On a special episode of The Excerpt podcast: A recent groundbreaking study revealed that alcohol-related deaths are surging for women even more than for men. What’s to blame? Dr. Paula Cook, host of The Addiction Files podcast and a board-certified addiction medicine and family medicine physician, joined The Excerpt podcast to talk about a dangerous culture around alcohol and why women face higher risks. She also advises how people can evaluate their own alcohol consumption habits to find out if changes are needed.

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Hit play on the player above to hear the podcast and follow along with the transcript below. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

Dana Taylor:

Hello and welcome to a special edition of The Excerpt, formerly 5 Things. I'm Dana Taylor, and today is Wednesday, November 8th, 2023.

Alcohol consumption has always been a health risk, but now more women are dying from alcohol and a recent study found that the rate is increasing more quickly for women than men. This includes women over 65. What's to blame? Dr. Paula Cook joins me now to discuss the factors that might be involved and what you need to consider when evaluating your own consumption habits. Dr. Cook hosts the Addiction Files podcast and is a board certified addiction medicine and family medicine physician.

Dr. Cook, thanks so much for coming on the show.

Dr. Paula Cook:

Sure. Thank you for having me.

Dana Taylor:

Okay, so let's talk about this recent study, which was undertaken by doctors at Hofstra University. They looked at data from the Centers for Disease Control and Prevention on over 600,000 deaths linked to alcohol between 1999 and 2020. From 2018 to 2020, they found that for men, the increase in alcohol-related death was over 12%, but for women it was almost 15%. What's behind this increase?

Dr. Paula Cook:

So, a lot of it has to do with women are drinking more. We just know that the consumption rates are up, women are drinking more in their teenage years, they're drinking more in their older years, in the women who are over 65 and the Baby Boomers, and also women are subjected to more stressors, I think, than they used to in terms of juggling things, and we're subject to different marketing schemes that are targeted directly at women similar to what happened in the past with tobacco. We're seeing these harms accumulate and we have unique differences compared to men in terms of the consequences to alcohol, so that contributes to the mortality data as well.

Dana Taylor:

Well, I did want to ask, how do men and women metabolize alcohol differently?

Dr. Paula Cook:

Well, there are several key differences here. Women are typically smaller than men, not always, but we weigh less. But more importantly, we have a different body composition most often. We have a lower water content, we typically have higher fat content than men do, and that means that alcohol concentrates more rapidly in our system, so it's not diluted into the water content as compared to men. That's a reason why women can drink the same amount of alcohol as men, but have a higher blood alcohol content.

That's not the only reason. We also have a lower amount of a enzyme in our small intestine that metabolizes alcohol compared to men so when we drink, we just have more of an effect of alcohol.

Dana Taylor:

Let's talk about some of the psychological risk factors here. Is it anxiety? Is it depression? Is it pandemic-related loneliness? What's driving this increase?

Dr. Paula Cook:

We certainly have high rates of all of those things in the US and women are highly susceptible to mood disorders just like you mentioned, depression, anxiety. Anxiety in particular seems to be a driving factor for people to self-medicate with alcohol, and women have identified that they feel more stress and they use alcohol as a coping mechanism to deal with stress. We have some interesting studies that came out of COVID showing that people certainly increased their drinking, women included, and women responded maybe even moreso to drinking due to stress related around the pandemic. We also have other things, like you said, loneliness. We've had some interesting data come out about loneliness. Dr. Vivek Murthy just wrote an interesting book about this. We have about 54% of the population who can say that loneliness plays a major role in their life and that can drive people to any substance use disorder but alcohol is so accessible, socially normalized, it can easily become an anecdote to these things. For some people it's not really a problem, maybe they have one or two drinks, but for other people who are more vulnerable, alcohol can certainly develop into risky drinking or high intensity drinking or even an alcohol use disorder.

Dana Taylor:

Was there any healthy amount of alcohol that a person can drink? Has the messaging around public guidance changed?

Dr. Paula Cook:

Alcohol is no longer considered healthy, so that's a very good question. There are limits around alcohol for people who can drink alcohol. There are certain people who really should avoid alcohol altogether. That would be people under the age of 21 because their brains are not developed yet, their frontal lobes, and we know that alcohol is very risky for the developing brain, and also it's illegal for people under the age of 21. Anyone who's taking a medication which interacts with alcohol, we need to be very mindful of that. Those people who may be operating machinery or driving, of course, taking care of others, shouldn't be drinking alcohol. Any woman of childbearing age who may become pregnant or who is pregnant should absolutely avoid alcohol for the risk of fetal alcohol syndrome. Then of course, men over age 65, women over age 65, we metabolize alcohol differently as we age, and so the risks may get higher. But the NIAAA, which is an organization under NIDA, the National Institute of Drug Abuse, has said that if you do drink, you should limit it to one drink of alcohol a day if you're a woman, and no more than two drinks a day if you're a man.

Dana Taylor:

Well, Mommy Needs Her Wine is part of a collection of memes we've seen for many years depicting women turning to alcohol for stress relief. Does this create pressure for women in particular? Is there a culture around drinking that's different now than it may have been in the past?

Dr. Paula Cook:

We're seeing social media normalize drinking, and of course we have these platforms around that just want to make light of it as we bring drinking into Main Street culture, it always has been, but moreso for women than it has been before. That, in the setting of marketing techniques that are targeting women specifically like, "Oh, look how glamorous this is, look how fun this is. We have these fun flavors, we have these drinks that are not really harmful for you," and I think this is all contributing to some of the harms that a lot of times women are just not even really aware of.

Dana Taylor:

Well, do you think that stigma plays a role in whether or not patients tell their doctors about their drinking habits?

Dr. Paula Cook:

Oh, absolutely. I think stigma always plays a role in any substance use disorder, and a lot of times we may not even know if we have a problem and we're ashamed to ask, but stigma certainly plays a role. People who have problems with alcohol, only about one in 10 are getting the treatment that they need, and out of those, few of them are getting gold standard treatment. In other words, they're getting FDA-approved medications, they're getting follow-up for the condition as a chronic relapsing, remitting condition as opposed to just acute, episodic care. Stigma certainly stands in the way, especially for women because as mothers, as people who run multiple roles, we work, we have families, we do lots of caretaking, if alcohol becomes a problem for us, that's embarrassing, especially if we're running these roles where it's not accepted socially, and so it's hard to come forward. Who do we come forward to? Will our doctor judge us? Who else can we tell, et cetera. There are a lot of barriers that come into play here.

Dana Taylor:

Well, do you think that there are more conversations happening between people and on a societal level as well about alcohol and its impact on us?

Dr. Paula Cook:

I certainly think so. Alcohol is the fourth leading preventable cause of death. It causes a huge amount of not only mortality burden for US citizens, but also morbidity. It causes a lot of consequences reducing the quality of life for people. We're interested in it because it contributes to high blood pressure, many cancers, it contributes to mood disorders, it causes insomnia. It's a big contributor of gastrointestinal disorders such as esophagitis and burning stomach gastritis, bleeding ulcers, other kinds of things, and so of course, alcohol is of high interest in the medical community. I think it's of interest in the mental health community too, because alcohol use is highly associated with suicide. I'm just not sure that the general public are aware of all of the risks of alcohol. We know we shouldn't drink and drive, that's pretty well advertised, and maybe that younger people shouldn't drink, but I think a lot of us don't know that it's very dangerous for our heart and our cardiovascular system, for example, or that the risk of breast cancer increases with every drink you have as a woman. As a female, we should be talking about this on a public level, we should certainly be talking about it to our own physicians, and making sure that we understand our personal risk when we decide to drink alcohol or not.

Dana Taylor:

Well, Dr. Cook, what do you advise people to do if they want to reevaluate the relationship with alcohol? How can people recognize an addiction to the substance or an unhealthy aspect to their habits?

Dr. Paula Cook:

There are some great resources online. I think that's a great way to start. If you're wondering where you sit and what your relationship is with alcohol, there is a website and a program that comes out of NIDA called Rethinking Drinking and it leads you through what's a standard drink, how much should you be drinking? Is your alcohol use at all problematic? What risks are associated with alcohol? If you decide, "Maybe I should cut back or moderate my use or try a month or two off of alcohol," it gives you resources to do that. Additionally, you could talk to your primary care provider about your alcohol use and ask them if you think you're within a safe limit or if it would be healthful for you to cut back. Of course, I don't think there's ever any harm in abstaining from alcohol for a while to see how you respond. Of course, if you're drinking heavily to the point where you have withdrawal symptoms when you try and cut back or stop, you absolutely need to get help stopping but otherwise, you can always try and see how you are off of alcohol, and if you feel better, then maybe you have an answer.

Dana Taylor:

Then finally, what are some other options people can utilize to de-stress in a healthier way?

Dr. Paula Cook:

We have good evidence to back up movement and exercise as a very effective way to de-stress and actually reduce anxiety and depression. There are medical studies showing that movement and exercise can be as effective as some commonly prescribed medications for anxiety such as an SSRI. Community and connection make a huge difference in terms of de-stressing, finding your tribe, finding the correct people to be with that support you, making sure you get good sleep. Having good sleep can improve people's mood and ability to cope with stress enormously. Then healthy nutrition. I think a lot of times we just don't feel well, we're not coping well, we're stressed out and we reach for something like alcohol. We could start by looking at what we're putting into our bodies. Is it nutritious? Is it healthful versus is it highly processed? Does it have things in it that really doesn't serve us and start right there. There are other things that are good, meditation has great benefit, yoga, other kinds of Eastern philosophies like acupuncture can be very good for de-stress, so doing some investigation and what works for you.

Dana Taylor:

Thank you so much for joining us, Dr. Cook.

Dr. Paula Cook:

You're very welcome.

Dana Taylor:

Thanks to our senior producer Shannon Rae Green for Production Assistant. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.