When Alcoholics Anonymous began in 1935, its founders disagreed on whether to accept women as members. Few believed that women could become alcoholics.

Today we know that women, like men, can become addicted to alcohol and other drugs. In fact, women seem to be more vulnerable than men to many adverse consequences of alcohol use.

Dr. Enoch Gordis, former director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), notes this fact in an NIAAA review of the research. "Women continue to be at higher risk than are men for certain serious medical consequences of alcohol use, including liver, brain, and heart damage," Gordis writes.

The reasons are many. One is that women metabolize alcohol differently than men. Women tend to have less body water than men of similar body weight. As a result, women end up with higher concentrations of alcohol in the bloodstream, even when they drink the same amounts as men.

Other factors unique to women, such as their brain chemistry, genetics, and hormone levels, may also contribute to higher blood-alcohol levels.

For women, the long-term effects can be catastrophic. Research cited by NIAAA indicates that:

• Compared with men, women develop alcohol-induced liver disease over a shorter period of time and after consuming less alcohol. Women are also more likely than men to develop alcoholic hepatitis and to die from cirrhosis. Women who drink heavily develop heart muscle disease at the same rates as male heavy drinkers, even though women have 60 percent lower lifetime alcohol use.
• Moderate to heavy drinking increases the risk of breast cancer.
• Higher levels of drinking increase menstrual disturbances, spontaneous abortions, and miscarriages.
• Fetal alcohol syndrome, a leading cause of mental retardation, can result when women drink during pregnancy.
• Among male and female drivers with similar concentrations of blood alcohol, women are more likely to die in car crashes.

And these are just some of the physical effects. Women with alcohol problems also tend to have a more complex mental health profile than men, according to Patricia Owen, director of the Butler Center for Research at Hazelden. Common psychological problems among women in treatment for alcoholism include depression, anxiety, eating disorders, borderline personality disorder, suicide attempts, posttraumatic stress syndrome, and histories of physical and/or sexual abuse. Rates of these disorders are at least twice as high among alcohol-addicted women as women from the general population.

Drinking increases a woman's risk of being a victim of violent crime, especially sexual assault. For instance, one survey of female college students found a significant relationship between the amount of alcohol the women reported drinking each week and their experiences of sexual victimization. Another study found that female high school students who used alcohol in the past year were more likely than non-drinking students to be victims of dating violence.

A strong association exists between domestic abuse and alcohol problems. For instance, one study reports that significantly more women undergoing alcoholism treatment experienced severe partner violence (eg, kicking, punching, threatening with a weapon) compared with other women in the community.

Despite the many coexisting issues for women with alcoholism, women who enter treatment tend to do as well as men or even better. In particular, the Twelve Steps of Alcoholics Anonymous offer powerful tools for women in recovery.

This idea surprises some people who read the Steps for the first time. For example, Step One calls for alcoholics to admit powerlessness. Can this suggestion work for women who want to become more empowered? Owen says yes.

"The Twelve Step program is specifically about powerlessness over alcohol and other drugs. It's not about women being powerless over life. Recovery actually teaches women where they do have power and how to use it."

"AA is the model for mutual-help programs," writes Stephanie Covington, author of A Woman's Way Through the Twelve Steps. "It is in this mutuality -- the open sharing of feelings, struggles, hopes, and triumphs without blame or judgment -- that women can find the most powerful resources for healing."

--Published Sept. 11, 2000