How women face unique alcohol use challenges, from physiology to stigma and child care

Lindsay Sutherland Boal was so gripped by shame about her dependence on alcohol that she had a hard time telling her group of mom friends she’d kicked the habit after her seventh attempt at sobriety. But once she divulged her “secret” in an online post 11 months after her last drink, Sutherland Boal realized she had plenty of support, including from women who contacted her to share their own struggles with booze. “There were women who reached out to me and said, ‘I have no idea what to do,’ “ she said from Toronto. “I was a daily drinker and had been for years,” said Sutherland Boal, who also kept that part of her life from her best friends and immediate family, including her husband, before ditching booze in January 2020. “So many of us, we’re mothers, we’re active in our communities, we have jobs, we’re caregivers for the elderly. Yet, we can’t figure this out. The shame around this is what keeps people silent.” The risks associated with alcohol use are in the spotlight after updated safer-consumption guidance by the Canadian Centre on Substance Use and Addiction (CCSA), which notes in a report that women face greater health and social risks, stigma and expectations. “I had enough of waking up so many times, saying ‘I won’t drink today’ and then be drinking at five o’clock,” Sutherland Boal said, adding she would not recommend her own approach of going it alone, without support from a family doctor or other healthcare provider. She got through the first few tough days without alcohol by walking daily and soon discovered she was feeling both mentally and physically healthier. Keeping up with the routine came to symbolize her step-by-step journey to sobriety. That prompted her to start a group called She Walks Canada, which offers drop-in Zoom meetings from Sunday to Thursday for women who are “sober curious,” newly sober, in long-term sobriety or wanting to reduce their alcohol consumption. The free sessions come with encouragement for women to walk, on their own or with others, and together accumulate a certain number of kilometres. The next goal, between March 6 and June 17, is for members to reach 40,000 kilometres to represent circumventing the globe, Sutherland Boal said. The group offers community support for women dealing with similar struggles, especially the challenges they face while also parenting, she said. Last month, updated alcohol guidance released by the CCSA—saying no amount of alcohol is safe and low-risk is defined as two drinks per week—quickly became a hot topic among hergroup, Sutherland Boal said. “I had, probably, 50 (direct messages) from participants saying, ‘What do we do?”‘ she said of concerns about the health risks of alcohol, including breast cancer, liver damage and heart disease at higher consumption levels. “There were people who were panicked about it, there were people who were glad that they weren’t drinking anymore and didn’t have to deal with it, there were people who felt that it was the last straw for them and the thing that they needed to take them to the next stage of, ‘I think now it’s time to quit.”‘ Some women did not take the advice too seriously, she said, adding others were grateful they had quit before the pandemic because it created a “perfect environment to overdrink” out of boredom and isolation. The CCSA said in its report that physiological differences between men and women at low levels of alcohol use have only a small impact on lifetime risk of death. “However, it is unequivocal that above the upper limit of the moderate risk zone for alcohol consumption (above six standard drinks per week), the health risks increase more steeply for females than for males,” it says. Women generally experience more risk of damage or disease at lower levels of alcohol consumption than do men, it says. “In general, males are more likely to develop alcohol use disorders, but females are more likely to develop organ and other bodily damage from drinking alcohol.” The CCSA’s report also says gender roles lead to women using alcohol to cope with stresses of caregiving roles, trauma and poverty, which can make dependence on alcohol, treatment and recovery more difficult. “Institutionalized gender differentially impacts women by applying increased stigma to women who drink, and barriers to treatment for women and mothers who use alcohol,” it says. “While all people living in Canada can benefit from nuanced information and messaging about alcohol use and safe drinking levels, it is especially important for women and girls,” it says noting “exploitative marketing” and increased vulnerability to sexual assault and intimate partner violence. Dr. Peter Butt, who co-chaired the CCSA’s guidance project, said there’s not enough attention on issues related to alcohol’s effects on women, who encounter “wine mom” memes on social media. Sutherland Boal also mentioned the prevalence of memes related to alcohol and motherhood, saying the “glamorization of toxic mommy wine culture” portrays women as weak and “drives me bananas.” While alcohol-related services have typically focused on men because they tend to drink more, day programs should provide child care so more women can have the opportunity to access them, said Dr. Butt, who is also an associate professor of family medicine at the University of Saskatchewan. “With regard to co-ed meetings, unfortunately it may not be a safe space for some women early on in recovery. So, women-only groups are often preferred. It’s a vulnerable time.” Healthcare professionals also need to communicate the message of alcohol harms with more “nuanced” conversations for both nonbinaryand transpeople because their physiology dictates their risks instead of how they see or identify themselves, Dr. Butt said. Biological factors such as body weight and size enhance the impact of alcohol on females, causing higher blood alcohol levels, faster intoxication, more risk for disease, including breast cancer and liver damage, the report says. Health Canada, which funded the CCSA’s project to update the guidance, has not yet replaced the previous alcohol guidelines from 2011 on its website. It said the federal government is reviewing the CCSA’s report and will continue to engage with “key stakeholders” as Ottawa works to “address harms and risks associated with alcohol use.” Part of the CCSA’s guidance called for alcohol containers to be labelled with information including health risks, but that led to pushback from the industry, which said their own education campaigns urge consumers to drink responsibly. “Any new information will be communicated to Canadians as soon as it is available,” Health Canada said in an email. British Columbia and Alberta have already posted the updated guidance online.

How women face unique alcohol use challenges, from physiology to stigma and child care

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