How are men and women different in their responses to alcohol?

Traditionally, men who were the breadwinners were also the drinkers; women did not drink in polite society, which has kept female drinking and alcohol abuse away from public discussion. Traditionally, conventionality characterized female roles; however, throughout the ages, women have used alcohol for medicinal purposes. Alcohol was used during childbirth. Women were encouraged to drink beer to enhance breastfeeding. Hot toddies and various fruit tonics have been used for menstrual cramps. A rise of alcohol consumption in women accompanied the rise of feminism. Changes in women's roles that involve exposure to traditionally masculine environments have provided women with opportunities to drink more openly. Today, women represent a growing number of drinkers who either have alcohol problems or are dependent on alcohol. Among younger women, the number of drinkers is approaching the number of men who drink.

Despite the growing numbers of women drinkers, continued differences remain between the two genders. Women prefer wine, whereas men prefer beer. Men prefer to drink in bars and ballparks, whereas women prefer to drink in restaurants or lounges. Men have more social problems than women due to drinking, such as having trouble with the law and DWIs, damaging property, and getting into fights. Alternatively, women tend to use either prescription drugs or over-the-counter drugs with alcohol. Women often take sedatives or tranquilizers with alcohol, whereas more men use cannabis and tobacco with alcohol. Women who use alcohol and drugs are more often involved with a drug-dependent partner and/or come from drug abusing and disorganized families than men. Men tend to become more aggressive with alcohol, whereas more women suffer more depression and anxiety, which may partly explain their increased use of sedatives and hypnotics with alcohol. Despite these differences, one alarming problem for both genders equally is driving a car knowing that he or she has had too much to drink.

Although men seem to have more social problems from drinking, women have more adverse physical effects as a consequence of alcohol use. They are more susceptible to organ damage than men. This is because women absorb and metabolize alcohol differently. Men, pound per pound, contain more water than women, whereas women have a higher proportion of body fat than men. Alcohol is water but is not fat soluble. The more water that is available, the more diluted the alcohol becomes and thus the less toxic it is to the brain and other organs in the body. In summary, as a result of drinking, more negative social responses occur in men, whereas women experience more physically toxic effects, possibly leading to serious health problems, such as heart disease, osteoporosis, high blood pressure, breast cancer, ulcers, and liver disease. Gender is a strong factor in understanding the use and abuse of alcohol.

Posttraumatic Stress Disorder (PTSD) a mental/emotional disorder that is characterized by persistent distressing symptoms lasting longer than 1 month after exposure to an extremely traumatic event.

Studies have demonstrated that individuals seeking treatment for PTSD have consistently had a high prevalence of drug and/or alcohol abuse, and the symptoms of the two disorders interface to the point that they feed off one another.

My spouse just returned from the service over seas. He refuses to talk about the time over there. He says he needs to drink because he has nightmares and trouble sleeping. I am worried that he is an alcoholic. What can I do?

Many soldiers returning from overseas are reluctant to talk about their combat experiences, making it difficult for wives to comfort or support them. Veterans often think that their wives might not understand if they talk about their experiences. Talking about it invokes bad memories and feelings of helplessness, severe anxiety, and distress. Many veterans are afraid that they may lose control of their feelings by talking about the injuries and deaths of their buddies. When they do talk about it, many cry, and some fear not being able to stop crying. The most frequently diagnosed disorder among soldiers returning from active duty is PTSD. PTSD is a reaction to a traumatic event, characterized by intense emotions that can exert a feeling of "going crazy." Studies have demonstrated that individuals seeking treatment for PTSD have consistently had a high prevalence of drug and/or alcohol abuse, and the symptoms of the two disorders interface to the point that they feed off one another.

PTSD is associated with a number of symptoms, including numbness, avoidance, and re-experiencing. The symptoms feed on each other so that one intensifies the other. Numbness often occurs immediately after the trauma and may persist. Some returning veterans feel numb, and if they do not feel numb, they want to suppress whatever feelings they might have by drinking alcohol or using other substances. Most veterans suffering from PTSD have few friends. Some fantasize living the life of a hermit in which they do not have to be around people. To avoid their feelings, many further retreat from close relationships, and normal marital relationships, which are often the closest, suffer the most. Consequently, there is a clinically significant disturbance in family relationships. Re-experiencing traumatic memories can be triggered by everyday seemingly trivial stimuli, such as helicopters flying overhead, the smell of urine, the smell of diesel, or the popping sound of popcorn. These stimuli provoke anxiety, stress reactions, depression, and anger. Thoughts about their combat experiences may intrude at any moment, making it difficult to concentrate. They are always on the alert. Consequently, they can rarely relax and enjoy themselves in a crowd. Very few who suffer from PTSD fall asleep easily, and then once asleep, they have recurrent dreams or nightmares that are related to their combat experiences, startling them awake.

People suffering from PTSD suffer from periods of anxiety and chronic depression. Frequently, many veterans self-medicate their symptoms using drugs or alcohol. Data from a 1988 study demonstrated that between 60% to 80% of treatment-seeking Vietnam combat veterans with PTSD also met the criteria for alcohol and or drug abuse. The assumption is that PTSD patients use alcohol and drugs to self-medicate their distressing symptoms. In a 1996 study, alcohol, marijuana, heroin, and benzodiazepines did help to control the severity of the symptoms, but cocaine made the symptoms worse; however, over time, as the drinking and drug using continues and tolerance develops, the symptoms not only increase but also return with the additional problems associated with chronic substance abuse.

Both conditions need to be addressed, or the chance of treatment success is minimal. Medication can assist in coping with the uncomfortable symptoms. The medication used most often is an antidepressant medication. Occasionally, it may be one of the medications used in the treatment of alcohol dependence to deter compulsive drinking. Benzodiazepines are rarely, if ever, used because of their addictive qualities. Other treatments include cognitive behavior therapy (assists patients to reframe stressful experiences and negative thoughts into more positive thinking), hypnotherapy (hypnosis) and behavior therapy (interventions that reinforce more desirable behaviors), desensitization (incremental exposure to stressful events as tolerated), relaxation therapy and guided imagery (both techniques to handle anxiety), and counseling (individual, group, and family therapy). Couples therapy is especially important for PTSD veterans and their wives in order to reverse the effects of the strained marital relationship. A wife's support and understanding of her husband is very effective in helping him to cope better with the debilitating symptoms of PTSD.

The Veterans Administration (VA) has treated thousands of veterans and has studied and published numerous articles related to PTSD and substance abuse. The VA provides specialized treatment for veterans suffering from PTSD with co-occurring substance abuse disorder and has done so since the 1960s. Besides providing the traditional approaches to substance abuse and mental illness, they also provide outpatient groups for veterans and support groups for wives. Seek help with your husband at the closest VA hospital or outpatient center or look up services that might be available at a local mental health center. The earlier you seek treatment the better the prognosis.

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