Although patterns of drinking and behaviour when inebriated vary cross-culturally, alcohol consumption affects men and women differently in all cultures for biological as well as social reasons. Women’s bodies metabolize alcohol differently from men’s because of their generally smaller body size, greater fat-to-muscle ratio, and fluctuating hormonal levels. Although the capacity to drink alcohol without showing strong effects of inebriation varies individually and can be modified by experience, in general, women get drunker faster on less alcohol than men. In addition, negative effects of chronic overconsumption of alcohol such as liver disease, anemia, peptic ulcers, high blood pressure, and hepatitis develop more quickly in women. Not only has breast cancer been linked to alcohol consumption in women, but also the well-cited protective factors of moderate consumption against heart disease only apply to women after menopause, and then only if women consume half the quantities permitted in men. Women have been found to suffer psychological harm from alcohol addiction more strongly than men, and addiction among women in most societies is so heavily stigmatized that female problem drinkers are at higher risk than men for depression, low self-esteem, and suicidal impulses. However, because most research on problem drinking has focused on men, health providers know less about female addiction and how best to treat it.
Alcohol use during early pregnancy can cause birth defects. Even a single instance of consuming 5-7 drinks in the first trimester can lead to fetal alcohol syndrome, which causes characteristic facial deformities, developmental disabilities, and seizure disorders. Heavy drinking can also trigger miscarriages. The effects of alcohol consumption in the second and third trimesters are poorly understood, but preliminary evidence suggests a link between moderate drinking (4 drinks or less per session) in later pregnancy and dyslexia, learning disabilities, and other forms of brain damage. Rates of fetal damage may vary by ethnic group, possibly because of differences in drinking behaviour and access to prenatal care. Concern over the effect of maternal drinking on fetal health has led to attempts to impose sometimes oppressive restrictions on drinking by women of reproductive age.
Heavy drinking has social as well as biological costs for women. Socially it makes women vulnerable to violence and sexual abuse. Although the exact nature of the link between alcohol use and violence, especially sexual violence, remains an object of debate, researchers have discovered some patterns. A double standard of women’s drinking can lead men to see inebriated women as legitimate targets for sexual aggression. Alcohol outlets such as bars vary in terms of the respectability of women who enter. In outlets at the lower end of the scale, men may regard any woman who enters as, by definition, sexually available, putting them at risk for harassment or rape.
Drinking impairs decision-making, makes people clumsy, and can lead to unconsciousness. This decreases women’s awareness of possible impending danger, and lowers their ability to respond to a hazardous situation. Because alcohol use can also increase a person’s risk of perpetuating a violent act (whether male or female), as well as intensify the degree of violence, women can be at risk of violence not only because of their own drunkenness but also because of that of their male partners. Even at moderate levels, alcohol encourages aggressiveness; at higher levels it can inhibit cognitive capacity. Drinking heavily forms part of male status-building in groups: men often encourage one another in capacity competitions. The combination of male status-building through heavy drink and impairment of reasoning capacity in both men and women can lead to violent escalation of sexual conflicts. Even moderate drinking can impair women’s ability to negotiate sexual behaviour, increasing their risk for pregnancy and sexually transmitted diseases as well.
Culturally based excusing of inebriate behaviour means that drunkenness can absolve personal responsibility in what anthropologists call a “time-out” phase, in which inebriates are not held to the same standards of behavior as sober people. For example, a rapist who demonstrates inebriation at the time of the assault may face a lesser legal penalty. Ironically, double standards often mean that juries see inebriated female rape victims as having invited assault, or confusing the rapist as to her intent, lessening his attributed guilt. Alcohol use also increases risk of conjugal violence. Women with a drinking problem are more likely to be slapped, beaten, kicked, hit, or have their lives threatened by their husbands. Conflicts related to finances, jealousy, and gender role transgressions can be heightened through regular alcohol abuse by both partners. Alcohol addiction can increase risk for codependency and economic dependence on men, constraining women from leaving abusive relationships, creating a vicious circle that is difficult to escape.
Concern over alcohol’s effects on women’s sexual continence and the health of their children has led to restrictive laws against female drinking and even against women entering bars. Feminist-led changes in sexual mores and the entrance of large numbers of middle-class women into the workplace have opened more opportunities to drink for women desiring social connotations surrounding drinking, such as glamour, independence, free choice, and masculine privilege, as women increasingly try to fit into a male-dominated world, to compete with men on equal footing in all levels, and see the double standard which governs drinking as oppressive. While employed men generally drink more heavily than employed women, women’s drinking rates increase with some types of employment. Women are generally more likely to drink if they earn enough to buy alcohol, have completed higher education, live in an urban area, and have professional employment, but researchers cannot make any strong connection between employment in itself and drinking problems among women. Greater access to alcohol and greater social freedom to drink among women can be seen as positive; increased moderate drinking among employed women does not necessarily imply a greater rate of problem drinking.
Since the 20 th century, U.S. feminists have seen women’s drinking in terms of greater freedom. Historically, though, in the United States, Mexico, and Great Britain, women led the 19th century temperance movement against drinking by both men and women. In the contemporary world, female-led anti-drinking movements have arisen in many developing countries in which women agitate politically against male drinking and also take steps to smash breweries and boycott alcohol products. In the United States and Great Britain, women have led political movements to criminalize driving under the influence, citing maternal grief at the loss of children to drunk driving crashes. Ironically, both women who seek to expand female access to alcohol, and women who seek to restrict alcohol use by both sexes see their efforts as improving women’s lives.