Characteristics of Australian women who drink at high-risk levels

June 2024
NCETA
Researchers at NCETA examined a cohort of the general population that is typically overlooked in research.

Background

Healthcare has historically centred the experiences and needs of male patients and clients, with little consideration given to the important biological and sociological ways in which women may differ 1-3. The AOD sector is no exception to this, and (non-gestating) women in the general population have often been under-represented in alcohol research and treatment 4-8. This is cause for concern, as although fewer women drink at high-risk levels than men, those who do drink are more vulnerable to alcohol-related harms. Neurochemical, hormonal, genetic and environmental factors result in significant differences in the ways in which women’s bodies absorb, distribute, and metabolise alcohol4. Consequently, women typically become impaired from alcohol at an earlier stage of drinking than men, and are more likely to experience harms such as cognitive- and motor-impairment, accidents, cancer, liver and heart disease4.  Furthermore, many social harms commonly experienced by women are influenced by alcohol consumption, including family and domestic violence, child abuse and neglect, sexual assault, unplanned pregnancies, and poor pre- and post-natal outcomes 9.

Women’s alcohol consumption behaviours have undergone substantial changes in recent decades. A convergence in alcohol consumption between men and women has been documented in several countries as women’s consumption increases 10-12. A systematic review and metaregression of English-language studies conducted between 1980-201413  found that among those born in the early 1900s, men were 2.2 times more likely than women to drink alcohol and 3.0 times more likely to do so problematically. By contrast, men born in the late 1900s were only 1.1 times more likely to drink alcohol and 1.2 times more likely to do so problematically. In an Australian context, daily alcohol consumption among women increased by 203% between 1950 and 1980, compared to just 6% among men 14.

Contemporary data indicate that 18% of adult Australian women drink at levels that place them at risk of alcohol-related disease or injury at least once a month 15. In 2021-22, women accounted for 31,440 treatment episodes for alcohol use 16 and 33,834 hospital separations for alcohol-caused diseases 17. Despite this, little is known about the characteristics of Australian women in the general population who drink at levels which place them at high risk of significant harm.

This research

For the first study of my PhD, I examined the characteristics and consumption behaviours of women who drink at very high-risk levels (11 or more standard drinks on a single occasion at least once a month), as well as the factors that predict heavy consumption and how these compare with men. The results presented below are extracts from the paper recently published by Drug and Alcohol Review; please refer to the full text for further details.

After analysing data on 10,406 women and 8,272 men from the 2019 National Drug Strategy Household Survey (NDSHS), I found that 3.1% of Australian women (N=312) drank at very-high risk levels. This corresponds to 309,182 individuals when data is weighted to be representative of the total Australian population. By contrast, 10.4% or 975,889 men reported drinking at these levels (non-weighted N=765). When the sociodemographic characteristics of these women and men were compared, women were significantly (p<.05) younger, were more likely to be unmarried, and had higher levels of psychological distress and mental health conditions than men.

Among women who drank at very high-risk levels, the most population beverage type was wine (38.0%), while the largest proportion of men drank beer (63.1%).  Approximately a quarter of both men and women had unsuccessfully tried to reduce their consumption in the past three months (23.9% and 28.2%, respectively) and had others express concern about their drinking (27.3% and 25.3%, respectively).

Slightly more than half of both women (56.8%) and men (52.6%) who drank at very high-risk levels considered their current consumption to be harmful, and both had experienced alcohol-related harms. However, women were more likely than men to be put in fear by someone under the influence of alcohol (27.5% vs 12.7%) and were also more likely to experience alcohol-related abuse from a relative or spouse (while for men the perpetrator was typically a stranger).

Harm minimisation strategies were relatively common among women who drank at very high-risk levels, particularly limiting the number of drinks consumed on a particular occasion (50.9%) and eating while consuming alcohol (43.9%). More than a third of women reported that they had reduced the amount (38.1%) or frequency (35.7%) of consumption in the past year, most commonly for health reasons. 

In an adjusted regression model containing the full sample of men and women as well as interaction terms with sex, odds of very high-risk drinking were significantly higher for respondents who were male, younger, employed, lived in a regional/rural/remote area, psychologically distressed, smoked, and used illicit drugs. Interactions with sex showed that very high-risk drinking declined at a younger age among men (after 24 years) compared to women (after 44 years). In addition, being married reduced the likelihood of very high-risk drinking more greatly among women compared to men, while living in a major city reduced the likelihood among men (but not women).

Discussion

This research indicates that a substantial number of Australian women are regularly drinking at very high-risk levels. Furthermore, men and women who drink at these levels have distinct health and demographic characteristics, and different factors are associated with their consumption. As such, a one-size-fits-all approach to the identification, prevention, and treatment of alcohol-related harms in this very high-risk group is unlikely to be appropriate or successful.

It is, however, acknowledged that this study was limited by the exclusion of those who do not identify as either male or female (the only response options available in the 2019 NDSHS dataset). Further research is needed into the needs of women and female clients, but also the alcohol-related behaviours and experiences of transgender, non-binary, and gender diverse people. In general, a greater awareness of the ways in which sex (and gender) can affect responses to treatment, policies, and health promotion messages would be of benefit to the AOD and wider health sector.

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