Mr Gray, a liver specialist pulls no punches. ‘Until about 10 years ago, my patients with alcoholic liver disease were mostly middle-aged men. But women now make up about half of my caseload.
‘It used to be that patients were in their forties and fifties when I first saw them. But I’m seeing sizeable and rising numbers of women in their twenties. Some have irreversible liver damage.’
One 26-year-old female patient died of liver cirrhosis. ‘And we’ve got a 29-year-old on the ward now who has been in hospital through drink for several weeks,’ says Gray. ‘She’s been drinking heavily for 10 years and her liver has packed up. She has a partner and a two-year-old child but she says, “I prefer wine to tea”, even though she knows the harm it’s causing her.’ The woman’s future looks gloomy. ‘She will probably get over this illness. But if she continues to drink after getting out, she will die. I’ve told her that.’
Many of his patients have been drinking excessively for years. ‘These are the steady drinkers. Typically they have a half-bottle of wine with their meal every night, or at lunchtime, and another drink at dinner. They are never drunk but they drink in a sustained manner. They don’t realise they’ve got a problem because they think alcoholics are down-and-outs, or pub regulars. They have wine with their meal and because of that they somehow think that takes away the harm, or they say, “but I don’t drink spirits”. These misconceptions are very common. I suspect there are thousands and thousands of women who are drinking at risky levels, all over the country.
‘Any liver specialist would tell the same story,’ adds Gray grimly. ‘Alcohol is a totally classless disease. It may be more discreet among the upper and middle classes, because they do a lot of it at home. But it causes harm across all social classes.’
Stephanie was an 18-year-old fresher at university when she realised she enjoyed heavy-drinking sessions: champagne mostly, often around 10 glasses a night. Friday, Saturday and Sunday evenings would usually follow the same pattern: alcohol-fuelled revelry at a party or nightclub, total intoxication, home at 2am – then a bad hangover. Unlike most young people, though, Stephanie kept on drinking like that for much of the next 17 years, despite her growing respectability as a senior teacher. She recalls with horror bumping into some 18-year-old pupils she taught when she was out with a group of girlfriends at the weekend. ‘They saw me early in the evening, thank God, not later on, when I would have been hopelessly drunk,’ she says.
Between the ages of 18 and 35, Stephanie’s drinking habits depended on whether she had a boyfriend. When she was in a relationship, she drank normal amounts. But when single, weekend excess was routine. ‘I needed alcohol to relax and meet guys. I did some pretty risky things and had some wild nights and a few one-night stands. We all did,’ Stephanie recalls. ‘Looking back, I know I was doing it because I was desperate to meet someone significant, especially when I reached my early thirties and wanted to settle down.’
Her years of regular binge drinking came at a price, though. ‘The next day, I wouldn’t get out of bed until 11 o’clock and I would vomit, cry for a long time and feel, not suicidal, but depressed, frustrated and angry with myself for having gone out and got very drunk, yet again,’ says Stephanie, who is now 42 and drinks only moderately.
In a way, Stephanie is lucky. The worst side-effect from her drinking was an ultimately successful battle with depression. Many suffer much more direct damage. Eight women a day die from chronic liver damage, often younger than men with the same condition, because they are physically less robust. As alcohol consumption has risen, so the gap between the amounts consumed by women and men has been closing.
While much media attention has been devoted to young ‘ladettes’ out binge-drinking, the real medical harm is being felt among middle-aged women. The number of women aged 35 to 54 dying as a result of alcohol-related damage more than doubled from 7.2 per hundred thousand in 1991, to 14.8 per hundred thousand in 2006. The numbers are rising at an alarming rate.
London property lawyer Leonora Kawecki died in 2003, aged 39, soon after being diagnosed with cirrhosis of the liver. ‘Like many other young professional women, Leonora had a busy social life and alcohol was very much a part of that,’ says her sister Julia. Treatment in a clinic could not save Leonora and she eventually died of internal bleeding – a complication of end-stage liver failure. Health experts warn that many other women like Leonora, who regularly consume well over the recommended ‘safe-drinking’ limits, and who often believe they do not have an alcohol problem, will be receiving a wake-up call before too long.
So why are more women drinking more? ‘Men and women have historically drunk in different ways, but that’s changing, partly because of the equality issue,’ believes Gray. ‘Some women think, “men can do it, so we can do it.” There’s also more disposable income and when women do go out, there doesn’t seem to be any inhibition.’
Recent years have seen profound changes in women’s drinking habits. Siobhan Freegard, the co-founder of a website for mothers called Netmums.com, was surprised by quite how many of her members were consuming well over the recommended safe-drinking limits when Netmums polled 4,000 of them last year. Despite having children, domestic responsibilities, and often jobs too, many mothers drank well over the 14-unit limit. ‘I’m a half-a-bottle-a-day girl and I know that takes me well over the recommended level. But because it seems a civilised quantity and it’s at home, it doesn’t seem so bad,’ says one mother-of-three.
‘Quite a few mums have this concept of “wine time”, that they’re entitled to have a reward drink in the evening. To some “wine time” is eight o’clock. But quite a lot of mums get their children to bed at seven and drink, and some even think, ‘school pick-up – only two hours to wine time”,’ says Freegard.
Professor Ian Gilmore, a liver specialist at the Royal Liverpool Hospital and the president of the Royal College of Physicians, points out that female heavy drinkers are being even more reckless than their male peers. ‘Women are more susceptible to the effects of alcohol. They are smaller, they metabolise drink less well and it affects their vital organs more.’
‘I’m not a sociologist,’ says Gilmore. ‘But the rise in women’s drinking is likely to be related to the fact that women are competing on more equal terms in the workplace and that many are holding down jobs, while bringing up a family. I suspect a lot of the increase is women who have this dual role using alcohol to unwind, to reduce the stress they’re normally under. But it is frighteningly easy,’ says Gilmore, ‘for a woman to go from having a glass or two at night, to drinking larger amounts and developing problems.”
Sarah Turner is a leading expert on women and alcohol. ‘Women are drinking more now than they have done for more than a century. There’s no doubt that the way young women are drinking now will mean that our health services will be burdened by middle-aged women with alcohol problems in years to come. It’s happening already, but it will get worse,’ warns Sarah.
In her view, the usual explanations for more women drinking more heavily – such as alcohol becoming both cheaper and more readily available – do not tell the full story of what hugely significant changes in behaviour and social attitudes are. ‘Historically, women have been the informal social controllers of men’s drinking, but women now, especially young women, are no longer playing that role and are becoming as outrageous as young men in terms of their drunken behaviour.’
SarahTurner director of The Harrogate Sanctuary relates a conversation she had last year with a taxi driver in York. She asked him which sorts of drunk passengers were most troublesome. ‘He told me that the scariest people he gets in his taxi are groups of drunk, middle-aged women. A group of drunk, young men may wind the window down and shout obscenities but usually stop if he says, “lads, I’ve had a long night, can you give me a break?” But he couldn’t calm down, or reason with, the groups of thirty- and forty-something women because they were more overtly aggressive,’ says Turner.
She pinpoints the rise in all-female groups, all out drinking heavily, as significant. ‘These are women who are staying single longer, are divorced, or whose kids have already left home. They have fewer responsibilities and more disposable income,’ says Sarah. ‘The fact that it’s all women gives a sense of empowerment and control, but with an aggressive edge to it. When they end up in the company of men, they start challenging the men, usually sexually, and by doing so are putting themselves at risk of sexual violence. Young women did not use to behave like that.’
Sarah is torn. She believes women’s emancipation over recent decades is hugely welcome. ‘And I’m not saying that women don’t have the right to behave as outrageously as men when they have been drinking.’ But she is troubled by the harm that some women who drink heavily are doing to themselves and the risks that they are running.
‘Some people say that women are paying the price of having their freedom, but I don’t agree with that,’ she says. ‘If you’re going to give people fewer responsibilities and more money, you have no guarantee that they will behave wisely – and that’s a major cause for concern.’
Now coupled with the economic downturn, there becomes even more excuses to drown their sorrows. All misusers of alcohol need ongoing support, the women she treats do not want to sign up to a life of meetings in draughty chapels and halls, but few are prepared to be open with their sobriety. Attitudes have to change says Sarah, and that can only come in the first place from clinicians, who up until now, have shown no desire to de-stigmatize this illness.