Alcohol Dependence in Women
In 1956, The American Medical Association recognized alcoholism
as a disease, and the majority of treatment and research for the next four decades
would be based on the disease concept (Downing, 1989). Research during this time
would also be based on the concept that alcohol dependence was a "male-oriented"
problem (Smith, 1992), and it was not until the 1990's that researchers seriously
began to look at gender differences in alcohol dependence (Beckman, 1993).
Significant differences began to emerge between alcohol dependent men and
alcohol dependent women, but the first result of looking at gender issues and
alcoholism was to realize that the prevalence of alcohol dependent women had been
greatly underestimated. The lifetime prevalence rate of alcohol abuse-dependence
in the United States is estimated at 12-16%, and until the late 1980's, it was
believed that women comprised only a third of that (Stewart, 1996). Research now
shows that women suffer an estimated one-half of the alcohol dependence in the
United States (Stewart, 1996, Harley, 1995). Based on a population estimate of
130 million women in the United States, that means that an additional 5-6 million
women will suffer from alcohol abuse and dependence than was previously thought.
As researchers began to explore gender differences in alcohol dependence,
a hypothesis emerged that while men tended to act out their problems more directly,
women were more likely to deal with problems and negative affect by internalizing,
an antecedent condition for alcoholism. Further proposed is that this very tendency
to internalize could account for the much higher levels of depression and low
self-esteem that is found in alcohol dependent women (Fischer & Goethe, 1998;
Turner,1993).
The lowered self-esteem of alcohol dependent women has been well documented
in recent research (Corbin, McNair & Carter, 1996; Kingree, 1995; Harley, 1995).
While lowered self-esteem is, of course, a problem itself, in females that are
alcohol dependent, it is consistently seen as a barrier to treatment as well (Smith,
1992).
Factors (or symptoms) seen as contributing to the lowered self-esteem of alcohol
dependent women include self-blame, guilt, and shame (Eliason & Skinstad, 1995;
Kingree, 1995). One model for alcoholism suggests that substance use reflects
a "self-medication" of these symptoms, especially feelings of guilt and shame.
While alcohol and drugs serve to reduce negative affect, this very reduction serves
to negatively reinforce continued substance use. Thus, the female alcoholic who
feels guilt and shame attempts to reduce these feelings by drinking, and only
ends up drinking more (Meisler, 1996).
Guilt and shame feelings, as is the case with lowered self-esteem, also lead
to less help-seeking behavior in female alcoholics. Our social system, which tends
to stigmatize women who drink, already offers less social support to alcohol dependent
women than it does to men (Blum, Nielsen & Riggs, 1998). Shame and guilt further
compounds the problem, and make it less likely that women suffering from alcohol
dependence will seek, or receive, help.
In summary, researchers find that alcohol dependent women typically tend to
internalize their feelings, suffer from low self-esteem and depressed moods, have
high levels of guilt, shame and self-blame, and tend to self-medicate these negative
feelings with alcohol, which only serves to increase the use of alcohol and the
accompanying negative affect. There is a lack of social support for women who
are alcohol dependent, which results in less treatment.
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© Susan M. Sherman, 2002
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