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Stress Drinking Has a Gender Divide

The Atlantic

www.theatlantic.com › ideas › archive › 2023 › 09 › women-heavy-drinking-alcohol-use › 675296

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More than a decade ago, when Holly Whitaker worked a director-level job at a Silicon Valley start-up, insecurities haunted her. She feared never being enough, never getting ahead. “There was just an inability to be with myself,” she told me, “and that manifested as fear.” She often sought comfort in alcohol. The relief would start even as she anticipated drinking; at the first sip, she began to feel warm and right; numb, but also energized.

In her 2019 book, Quit Like a Woman, Whitaker describes drinking alone after a night out, feeling proud to have had “only” a bottle of wine in a day, and carrying airplane shots of liquor around in her purse. Sometimes, she would start drinking in the morning and go until she passed out. “Anytime I felt anything I didn’t want to feel, I used outside things to manage that, and alcohol was very effective,” she said. The next day, she would feel shaky and even more stressed—and still be facing the demons she drank to avoid.

Now sober, Whitaker views her past drinking as a perverse form of dealing with anxiety. She and others are urging women to see how alcohol is becoming a modern-day tranquilizer, a substance that the booze industry peddles to successful, stressed-out women as a way to forget their problems—while quietly making them worse. “If you look at the history of Valium, or Miltown,” Whitaker said, naming two early sedatives, “women have been sold coping mechanisms for their daily lot for a long time. Coping mechanisms instead of actual solutions.”

[From the July/August 2021 issue: America has a drinking problem]

The uncomfortable truth is that many women today are drinking too much. Though men are still more likely to die of alcohol-related causes than women are, alcohol-related hospitalizations and deaths are rising faster among women than men. During the first year of the pandemic, women increased their “heavy drinking” days—days on which they had four or more drinks—by 41 percent, compared with 7 percent among men. One might dismiss the spike as attributable to the stresses of the pandemic, except that women’s high-risk drinking was increasing rapidly before then, too. Men born in the early 1900s were three times as likely as women to drink in problematic ways; today, women are almost as likely as men to do so. Female college students now binge drink more than male college students do.

Problem drinking has risen fastest among women in their 30s and 40s, the age at which many are squeezed between careers, motherhood, and aging parents. Overwhelmingly, high-income, highly educated women are the ones who drink. This may seem odd because high-income women should be better able to afford help with child care, chores, and other responsibilities that can cause stress. But although this group has more resources, the standards for child-rearing, housing, and career achievements in this cohort are also ratcheting ever higher. The strain of keeping up with the Joneses depends on which Joneses you’re keeping up with.

Few successful women would willingly get hooked on Valium, but large numbers today are dosing their discomfort with alcohol. Gradually, booze has become the 21st-century “mother’s little helper.”

When I called up Julie Patock-Peckham, a psychology professor at Arizona State University, I told her that the sense I got from the research was that women, to a greater extent than men, tend to drink to cope with stress and negative feelings. She didn’t even wait for me to finish the sentence. “Correct,” she said. “That’s been well established in the literature for probably 30 years.”

One study found that the stress of the pandemic was related to the number of drinks consumed among women, but not men. Surveys of teens in Europe have found that girls tend to drink to cope, but boys tend to drink to socialize or to enhance their already good feelings. One review of studies, from 2019, notes that “women are generally more likely to drink to regulate negative affect and stress reactivity.”

This gender divide revealed itself yet again in a study that Patock-Peckham and her co-authors published just last year. For the experiment, Patock-Peckham exposed both male and female participants, aged 21 to 35, to a stressful situation: First, they had five minutes to prepare a speech about what they like and don’t like about their bodies, personalities, and lives. Then, they presented those speeches to an attractive, unsmiling audience. Finally, they had five minutes to count backwards from 1,022, subtracting by 13—again, while the attractive audience watched. If they made a mistake, they had to start over.

Then, the participants were randomized to have either three alcoholic drinks or three placebo drinks that tasted like they might contain alcohol. At this point, the participants were still pretty stressed out, and for the next 90 minutes, they had a chance to blow off some steam: They were allowed to have as much alcohol as they wanted (within reason) from an open bar. (They sobered up and were given a ride home afterward.)

Patock-Peckham noticed something strange when she examined the resulting data by sex: Men who were given the alcohol first drank more during the “free” period than the men who received the placebo. They were nudged into drinking by a combination of stress and those first few, researcher-provided cocktails. But for women, whether they got the alcohol or the placebo didn’t matter the way it did for the men: Just being stressed out was enough to drive the women to drink heavily. It’s thought that people are more likely to be disinhibited—to drink more—only after they’ve already had some alcohol. But this finding suggests that women are so much more sensitive to stress that it alone can prompt them to drink. “The reason why I think it’s disturbing is if you think about what happened to women during the pandemic,” Patock-Peckham said, “you’re now Zooming your job from home. You’re homeschooling your children from home … You have gone off the deep end in terms of your stress level. It’s inescapable.”

In the short term, alcohol can be extremely soothing; it mimics the effect of a relaxing brain chemical called GABA. “It’s taking you out of your head a little bit,” Patock-Peckham said. “You’re not going to be overthinking things.” But the effect is short-lived: When someone who has been drinking starts to sober up, levels of GABA in the brain go down, and excitatory chemicals like glutamate and cortisol rise, so people wind up feeling more anxious in the aftermath. Drinking is merely borrowing happiness from tomorrow, as the aphorism goes.

Still, many people use drinking to erase a stressful day and ease into the evening. Ann Dowsett Johnston, the author of Drink: The Intimate Relationship Between Women and Alcohol, describes a typical night back when she used to drink: She’d race in from a hard day at the office and, staring down several hours of cooking and child care, immediately pour herself a cold glass of Pinot Grigio. Once, her fiancé pointed out that the fridge was open before her coat was off. “We see the aim for perfectionism on the part of women,” says Johnston, who is now a psychotherapist, “and then we see self-medication of largely depression, anxiety. It’s an exit strategy; it’s a way to numb.”

From her female clients, Johnston often hears complaints like “My plate is too full and I’m not doing well at anything.” She writes that one thing that seems to “protect” women from falling into alcoholism is being in a “low-status occupation.” The more you have, it seems, the more you worry about losing.

Women’s use of alcohol to regulate stress is a problem because women develop alcohol-related health issues more rapidly than men. Because women’s bodies process alcohol differently, booze affects women’s brains more severely; it’s more likely to increase their risk of liver disease and cancer. Each additional drink a woman consumes daily increases her breast-cancer risk, and alcohol accounts for about 15 percent of all breast-cancer cases. Younger women are driving an increase in deaths from alcoholic liver disease. “It’s worse for women to have an alcohol-use disorder than men,” Patock-Peckham told me. “The trajectory to serious disease is so much faster in women that it’s dangerous for women to use that as a stress outlet.”

Every era has a sedative that’s meant to resign women to their fate. In the 19th century, doctors prescribed opiates such as laudanum for menstrual cramps, “nervous dyspepsia,” and other “female problems.” Women soon comprised the majority of morphine and opium addicts, among them “our weary sewing-women and … our disappointed wives,” as one writer put it. A medical textbook from 1886 suggested dope as a path to female docility: “To women of the higher classes, ennuyee and tormented with neuralgias or the vague pains of hysteria and hypochondriasis, opium brings tranquility and self-forgetfulness.”

After World War II, as working women returned to the home, sedatives like Miltown and Valium became popular. These were the tranquilizers that inspired the Rolling Stones—not exactly a drug-averse bunch—to warn against the dangers of middle-class addiction in their 1966 hit “Mother’s Little Helper.” One 1968 ad noted, with some self-awareness, “Some say it’s unrealistic to educate a woman and then expect her to be content with the Cub Scouts as an intellectual outlet.” But it offered the perfect solution: Miltown, which can relieve “anxiety and tension states.” One Valium ad boasted that after just a week of taking the drug four times a day, a woman named “Sally Wilson” became “less tense and taut; she’s more friendly and cheerful and wants to be part of her world,” the historian Andrea Tone writes in The Age of Anxiety.

Sexist doctors were “more likely to just see women as making annoying complaints that were about things that were all in their heads. And it was delightful to have a pill that seemed to take care of that, from the doctor’s point of view,” says David Herzberg, a historian at the University at Buffalo and the author of Happy Pills in America. Freelance journalists, actually employed by pharmaceutical companies, wrote articles for popular magazines about how sedatives “could cure everything from the blahs to sexual frigidity … every kind of a la mode problem that women experienced,” Herzberg adds. Women were twice as likely to be prescribed the pills as men; at one point, a fifth of American women were taking Valium.

Just as the addictive dangers of Valium became unignorable, Eli Lilly invented Prozac. Energizing and nonaddictive, it was everything Valium wasn’t. Though the blockbuster antidepressant was marketed toward both genders, “there were some explicitly gendered Prozac ads that had to do with pitching Prozac to help women handle the double workday. So, you know, ‘Alert at work, able to do the stuff at home,’” Herzberg says. In the end, the gender ratio of antidepressant prescriptions was similar to that of Valium. In the early 2000s, Prozac’s makers repackaged the drug, literally, in a pink-and-purple capsule; rebranded it as Sarafem; and marketed it to women to treat PMS.

Alcohol has slid along a similar trajectory, with the industry assuring women that all they need to get through the day is a glass of something. In the 1970s, women’s magazines advised readers that wine could be part of an “Anti-Tension Diet,” as the journalist Gabrielle Glaser writes in Her Best-Kept Secret. “Daily use of wine is recommended,” read a 1977 issue of McCall’s.

Starting in the ’90s, alcohol companies launched products like Smirnoff Ice that were meant to appeal to young women. A book in the early 2000s promoted the idea that a thin, fabulous, European lifestyle allowed women to drink wine with almost every meal. (In reality, a glass of red wine has nearly as many calories as a can of regular Coke.) TV shows featured their strong female leads swigging from goblets of vino, which was “most commonly used as a symbol of the stress that the woman who is drinking it is experiencing,” as my colleague Megan Garber pointed out.

Around 2011, Diageo, the maker of brands like Smirnoff and Captain Morgan, sent 950 employees to a “Facebook boot camp” to learn to pitch their products on the platform, boasting afterward that it saw “significant returns on investment.” Today, women are much more likely to be diagnosed with depression and anxiety than men, and alcohol marketers promote drinking as a solution to both. A recent analysis of alcohol companies’ Facebook and Instagram posts by researchers in the U.K. and New Zealand found that “drinking was depicted as well-deserved time out from women’s busy and at times mundane everyday lives,” and that “alcohol use was encouraged as a feminine way of dealing with stress.” One such ad argued that a box of red wine is “perfect for busy moms.” Today, there’s Mommy’s Time Out Pinot Grigio, Mom Juice rosé, and Mom Water canned cocktails.

There aren’t enough studies on whether women drink more when they’re advertised lady-friendly booze, but underage drinking, which is better studied, does have a relationship to advertising. “Alcohol marketing plays a causal role in young people’s decisions to drink, and to drink more,” says David Jernigan, a health-policy professor at Boston University.

But the promotion of alcohol is subject to few restrictions. In 2014, the head of the National Institute on Alcohol Abuse and Alcoholism promised an executive at the Distilled Spirits Council that it would not fund research on the relationship between alcohol advertising and underage drinking. (In response to Stat, which broke the story, NIAAA Director George Koob said he meant that he wouldn’t support “research that was not of the highest scientific quality.”) The alcohol industry has spent more and more in political contributions with every presidential election cycle.

There’s a risk, inherent in this topic, of coming off like a particularly joyless Mennonite, and I’m certain that fate will be inescapable here. I feel doubly weird about this because I do drink, and I enjoy it. (I enjoy it so much, in fact, that I’m currently on a hiatus, but I will probably have a drink again at some point in the future.) Among the indignities I’ve drowned with a bottle of wine are a traumatic IUD insertion, an offer not accepted on a coveted house, and a book I wrote about social interaction that came out in April 2020. I know how easily a good cocktail can pull the plug on rumination. In the past I’ve criticized the CDC for telling women who aren’t on birth control that they shouldn’t drink at all, a rule I still think is too paternalistic.

[From the April 2015 issue: The irrationality of Alcoholics Anonymous]

It can be tempting to shut down any anti-alcohol message with the argument that women should be allowed to drink heavily if they want to. Johnston told me she doesn’t travel to college campuses anymore; she gets too much pushback from students who say they have a right to drink, and no one’s going to tell them otherwise.

And it’s true—women should be allowed to drink. But I keep returning to the argument feminists used to combat the rash of Valium addictions in the 1960s: that women wouldn’t need Valium if their lives were made a little easier, if they had universal child care, better working conditions, and more equitable distributions of domestic labor. You don’t need to take a sledgehammer to your stress if you have less stress. For her part, when Whitaker quit drinking, she switched to healthier coping mechanisms, such as exercise, breathwork, and essential oils. She moved from a shoebox-size city apartment to a wooded area with more space. She left the start-up job and now has a more balanced life.

Similarly, a beer or two can, at least temporarily, help you tolerate a day on which day care is closed, work is nuts, your husband is playing video games, and an elderly relative is having a health scare. But what if you didn’t need the alcohol, because child care was ubiquitous and affordable, health care was cheap, and gender norms were more balanced? Maybe the “mother’s little helper” we all need is a little actual help.