ALCOHOL—AN IMPORTANT WOMEN’S HEALTH ISSUE

While it's true that men are more likely to drink alcohol and more likely to drink greater amounts, women have a higher risk of developing problems from alcohol consumption. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man's even if both are drinking the same amount. This is because women's bodies generally have less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol is less diluted in a woman's body than in a man's. Women become more impaired by alcohol's effects and are more susceptible to alcohol–related organ damage. That is, women develop damage at lower levels of consumption over a shorter period of time.

Considering that about one–third of American women report regular alcohol consumption and 2.3 percent, or 2.5 million women, meet the criteria for alcohol dependence, it is clear that research to better understand the effects of alcohol in women is critical.

Results from national surveys show that alcohol use is prevalent among both adolescents and young adults. And while heavy drinking remains more common among young men, the number of young women who drink heavily is alarmingly high.

Adolescence is a critical stage of development. Rapidly changing body systems may be especially vulnerable to alcohol's effects. Drinking during this time of accelerated brain and hormonal maturation may have long–term consequences.

During adolescence, striking physical changes occur in the brain. The prefrontal cortex, the brain region thought to be involved in various goal–directed behaviors, undergoes substantial changes. The amygdala, the brain structure believed to be involved in a person's emotional reactions and coordinating the body's response to stress, also undergoes developmental changes. Changes in these systems have a powerful effect on adolescent psychological functioning and behavior. As a result, some adolescents may be more likely to engage in risk–taking behaviors, such as experimenting with alcohol and other drugs.

In adolescents with significant alcohol use problems, the volume of the hippocampus, a brain region important for learning and memory, has been found to be significantly smaller than in control subjects. Limited research suggests that women may be more susceptible than men to shrinkage of brain regions. Whether this is true in adolescent girls is not yet known.

Adolescence is a time of dramatic changes in hormone levels and patterns. Gender differences in the body's hormonal response to stress also begin to emerge. Some girls may be at particular risk for emotional difficulties, depression, and problems with self–image as well as an increase in risk–taking behaviors. In addition, during early adolescence, girls may be especially vulnerable to stress. Levels of perceived stress have been found to be the most powerful predictor of alcohol and other drug use, after peer substance use.

Finally, evidence from animal studies suggests that alcohol may affect adolescents differently than adults. Adolescents do not become as uncoordinated or sleepy when drinking alcohol as adults do. Adolescents do, however, appear to be more sensitive to alcohol–induced disruptions in certain types of memory. Clearly, more research is needed to explain how gender differences may influence the way alcohol affects the developing adolescent brain and other body systems. What is known, however, is that the younger a person begins drinking, the more likely he or she is to develop a problem with alcohol later in life?

Alcohol use may have effects on female reproductive function at several stages of life. Some research suggests that the growth spurt and normal timing or progression of puberty may be at risk in human adolescents who consume even moderate amounts of alcohol on a regular basis. Heavy drinking has been shown to disrupt normal menstrual cycling and reproductive function. The reproductive consequences associated with alcohol abuse and alcoholism range from infertility and increased risk for spontaneous abortion, to impaired fetal growth and development.

Fetal Alcohol Syndrome

Maternal alcohol use during pregnancy contributes to a wide range of effects on exposed offspring, including hyperactivity and attention problems, learning and memory deficits, and problems with social and emotional development. The most serious consequence of maternal drinking during pregnancy is fetal alcohol syndrome (FAS). Children with FAS have a distinctive set of facial anomalies, growth retardation, and significant learning and/or behavioral problems. Even children prenatally exposed to lower levels of alcohol may exhibit learning and behavioral problems. Thus far, a threshold below which no fetal damage will occur has not been established. In the absence of such information, following the Surgeon General's recommendation that women abstain from drinking alcohol during pregnancy remains the safest course.