What’s Gender Got To Do With It?

About one-third of alcoholics in the United States are women. But despite having differences in the causes and symptoms of alcoholism, men and women receive the same treatment. Why?

By Regina Walker
Originally published in The Fix

It is estimated that of the roughly 15 million alcohol-abusing individuals in the United States, approximately 4.6 million (almost one-third) are women. The disease may be the same but there are numerous differences between men and women in the cause and symptoms of alcoholism. You’d think this would naturally lead to different treatment strategies for women and men – but you’d be wrong. Despite a huge body of evidence that women with an alcohol dependency are different from men in essential respects – from alcohol metabolism, to psychological consequences, to social perceptions – women are still, and all too often, square pegs forced into the round hole of a one-size-fits-all treatment strategy, with often predictably poor results.

Biologically, women react differently to alcohol. Alcohol is more soluble in water than fat. A woman’s body contains more fatty tissue than a man’s of the same size, so women tend to experience a higher blood alcohol level than men even if they’re the same size and drinking the same amount. Women also make smaller amounts of alcohol dehydrogenase – the liver enzyme that breaks alcohol down – which also adds to a heightened blood alcohol concentration.

Essentially, women experience significantly greater damage from alcohol than men. Female alcoholics have death rates 50 to 100% higher than those of male alcoholics. A greater percentage of female alcoholics die from suicides, alcohol-related accidents, circulatory disorders, and cirrhosis of the liver. Women are much more vulnerable to damage to cognitive functioning than men as a result of long-term alcohol abuse as well (though, unsurprisingly, both male and female alcoholics performed more poorly than nondrinkers during specific cognitive functioning tests). And in general, studies comparing alcohol dependency in women and men show that though women don’t drink as much, or for as long, as men, they still show equivalent damage.

Women who suffer from alcoholism face bigger challenges, not just physically, but psychologically as well. All alcoholics suffer from the social stigma of the disease but women are especially judged as morally weak when they deviate from their expected roles as caretakers of others including children and partners. In the “Big Book” of Alcoholics Anonymous, there is a chapter entitled, “To The Wives.” The goal of the article is to assist the wives of alcoholics in dealing most effectively with their alcoholic husbands. But what of the female alcoholic in AA? Women alcoholics are often portrayed (in books and movies) as sexually promiscuous and lacking self-control.

It is estimated that between 30% and 80% of alcoholic women were victims of sexual abuse in childhood. Although there is no definitive connection between early sexual abuse and alcoholism, the implications for the treatment of alcoholic women are significant. Many women who have experienced physical, sexual, or emotional abuse may develop post-traumatic stress disorder (PTSD) and use alcohol to self-medicate the symptoms of this disorder.

Often, the shame and guilt experienced by women prevent them from seeking treatment. They may be more reluctant to acknowledge that a problem exists for fear they will be punished or humiliated. If the woman is the primary caregiver of young children, she will need support in terms of child-care to access treatment. In addition, these women may fear the loss of the children through the legal system if they request help and acknowledge their alcoholism.

Pregnancy itself may present a barrier to treatment. Laws in some states impose criminal consequences for women who are abusing drugs or alcohol during pregnancy.

Recovery rates for addicted women in treatment are lower than men.

And why is that?

Much discussion in the addiction field has been made about the need for “women specific” treatment but little change has been made to address the unique challenges female alcoholics and addicts face.

Most treatment programs still follow the 12-step approach to recovery: a program developed by men and primarily for men. Next to most beds in inpatient treatment programs, you will find a copy of the “Big Book” of Alcoholics Anonymous.

Yet, numerous other self-help programs exist to support and assist the addicted individual. Unfortunately, they do not get the press AA does and thus, there are fewer of these meetings occurring and less is known about them by those seeking help for alcoholism.

One such program that is geared directly toward women is “Women For Sobriety.” Founded in 1973 by Dr. Jean Kirkpatrick, a lifelong alcoholic who made numerous attempts at treatment and sobriety, Dr. Kirkpatrick (inspired by the writings of Ralph Waldo Emerson and other metaphysical writers) created “Women For Sobriety” also called “The New Life Program.” Dr. Kirkpatrick expressed the belief that the concept of “powerlessness” used in AA was counterproductive for women. Her belief was that most women were socialized to feel powerless and it was important to empower women. She believed that most female alcoholics suffered from low self-esteem and therefore required treatment that would support them in rebuilding a positive self-image, thus making sustained sobriety a possibility.

Dr. Kirkpatrick believed that most female alcoholics shared other problems, including depression, loneliness, excessive feelings of guilt and that these problems fueled active addiction. Recovery therefore needed to address these issues and rebuild the self-esteem, confidence, and sense of competence of the recovering female alcoholic.

Women For Sobriety focuses on letting go of past mistakes and creating a more hopeful and productive future. The program strongly emphasizes the importance of group support.

A pivotal component of the program is the 13 Statements (Affirmations) which form the basis of “The New Life Program.” These 13 Statements include:

  1. I have a life-threatening problem that once had me.
    I now take charge of my life and my disease. I accept the responsibility. 
  1. Negative thoughts destroy only myself.
    My first conscious sober act must be to remove negativity from my life. 
  1. Happiness is a habit I will develop.
    Happiness is created, not waited for.
  1. Problems bother me only to the degree I permit them to.
    I now better understand my problems and do not permit problems to overwhelm me.
  1. I am what I think.
    I am a capable, competent, caring, compassionate woman.
  1. Life can be ordinary or it can be great.
    Greatness is mine by a conscious effort.
  1. Love can change the course of my world.
    Caring becomes all important.
  1. The fundamental object of life is emotional and spiritual growth.
    Daily I put my life into a proper order, knowing which are the priorities.
  1. The past is gone forever.
    No longer will I be victimized by the past, I am a new person.
  1. All love given returns.
    I will learn to know that others love me.
  1. Enthusiasm is my daily exercise.
    I treasure all moments of my new life.
  1. I am a competent woman and have much to give life.
    This is what I am and I shall know it always.
  1. I am responsible for myself and for my actions.
    I am in charge of my mind, my thoughts, and my life.

The concept set forth by Dr. Kirkpatrick is similar in many ways to the cognitive-behavioral approach to change. Dr. Kirkpatrick saw that actions and personal beliefs follow our thinking. When she was able to consciously alter her negative beliefs about herself to more positive, productive ones, she found she could remain sober. Women For Sobriety seeks to teach, support, and encourage female alcoholics to tap into their own personal strength and ability for positive change – rather than reinforce disempowering stereotypes of helplessness.

Some changes have been made in the treatment of the addicted woman; gender specific groups and gender matching with counselors, for instance. This, however, is only a beginning; much more needs to be done to remove the stigma attached to the female alcoholic/addict and to more thoroughly address her needs in treatment.

Regina Walker is a writer, photographer and psychotherapist in NYC. She is the Senior Writer of Revolution Magazine (USA).

She has written a number of articles published on The Fix.

For another related article, click here: Women for Sobriety and the New Life Program.


11 Responses

  1. Maureen H. says:

    What an important essay!

  2. Diane I says:

    I can so identify with this article!! Right from the start in AA I disagreed with the idea that I heard in meetings about “reducing my ego”! I felt so insecure and had such low self esteem. I needed to feel empowered. And yes the stigma at that time was even greater than it is now. Thanks for this great article Regina!

  3. Bob K says:

    I remember Regina from her outstanding pieces on Audrey Kishline, the founder of Moderation Management. Audrey’s was not a happy tale.

    This essay is outstanding and counters the AA “group-speak” that we’re all EXACTLY the same. Bill W. felt he had to get over his “power-driving,” a level of ambition that brought a brief period of acclaim and financial success, but did not relieve his need to guzzle a couple of bottles of bootleg hooch everyday. The ego reduction that the AA founder needed was quite different from what might aid a sexually-abused woman in forging a path to recovery.

    About five years ago, I felt a powerful urge to write about women in AA but I think we’ve had more than enough man-splaining.

    Thank you Regina Walker for a terrific report!

  4. Lisa M says:

    Thank you for this great article. If you go in ITUNES and look for a podcast GETTING TO SOBRIETY you will find an 8-23 minute (mostly 11) episode on each of the statements listed above. I am not a meeting person never have been – for recovery or anything prior to the drinking problem. Podcasts and on line sites like this with wonderful posts have energized my sobriety and there are more and more all the time.

  5. Kathy O. says:

    As a woman in long-term recovery, I believe this information is not only pertinent to my continuing sobriety but also a valuable tool as we sponsor/mentor women who are newly recovering. More and more I feel hesitant to direct them to a “textbook” full of antiquated and male gender specific verbage.

  6. Susan V. says:

    Fantastic article well written. I love the guys in my AA meetings but they just don’t get me. I feel so alone! They think I am fighting when I say I am tired of saying I an an alcoholic at meetings. I am so much more than that. Labels matter! I am now saying I have a substance use disorder that used to have me at meetings and afterwards when I speak again I just say my name. This is extremely difficult as I get negative push back for going outside of the lines. I have been working diligently to start Women for Sobriety here in Billings, Montana and it is like pulling teeth. Thank God I have a counselor cheering me on! My number 307 461 0529 if anyone would like to text me an “atta girl” I sure could use it! Sue Vogel, RN and progressive woman trying to help others through Women for Sobriety.

  7. Ditto to praise below, in the early 1990s there were some fine contributions to the much-needed narrowing in the gender-gap in the conversation of addiction and recovery. Regina Walker has also done a piece on five female addiction-memoirs including Jowita Bydlowska’s Drunk Mom and more.

    Many Road, One Journey: Moving Beyond the 12 Steps by Charlotte Davis Kasl, PhD, not her first book on the subject but one that I heard has been a game changer. The other – familiar to AA Agnostica regulars – is the resurrected, The Alternative 12 Steps: A Secular Guide to Recovery. More recently Marya Hornbacher’s Waiting: A Nonbeliever’s Higher Power (2011). Drink: The Intimate Relationship Between Women And Alcohol (2013) by Ann Dowsett Johnston should be on this list, too.

    I find these books helpful, personally. These days are good for getting caught up on reading – good isolation.

  8. Richard K. says:

    I like what Diane l posted. Ego Deflation was confusing to me. I needed an Ego Boost. Talk about feeling less than.

  9. Bethany says:

    I am so inspired by this article, Regina! I love it that sober women’s voices are heard more frequently and are stronger than ever. We need to hear each other. We need to see each other! To be validated by listening to other women describe how they approach their lives from a similar emotional and psychological framework. And to hear these things while we’re sitting alongside our brothers in recovery, enhancing the recovery community as a whole. This will not only help us deepen in our commitment to our sobriety but will help us to challenge some of the [masculine] voices that we’ve internalized our whole lives that tell us to act and feel in ways that may be counter to our natural responses to life. It will empower us. Thank you too to those who left comments with references to literature and podcasts. I cannot wait to check them out and to find Women for Sobriety. I recently discovered a site called The Temper. It includes a link to 30 Powerful Women’s Recovery Memoirs.

  10. Steve K says:

    Interesting article, and I generally agree with the bio-psycho-social differences highlighted. However, I think men too suffer from guilt and shame in relation to their addiction – and the causes and consequences of it. Anxiety, depression and loneliness are also common in male alcoholics/addicts.

    I would suggest that shame/low self-worth often tends to manifest differently in men and women. Men often compensate with egotism, arrogance and aggression as a defense mechanism for their insecurity (Bill Wilson was very insecure), whereas women may often be more passive. Step Four in the 12 & 12 does suggest handling those suffering from ‘self-loathing’ differently compared to those who are ‘self-righteous’. Insecurity is usually common to both manifestations, though. Some of the language used in AA literature is shaming and does need revising to use more empowering terminology. Both men and women who suffer with addiction need to develop self-love and compassion, which in turn leads to less fear-based egotism and self-centredness. Shame, regardless of its causes, is common to both genders and is a major causal factor leading to addiction in many.

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