Women and alcohol: Why we drink and how we can empower our sober curiosity 

So you’re thinking about getting sober. Maybe your body can no longer rebound from red wine hangovers. Maybe the wellness industry has finally hammered home the contradiction in eating quinoa for lunch, then drinking a bottle of toxins at night. Maybe you’re worried about your liver health, or premature aging, or your worsening bouts of anxiety and depression. Your rational mind is highly motivated to change your drinking habits, but something is still holding you back. It turns out that some of those sobriety barriers might be gender-based.

There’s no longer a gender gap in how much men and women drink, but there’s still a significant gender gap in why men and women drink. Women are more likely to drink to cope with negative emotions like stress. When you drink to cope, you progress more quickly toward problem drinking and alcohol use disorder (AUD). You’re also more likely to experience alcohol-related harms and physiological dependence. 

If women tend to drink for different reasons, it stands to reason that they might stop drinking for different reasons. Traditional 12-step recovery programs like Alcoholics Anonymous (AA) were designed by men, for men. And up until fairly recently, most medical research into addiction focused on male subjects. But there are important distinctions in how male and female bodies process alcohol. There are also social and environmental reasons why women develop AUD. By addressing these gender-specific issues, more women can get the support they need to recover from destructive relationships with alcohol.

How Drinking Affects Women’s Bodies 

When I was in college, no one ever explained to me why it wasn’t a positive, quasi-feminist accomplishment to be able to keep up, shot for shot, with my male peers at the bar. It turns out the same amounts of alcohol were doing more damage to my body than to my male counterparts. Here’s how drinking affects women’s bodies differently:

• Our hearts: Women can develop cardiomyopathy (a disease of the heart muscle) from a lower lifetime dose of alcohol than men. 
• Our brains: Women seem to experience more cognitive decline and brain shrinkage than men due to alcohol use. Women are also more susceptible to blackouts. 
• Our moods: Women tend to drink in response to negative feelings, and women experience more mood and anxiety disorders than men. 
• Our metabolisms: Women have lower levels of a digestive enzyme called gastric alcohol dehydrogenase, meaning they require more time to metabolize alcohol. 
• Our fat-to-water ratios: Women carry less water (which dilutes alcohol) and more fat (which can’t absorb alcohol). Thus the same amount of alcohol leads to a higher blood alcohol content (BAC) in women than men. 
• Our livers: Women have a higher risk of cirrhosis and other alcohol-related liver diseases than men. 
• Our breasts: Drinking leads to higher risk of breast cancer in women. Alcohol can also increase the risk of mouth, throat, esophagus, colon, and liver cancers.
• Our hormones: Alcohol dependency has been correlated to estrogen levels. When estrogen levels are high, alcohol can feel more rewarding. 
• Our life spans: Alcoholic women die at rates 50% to 100% higher than alcoholic men. 

In short, women process alcohol differently than men and are more at risk for harm. Knowing all of this, why are we still drawn to the bottle (or in the case of college-me, Crystal Light and vodka cocktails)? 

Why Women Drink

All drinkers have their own psychological triggers and genetic vulnerabilities, plus alcohol is universally a highly addictive drug, but here are some science-backed generalizations about why women drink:

• For the same reason that all genders drink: Because it’s fun. Or at least it can be, until it’s not. According to Rachel Cavallaro, a licensed psychologist at Thriveworks in Boston, alcohol breaks most of the superficial promises it makes. “In the short term, yes it can be helpful in achieving the desired result, but once it metabolizes you will feel more anxious and depressed and will have poorer sleep quality.” Heavy drinking can also make you miss out on experiencing joy in the moment. “Over time the world can get smaller and smaller if alcohol use progresses,” says Dr. Cavallaro.
• Because alcohol can be a social lubricant, especially for women with anxiety, insecurity, or social inhibitions (hello me and all my friends). Alcohol suppresses activity in the prefrontal cortex, sometimes leading to a more relaxed, playful state that can facilitate social bonding. So when you feel less anxious and inhibited, you might be able to connect more easily with your fellow humans, which makes you happy. And then maybe you attribute the happiness to the alcohol rather than the flood of endorphins that arises from bonding.  
• Because women are stressed. Women are more likely than men to have new onset AUD in response to stressful life events, and they’re more likely to relapse due to stress. Studies done on female rodents show that depression can drive alcohol consumption. Negative affect (anxiety, fear, anger, irritability, and sadness) can predict AUD in women. Men, on the other hand, tend to drink to enhance positive emotions. 
• Because of industry messaging. Women are a huge market for the billions of dollars that the alcohol industry spends on advertising each year. Many experts compare these campaigns to those used by Big Tobacco to recruit female smokers in the 1960s. Some advertisers encourage more women to drink by framing alcohol consumption as a female emancipation or gender equality issue. Drinking has even been positioned as a playful part of “mom culture”.
• Because women tend to internalize their feelings. The degree to which a woman ruminates can help predict alcohol-related problems in their future. This isn’t true for men.
• Because they’re twice as likely to have post-traumatic stress disorder (PTSD). And women who have experienced a trauma like sexual violence or an abusive relationship are twice as likely to have AUD.
• Because they’re ashamed to admit they have a problem. Dr. Cavallaro says that women worry more than men about the perceived consequences of what other people will think of their habit. A woman might anticipate being judged as a lush or a bad parent, as weak-willed or trashy or unhealthy, if she’s open about her addiction to alcohol. And though AUD is a health issue, what female addict volunteers her true number of weekly drinks to her doctor?
• Because women do too much. Of course women are stressed. They’re working, raising kids, caregiving, juggling domestic and emotional labor. And they’re often isolated, doing it all without the village they need—especially during the pandemic. So they’re drinking alone, at home, as a form of self-soothing that masquerades as self-care.

How Women Can Take Control of Their Alcohol Use

If you’re a woman in America, you probably don’t need another thing undermining your self-esteem. We spend enough time thinking about how flawed we are. So remember that alcohol is more addictive than meth and nicotine. Using it in a sustainable, adaptive way in our current society is difficult to impossible. This is not your fault. But you can do something about it. 

More and more women are saying “no,” or at least, “less.” And sometimes, “Maybe, but let me meditate for 20 minutes first.” There are multiple pathways to girl-powered recovery:

• Medical intervention. Addiction is a disease that alters your brain chemistry. You don’t try to heal from heart or lung disease on your own. You see a doctor. And you deserve specialized support for addiction as well. Some people have success with medications like naltrexone that ease alcohol cravings or make drinking less enjoyable. 
• Supportive therapy. As far as substance abuse treatment is concerned, women in recovery tend to value positive relationships more than men. This means they can benefit greatly from supportive therapy with a nurturing, compassionate counselor. A confrontational approach that seeks to “break people down” so they can start rebuilding simply doesn’t work as well for women in therapy. 
• 12-step programs. Programs like Alcoholics Anonymous offers same-sex support groups for women who might feel uncomfortable in a coed environment. But AA prescribes the same treatment for everyone: sobriety. For some drinkers, this black-and-white, one-size-fits-all, “every alcoholic is powerless” approach doesn’t do enough to address individual differences or underlying mental health concerns. Quitting cold turkey can also intensify cravings for alcohol and lead to relapses. 
• In the sober curious movement, the first step toward empowerment is not alcohol abstinence, but inquiry. This means that before you take a sip of your cocktail, you ask yourself why you’re choosing to drink, how the drink is going to affect your overall well-being, and why you might feel obligated to drink. These questions can lead to deeper inquiries about who you are and what you want. They may also lead you to a sober bar. 
• Mindfulness-based interventions (MBIs). The mindful drinking movement asks people to examine the effects of alcohol on their mental health, their interactions with their environment, and their relationships. If you drink alcohol, you can examine the consequences without judgement, as if you’ve conducted an objective experiment. Your hangover or hangxiety might be a gentle reminder that you’re better off abstaining from alcohol. In a professional therapy context, MBIs are effective for treating a wide range of addictions. 
• Positive affirmations can benefit women in recovery by replacing the negative self-talk that often serves as the default female monologue. The nonprofit support group Women for Sobriety (WFS) uses 13 affirmations in its recovery program, including “Happiness is a habit I am developing” and “The past is gone forever.” 
• Motivational enhancement therapy (MET) is a treatment program designed to enhance a person’s internal motivation to change. 
• Emotional regulation helps women identify their emotions instead of camouflaging them with alcohol. 
• Cognitive behavioral therapy (CBT) tackles thought distortions, learning processes, and motivations underlying someone’s AUD. 
• When women get sober within a community of people with similar stories, they can empower each other. 
• Contingency management awards prizes for abstinence. It can be an effective tool in formal treatment programs.
• Behavioral science. One female Thriveworks executive stopped drinking in part by reading literature about how to change habits in general. She now calls sobriety “her superpower.” 

There’s a broad spectrum of AUD. One person might successfully curb her unhealthy drinking habits by equating sobriety with feminism or her lifestyle identity. Another person may require medical treatment for withdrawal. Mindfully drinking one’s way toward sobriety might be an option for someone with moderate alcohol dependency, but not for someone with severe AUD. 

Perhaps the takeaway here is that recovery should be personalized not just to specific genders, but to every individual. “I now take charge of my life and well-being,” reads the first affirmation of Women for Sobriety. “I accept the responsibility.” 

Here’s a selected list of further resources about sobriety that may help you find your own path.

Sobriety Resources

Books 

“Sober Curious” by Ruby Warrington

“Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol” by Holly Whitaker

“The Unexpected Joy of Being Sober” by Catherine Gray

“This Naked Mind: Control Alcohol, Find Freedom, Discover Happiness & Change Your Life” by Annie Grace

“We Are the Luckiest: The Surprising Magic of a Sober Life” by Laura McKowen

“Quit Drinking” by Allen Carr

“Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control” by Gabrielle Glaser

Podcasts

The Soberful

The Sober Therapist

This Naked Mind 

Seltzer Squad

Communities 

The Temper

Tempest

SHE RECOVERS

Soberocity

SMART Recovery

Women for Sobriety

Alcoholics Anonymous