Our Lens on the Sex, Gender, and Diversity Issues on This Topic
Alcohol is the most common substance used by women. Over the past decade, women’s use of alcohol has increased. Studies suggest that women are less likely to drink and less likely to report heavy drinking than men but that drinking patterns are changing. In 2010, an estimated 10% of Canadian women reported being heavy drinkers, defined as 5 drinks or more on one occasion . However, new Canadian low-risk drinking guidelines from 2011 have lowered the threshold for what is considered low-risk drinking and suggest that women should drink no more than 3 drinks on one occasion to reduce the risk of harm and injury. These new guidelines will likely result in a higher prevalence of what is considered female heavy drinking than previously estimated .
Alcohol use may also negatively affect puberty and disrupt normal sexual reproductive functioning, which may result in a number of menstrual and reproductive problems, including irregular menstrual cycles, absence of ovulation, and infertility . Research also suggests that compared to men, women may exhibit a more rapid progression to addiction to and/or dependence on alcohol  and may develop cirrhosis of the liver with less alcohol and over a shorter period of time .
Biological differences between men and women may result in a number of female-specific reactions to alcohol use. For example, compared to men, women reach higher peak alcohol levels from equal dose per pound body weight  which may be the result of slower alcohol absorption tissues and less water to dilute alcohol in the blood stream as well as lower levels of enzymes needed to metabolize alcohol . Women can therefore be at increased risk for adverse effects of heavy drinking, such as hypertension, osteoporosis, brain shrinkage and impairment, breast cancer, and gastric ulcers .
A key sex difference is related to alcohol use in pregnancy. Alcohol is a teratogen and a range of birth defects and developmental disabilities described by Fetal Alcohol Spectrum Disorder can be a result of maternal alcohol use in pregnancy .
Women differ significantly in the reasons for alcohol use, the pathways to problematic use, and the social consequences of alcohol use . Although men exhibit a number of problematic drinking outcomes (e.g., absenteeism, family problems, violence), increased alcohol consumption patterns among young and middle-aged women are resulting in elevated concerns regarding future social and health consequences . Many women identify their alcohol use as a way to cope with experiences of violence  and women often drink more after a violent incident . Early experiences of violence are associated with initiating alcohol use at a younger age . For example, women in treatment for alcohol problems are more likely then men to report being sexually abused as children . The rate of alcohol problems has been found to be up to 15 times higher among women who are survivors of intimate partner violence .
 Statistics Canada (2010). Heavy drinking, 2010. http://www.statcan.gc.ca/pub/82-625-x/2011001/article/11462-eng.htm
 Butt, P., Beirness, D., Cesa, F., Gliksman, L., Paradis, C., & Stockwell, T. (2011). Alcohol and health in Canada: A summary of evidence and guidelines for low risk drinking. Ottawa, ON: Canadian Centre on Substance Abuse.
 Health Canada (2007). Best practices: Treatment and rehabilitation for women with substance use problems. http://www.hc-sc.gc.ca/hc-ps/pubs/adp-apd/bp_women-mp_femmes/sectionII-eng.php
 Greenfield, S. F. (2002). Women and alcohol use disorders. Harvard Review of Psychiatry, 10, 76-85.
 Poole, N., & Dell, C. A. (2005). Girls, women and substance use. http://www.ccsa.ca/2005%20CCSA%20Documents/ccsa-011142-2005.pdf
 Emanuele, M. A., Wezeman, F., & Emanuele, N. V. (2002). Alcohol’s effect on female reproductive function. Alcohol, Research & Health, 26, 274-281.
 Piazza, N., Vrbka, J., & Yeager, R. (1989). Telescoping of alcoholism in women alcoholics. International Journal of Addictions, 24, 19-28.
 Lieber, C.S. (1997). Gender differences in alcohol metabolism and susceptibility. In
R.W. Wilsnack & S.C. Wilsnack (Eds.), Gender and Alcohol: Individual and Social Perspectives (pp 77-89). Rutgers Centre of Alcohol Studies, Publications Division: Piscataway, NJ.
 Chudley, A. E., Conry, J., Cook, J. L., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal, 172(5 suppl), S1-S21.
 Poole, N., & Greaves, L. (2007). Highs and lows: Canadian perspectives on women and substance use. Toronto: Centre for Addictions and Mental Health.
 Hensing, G., & Spak, F. (2009). Introduction: Gendering socio cultural alcohol and drug research. Alcohol and Alcoholism, 44, 602-606.
 The National Centre on Addiction and Substance Use at Columbia University. (2003). The formative years: Pathways to substance abuse among girls and young women ages 8-22.
 Logan, T. K., Walker, R., Cole, J., & Leukfeld, C. (2002). Victimization and substance abuse among women: Contributing factors, interventions, and implications. Review of General Psychology, 6, 325-397.
 The National Centre on Addiction and Substance Use at Columbia University. (2005). Women under the influence. John Hopkins University Press: Baltimore, Maryland.
 Women and alcohol: A women’s health resource.
 United Nations (2004). Substance abuse treatment and care for women: Case studies and lessons learned. United Nations Office on Drugs and Crime. http://www.unodc.org/pdf/report_2004-08-30_1.pdf
 Quinn, K., & Rugkhla, P. (2010). Women and alcohol. Gender Impact Assessment No. 11. Women’s Health Victoria. http://whv.org.au/publications-resources/publications-resources-by-topic/post/women-and-alcohol-gia
 Greaves, L., Chabot, C., Jategaonkar, N., Poole, N., & McCullogh, L. (2006). Substance use among women in shelters for abused women and children: Programming opportunities. Canadian Journal of Public Health, 97, 388-392
 Women’s Addiction Foundation. (2002). Lesbians and bisexual women and substance use. Women’s Addiction Foundation.
 Poole, N., & Isaac, B. (2001). Apprehensions: Barriers to treatment for substance-using mothers. British Columbia Centre of Excellence for Women’s Health. http://www.bccewh.bc.ca/news-events/documents/SOGCGuidelinesPracticePolicyApril192011.pdf
 World Health Organization (2010). Equity, social determinants and public health programs. Edited by E. Blas & A. S. Kurup. http://whqlibdoc.who.int/publications/2010/9789241563970_eng.pdf
 Healthy Choices in Pregnancy. (2007). http://www.hcip-bc.org