Trend in Alcohol-Related Deaths Is Higher in Women
For years, Alix Hays camouflaged her heavy drinking with a busy social life.
She’d meet up with girlfriends for happy hour or join friends at the lake, bringing along a cooler of beer. Her weekend drinking spilled over into the work week when a friend’s birthday or another celebration popped up. Too often, one margarita would morph into four or five.
After March of 2020, her teaching job was put on pause due to the pandemic, and Hays was left with a lot of time. Her drinking escalated to daily, first with her roommates and then eventually alone, leaning heavily on rum or tequila.
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“The pandemic got me to the point where I no longer tried to hide it,” said the 29-year-old Seattle resident. “I was just drinking to get drunk, with or without anyone.”
Recent study findings confirm what’s been visible in the booze-filled images on social media and elsewhere — the pandemic fueled an upswing in drinking, at least among some groups. But the trend in heavier drinking among women, as well as related liver damage and other health effects, is not new, extending back at least two decades, said Aaron White, an alcohol researcher, and a senior scientific advisor to the director of the National Institute on Alcohol Abuse and Alcoholism, or NIAAA.
From 2019 to 2020, alcohol-related deaths increased by one-fourth — 27.3 percent for women and 25.1 percent for men — according to an analysis by White and colleagues, published this spring in the Journal of the American Medical Association. But an earlier study, which White also led, found even more striking gender differences from 1999-2017. Men still suffered the most alcohol-related deaths, comprising three-fourths of fatalities across the nearly two decades. But the increase in deaths was higher in women during that time stretch — up by 136 percent versus 93 percent in men.
“Every racial and ethnic group is showing increases in alcohol-related harm,” White said. “But it’s been larger for middle-aged White women than other groups overall over the last 20 years.”
White’s analysis found that the largest annual mortality increases in deaths occurred among non-Hispanic Whites. But it’s a complex picture, according to an overview of studies looking at U.S. women and alcohol published in 2019. While U.S. teen girls and young women are drinking less than in prior decades, women in their 30s and 40s are drinking more. Another more recent study in the Annals of Epidemiology, which looked at binge drinking among working men and women ages 30 to 49, found that while harmful drinking had increased in both genders, high-achieving women were particularly vulnerable.
“The increases that we are seeing in that age band are really concentrated among women with a college degree or higher, women at the highest levels of family income and the highest levels of occupational prestige,” said Katherine Keyes, a co-author on both studies and a professor of epidemiology at the Columbia University Mailman School of Public Health in New York City.
As her drinking escalated, Hays would sometimes finish as much as two-thirds of a 1.75-liter bottle of hard liquor a day, usually rum. Her nanny job didn’t start until noon, so she could sleep in. “I would wake up, and I’d be horrified, and I’d be, ‘OK, I’m going to slow down.’”
She didn’t, despite fretting about the health effects, thinking: “There’s no way my body is going to handle it. Something is going to happen.”
Women are more likely to experience health consequences at lower levels of drinking, and not just because they often weigh less, according to the NIAAA.
Women’s bodies carry less water, boosting their blood alcohol content higher than in men at the same weight. Alcohol increases the risk of breast cancer, starting at one drink a day. Women who misuse alcohol also are more likely to damage their hearts or livers than men who imbibe the same amount. One analysis of cirrhosis studies showed that women who drink one to two alcoholic beverages daily faced a substantially elevated risk for cirrhosis, whereas men did not.
Not everyone hit the liquor cabinet during the early days of the pandemic, said Adam Leventhal, who directs the Institute for Addiction Science at the University of Southern California. He was involved with a study that focused on drinking patterns during the first 42 weeks and found a mix of reactions — some people boosted their intake, while others cut back.
Some reductions might have been due to fewer social outlets or to a renewed commitment to healthier living amid a pandemic, Leventhal theorized. But he also worries about the group who acknowledged drinking more, and whether they assume they can dial back once the pandemic is finally in the history books. “After many months,” he said, “it may not be as easy as it was before to change.”
The shift to working from home also opened the door to new problematic habits, said Jessica Dueñas, who founded the online group Bottomless to Sober after quitting in late 2020. Some professionals reported drinking during work hours “because it just helped take the edge off,” she said.
Even during video meetings, Dueñas said, “if you have a high tolerance, it’s not that hard to hide that you’ve been drinking.”
Jacqueline, a 40-year-old teacher, described herself as a social drinker before the pandemic. Then she started having a glass of wine daily, then a few, and over the months switched to hard liquor.
Jacqueline, who is now in recovery and asked that her full name not be used, recalls struggling with single parenting and teaching amid the viral crisis. Before she quit, she experienced stomach discomfort, and doctors warned that she risked developing pancreatitis.
“I was depending on it [alcohol] every single day,” she said. “I’d wake up in the morning, and I’d have to have a drink, like usually I’d have a shot of something. I thought that if I just had a little drink in the morning, then it would be fine throughout the day.”
Societal changes in recent decades may have contributed to heavier drinking patterns among women, Keyes said. For instance, women are more likely to reduce their alcohol consumption once they become parents. But the average age for having a child has shifted upwards, and more women are choosing not to have any, she noted.
Work culture also might be influential, Keyes said. Her Annals of Epidemiology study looking at binge drinking in the workforce found that those who worked in the legal profession had the greatest increases from 2006 to 2018, among both men and women.
“My hypothesis or speculation is that there are drinking cultures at workplaces, especially in these hard-charging workplaces or traditionally male-dominated workplaces,” she said. “You’ve got to be one of the boys, right, if you want to move up in the hierarchy.”
The pandemic messages on social media didn’t help, said Dueñas, such as jokes about “mommy wine,” or not having to wait until 5 p.m., or hiding alcohol in a to-go coffee cup. “Removing the stigma around day drinking definitely became a thing,” she said.
In the months since getting sober, Dueñas said, it’s been difficult to miss the various products that might appeal to women, such as fruit-flavored vodkas. Or the proliferating hard seltzer beverages that look so much like the non-spiked version that Dueñas must be careful not to grab the wrong product when she’s buying sparkling water.
Another hurdle is the perception that moderate drinking conveys health benefits, one that recent studies have refuted, Keyes said. “There really is no safe level of drinking,” she said. “I think generations of people, especially older folks, have been influenced by this message that a drink a day is good for your health.”
The latest federal guidelines recommend that men consume two drinks or fewer daily and women one or fewer, and stipulates that drinking less is better for health. Heavy drinking is defined as more than three drinks on any day or more than seven a week for women, according to NIAAA. For men, it’s more than four drinks daily or more than fourteen a week.
To assist those questioning their own drinking patterns, the NIAAA has launched Rethinking Drinking, with educational resources, including signs that someone might be running into trouble. Physicians could play a bigger role by routinely checking in with patients about their consumption, White said.
“Unfortunately, it just doesn’t get done enough,” he said. “Nobody bothers to ask you if you’re drinking a bottle of wine a night.”
In late January of 2021, a relative at a family wedding criticized Hays for her drinking — by 10 a.m. she had already downed three glasses of champagne — and she resolved to take a break. It lasted two days. “I was half a handle of Patron in, when I finally broke down and called for help,” she said.
After finding out that rehabilitation programs were full, Hays started attending Alcoholics Anonymous meetings virtually, sometimes several a day. That same month she became ill with Covid-19 and couldn’t leave her home. People she had met through AA talked to her at all hours and dropped off self-help books and groceries.
As Hays felt better, she struggled to find other women in recovery who she could meet up with for hiking and other activities. She ended up co-founding the Sober City Movement, which connects individuals who are in recovery or trying sobriety — sometimes described as sober curious — with like-minded individuals.
Hays is back in college and studying human development. She turns 30 in August, a milestone that felt out of reach during her dangerous drinking days. What’s ironic now, she said, is that she felt like a failure when she finally admitted that she couldn’t stop.
“It wasn’t until after I got sober that I realized that wasn’t me being a failure at all,” she said. “That was me being strong as hell. It’s survival — you’re surviving, you’re fixing yourself.”
Charlotte Huff is a Texas-based journalist who writes about the intersection of medicine, money, and ethics. Her work has appeared in Kaiser Health News, Slate, STAT, and Texas Monthly, among other publications.