How Alcohol Affects Men and Women: Is There a Gender Divide?

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The most recent National Survey on Drug Use and Health revealed 7% of American men have alcohol use disorder (AUD), while only 4% of women have AUD.¹ The effects of alcoholism male vs. female adults, youth, and young adults in America are alarming. Whether the issue is alcohol and fertility, female alcoholics, or aging among males, alcohol has a negative impact.

Social Factors of Male vs. Female Alcoholism

Research on the differences of male vs. female alcoholics shows variances in the stages leading to alcohol use disorder, often involving social factors. Stages include acquisition, escalation, maintenance, withdrawal, and relapse. Men are more likely to engage in risky behaviors, especially if trying to fit in with peers. Women are more likely to misuse alcohol as a form of self-medication. Men experience greater symptoms of withdrawal than women, but they can also maintain abstinence longer.²

Binge drinking behaviors also differ between men and women, as do the predictors or causes of binge drinking. Men are more likely to binge drink, but the number of women binge drinking is increasing faster than the number of men. Other gender-specific predictors of alcohol misuse include:³

• Males start drinking alcohol at a younger age than females.
• Disinhibiting traits, such as impulsiveness and sensation-seeking, are higher among males.
• Co-occurring disorders like anxiety and depression are higher among females.
• Men with a co-occurring disorder participate in alcohol misuse much more than men without a co-occurring disorder.
• Male college students with anxiety engaged in risky alcohol misuse more than males with depression.

Social and cultural differences also exist. Below are some evidence-based findings from recent research on alcohol misuse:⁴

• Caucasians report the highest overall alcohol misuse.
• American Indians and Alaska natives report the highest levels of binge drinking.
• Social stressors, such as discrimination, increase rates of alcohol misuse.
• Disadvantaged neighborhoods have more places to buy alcohol and lead all other communities in alcohol misuse among residents.

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Alcoholism Male vs. Female and Metabolism

The process of metabolism begins the moment you consume alcohol. The enzyme responsible for this process is alcohol dehydrogenase (ADH). Males and females have different levels ofADH activity in the stomach and liver, which are the first two places alcohol travels. ADH processes some alcohol out of the system and sends the rest into the bloodstream.⁵

Men have much higher levels of ADH in the stomach and liver than female alcoholics. Some men can reduce the absorption of alcohol by up to 30%. Women have minimal amounts of ADH, causing them to absorb almost all the alcohol consumed. This means a male and female can consume the exact amount of alcohol, but women will have much higher amounts enter their bloodstreams, consequentially causing them to have higher blood alcohol concentrations.⁵

Women also typically have more body fat than men and less bodily water, which is how alcohol disperses to the body. This is another reason women become more impaired when drinking the same amount of alcohol as men.⁶

Male vs. Female Long-term Alcohol Effects

Due to differences in metabolism, women will experience the intoxicating effects at higher rates than men, even when they consume the same amount of alcohol. Males and females develop alcohol use disorders that produce very different long-term physical and psychological effects.

Liver Disease

Alcohol causes severe damage to the liver in both men and women, although in different forms. Women tend to develop liver problems at higher rates than men. Examples of liver problems more common to women who misuse alcohol include:⁵

• Acute liver failure
• Autoimmune hepatitis
• Benign liver lesions
• Fibrosis
• Primary biliary cirrhosis

Men are more likely to die from chronic liver diseases than women, which correlates with men having more malignant liver tumors than women.⁵

Male vs. female alcohol-related liver disease (ALD) studies present eye-opening results. One study on liver transplants among men and women with ALD shows that men are 95% more likely to be listed for a liver transplant and 105% more likely to receive a liver transplant than women. This may be because more men die of chronic liver disease than women or because women have more co-morbid disorders and misuse alcohol with other substances, including opioids.⁷

Another study shows alcohol consumption affects women’s livers more commonly than men. Several reasons for why severity increases in women include:⁸

• Higher endotoxin levels
• Estrogen activates liver Kupffer cells
• Higher oxidative stress and inflammation
• Drug-induced liver injuries

Race is a factor that significantly impacts the age and severity of alcoholic liver diseases, such as alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. A study comparing Hispanic, Caucasian, and African American patients with ALD shows Hispanic males get affected at much higher levels than the other races. Researchers explain co-morbid factors that may be responsible for the difference, including:⁹

• Hispanic patients are younger when symptoms begin.
• Hispanic patients present with higher rates of obesity.
• Hispanic patients present with more cases of diabetes and metabolic syndrome.

Other key findings are that African Americans have more cases of Hepatitis C and were the group with the highest number of hospital admissions.⁹

Mental Illness

Research indicates that women with alcohol use disorder are more likely to be affected psychologically than men. Researchers suggest the reasons alcohol misuse and psychological distress are higher in women may include:¹⁰

• Blood alcohol levels remain higher after intake in women, giving alcohol more time to affect organs such as the brain, where neurotransmitters responsible for mood and suicidal thoughts exist.
• Female gonadal hormones, such as estrogen, change serotonin levels and make women more vulnerable to depression.
• More women than men have lower adrenal reactivity.
• Women tend to have more negative thinking when intoxicated, which leads to psychological distress.

Breast Cancer

Breast cancer can occur in males and females. In the United States, up to 10% of breast cancer diagnoses are attributable to alcohol. However, alcohol produces gender-specific risks for women:¹²

• Breast tissue in women is more vulnerable to diseases and tumors than in men, especially before first pregnancy
• Increasing sex hormone levels
• High breast density

Esophageal Cancer

Studies show that esophageal cancer, specifically squamous cell, is more prevalent in African American men living in the United States. Although documented U.S. studies are limited, risk factors have come to the forefront. Risk factors may include:¹³

• Heavier alcohol misuse
• Genetics and family history of cancer
• Use of tobacco
• Poor oral health
• Co-morbid conditions

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Reproduction

Alcohol increases the chances of infertility in women. Here are several ways in which it affects fertility:¹⁴

• Alcohol diminishes ovarian reserves
• Binge drinking two or more times a week can significantly reduce fertility
• Alcohol can cause early menopause
• African American women misusing alcohol two or more times a week have a 26% reduction in the hormones associated with fertility

Men’s fertility is affected by alcohol too due to the following reasons:¹⁴

• Reduces sperm count
• Reduces gonadotropin and testosterone hormone release
• Testicular atrophy
• Sexual functioning is impaired

Aging

Alcoholism male vs. female is increasing among older adults. Data suggests this is particularly true among older women over 60. As a person ages, tolerance for alcohol decreases, and it takes less of the substance to become intoxicated. This puts an older person at risk for more accidents and injuries.¹⁵

Men vs. Women AUD Treatment

Alcohol affects men and women differently, even when seeking treatment. Gender barriers to treatment are found through multiple studies, such as women finding it more challenging to follow through with treatment due to finances and family obligations. Most studies show men utilize treatment services much more than women. There are many explanations, including:¹⁶

• Women believe they should overcome alcohol use disorder by themselves.
• Women may seek mental health treatment rather than AUD treatment because they consider alcohol misuse a psychological problem.
• Women report more emotions surrounding stigma, embarrassment, and fear that prevent them from seeking treatment.
• Women have more transportation, insurance, childcare, and family resistance challenges.

Today, alcohol use disorder treatment provides gender-specific programs at each level, from detox to inpatient rehab to outpatient counseling. Providers are also adapting online programs and services that make alcohol recovery a reality for many men and women. With the help of a treatment team, you can personalize a program to meet your lifestyle demands and preferences.

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Resources

1. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Use in the United States.
2. Becker, J. B., McClellan, M. L., & Reed, B. G. (2017). Sex Differences, Gender, and Addiction. Journal of Neuroscience Research, 95(1-2), 136 – 147.
3. Wilsnack, R. W., Wilsnack, S. C., Gmel, G., & Kantor, L. W. (2018). Gender Differences in Binge Drinking. Alcohol Research: Current Reviews, 39(1), 57 – 76.
4. Sudhinaraset, M., Wigglesworth, C., & Takeuchi, D. T. (2016). Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework. Alcohol Research: Current Reviews, 38(1), 35 – 45.
5. Duke University. (2021). Gender Differences in Alcohol Metabolism.
6. National Library of Medicine. (2021). Alcohol.
7. McElroy LM, Likhitsup A, Scott Winder G, Saeed N, Hassan A, Sonnenday CJ, Fontana RJ, Mellinger J. (2020). Gender Disparities in Patients with Alcoholic Liver Disease Evaluated for Liver Transplantation. Transplantation, 104(2):293-298.
8. Guy, J., & Peters, M. G. (2013). Liver Disease in Women: The Influence of Gender on Epidemiology, Natural History, and Patient Outcomes. Gastroenterology & Hepatology, 9(10), 633 – 639.
9. Levy, R., Catana, A. M., Durbin-Johnson, B., Halsted, C. H., & Medici, V. (2015). Ethnic Differences in Presentation and Severity of Alcoholic Liver Disease. Alcoholism, Clinical and Experimental Research, 39(3), 566 – 574.
10. Jeong, J. E., Joo, S. H., Hahn, C., Kim, D. J., & Kim, T. S. (2019). Gender-Specific Association between Alcohol Consumption and Stress Perception, Depressed Mood, and Suicidal Ideation. Psychiatry Investigation, 16(5), 386 – 396.
11. National Cancer Institute. (2021). Alcohol and Cancer.
12. Liu, Y., Nguyen, N., & Colditz, G. A. (2015). Links Between Alcohol Consumption and Breast Cancer: A Look at the Evidence. Women’s Health, 11(1), 65 – 77.
13. Abnet, C. C., Arnold, M., & Wei, W. Q. (2018). Epidemiology of Esophageal Squamous Cell Carcinoma. Gastroenterology, 154(2), 360 – 373.
14. Van Heertum, K., & Rossi, B. (2017). Alcohol and Fertility: How Much Is Too Much? Fertility Research and Practice, 3, 10.
15. National Institute of Alcohol Abuse and Alcoholism. (2021). Older Adults.
16. Gilbert, P. A., Pro, G., Zemore, S. E., Mulia, N., & Brown, G. (2019). Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample-+. Alcoholism, Clinical and Experimental Research, 43(4), 7