibers fell into two categories. For one group of women, drinking was an act of rebellion, and a powerful declaration of modernity. For another, it was a shameful sin, a weakness to be hidden. None of this thinking, now a century old but still deeply embedded in popular culture, takes into account what we now know about science, gender differences in the brain, and our peculiar history with alcohol itself. Nor does it presume to imagine the enormous ways in which our society has changed--particularly for women, who after all drink for reasons unimaginable to their colonial sisters. Excerpted from Her Best-Kept Secret: Why Women Drink - And How They Can Regain Control by Gabrielle Glaser All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.