Gender differences in drinking: why do they still exist?

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1 Gender differences in drinking Marja Holmila & Kirsimarja Raitasalo SOCIAL CHANGE AND GENDERED DRINKING: A SYMPOSIUM IN HONOUR OF LUDEK KUBICKA Gender differences in drinking: why do they still exist? Marja Holmila & Kirsimarja Raitasalo Alcohol and Drug Research Group, Stakes, National Research and Development Centre for Welfare and Health, Helsinki, Finland Correspondence to: Marja Holmila Alcohol and Drug Research Group Stakes National Research and Development Centre for Welfare and Health PO Helsinki Finland Submitted 19 March 2004; initial review completed 7 July 2004; final version accepted 3 March 2005 SOCIAL CHANGE AND GENDERED DRINKING: A SYMPOSIUM IN HONOUR OF LUDEK KUBICKA ABSTRACT Aims The paper discusses the kinds of reasoning that have been presented as possible mechanisms and reasons for gender differences in alcohol consumption. Design and methods An overview of the existing literature from different countries is presented. Findings The existing studies provide a picture of great cultural variance in patterns of alcohol use among men and women. The gender differences in drinking behaviour have been shown to be linked with many aspects of biological differences between men and women leading to women s greater vulnerability to alcohol, of women s and men s differing needs, reasons and motivations in relation to drinking, of gender-specific roles in other areas of life and of ways in which societies regulate peoples behaviour, often giving women the role of warden or moderator of others drinking. Conclusions The gender differences in drinking behaviour continue to be considerable and are found in all cultures studied so far. Several studies have argued for reasons underlying these differences, but they still remain largely unexplained. KEYWORDS Alcohol use, convergence of drinking habits, gender. INTRODUCTION Gender differences in alcohol consumption are found everywhere to such an extent that they can be considered one of the few universal gender differences in human social behaviour. Studies throughout the world have shown that men are less often abstainers, consume more alcohol and cause more problems by so doing (Järvinen & Olafsdottir 1989; Helzer et al. 1990; Plant 1990; Fillmore et al. 1991, 1997; Hupkens et al. 1993; Wilsnack et al. 2000). However, the sizes of these gender differences vary greatly from one society or social context to another. Wilsnack & Wilsnack (1997), the editors of an important and comprehensive book on gender and alcohol, point out various reasons why this topic is one of constant interest and importance. According to them, gender differences in alcohol use have been important ways in which societies have symbolized and regulated gender roles. Cultural differences in normative drinking patterns help to reveal how, and to what extent, societies differentiate gender roles, for example, by making drinking behaviour a demonstration of masculinity (Driessen 1992; McDonald 1994; Campbell 2000; Roberts 2004) or by requiring women to abstain from alcohol or curb their consumption (Nicolaides 1996; Willis 1999; Martin 2001). Therefore, better understanding of how men s and women s drinking patterns differ is an important key to answering broader questions of how and why and to what extent societies try to encourage women and men to behave differently (Wilsnack & Wilsnack 1997). In other fields of research, many studies place a greater emphasis on biological or psychological factors in explaining why gender differences in alcohol use are found in all societies studied so far. Gender differences in alcohol consumption also encourage costly biases in the ways in which societies try to control or reduce alcohol-related problems. On one hand, the association of heavy drinking with displays of 2005 Society for the Study of Addiction doi: /j x Addiction, 100,

2 1764 Marja Holmila & Kirsimarja Raitasalo masculinity or male camaraderie may encourage male drinkers to deny or minimize problems or risks resulting from their drinking, or to regard drunken behaviour as normal or permissible, even when it leads to violence (Tomsen 1997; Graham & Wells 2003). On the other hand, assumptions that women do not drink heavily may lead initially to women s drinking problems being minimized or ignored, for example, by medical practitioners (Brienza & Stein 2002; Svikis & Reid-Quinones 2003). However, when women s alcohol abuse or dependence becomes conspicuous, the social reaction may shift from indifference to outrage and efforts to punish women who drink in socially disapproved ways (Beckman & Amaro 1986; McLaughlin 1991; Wilsnack 1991; Abel & Kruger 2002). From society s point of view, the possibility of equal numbers of women and men becoming heavy drinkers is worrisome. An increase in women s drinking and drinking problems is viewed as increasing problems for children, homes and society s traditional moral order. At the same time as the possibility of increased drinking by women tends to create moral alarm (Fillmore 1984) it has been in the interests of the alcohol industry to promote moderate drinking among women, because in many countries they have been the obvious group in which the market has been far from saturated. Thus the question of whether it is possible for the gender ratio in alcohol consumption to become smaller is a politically and economically important one. There are many questions about gender and alcohol that need further clarification. Neither the universality nor the variability of the gender differences in alcohol use has been explained adequately. No one has yet produced a theory that explains adequately why gender differences in drinking occur so consistently but are so variable in magnitude (Wilsnack & Wilsnack 1997). This paper discusses the kinds of reasoning that have been reported by researchers from different fields of alcohol studies and that could lead to finding the mechanisms and reasons that account for gender differences in drinking. The discussion is based on studies that have used different methodologies in different countries and cultures, at different times and among different kinds of populations, thus creating a rich picture of great variance and cultural diversity. We have attempted to look for findings and points of view which re-occur in different studies, in spite of their methodological and theoretical differences. For the sake of simplicity, men and women are in this text often discussed as if they were monolithic groups. It is to be stressed that this is only a partial picture. Age, social class, ethnicity, place of residence and religion, among other things, contribute to the rich variation within both genders in each culture and across cultures. POSSIBLE REASONS FOR GENDER DIFFERENCES IN DRINKING Studies in different fields in biology, psychology, history and the social sciences have produced literature on men s and women drinking and their differences. It is to be expected that the gendered culture is a product of several interactive forces moulding peoples behaviour and thus different methodologies and fields of science are needed to explain it. Studies on biological gender differences have shown that alcohol has differing effects on the female and the male body. Due to the greater average content of lipids and the smaller average content of water in women s bodies, the same amount of alcohol per body weight, consumed in the same length of time, leads to higher blood alcohol levels for women than for men (e.g. Mumenthaler et al. 1999; Ramchandani, Bosron & Li 2001). Ethanol metabolism (Lieber 2000), gender-differences in pharmacokinetics of alcoholism (Baraona et al. 2001) and gender-related effect of alcoholism on brain volumes (Hommer et al. 2001) have also been suggested to be biological reasons for women s greater vulnerability to the effects of ethanol. Some of these biological differences are also related to age (Parlesak et al. 2002). The harmful health-related effects of alcohol consumption are also different, to some extent, for men and women (Kubicka et al. 1992; Lo 1996; Caldwell et al. 2002; Canterbury 2002; Giancola et al. 2002), fetal alcohol syndrome being the most obvious one. Another example is the effect of combinations of gender differences in drinking styles and gender differences in reactions to stress. For instance, alcohol may play a direct role in cardiovascular disease mortality related to the physiological effects on the cardiovascular system of binge drinking (more common in men), including the precipitation of sudden death. It may also play an indirect role via the methods that men and women use in order to cope with stress and depression (Rethelyi, Purebl & Kopp 2002). Psychological studies looking at women s and men s needs, reasons and motivations in relation to drinking have brought forward some elements of the mechanisms, which together with the biological differences seem to be incremental in making this difference so universal. A British study on middle-class individuals found significant gender differences in adopting risky health behaviours. For men, such behaviours were significantly associated with marital status, the experience of social mobility and region. For women, on the other hand, social correlates included the presence of dependent children, educational level and the number of hours spent in paid employment (Burrows & Nettleton 1995). Other studies have found repeatedly that divorce, widowhood or

3 Gender differences in drinking 1765 marital status is related differently to drinking in different social, age, cultural and gender groups (Temple et al. 1991; Fillmore et al. 1997; Hajema & Knibbe 1998; Power, Rodgers & Hope 1999; Ahlström et al. 2001; Leonard & Mudar 2003). In a Finnish drinking habits survey, women reported more commonly that drinking had helped them to sort out interpersonal problems at home or in the work-place, feel more optimistic about life and express their feelings better. Men reported more commonly that drinking had helped them to be funnier and wittier and to get closer to the opposite sex. Men tended to perceive more hedonistic benefits, while women perceived more functional benefits and reported more reckless behaviour in drinking situations (Mäkelä & Mustonen 2000). Women s and men s attitudes towards alcohol, tobacco and other drugs also differ (e.g. Kauffman, Silver & Poulin 1997). A study of primary school children in Britain revealed that even at such a young age, girls showed greater likelihood than boys of understanding the dangers which drugs, alcohol and violence may pose for family relationships (Halstead & White 2001). A US study pointed out that college students had gendered perceptions of avenues to prestige during adolescence. Men were more likely than women to report that male adolescents accrued prestige by engaging in behaviours such as sexual activity, drug and alcohol use and fighting (Suitor, Minyard & Carter 2001). Social studies have also pointed out the gender difference in drinking control. It has been suggested that men s drinking control is more externalized than women s, making men more prone to bingeing in situations in which external control is not effective or when a situation is defined as time out and thus outside normal controls. Women, on the other hand, have a more internalized mechanism of drinking control and are less likely to be able to indulge in binge drinking. Some Finnish studies have pointed out that Finnish working-class men in particular tend to think that self-control of drinking is not a part of men s inner nature and thus would constitute a limit to their freedom. Consequently, male heavy drinkers in Finland often define their life history as an oscillation between settling down with a good woman and breaking out into freedom in a drunken binge (Alasuutari 1990). In other countries as well, the role of warden or moderator of their partner s drinking is attributed frequently to women; conversely, the role of inciter is more often ascribed to men in relation to their wives drinking. The predominant direction of efforts to control drinking within the family is from women to men, and from older generations to younger (Holmila 1987; Järvinen 1991; Room, Greenfield & Weisner 1991; Room, Bondy & Ferris 1996). A study of young couples in Finland, Estonia and Russia in the 1980s (Holmila 1988; Holmila, Mustonen & Rannik 1990) showed that wives are far more likely than husbands to try to control their spouses drinking, although the attempt is often not successful. In Scandinavia in the earlier part of the 1900s, formal state control systems also put the wife in the position of acting as an agent controlling her husband s drinking (Frånberg 1987; Järvinen 1991). ARE MEN S AND WOMEN S DRINKING HABITS BECOMING MORE SIMILAR? Men s and women s drinking in various countries The volume of alcohol consumed by men is considerably higher than that consumed by women. For instance, a comparative study (ECAS) on trends in drinking patterns in the European Union countries found that women s share of the total alcohol consumption is about 30% (Simpura & Karlsson 2001). In the Biomed Study, where 10 European countries were compared (Bloomfield et al. 1999), the same was found: men were less often abstainers, more often consumed larger amounts of alcohol and were more often heavy drinkers than women (Ahlström 1999). The US National Longitudinal Alcohol Epidemiologic Survey conducted in 1992 showed that the proportion of life-time drinkers exhibiting alcohol dependence at some point during their lives was 24% for men and 15% for women. The same authors also discussed sex differences in binge drinking and concluded that the risk of developing alcohol dependence may be explained by lifecycle factors, with men s excess risk peaking during the young adult/college years (Dawson 1996). Most epidemiological studies comparing men s and women s drinking concentrate on the overall volume of drinking, but also show that men generally become intoxicated more often than women and are more often heavy drinkers. Are men s and women s drinking patterns converging? There are few data on how the ratio of the volume of men s and women s drinking in different countries may be changing. In some countries, however, these trends have been studied systematically. Bloomfield et al. (2001), when comparing four countries, found gender convergence only in Finland, but not in Germany, the Netherlands and Switzerland. The Finnish Drinking Habits Survey has been implemented every eighth year since 1968 (Mustonen et al. 1999). According to the results of this survey, the proportion of alcohol consumed by women in Finland increased radically in the 1970s, not at all in the 1980s and increased again, although at a slower pace, in the 1990s.

4 1766 Marja Holmila & Kirsimarja Raitasalo In New Zealand, McPherson, Caswell & Pledger 2004) found evidence for gender convergence across a range of measures of alcohol consumption and alcohol-related problems. In the Netherlands, estimates of women s proportion of the total alcohol consumption from the 1950s to the 1980s show no clear trend. The figure has been around 30% at all points of measurement (Gadourek 1963; Jessen 1974; Adriaanse et al. 1981; Swinkels 1991). However, a Dutch study in the 1980s concluded that some signs of convergence of male female differences in alcohol consumption appeared in the 1980s (Neve et al. 1996). In Sweden, there are signs of a slow increase in women s proportion of the total consumption of alcohol. Reports from 1967 (Nilsson & Svensson 1971) and 1979 (Hauge & Irgens-Jensen 1987) give, respectively, proportions of 20% and 28% of the total alcohol consumption for women. Since 1982, the reports show a fluctuation in women s proportions of between 28% and 33% (Drogutvecklingen in Sverige 2000). Bergmark (2004) found evidence for gender convergence in Sweden for one of several drinking pattern indicators; generally, changes in drinking patterns were in the same direction for both men and women. Norwegian data on women s proportion of drinking are available from the 1970s onwards. The figures show a rise from 22% in 1973 to 30% in Thereafter, the share has fluctuated, staying below 30% (Nordlund 1977, 1981, 1985, 1987). The trend in alcohol consumption among Italian women is characterized by the growth of moderate consumers, especially among young women (Osservatorio 2001). What could explain the convergence of men s and women s drinking? Some researchers have looked at possible reasons for the convergence of men s and women s drinking and have found convincing reasons for the likelihood that many women will start using alcohol in the same way as men (Kunz & Graham 1996; Bloomfield et al. 2001; Roche & Deehan 2002). Most of these explanations refer to general changes in women s lives. When women have started to work outside the home they have adopted male values and behaviour patterns, and their freedom as individual consumers has increased. Various social mechanisms are thought to mediate the connection between these general changes and women s drinking. The stress caused by the new dual role in women s lives has been regarded as one mechanism underlying increased drinking among women. According to this line of thought, employment outside the home has created simultaneous expectations and demands related to the old and new feminine roles. This has increased women s feelings of stress and their work-load, resulting in an increasing need for the quick fix provided by intoxicants (Fillmore 1984). The association between a woman s drinking habits and the sex-typicality of her occupation led Paula Johnson (1982) to make the following comment: While many women find tremendous fulfilment in non-traditional roles, the fact remains that women in these roles may experience greater stress due to traditionalists expectations and a society that is set up to deal only with women in traditional roles (p. 95). A second possible mechanism involves the extent to which a society s drinking culture supports and encourages drinking companionship between men and women, thus encouraging joint drinking contexts for men and women (Holmila 1993). A third possible mechanism, the contagion effect, refers to women s need to copy the lifestyle of people who have higher status than they do. Haavio-Mannila (1991) found that irrespective of an occupation s socio-economic level, the sex composition of the work-place was associated significantly with female alcohol use. There was a linear relationship between women s drinking frequency and the sex composition of the work-place (ranging from a situation in which colleagues were only women to cases involving mainly women or roughly equal numbers of both men and women, to situations in which colleagues were mainly or only men). Women working alone and women sharing work tasks with other women drank least often, and token female employees working alongside men drank most often. The results were interpreted in terms of the imitation or contagion effect of significant others. Women working with men want to resemble men in their drinking behaviour in order to be accepted as equal colleagues by men, whose social ranking in work life can be seen as superior to that of women. The contagion effect did not operate in the opposite direction: the sex composition of the occupation or work-place had no impact on men s drinking patterns. A fourth suggested mechanism is one in which the convergence of men s and women s drinking is not only a matter of changes in gender roles in general but specifically of changes in the position of alcohol as a symbol of gender roles (Eriksen 1999). When the climate of opinion concerning alcohol changes, a society becomes more or less tolerant towards women s drinking. This reflects how the society views alcohol: as a natural part of sociability or as a special product to be controlled or even as a moral threat (Paakkanen 1995; Mustonen 2003). Not only can women s drinking change, but also men s drinking could, in theory, change in such a way that men adopt more traditionally feminine drinking styles. This would imply a more rapid reduction in the volume of men s drinking than in women s drinking, and particularly a reduction in heavy drinking by men. It has been harder to find empirical evidence for such a development than for other possible mechanisms of

5 Gender differences in drinking 1767 convergence, even though some studies have shown this to happen (e.g. Midanik & Clark 1994). CONCLUSIONS Existing data on alcohol consumption show that gender differences in alcohol use continue to be considerable and are found in all cultures studied so far. Biological studies have shown differences in the effect of alcohol on the female and the male body Psychological and social studies have observed that women and men seem to have different needs, reasons and motivations in relation to drinking, that their drinking leads to differing consequences, that the connection between drinking and men s and women s life-cycle differs, that in many cultures alcohol is one of the more powerful symbols of gender roles and identities, and that societies normative structures maintain the traditional difference in many ways. There is also research indicating a convergence of male and female drinking. Different degrees of gender difference in drinking seem to have prevailed during different periods in the past. At present the difference is narrowing in many countries. Most of the explanations for this phenomenon refer to general changes in women s lives. When women have started to work outside the home, they have adopted male values and behaviour patterns, and their freedom as individual consumers has increased. Various social mechanisms mediate the connection between these general changes and women s drinking: the stress caused by women s dual role, the effect of contagion occurring between men and women working together, changes in male-female drinking companionship, and changes in alcohol s position as a symbol of gender roles. 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