Midlife Women Have a Drinking Problem. Here's What's Behind It & How to Know if You're at Risk
Excessive drinking is on the rise for midlife women. For decades, data indicated that men were more likely than women to develop alcohol use disorders (AUDs) like binge-drinking. While that still holds true, “we’ve seen overall that the gender gap is closing,” says Dr. Dawn E. Sugarman, research psychologist at McLean Hospital.
“In the ‘90s, it was about 5-to-1 male-to-female for alcohol use disorders, and that’s now down to 2-to-1, or less than 2-to-1 for certain age groups.” This includes women aged 35 and up, who are drinking excessively at increasingly high rates.
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Excessive alcohol use is an umbrella term that describes a range of harmful drinking patterns, including AUDs. Binge-drinking is defined as consuming four or more drinks on the same occasion for women, according to the Centers for Disease Control and Prevention (CDC). Heavy drinking — for women, consuming eight or more drinks per week — is considered excessive alcohol use but not necessarily an AUD. AUDs typically involve “repeated significant distress and problems functioning in your daily life,” per the Mayo Clinic.
In the United States, excessive drinking is a leading cause of preventable deaths. It’s associated with a host of negative long-term health effects, including an increased risk of breast cancer in women.
Because of differences in how they metabolize alcohol, “if a woman of the same weight drinks the same amount as a man, the woman will have a higher blood alcohol content, and the alcohol will stay in the body longer,” Dr. Sugarman tells Flow. This makes women “more susceptible to the negative consequences of alcohol use,” she explains. “Essentially, they tend to get sicker faster than men.”
Research indicates that women who recently turned 35, as well as women who haven’t had children by age 35, are the two subgroups of women at the highest risk of binge-drinking and having AUD symptoms. This trend has dangerous consequences: During the height of the COVID-19 pandemic, alcohol-related deaths for midlife women increased by a staggering 42 percent in just one year.
So, why are midlife women drinking excessively at higher rates? What do women in this group need to know about the dangers of excessive alcohol consumption? And what can be done to combat this, individually and on a policy level? With Dry January on the brain, Flow spoke with experts in the space to better understand this alarming trend. Here’s what they had to say.
Why is excessive drinking on the rise for women in this age group?
Many factors have contributed to the rise in excessive drinking among midlife women. Per one recent study from the journal Addiction, the uptick in problematic drinking patterns in midlife women can be correlated with more women delaying or forgoing having children. In other words, shifting social norms and expectations around parenthood may be at play here.
But mothers in this age group aren’t exempt. According to another study, midlife women who have children also drink excessively at higher rates than they used to.
“We don’t know why middle-aged mothers are drinking more than in previous decades,” Dr. Rachel Sayko Adams, lead author of the Addiction study and research associate professor at Boston University School of Public Health, tells Flow. “We speculate that it has to do with a variety of cultural changes happening all at once, and that the social acceptability of drinking among mothers has shifted.”
It’s hard to ignore the proliferation of “wine mom” culture. “It’s become this normative thing around how people are told to deal with stress,” notes Dr. Sugarman. “Like, ‘Oh, your kids are misbehaving? Have a glass of wine to relax.’ … This [messaging] was already increasing, but it got a lot worse with the COVID-19 pandemic.” Likewise, research suggests that women are more likely than men to drink as a means of alleviating stress or anxiety.
From slogan wine glasses to hot-pink bottles of rosé, the alcohol industry fuels the wine mom narrative at every turn. Dr. Sugarman likens it to what the tobacco industry did in the late 20th century with Virginia Slims cigarettes, which were marketed to women with pseudo-feminist messaging.
“I think there’s more [alcohol] marketing towards women now,” Dr. Michelle Leff, acting deputy director and senior medical advisor at SAMHSA’s Center for Substance Abuse Prevention, tells Flow. “There are things like mommy wine marketed as low-calorie or natural. You’ll see these very feminine-designed bottles.”
Underpinning all of this is the normalization of excessive drinking in American culture. Weddings, nights out with friends, even after-work happy hours — in many social settings, consuming copious amounts of alcohol is sanctioned, if not explicitly encouraged.
For women, excessive alcohol consumption poses unique dangers.
Excessive alcohol consumption is dangerous for everyone, regardless of gender. However, it bears repeating: Women are more vulnerable to the negative health effects of excessive drinking. That includes cognitive impairment, heart disease, and liver failure, to name just a few.
Compared to men, women face higher rates of depression and anxiety, says Dr. Sugarman. “And alcohol makes both of those worse.” In fact, the women she treats for substance use disorders usually have another mental health-related comorbidity.
The elevated risk of breast cancer is particularly relevant for midlife women, as breast cancer risk already increases with age. In the U.S., breast cancer is the second most-common cancer in women. It’s typically diagnosed after age 50, although cases on the rise in younger women.
“There are studies that show that women who consume about one drink per day have a 5 to 9 percent higher chance of developing breast cancer than women who do not drink at all,” notes Dr. Leff. Still, she finds that many women aren’t aware of this link. To her, this suggests a need for more education about the dangers of prolonged, excessive drinking.
On a structural level, national groups like SAMHSA work to combat the rising rates of AUDs with educational programing. SAMHSA tends to focus on “primary prevention efforts” — so, informing youth and young adults about the dangers of underage and/or excessive drinking. While midlife adults aren’t the target audience for these campaigns, they may benefit indirectly.
“Sometimes, we need to be reminded that children look up to the adults in their lives and mimic them all the time,” says Dr. Leff. “Parents may realize, ‘Maybe I am drinking excessively, or maybe I shouldn’t be drinking in front of my kids,’ because they realize that their habits can have a direct deleterious effect on their children. And that can motivate some adults to decrease their drinking or seek treatment.”
Concerned about your drinking? Here’s where to get help
To reduce the risk of harm from alcohol, the CDC recommends that women limit their drinking to one drink or less per day. Women who are pregnant or might be pregnant shouldn’t drink at all.
If you’re worried about your alcohol consumption, it’s worth examining how your drinking habits stack up against official guidelines. “A lot of people start by talking to their primary care provider if they have a good relationship,” notes Dr. Sugarman.
Screening tools like the Partnership to End Addiction’s AlcoholScreening.org or SAMHSA’s Screen4Success may help, too. The latter connects users with local and national resources to address concerns like binge-drinking or other substance use disorders. Depending on the severity of their disorder, that could include in-patient treatment with an addiction medicine specialist or a virtual self-help program.
“People can use this tool for self-screening, or you could send it to someone you’re concerned about,” Dr. Leff explains. You could even help a loved one fill out SAMHSA’s screener, which also creates an opportunity to talk about problematic drinking patterns.
Even if your drinking habits aren’t excessive, you may still benefit from thinking critically about your alcohol intake. Over the past few years, Dr. Sugarman has witnessed an uptick in popularity of the sober-curious movement and challenges like Dry January. Culturally, she does think there’s been “a shift in that direction,” although it’s certainly not widespread.
As for the merits of Dry January? It’s all about your thinking, says Dr. Sugarman: “If your mindset is just counting down the days until February 1, then it’s probably not going to be that beneficial for you. But if you really take the time to think about, ‘How do I feel without alcohol?’ and, ‘How do I do the things that I thought I needed alcohol to do before?’ and look at the pros and cons, then it can really be something beneficial.”
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