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Women at Greater Risk Than Men From Alcohol Abuse, Studies Show : Men drink more, and more men drink. But biological factors force women to pay a higher toll for tippling.

TIMES HEALTH WRITER

When it comes to drinking alcohol, the Gender Gap may be at its widest.

According to researchers, men and women shouldn’t be compared when looking at the health risks of alcoholic beverages.

While men generally consume more alcohol than women, emerging research shows that women are suffering far greater consequences from drinking.

Decades of surveys have shown that male alcoholics outnumber female alcoholics by about 3 to 1. And many more men undergo treatment for problem drinking than women. Based on these facts, both media images and scientific studies of problem drinking have tended to focus on men.

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That is changing, however, as new studies raise a plethora of issues specific to women, according to several researchers attending a three-day American Psychological Assn. meeting on women’s health, which ended Saturday.

“We have paid way too little attention to gender differences in substance abuse and prevention,” said Alan Leshner, director of the National Institute on Drug Abuse.

For example, research has shown that alcohol is metabolized differently in women and has a stronger impact on a woman’s body than a man’s.

In addition, even light to moderate alcohol consumption might influence the rate of some diseases that are more prevalent in women, such as breast cancer, osteoporosis and depression. Alcohol use can also affect pregnancies and the health of infants born to mothers who drink.

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Finally, among heavy drinkers--usually defined as 14 or more drinks a week--alcohol causes physical ailments, such as liver disease, far quicker in women. Yet female alcoholics say they have a harder time getting treatment while researchers report that they know little about how women fare in treatment or what approaches best help them recover.

This negative portrait is leading health experts to rethink their strategies for advising women about alcohol consumption and treating problem drinkers.

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Studies on drinking traditionally compare women to men. And because women drink on fewer occasions and consume fewer drinks, they often appear at much lower risk for problems than men.

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“But there have been a lot of questions about these studies. It’s actually difficult to make any comparisons between men and women,” said Thomas Harford, of the National Institute on Alcohol Abuse and Alcoholism.

The gender differences begin with the fact that women do not tolerate alcohol like men. Women have more body fat and less body water, allowing alcohol to move into the bloodstream faster. Moreover, women appear to have less of an enzyme called alcohol dehydrogenase, which metabolizes alcohol in the stomach. Because of this deficiency, “more alcohol is getting into the system and more is getting to the liver,” said Dr. Mary Dufour of the NIAAA.

Hormone fluctuations also affect the way women metabolize alcohol. Blood-alcohol levels in women peak faster in the days just before menstruation.

But beyond the problem of getting drunk faster than men, women need to consider the health effects of even moderate drinking in a manner that doesn’t apply to men, Dufour said. According to a 1988 national survey, about half of U.S. women don’t drink alcohol while about 7% are heavy drinkers (two or more drinks a day). The remainder drink lightly (one to 13 drinks per month) or moderately (four to 13 drinks a week).

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Some studies, for instance, show that as few as three drinks a week may increase a woman’s risk of breast cancer by 50%, she said. Breast cancer is the second leading cause of cancer death among women.

Alcohol may also make women more susceptible to hemmorrhagic stroke in which a blood vessel breaks. And studies show alcohol may interfere with bone calcification, making women at higher risk for osteoporosis.

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The good news, however, is that many studies show that drinking moderate amounts of alcohol--particularly wine--can protect against heart disease for both sexes. This is especially important for women, Dufour noted, because after menopause women’s rates of heart disease skyrocket. Heart disease is the leading cause of death in women.

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“How do you deal with all of these risks and benefits?” Dufour said.

Part of the answer is unique to each woman, who should consider her own individual risk of disorders like breast cancer, she said. But, in heeding a call to establish guidelines, researchers meeting last year in Toronto recommended that post-menopausal women who drink moderately are probably doing little harm and may be lowering their risk of heart disease.

However, for younger women, “the risk is greater than the benefits,” Dufour said of the panel’s recommendations. They still face the risks of pregnancy-related alcohol problems--such as miscarriage and Fetal Alcohol Syndrome--and auto accidents from drinking and driving.

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Researchers admit that women who drink lightly or moderately may remain confused about the health effects of alcohol because of the many outstanding questions. For example, while women are generally advised not to drink while pregnant or if they intend to become pregnant, no one knows how much alcohol is actually harmful to a fetus.

“The messages are really muddled,” says Eleanor Z. Hanna, of NIAAA. “Because alcohol research in women has been given the short shrift, we are confused about its role as a health factor, especially among women are not heavy drinkers.”

Much more is known about the health hazards of heavy drinking in women. But here, too, women are handicapped by a dearth of research on treatment for alcohol problems.

In one review of 259 studies on alcohol treatment, only 2% of the studies focused on women specifically and only 11% of the studies attempted to examine the data on women separately.

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The paucity of information on alcohol treatment of women may be due to the fact that women represent only about 20% of the people who seek treatment, studies show. But this percentage may be because women cannot get into treatment centers or find the male-oriented treatment less effective, experts said.

One study by University of Maryland researcher Karen Allen showed that women cannot get intensive treatment because of their responsibilities at home (such as having no child care), their inability to pay, fear of having their children taken away while they are in treatment and their feelings of shame at having to admit to an alcohol problem.

For treatment to be successful, women need to be assured that their children will be safe while they are in treatment and that they will be treated with compassion, said researcher Gloria Hamilton of Middle Tennessee State University. They also need the support of other recovering women.

“In this decade, we are seeing a surge in centers that recognize that women’s issues must be considered,” she said. If these issues are addressed, “We can usually predict their recovery.”

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Few centers specialize in women’s recovery, however. In one case, said Hamilton, a woman involved in a divorce and custody case anguished about what to do with her young child if she entered a treatment facility. She finally decided to entrust the child to his father. While in treatment, the father killed the child. The woman asked Hamilton to share her story with people who operate treatment centers.

“She believed that one tragedy was enough to convince treatment centers that there needs to be child care programs in place so women can enter treatment,” Hamilton said.


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