Drinking Problems

Drinking Problems

The Keys to Beating the Bottle

She thinks it's her little secret. But everyone knows she has a flask in her briefcase. She tries to hide the alcohol on her breath with loads of mouthwash. Her "lunch" consists of three glasses of red wine. After work, she zips over to her favorite watering hole and hangs out until last call.

That's the classic image of a woman with an alcohol problem. But alcohol abuse has many subtle faces. It could be your business partner, who drinks only on weekends. It could be your neighbor, who continues to drink despite pleas from her children. And yes, it could be you.

"An alcohol problem can strike anyone, at any time, from any walk of life. No one is immune from it," says Donald Damstra, M.D., an addiction medicine specialist and substance abuse consultant in Phoenix.

And no matter what you call it--alcoholism, drinking heavily or "that little problem"--abusing alcohol is a potent and sometimes deadly ager. It can destroy your liver, decimate your heart, dangerously elevate your blood pressure, sap your energy, ravage your stomach, shatter your sex life, decrease your fertility, short-circuit your brain, aggravate diabetes, lower your immunity, increase your cancer risk and trigger depression, stress and social problems, including marital and job difficulties.

"When you see people who have been drinking heavily for a number of years, they tend to look bad. Some women in their forties can look like they're in their sixties. Their skin just looks old, their gait isn't good, they're overweight and often they have lost bone mass--so they look like little old women a lot earlier than they should," says Frederic C. Blow, Ph.D., research director of the Alcohol Research Center at the University of Michigan in Ann Arbor.

Who Has a Problem?

Almost every woman who drinks has experienced a hangover and the other tortures that occur after one too many. But after we recover from a few of those self-inflicted disasters, many of us learn to moderate our drinking.

"Drinking generally decreases as we age," Dr. Blow says. "It may be related to chronic diseases such as diabetes and high blood pressure or increased use of medications, or it could be that people just don't feel like drinking as much."

Women may also drink less as they get older because they find alcohol seems to have a greater kick. That's because as you age, your body is less able to handle alcohol, Dr. Damstra says.

In fact, alcohol consumption in the United States is at its lowest level since 1967, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The average American drinks about 21/2 gallons of alcohol each year. That's roughly the equivalent of 11/2 12-ounce cans of beer a day. That's within the range of one to two drinks a day that doctors believe can reduce your risk of heart disease. A standard alcoholic beverage is one 12-ounce beer, a 5-ounce glass of wine or a cocktail made with 11/2 ounces (or one shot) of liquor.

Nearly half of all women ages 30 to 44 abstain from alcohol, and most that do drink do it more moderately than men, according to the NIAAA. But in a federally funded study, one in every 20 women reported a significant alcohol-related problem or a symptom of alcohol dependency in the previous 12 months, says Sheila Blume, M.D., medical director of the alcoholism, chemical dependency and compulsive gambling programs at South Oaks Hospital in Amityville, New York.

Problem drinking can cause difficulties such as absenteeism at work and child neglect, to name two. But how much or how often a woman drinks isn't conclusive evidence that she is among the 5 million American women who have serious drinking problems, Dr. Damstra says. That number is probably underestimated, however, because women are more likely to try to hide drinking problems. So it takes longer for us to seek help, Dr. Damstra says. (By comparison, 12 million men are considered to be serious problem drinkers.)

A key measure, he says, is if drinking is more important than other aspects of a woman's life, including her family, her health and her job.

"There are some heavy drinkers who are not addicted to alcohol. These are the women who quit drinking when their doctors tell them they have ulcers or other compelling reasons to stop. But if you're addicted to alcohol, you'll tell the doctor 'Take the ulcer out, Doc. I have to keep drinking,' " Dr. Damstra says. "When drinking causes serious negative consequences, no matter if they're physical, psychological, social, economic or spiritual, and the woman continues to drink, then her drinking is out of control and is considered alcoholism."

Why some women have problems with alcohol and others don't is still being sorted out. Researchers believe there is genetic predisposition, since women with family histories of alcoholism are more likely to become alcoholic. But predisposition doesn't mean a woman is doomed to be alcoholic, nor are women without family histories immune from drinking problems, says Norman Miller, M.D., associate professor of psychiatry at the University of Illinois College of Medicine in Chicago. Although the process is complex, some researchers speculate that a woman's risk for alcoholism depends on a combination of factors in addition to genetic predisposition, including religious and moral attitudes, self-esteem, depression and peer pressure. But whatever the cause, the result is an addiction that prematurely ages you in tragic and unnecessary ways.

Dangerous in Big Doses

When you savor a cocktail after a long day at work, you're drinking one of the most unusual substances on earth. Alcohol acts as a source of empty calories and is a drug that affects your judgment and emotions.

Moderate drinking--a drink a day for women, two drinks a day for men--has some benefits, including lowering your heart disease risk. But in larger amounts, alcohol is a poison that affects every cell in the body, says Dr. Blume.

"Alcohol is a very tiny molecule carried in the bloodstream, and unlike other drugs, it's so small that it gets completely inside every cell. So its ability to do harm and mischief is endless," Dr. Blume explains.

In fact, women may be affected by alcohol sooner than men because we usually weigh less and have less of a key enzyme that metabolizes alcohol in our stomachs. So we end up with higher concentrations of alcohol in our blood when we drink.

"All the physical complications progress much more rapidly once alcoholism begins in women," Dr. Blume says. "Women reach a point of serious damage on fewer drinks per day and over fewer years than men."

For example, alcohol can momentarily suppress production of growth hormone, which keeps our cells vigorous and active as we age, says Mary Ann Emanuele, M.D., professor of endocrinology at Loyola University Medical Center in Chicago. "Blood levels of growth hormone in normal adults fall after drinking, and that could be detrimental," Dr. Emanuele says. "Studies show that these changes do reverse after several hours. However, we don't know if continued heavy drinking can cause permanent suppression of the hormone."

Excess alcohol consumption also generates free radicals, chemically unstable oxygen molecules that can damage the heart and liver and accelerate the aging process throughout the body, says Eric Rimm, Sc.D., a nutritional epidemiologist at the Harvard University School of Public Health in Boston.

Drinking heavily, for instance, severely damages a woman's skin. "It causes rhinophyma--that famous big red nose, like W. C. Fields had. It causes blotchiness, puffiness and decreased skin tone, so a woman who drinks heavily will look prematurely aged," Dr. Blume says.

In addition, studies have shown that people who consume three or more drinks a day have a 40 percent greater risk of developing high blood pressure, which has been linked to heart disease and stroke.

Excessive alcohol use can lead to cirrhosis, an incurable disease that stimulates the formation of scar tissue that destroys the liver. But if a woman stops drinking, the progress of the disease is slowed, and her life can be prolonged. Heavy drinking also increases the risk of liver cancer.

"Alcohol is associated with some types of cancer, particularly in those parts of the body that come in direct contact with alcohol, such as the esophagus, throat and liver," Dr. Rimm says. "These types of cancer are usually rare, but among people who drink five or six drinks a day, they become less rare."

Some researchers believe that these cancers are more common in heavy drinkers because alcohol addiction suppresses the immune system and lowers the body's defenses against diseases such as cancer and AIDS.

The Toll It Takes on Sex

And as if that weren't enough, alcohol use also impairs judgment and lowers inhibitions, so you'll be more likely to engage in risky sexual behaviors and have a greater chance of infection from AIDS and other sexually transmitted diseases. In addition, says Ronald R. Watson, Ph.D., director of the Alcohol Research Center at the University of Arizona in Tucson, evidence from animal studies suggests that if you have AIDS and continue to drink, you increase damage to your immune system, reduce your body's vitamin and mineral levels and speed the progress of the disease.

But if you drink too much, you probably won't have much of a sex life. Heavy drinking can suppress orgasms and lower your sex drive. It can also decrease your fertility and cause birth defects in unborn children, Dr. Blume says.

"A single drink probably isn't going to cause brain damage or birth defects," Dr. Blume says. "The reason women are advised not to drink if they are planning to get pregnant or are pregnant is that the true minimum amount of alcohol that is harmless is not known and may differ from woman to woman. What may not cause damage to one woman's baby may cause serious harm to another. So since alcohol is not a necessary nutrient, the safest course is to not drink at all."

Alcohol can also disrupt menstrual cycles and cause early onset of menopause, adds Judith S. Gavaler, Ph.D., chief of women's research at Baptist Medical Center and a member of the Oklahoma Medical Research Foundation, both in Oklahoma City.

There is little doubt that alcohol abuse can cause blackouts, seizures, hallucinations and brain damage. Up to 70 percent of people entering alcohol treatment programs have difficulties with memory, problem solving and clear thinking. Heavy drinking can cause confusion, slowed reaction time, blurred vision and loss of judgment and muscle coordination, all which lead to injury and fatal accidents.

Men and women who drink more than five drinks in one sitting are twice as likely to die from injuries as those who don't drink that much, according to researchers at the Centers for Disease Control and Prevention in Atlanta. In fact, the National Highway Traffic Safety Administration estimates that between 45 and 50 percent of all traffic fatalities in the United States each year are alcohol-related. And other statistics suggest that an estimated 22 percent of all deaths due to disease, accidents and homicides are alcohol-related.

"Heavy drinkers die younger--there's no question about that," says Michael Criqui, M.D., professor of epidemiology at the University of California, San Diego, School of Medicine.

But even if you've drunk heavily for years, there is hope that you can still lead a long and healthy life if you quit, Dr. Damstra says.

Seeking Sobriety

Acknowledging that you have a drinking problem is an important first step in the struggle to stay sober. "The sooner that alcoholism is recognized and treated, the less likely the disease will cause permanent damage," Dr. Damstra says. "Most alcoholics begin to feel better very quickly after they stop drinking. Many of the physical complications that are caused by excessive consumption begin to heal within two to three weeks."

High blood pressure, for instance, often returns to normal within a week or two, while stomach irritation and some types of liver damage are reversible within a month. But it can take more than a year to recover from some longtime effects of alcohol consumption, such as impaired memory and concentration. Other conditions, such as cirrhosis of the liver and damage to the pancreas, may be irreversible. Here are some tips to help you get a fresh start without alcohol.

Seek help. If you believe that alcohol is controlling your life, ask your doctor for help or contact an alcohol treatment program in your area. Or for confidential information, write to Women for Sobriety, Box 618, Quakertown, PA 18951 (include a self-addressed, stamped envelope), or Alcoholics Anonymous, P.O. Box 459, Grand Central Station, New York, NY 10163.

Tell a friend. Some studies suggest that if the person with an alcohol problem goes public, it's easier for her to quit, says Dr. Blow. If you tell the people who are important to you--co-workers, family--that you're not going to drink anymore, it does two things. First, it reduces the amount of peer pressure that will be placed on you to drink. Second, it makes it easier for you to stick to the commitment, because you've made it out loud to the world.

Sobriety begins at home. In the early phase of recovery, ask friends and family to not drink around you. Ask your partner to participate in your recovery by attending counseling sessions with you, Dr. Damstra says. If he refuses, he may have a problem, too, and you might have to decide if continuing the relationship is worth jeopardizing your recovery.

Say the three magic words. If you do go to a party or another gathering and are offered an alcoholic beverage, simply say "I don't drink" or ask for a soft drink, Dr. Blume says. No further explanation should be necessary. If the people around you continue to pressure you to drink, leave.

Find new pals. Hanging out with your old drinking companions, even if you swear you won't drink, is a disaster waiting to happen, Dr. Damstra says. First, you need to get involved in a 12-step recovery program. Then find people who are interested in staying sober at your recovery group, church or gym.

Invest in fun. Volunteer at a neighborhood school or get involved in a theater group, Dr. Damstra says. The more activities you do, the more you'll realize that being sober is more fun and rewarding than drinking.

Accept no substitutes. Stay away from nonalcoholic beers and wines. "It will remind you of the taste of the real thing and, by association, make you crave alcohol," Dr. Blume says.