Alcohol MD

Alcohol Gender and Age differences

Adolescent Drinking

Underage drinking is thought to be a powerful predictor of later adult alcohol abuse and alcohol dependence. Children who start drinking at 14 years of age or younger have lifetime alcohol dependence rates of 40% or more as opposed to 10% among those who began drinking at age 20 or older.

There may be several explanations for underage drinking’s predictive effect. Early use may be merely a genetic marker and not a cause of later adult alcohol abuse. Secondly, alcohol use during childhood may actually alter neurodevelopment leading to adult alcohol abuse. Thirdly, adolescent initiation to alcohol may be a manifestation of a vulnerability to so-called "problem behaviors" which are in general shared by one's overall environmental and genetic background). If you are a parent you may already be looking for signs that your teen may need treatment

Impact of Alcohol on the Adolescent Brain

Research suggests that alcohol may affect the adolescent brain more adversely than an adult's since a child's brain is in a state of transition and undergoing development. Memory studies in rats and humans have suggested that adolescents might be more sensitive to the memory deadening effects of alcohol than their adult counterparts. Studies in the hippocampus have suggested that NMDA-mediated synaptic activity and long-term potentiation are disrupted more in immature rats than mature rats. Neuroimaging studies have cited compositional changes in the white and gray matter of the brain during adolescence in the frontal, parietal, and temporal lobes.


Use of alcohol, tobacco, and other drugs (ATOD) is prevalent among adolescents. Alcohol is the most common substance abused by youth, According to a national survey, 54% of 8th graders, 72% of 10th graders and 82% of 12th graders have used alcohol during their brief lifetime (Johnston et al.,1998). Among students, 31.3 % of 12th graders engage in “heavy drinking”, defined as one occasion of 5 or more drinks in the last two weeks and 25% of 9th graders in the past month. Traditionally, boys consume more alcohol then girls, but currently the gap is closing with consumption rates approaching the same level for both genders.

Alcohol Prevention and Education

Use of alcohol, tobacco and other drugs peaked among adolescents in the late 1970's. However, over the last twenty years, schools have earmarked substantial public and private monies to prevent youth from using alcohol, tobacco and other drugs. Most ATOD use begins prior to age 20 and schools are in the unique situation of having broad access to this audience. The primary ATOD prevention strategy has been education which obviously fits in well with the underlying goal of all schools.

Alcohol and the Elderly

Alcohol affects the elderly differently, triggering a unique set of special considerations. Since an individual’s mental and physical capabilities tend to diminish with age, relatively small amounts of alcohol can contribute to increased falls and accidents. Furthermore, changes in body metabolism can make an elderly person more susceptible to the effects of alcohol. Frequently, seniors consuming the same amount of alcohol as they did in their youth leads to a greater level of impairment. It is for these and other reasons, that the National Institute of Alcohol Abuse and Alcoholism recommends that individuals 65 and older limit alcohol consumption to only one drink per day. Late onset alcoholism (beginning at age 60 or older), although relatively rare, is often misdiagnosed as depression.

Medication and Alcohol Interactions

The elderly typically take more medications than their younger counterparts and the synergistic effects can prove fatal. The effects of alcohol can be magnified by the use of drugs such as antihistamines, sleeping pills, pain medications, and antidepressants. Approximately 100 over-the-counter and prescription drugs interact adversely with alcohol and can lead to illness or death. Due to potential drug interactions, it is extremely important to always obtain a drinking history at the first patient encounter regardless of an adult patient's age.

Alcohol and Women

Contrary to popular belief, women do not necessarily drink more due to the stress of assuming multiple roles (i.e. wife, mother, employee). In fact, research indicates that the opposite tends to occur with more women abusing alcohol after losing a particular role. For instance, women who are divorced or separated tend to abuse alcohol more often than their married or widowed counterparts . Cohabitation is often not a factor, because unmarried women living with a partner have the highest rates of alcohol abuse.

Prevalence of Alcoholism among Women

Drinking among women is most common between the ages of 26 and 34, while binge drinking (defined as at least 5 drinks per occasion, during at least 5 days out of the month) is most common in women aged 18 to 25. Statistically women are less likely to abuse alcohol than men. This lower rate is likely to be the result of the stigma attached to female drinkers, cultural factors and innate differences between the sexes. Moreover, if women engage in problem drinking, they are more likely than men to "grow out" of alcoholism. Because of these and other factors, alcoholism often goes undetected in some women - particularly elderly women. In fact, only 1% of elderly, female alcoholics are accurately diagnosed; instead, they are often diagnosed with depression

Negative Consequences of Alcohol in Women

When females abuse alcohol, they often encounter more problems than men. Women experience different morbidity and mortality rates from alcohol than men. Women suffer from an increased incidence of hepatitis, a higher mortality rate from cirrhosis, and an increased morbidity from alcoholic liver disease. Heart, brain and other liver damage from alcohol are also more prevalent in females. Several studies suggest that women are more susceptible than men to alcohol-related liver damage. Women suffer from these and other adverse consequences even if they consume less alcohol than their male counterparts.

Other research shows that the rate of depression is significantly higher among female alcoholics than male alcoholics. Female alcoholics were more than seven times likely to develop depression than male alcoholics. Researchers also found a stronger genetic association between alcoholism and depression in women than in men.

Menstrual problems, spontaneous abortions and miscarriages are all positively correlated with how much alcohol a woman consumes. One highly publicized study from the Journal of the American Medical Association attributed a higher incidence of breast cancer in women who drink while other studies have not found an association between alcohol consumption and breast cancer. Many researchers remain unconvinced that alcohol is acting independently and instead point to various lifestyle and personal traits that are characteristic of drinkers.

Even when differences in body mass are accounted for, women achieve higher concentrations of blood alcohol, becoming more impaired than men after consuming the equivalent amount of alcohol. This disparity is due partly to the fact that a female's body contains proportionately less water than a male’s. Moreover, since women have a higher percentage of body fat and alcohol is deposited in fatty tissues, alcohol remains in the female body for a longer period of time. The menstrual cycle and the fact that women produce a lower amount of enzymes necessary to break down alcohol make a woman more susceptible to the effects alcohol. These differences illustrate why women become more impaired and why the recommended alcohol limit for women is lower than men even if differences in body weight are accounted for.

Fetal Alcohol Syndrome (FAS)

Alcohol consumption during pregnancy can have vast effects on the newborn, from facial deformities, limb abnormalities and learning disabilities to social and substance abuse problems into adulthood. Fetal Alcohol Syndrome (FAS) is a term used to describe various birth defects caused by maternal drinking during pregnancy.

FAS is the leading cause of preventable mental retardation. Clinically, FAS is defined by four criteria:

1. Maternal drinking during pregnancy

2. Facial abnormalities

3. Growth retardation

4. Brain damage

Prevalence of FAS

The Centers for Disease Control state that the incidence of FAS is less than 1 case out of 1000 (more precisely, .67/1000). Annually, 4,000 to 12,000 children are born with physical and cognitive disabilities attributed to FAS and thousands more experience less severe abnormalities that persist through adulthood. Frequently, attention problems exhibited by FAS children are misdiagnosed as attention deficit hyperactivity disorder (ADHD).

Cause and Prevention of FAS

Experts are uncertain of exactly how much alcohol will cause FAS. It is unlikely whether a precise, quantifiable, permissible amount will ever be known since vulnerability to alcohol varies widely among individuals, taking into account genetics, nutrition, environment, health status and maternal age.

Negative effects appear to be attributed to higher consumption per occasion; therefore, it is extremely important to never exceed one drink on any occasion while pregnant. Currently, the best advice is abstinence since FAS is entirely preventable if a woman abstains from alcohol during pregnancy. This guideline has been supported by United States Surgeon General who, since 1981, has advised women who are either pregnant or considering pregnancy to refrain from consuming alcohol. Unfortunately, despite increased public awareness, maternal drinking during pregnancy is becoming more prevalent as of late.

Alcohol and Breast Feeding

Heavy alcohol consumption can have a detrimental effect on the production, volume and composition of breast milk, as well as adverse affects on the infant. Therefore, women should abstain from alcohol while breastfeeding.

Although moderate alcohol consumption does not have an adverse effect on breast feeding and breast milk, ideally nursing should be postponed two hours for each drink consumed. Alcohol does not remain in breast milk long, so if a nursing mother is planning on feeding her baby soon, she can simply pump out the alcohol contaminated milk, discard it and resume her breastfeeding schedule

Social Drinking

“Moderate” or “Social” Drinking is considered to be one drink a day for women and one to two drinks a day for men. The difference between a social drinker and problem drinker is that the social drinker can stop after one or two drinks, whereas a problem drinker's urge to drink increases with each drink consumed. The craving intensifies the more the individual drinks, therefore the abuser is trapped in a vicious cycle.

A popular saying in Alcoholics Anonymous summarizes this concept that one drink sets the occasion for the next drink: “one drink is too many and one hundred drinks are not enough”.

Binge Drinking

Binge drinking is almost a typical aspect of college life, and prevalent in general population as well. The most prominent age for binge drinking is 18-21 years, with a 42% prevalance in students and 34% among non-students. So how do we determine whether massive alcohol consumption is considered only binge drinking, or alcohol abuse or alcoholism? Considering that a heavy binge drinking college student could easily consume 6 or more alcoholic drinks in an evening, on multiple evenings of the week, there is a concern for the development of alcoholism if the disorder is not considered already.

Binge Drinking:

Male 5 or more drinks per sitting
Female 4 or more drinks per sitting
Frequent Binge Drinker 3 or more occurences per 2 weeks


1 beer (12 ounces) = 1 glass of wine (5 ounces) = 1.5 ounce of liquor

Alcoholics are individuals in which drinking controls their lives. These individuals are dependent on alcohol and need it to function properly, including the reduction of withdrawal symptoms and cravings. The difference between binge drinking and alcoholism is the ability of binge drinkers to control their drinking and the absence of alcohol in their normal lives beyond the social environment. Alcohol abuse develops in a binge drinker when their schoolwork, work or family obligations begin to be neglected. There may also be legal problems. However, the dependence on alcohol, like that seen in alcoholics, is not present.