If the glass is always full . . .

Society has a strict view of what a good mother should be, and women who have a drink problem are judged more harshly than men, which means women are slower to seek help when they need it, writes MICHELLE McDONAGH

IT CAN START very innocently with a glass of wine at dinner in the evening to help you unwind after a stressful day at work or indeed, at home with the kids. One glass leads to another and to another and before you know it, you can find yourself in the habit of drinking a bottle of wine a night all by yourself.

“Women are drinking at home a lot more these days and wine is not regarded as being as serious as spirits. People do not realise how much they are drinking when they drink at home, it’s very subtle in the way it sneaks up on you. If you are drinking half a bottle of wine a night, that’s too much,” explains Dr Gerardine O’Keeffe, consultant psychiatrist with a special interest in addiction at St Patrick’s University Hospital, Dublin.

Many people equate one bottle of wine with four or five glasses, but O’Keeffe points out that one bottle contains eight or nine units of alcohol and women should not be drinking more than 14 units per week.

“The women I see in our addiction services mainly drink wine. It’s very easily accessible and is seen as more socially acceptable than spirits. It can be bought everywhere, at the local garage, supermarket or corner shop. Women talk about drinking a glass while cooking dinner, another during dinner and then continuing after until a half bottle or more is gone, and this is too much for women to be consuming every night.”

An analysis of data from a Slán lifestyle study published earlier this month revealed that women and older people in Ireland are especially at risk of drinking alcohol in a manner harmful to themselves. It shows that four in 10 women and seven in 10 men are drinking excessively over an extended period.

Worryingly, the Slán data reveals that a higher proportion of women in Ireland drink when compared with other EU countries (77 per cent compared with 66 per cent). During the period of the three Slán surveys from 1998-2007, an age difference in patterns of drinking has emerged, with the increase in drinking most notable for women in the 45-64 age group.

The survey’s authors note: “An increase in the frequency of drinking for women aged 45-64 has also been observed in the UK where a recent review of trends over 20-30 years has highlighted a general increase in consumption for women. The changing nature of women’s drinking patterns and the closing of the ‘gender gap’ in drinking behaviour has been signalled as a cause for concern across a number of countries since women are more vulnerable to the effects of alcohol than men.”

There are many major differences between women and men with alcohol addiction, O’Keeffe explains. Women tend to have very different reasons for drinking in the first place, are affected differently by alcohol, are judged more harshly by society and face major barriers in accessing treatment compared with men.

O’Keeffe has recently moved to St Patrick’s Hospital from the Maudsley Hospital in London where she worked mainly in the area of women and addiction, and she is continuing to focus on this work in Ireland.

She says: “There is a difference between the impact of alcohol on women and men, for example, women become intoxicated after drinking a smaller amount of alcohol and achieve higher blood-alcohol concentrations after drinking the same amount as men. They also advance faster from initial use to regular use of substances. Women are likely to develop liver disease faster than men and do not need to drink as much to do so.”

O’Keeffe added that two-thirds of alcoholic women have mental health problems and are more likely to experience anxiety, depression, eating disorders, phobias and panic disorders than men. They are also at a higher risk of suicide ideation and completion.

Excess alcohol consumption is associated with an increased risk of breast cancer and can also affect a woman’s fertility, menstrual cycle and sexual responsiveness, she says.

O’Keeffe comments: “Women identify different reasons for their drinking than men and often see drinking as a way of coping with specific crises or personal problems. There are a lot of barriers to women accessing treatment including guilt and shame.

“Society has a strict view of what a good mother should be and women who drink are judged more harshly than men, so it can be very difficult for a woman to acknowledge that she has a problem with alcohol. There’s the fear that she will lose the support of a loved one and be left isolated and alone.”

A huge fear for women entering treatment, explains O’Keeffe, is that they will have to hand their children over to the child welfare services and may never get them back.

She highlights the need for GPs, social workers and psychiatrists to be aware of the requirements of women with alcohol problems and to help them to access the services they need. The lack of flexible services and support means it can be difficult for women with children to commit to inpatient rehabilitation treatment, which can last for at least four weeks, she says.

Women also tend to be slower to attend AA meetings than men, but there is a women-only group called ANU – based on the US organisation Women for Sobriety – that runs regular meetings at St Patrick’s Hospital.

“It’s unclear from the research whether women-only treatment programmes are better than standard alcohol treatment programmes. In my view, the services need to be aware of the issues specific to women and to focus on these when they come into hospital for treatment,” says O’Keeffe.

As well as an addiction treatment programme, St Patrick’s runs a four-week dual diagnosis programme for the treatment of addiction along with depression, anxiety, eating disorders and other issues. At the end of these programmes, the hospital offers a 12-week step-down course incorporating education and support and further after care if required.

O’Keeffe explains: “I am planning to develop an addiction section on our website [www.st patrickshosp.com] to offer addiction education and advice and online meetings. A lot of the time, women can’t get to support meetings because they live in isolated areas or are rearing children, so online meetings could be of great benefit to them.”

The high incidence of binge drinking among young Irish women is another major concern of O’Keeffe, who points out that heavy drinking at a young age can affect the immature brain and, indeed, some women are showing signs of brain damage due to alcohol abuse.

Yet another concern is drinking among the elderly which, she says, is much more common than one might think (and confirmed by the latest Slán data), and she predicts an increase in the diagnosis of alcohol dementia in the elderly in the future.

While older people may not be able to drink as much as they did when they were younger, alcohol has a more harmful impact on their bodies and they are more vulnerable to falls, she explains.

Any woman who feels she may have a problem with alcohol should go to her GP as the first port of call for a full physical examination and liver function test, advises O’Keeffe.

“I believe the overall solution lies in education. We need a culture shift – especially in young women – away from the drink and pub culture, for example on the continent, it’s much more acceptable not to drink and to maybe sit over a coffee instead.”