Girls Play Hard-Part One: Alcohol
Updated: Nov 2, 2019
There has been a lot of attention given these days to the opioid crisis, but society’s drinking problem cannot be overlooked, and particularly women’s issues with drinking. A 2018 survey by SAMSA indicated that 67 million Americans age 12 and older engage in binge drinking (consuming ﬁve or more drinks during one occasion for men, or four or more drinks per occasion for women), and 16.6 million of those 67 million binge drink ﬁve or more times per month. The percentage of people who were current heavy alcohol users in 2018, about 6.1 percent of the population was similar to the percentages in 2016 and 2017. Still, it was lower than the percentage in 2015 (6.5 percent) (SAMSA 2018).
Alcoholism is an equal opportunity disease. The alcoholism as a disease concept goes back to Benjamin Rush (1745-1813), the signatory of the United States Declaration of Independence, or his contemporary Thomas Trotter (1760-1832), a Scottish naval physician. It took until 1956 to be recognized as an illness by the American Medical Association. Long before that time, the Alcoholics Anonymous movement that was started in 1935 by Bill W and Dr. Bob, (inspired by workings of the Oxford Group) viewed alcoholism as "a malady of mind, emotions, and body," not a moral failing.
Typically we expect men to be alcoholics and have the stereotypical view that they are staggering in the streets, out of bars or cars. Historically, men had a higher incidence of substance use disorders and higher rates of problem drinking (binge drinking, heavy drinking, drinking to intoxication), but women are rapidly closing the gap. Studies examining changes in alcoholism rates between 2001/2002 and 2012/2013 suggest an increase of 53% in high-risk drinking in women of all ages, compared to an increase of only 12% in men. For young millennials, there is no gap between men and women in substance abuse at all. Even with this high rate of substance abuse, women and girls may not be even asked about substance use or drinking in doctors or therapists.
Drinking alcohol or substance use may start with curiosity, boredom, sense of adventure, peer pressure, a sleepover, older siblings, or an unlocked liquor cabinet at home. Girls may still be in middle school when they try alcohol and other substance for the ﬁrst time. Some consider a woman or girl who drinks to be relaxed and cool, but this perception ceases when she gets drunk, and then, paradoxically, she is considered problematic or ‘loose.’ Men drinking excessively are considered “foolhardy” and tend to get slacker, but women are judged quicker, more harshly, and face isolation faster.
Alcohol is a social lubricant, and many social activities involve drinking. Some people develop an addiction, thanks to the combination of the genetics and addictive properties of alcohol, as well as its prevalence. It may seem that everyone has lots of fun when they drink and that that makes frequent drinking okay; this mindset is called "normalizing."
Women process alcohol in a different way than men and thus are more impacted physically. They have more body fat and absorb alcohol faster. They also have a lower quantity of the enzyme that breaks down alcohol. Thus, alcohol lingers in the female body longer because they do not metabolize it and get it out of the body as quickly as men. As a result of these factors, women progress through alcoholism more rapidly. This is called telescoping. This faster progression leads to higher alcohol levels to get the same effect, and thus a higher impact on body organs and more damage.
Women drinking heavily for an extended period will experience a much greater risk of health conditions related to drinking (alcohol-related hepatitis, cirrhosis, liver and breast cancer, etc.). They are prone to engage in risky sexual behavior (due to impaired by alcohol frontal lobe function and decision making) or be victims of crime, assaults, accidents, and sexual violence. Some consider intoxicated girls and women "fair game."
The statistics about women drinking, even during pregnancy, is staggering; many pregnancies are alcohol exposed. In Poland, one in three women admits to consuming alcohol during pregnancy, according to data from NFZ (Polish national health system). According to the CDC (Centers for Disease Control in the US), about 10% of pregnant women admit to consuming alcohol in the past 30 days, and about 3% admitted to binge drinking in that period. In the US, about half of all pregnancies are not planned, and women may not know if they are pregnant until about the sixth week of pregnancy or beyond. Keep in mind that not all of these female drinkers are alcoholics. Still, no amount of alcohol during pregnancy has been established as safe (according to the Surgeon General Recommendations and CDC).
Kinga Debska is a Polish Director who tries to bring attention to problems women have with drinking. She wrote and directed the movie “Playing Hard/ Zabawa, Zabawa” 2018. She worked on the movie for several years and spent months collaborating with a blogger and author Mika Dunin who was writing about her battle with addiction. Debska based the screenplay on real-life stories of women in recovery. She gained interest in problematic drinking in women when ﬁlming a documentary about a Polish actress who struggled with this disease.
Debska tells the story of three female alcoholics, without unnecessary pathos or attempts to shock the viewer with physiology. The characters are polished and attractive. Debski’s warm and empathetic lens portrays three heroines at different stages of alcohol addiction. She tries to show the complexity of this disease, defenses that the women employ to justify ongoing drinking, and some of the family dynamics related to alcoholism. The stories of an accomplished surgeon who drinks at work, a successful lawyer who uses her husband’s political inﬂuence to cover her alcohol use related deeds, and an ambitious university student who “is playing (really) hard” are intertwined. On the surface, it seems that each of them is doing exceptionally well or is on the top of their career. They do not see it as a problem. They use drinking to “cope with the stress” of their success, motherhood, and other social obligations. They do not see themselves as alcoholics, and they think they can make changes if they wanted to. They deal with the disease in different ways, lose different things due to the addiction, and hit one rock bottom after another. There is no happy ending here for all of the three women, just as there is no happy ending in a life for many people affected by addiction. Debska tries to avoid moralizing or preaching and points out the real-life dangers of drinking.
Movie trailer: https://www.youtube.com/watch?v=bRgitJjBwpY
In her movie, Debska attempts to give hope that recovery is possible. Women can and do recover. Admitting to having a problem with drinking may be a problem in and of itself, due to the social stigma; the worry of how disruptive going to treatment would be too normal life for a high school or college student. It may disrupt essential parts of life, such as graduation, work, or childcare. Treatment issues that girls and women face are more relational; they focus on self-reliance, empowerment, not trusting others blindly, self-care, and self-respect. Recognizing the truth is part of recovery. Addiction is more devastating for women, as it is an isolating condition, and women and girls tend to lose their connections to addiction faster.
Alcoholism and addiction is very much a family disease. The relationships change with the progression of the disease. Often there may be other family members, parents, or signiﬁcant others who also struggle with addiction or do not recognize it. Learning about addiction, recognizing unhealthy boundaries, enabling behaviors, relational guilt, and understanding the true meaning of empathy are all part of the journey of recovery.
Unfortunately, Director Debska will not hold Q&A as advertised previously. There will be a one-time special showing of the movie on November 4, 2019, at 6:30 PM. This is a rare opportunity to see a Polish movie this year in Minneapolis.
Advance tickets are $20.00 trough November 3; $25.00 at the door. Thirty minute discussion will follow the movie.
Katarzyna Litak, M.D., ABAM