Alcohol Use And Binge Drinking Among Georgia Women

Consumption of past month Alcohol Use and Binge Drinking among women in Georgia

Excessive alcohol consumption among women are of special concern to public health. In Georgia, excessive drinking of alcohol results in 2,555 deaths and 79,183 years of potential life lost each year (1). Many adverse health outcomes associated with excessive alcohol consumption in women which include cancer, heart disease, stroke, liver cirrhosis, preterm birth (5,7), fetal alcohol syndrome (3), and unintentional and intentional injuries (2).  Although studies have been conducted on alcohol consumption of women in U.S., there is limited data on alcohol drinking patterns or changes in demographic shifts for alcohol drinking patterns among women in Georgia. Therefore, this study was conducted to compare alcohol consumption patterns of women in Georgia reported in 2011 with those reported in 2016.

The study used secondary data from telephone interviews of 14362 adults aged ≥18 years residing in Georgia; that participated in the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2011 and 2016. Overall, 8977 women were analyzed. Measures focused on alcohol use and binge drinking and on the intensity of binge drinking in the past 30 days.  Prevalence and 95% confidence intervals (CIs) for past month alcohol use (in the past 30 days) and binge drinking (4+ drinks on more than one occasion) by the study population were estimated overall and then analyzed. Among the surveyed women (N=8977), overall past month alcohol use showed a significant decrease in relative risk (2.5%, p<0.0001, Table1) from 2011 to 2016.  However, significant increase in relative risk of past month alcohol use from 2011 to 2016 were found among women 65 years and older (41.8%, p <0.0001, Table 1) when compared to other age groups.  Similarly, significant decline in the relative risk (12.6 %, p<0.0001, Table 2) of binge drinking among surveyed women from 2016 to 2011.  However, significant increase in relative risk of binge drinking among women 65 years and older (145%, p<0.0001, Table 2) when compared to other groups from 2011 to 2016.


Alcohol is a risk factor for women for adverse health conditions.  Overall, the findings showed that past month prevalence of alcohol use among women significantly decreased from 43.6% in 2011 to 42.5% in 2016 for Georgia. This is lower than the national estimates of past month alcohol use (57%) and 2016 (54%) in 2013.  However, significant increase in the relative risk of past month alcohol use (41.8%) and binge drinking (percent change: 145 %) was seen among subgroup populations, particularly notable among women who are 65 years and older. Older adults are at particular risk for falls and injuries (6) and the unintentional injury death rate (8) ED-treated falls (9) hospitalized fall rates (2) and fall-related traumatic brain injury deaths (10). In 1990, those over the age of 65 comprised 13 percent of the U.S. population; by the year 2030, older adults are expected to account for 22 percent of the population. (U.S. Bureau of the Census 1996). As the population age 60 and older increases, there could be the potential for increase in the rate of alcohol consumption patterns leading to alcohol-related risks in this age group.


  1. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) [database]. Accessed Dec 13, 2013.
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hospital emergency departments among persons aged 65 years and older, United States, 2006-2011 J Safety Res. 2016;56:105-109.

  1. Ethen MK, Ramadhani TA, Scheuerle AE, et al. Alcohol consumption by women before and during pregnancy. Matern Child Health J 2009; 13:274–85.
  2. Grant, B. F., Chou, S. P., Saha, T. D., Pickering, R. P., Kerridge, B. T., June Ruan, W., Zhang. (2017). Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 74(9), 911.
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  4. Kramarow E, Chen LH, Hedegaard H, Warner M. Deaths from Unintentional Injury Among Adults Aged 65 and Over: United States, 2000-2013. NCHS Data Brief 199. Hyattsville, MD: National Center for Health Statistics, 2015.
  5. Rehm J, Baliunas D, Borges GLG, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010;105(5):817-843.
  6. Stevens JA, Rudd RA. Circumstances and contributing causes of fall deaths among persons aged 65 and older: United States, 2010. J Am Geriatr Soc. 2014;62(3):470-475.
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  8. White A, Castle IJ, Chen CM, et al. Converging patterns of alcohol use and related outcomes among females and males in the United States, 2002 to 2012. Alcohol Clin Exp Res. 2015;39(9):1712-1726. PMID: 2633187


Table 1: Prevalence of and Percent change in 1- month Alcohol Use for Women in Georgia, U.S. by Sociodemographic characteristics, 2011 and 2016

Characteristic                 BRFSS Survey



              BRFSS Survey




% Change
  % (95% CLa) p-value % (95% CLa) p-value  
Total 43.6 (41.7-45.5) <0.0001 42.5% (40.1-45.0) <0.0001 -2.5
18-24 49.8(41.0-58.6)   46.0(39.6-52.4)   -7.6
25-44 52.0(48.6-55.3)   56.3(52.8-59.7)   8.2
44-65 42.1(39.7-44.5)   48.6(45.8-51.5)   15.4
65+ 23.4(21.0-25.7) <0.0001 33.2(30.6-35.9) <0.0001 41.8
Race /Ethnicity          
White/Non-Hispanic 46.2(44.0-48.5)   45.8(42.6-48.9)   -0.9
Black/Non-Hispanic 41.2(37.2-45.1)   39.8(35.2-44.4)   -3.3
Hispanic 33.1(24.4-41.7)   33.9(24.9-42.9)   2.4
Other 41.0(30.8-51.1) 0.0102 34.1(21.9-46.3) 0.0140 -16.8
No High School 22.6(17.4-27.9)   29.7(24.5-35.0)   31.4
High School 38.0(34.2-41.7)   39.3(35.9-42.7)   3.4
Attended College 44.7(41.1-48.3)   52.5(49.1-56.0)   17.4
College or technical school graduate 62.6(59.7-65.4) <0.0001 64.5(61.8-67.3) <0.0001 3.0
<$15,000 39.9(34.8-45.1)   23.7(17.3-30.2)   -4.0
$15,000-$25,000 44.6(40.7-48.6)   28.0(22.7-33.4)   -3.7
$25,000-$35,000 44.4(39.5-49.2)   41.5(33.1-49.9)   -6.5
$35,000-$50,000 51.1(46.7-55.5)   46.5(39.6-53.4)   -9
>=$50,000 63.7(61.4-66.0) <0.0001 63.4(59.4-67.4) <0.0001 -0.4



Table 2: Prevalence of and Percent change in binge drinking** for Women in Georgia, U.S. by Sociodemographic characteristics, 2011 and 2016


Characteristic                 BRFSS Survey



              BRFSS Survey




% Change
  % (95% CLa) p-value % (95% CLa) p-value  
Total 11.1 (9.6-12.5) <0.0001 9.7(8.2-11.2) <0.0001 -12.6
18-24 22.8(15.6-30.1)   13.8(7.6-20.0)   -39.4
25-44 14.9(12.4-17.5)   13.4(10.4-16.4)   -10.0
45-64 7.4(6.0-8.7)   8.3(6.2-10.5)   12.1
65+ 1.1(0.6-1.6) <0.0001 2.7(1.6-3.9) <0.0001 145
Race /Ethnicity          
White/Non-Hispanic 12.2(10.4-14.0)   9.6(7.7-11.5)   -21.3
Black/Non-Hispanic 8.2(5.9-10.6)   9.8(6.8-12.8)   16.3
Hispanic 10.8(4.5-7.1)   9.4(4.0-14.9)   -12.9
Other 17.0(7.1-27.0) 0.0419 9.0(2.3-15.8) 0.9968 -47.0
No High School 9.5(5.3-13.8)   7.0(2.4-11.7)   -26.3
High School 10.2(7.5-13.0)   5.8(3.5-8.0)   -43.1
Attended College 10.6(8.1-13.2)   11.4(8.5-14.3)   7.5
College or technical school graduate 13.6(11.3-15.9) 0.1584 13.2(10.4-16.0) 0.0002 -2.94
<$15,000 9.3(5.4-13.3)   9.2(5.5-13.0)   -1.07
$15,000-$25,000 11.2(7.7-14.8)   13.8(10.5-17.1)   23.2
$25,000-$35,000 7.4(3.6-11.2)   9.2(5.5-13.0)   24.3
$35,000-$50,000 9.7(6.6-12.9)   17.3(12.9-21.7)   78.3
>=$50,000 13.2(11.0-15.5) 0.0773 17.0(14.7-19.3) 0.0003 28.7


a- CL means Confidence Limits

** Binge Drinking in women defined as women having 4+ drinks on one occasion


Table 3: Intensity of Binge Drinking Prevalence and Percent change by Age category for Women in Georgia, 2011

  Past 30 days, average # of drinks had on days you drank
Age categories 1 drink 2 drinks 3-4 drinks 5 drinks or more
  % (95% CLa) % (95% CLa) % (95% CLa) % (95% CLa)
18-24 40.1(27.7-52.6) 21.3(11.2-31.4) 20.1(10.7-29.6) 18.5(9.1-27.9)
25-44 45.8(41.1-50.4) 30.4(26.2-34.6) 16.6(12.8-20.4) 7.2(4.5-9.9)
45-64 54.6(50.8-58.4) 30.4(27.8-33.8) 11.1(8.4-13.7) 3.9(1.9-5.9)
65+ 70.2(64.7-75.6) 23.2(18.1-28.3) 4.6(2.2-7.0) 2.0(0.4-3.6)

p-value: <0.0001; a- CL means Confidence Limits





Table 4: Intensity of Binge Drinking Prevalence and Percent change by Age category for Women in Georgia, 2016

  Past 30 days, average # of drinks had on days you drank
Age categories 1 drink 2 drinks 3-4 drinks 5 drinks or more
  % (95% CLa) % (95% CLa) % (95% CLa) % (95% CLa)
18-24 42.7(28.9-56.5) 23.1(12.3-33.9) 23.7(11.8-15.6) 10.5(2.4-18.6)
25-44 47.7(41.1-54.2) 36.5(30.1-42.9) 12.4(8.2-16.7) 3.4(1.2-5.6)
45-64 49.9(44.1-55.6) 33.2(27.7-38.6) 11.1(7.5-14.7) 5.9(2.4-9.3)
65+ 71.8(65.7-77.8) 20.1(14.9-25.3) 6.4(3.3-9.6) 1.7(0.0-4.4)

p-value:0.0017; a- CL means Confidence Limits


Differences in heavy alcohol consumption and depression among Non-Hispanic Black women compared to Non-Hispanic White women in the United States

Have you ever wondered what the differences in alcohol dependence and depression were among Non-Hispanic black women compared to Non-Hispanic white women? 

  Well have no fear, Quonesha is here (to inform you)! 

Depression and alcohol use disorder affects many Americans nationwide. Evidence suggests that depression and alcoholism are closely associated as there are at least 30-40% of those with alcohol dependence that experience some type of depressive disorder (Hobden, Bryant, Sanson-Fisher, Oldmeadow, Carey 2018); however, there is conflicting evidence that suggests whether depression causes alcohol dependence or if alcohol dependence is the cause of depression (Boden & Fergusson 2011).

Although the prevalence of alcohol dependence affects many racial groups, Non-Hispanic black women are known to be less likely than persons of other racial groups, such as Non-Hispanic whites, to use and abuse alcohol. In contrast, the prevalence of depression is higher among Non-Hispanic black women (9.2%) compared to Non-Hispanic white women (7.9%) (Klein, Sterk, Elfison, 2016 & Caetano, Baruah, Chartier, 2011).

For a further look into previous research studies, I decided to take it upon myself to conduct my own study that examined the differences in heavy alcohol consumption and depression among Non-Hispanic black women compared to Non-Hispanic white women.

To conduct this study, I used data from 2015-2016 National Health and Nutrition Examination Survey (NHANES)  to examine the differences in heavy alcohol consumption and depression among Non-Hispanic black women compared to Non-Hispanic white women residing in the United States. There were 971 (32.6%) Hispanic women, 651 (21.8%) Non-Hispanic black women, 910 (30.6%) Non-Hispanic white women, and 444 (15%) women of other racial groups present in this research study; however, Non-Hispanic black women and Non-Hispanic white women where used for this study.

Heavy alcohol consumption was measured by women that consumed more than eight drinks per week or more than three drinks per occasion, and mental health status was measured using a depression screening that asked participants a series of questions regarding depression. To analyze the data, i decided to perform Chi-square tests of independence and logistic regressions to predict the relationship between the independent variable, race, and the dependent variables, heavy alcohol consumption and depression. 

There were significant differences among Non-Hispanic black women compared to Non-Hispanic white women, regarding heavy alcohol consumption (p-value: 0.002). However, there were no significant differences among Non-Hispanic black women compared to Non-Hispanic white women, regarding depression (p-value: 0.288) and depression and heavy alcohol consumption (p-value: 0.242).

Additionally, the logistic regression analysis found that there were significant differences between the two groups regarding heavy alcohol consumption (p-value: 0.007, O.R: 1.51, 95% C.I: 1.13, 1.99). However, there were no significant differences among the two groups regarding depression (p-value: 0.259, O.R: 1.16, 95% C.I: 0.88, 1.55) and depression and heavy alcohol consumption (p-value: 0.271, O.R: 1.34, 95% C.I: 0.77, 2.32)

  Depressed* Heavy alcohol consumption* *Depressed and heavy alcohol consumption
  **N (%) P-value Odds Ratio

(95% CI)

**N (%) P-value Odds Ratio (95% CI) **N (%) P-value Odds Ratio

(95% CI)

Total 370 (25.9) N/A N/A


381 (35.4) N/A N/A


134 (34.8) N/A N/A


†Race/ Ethnicity

    Non-Hispanic Black women

    Non-Hispanic White women



132 (3.6)


238 (22.2)







1.00 (ref)


1.16 (0.88,1.55)



120 (3.9)


261 (31.5)







1.00 (ref)


1.51 (1.13,1.99)



43 (4.0)


91 (30.8)







1.00 (ref)



(0.77, 2.32)



The results from this study both contradict and support previous studies. The analyzed data indicates that there were significant differences among Non-Hispanic black women compared to Non-Hispanic white women regarding heavy alcohol consumption, which supports previous studies. However, there were no significant differences among Non-Hispanic black women compared to Non-Hispanic white women regarding depression and depression and heavy alcohol consumption, which contradicts previous studies. Additional research is clearly needed to better understand the etiology and patterns of alcohol use and depression among women across and within racial and ethnic groups. 

I also think that a better understanding of the underlying causes of alcoholism and depression among the two groups will inform public health officials to develop effective prevention programs and interventions that are specifically targeted towards each group (Withbrodt, Mulia, Zemore, Kerr 2014 & Assari 2014).  Affordable alcohol rehabilitation centers that provide mental health services with certified clinicians should be placed in areas with increased rates of alcohol abuse and depressive disorders to make certain that every individual, regardless of race, can receive the same treatment.



Assari S. (2014). Separate and Combined Effects of Anxiety, Depression and Problem Drinking on Subjective Health among Black, Hispanic and Non-Hispanic White Men. International journal of preventive medicine5(3), 269–279.

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-     914.

Caetano, R., Baruah, J., & Chartier, K. G. (2011). Ten-Year Trends (1992 to 2002) in Sociodemographic Predictors and Indicators of Alcohol Abuse and Dependence Among Whites, Blacks, and Hispanics in the United States. Alcoholism: Clinical and Experimental Research.

Hobden, B., Bryant, J., Sanson-Fisher, R., Oldmeadow, C., & Carey, M. (2018). Co-occurring depression and alcohol misuse is under-identified in general practice: A cross-sectional study. Journal of Health Psychology, 23(8), 1085–1095.

Klein, H., Sterk, C. E., & Elifson, K. W. (2016). The Prevalence of and Factors Associated with Alcohol-Related Problems in a Community Sample of African American Women. Journal of Addiction, 2016, 1-11.

Witbrodt, J., Mulia, N., Zemore, S. E., & Kerr, W. C. (2014). Racial/Ethnic Disparities in Alcohol-Related Problems: Differences by Gender and Level of Heavy Drinking. Alcoholism: Clinical and Experimental Research,38 (6), 1662-1670.

Alcohol prevention strategies: Prevention efforts should be different for men and women

Over the past few weeks in class, we’ve had conversations about alcohol use and risks associated with it. The NIAAA described the health risks associated with excessive drinkings such as heart disease, cancer, problems of the liver, pancreas and others such as sexually transmitted infections, violence, suicide. Most researchers believe that risks associated with alcohol drinking outweigh any potential health benefits from moderate drinking. As an example, Professor Walter Willett of epidemiology and nutrition at Harvard T.H. Chan School of Public Health thinks that heavy drinking is harmful.

What’s moderate drinking?


  The CDC  and NIAA defines the term “moderate drinking” as  

       1. Beer 12 ounces (5% alcohol content).

       2. For malt liquor 8 ounces  (7% alcohol content).

       3. For wine 5 ounces  (12% alcohol content).

       4. 1.5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whisk


A new study on  Alcohol: Balancing Risks and Benefits concluded that there’s no amount of alcohol consumption that’s safe for overall health — a finding that’s likely to surprise moderate drinkers, and that has left some experts unconvinced.

The federal, state and local authorities in the US work together to minimize health risks associated with alcohol drinking.  

In this blog, I’m sharing some of the alcohol prevention strategies I’ve learned for the past few weeks while taking a class in Special topics in Epidemiology on alcohol and women.

  • Prohibitions of alcohol sponsorship of public events – Alcohol sponsorship by alcohol companies has been a  debated issue in recent months. According to a Sponsorship Today report, more than $1 billion was spent on sports sponsorships by beer companies alone in 2012. prohibition by integrating sports sponsorship with responsible consumption messages. 
  • Increases in price through excise taxes –Increase taxes have consistently been found to reduce alcohol consumption and problems, especially among youth. Alcohol excise taxes affect the price of alcohol and are intended to reduce alcohol-related harms, raise revenue, or both. Alcohol taxes are implemented at the state and federal level, and are beverage-specific (i.e., they differ for beer, wine, and spirits). In the US, Alabama and Washington’s state have some of the highest taxes on alcohol
  • Controls on alcohol advertising (especially on billboards, sides of buses, and in other public areas)-The alcohol industry are among the leading advertisers on billboards. Billboards advertising beer and hard liquor are readily visible to children. These advertisements expose and encourage excessive drinking among youth. Laws of Billboard advertisement in Georgia prohibits advertising alcoholic drinks and tobacco products at children, educational and medical institutions, culture and sports organizations within 100 meters radius of them is prohibited.

  • Limiting hours of sale:    –Another strategy to prevent excessive alcohol consumption and related harms is to limit access by limiting the hours during which alcohol can legally be sold.  In the US they differ from one state to another. In Atlanta, Georgia, packaged liquor may be sold between 12:30 p.m. and 11:30 p.m. on Sunday, and between 8:00 a.m. and 11:45 p.m., Monday through Saturday. Packaged beer and wine may be sold at any time except between midnight Saturday night and 12:30 p.m. Sunday afternoon, or between 11:30 p.m. Sunday night and 12:01 a.m. on Monday.  Alcoholic beverages may be served in bars and restaurants between 12:30 p.m. and midnight on Sunday, and between 9:00 a.m. and 2:30 a.m., Monday through Saturday.


Should we make these strategies different for women and men?

The answer to this question is YES. Alcohol offers each group a different spectrum of risks. It is necessary for everyone, especially policymakers to understand that alcohol affects women’s bodies differently. Unlike males, women are more likely to suffer the health and social effects of alcohol consumption. Also, women are vulnerable to the secondhand effects or alcohol harms of excessive alcohol consumption among others.

With a recent report on an increase in the number of women who drink, there should be an awareness of these health risks and make informed decisions about alcohol use. As such, it should be given special attention.

We also need to be aware that women are the target for more recent alcohol ads and campaigns. Advertisers market liquor as “diet” or “natural” in an effort to appeal to health-conscious women. 

I Didn’t Black Out, I Just Got A Little Absinthe-Minded

To have an effective prevention strategy, you must first understand what causes people to engage in such behaviors you’d like to prevent. Knowing why people do what they do is a critical first step in creating meaningful change. As most people can personally attest to, making or breaking habits is hard work. If successful, it is often only after many false starts. To make a long-lasting change at the population level you need buy in from many; however, you must also recognize that with many people, comes many different ‘why’s’.

Consider alcohol consumption; people overindulge for many reasons. Simplistically, we can divide those reasons into two overarching concepts, positive reinforcement and negative reinforcement. It has been established men typically drink for the former, and women for the latter. Because the motivating factors for drinking differ among gender, so too should an effective prevention strategy.  Targeting a campaign about alternative ways to party and celebrate without alcohol, especially regarding sporting events may be effective for men, but significantly less so for women, because that’s not why the majority of women drink or abuse alcohol.



Women drink to excess to alleviate societal pressures and undiagnosed or unregulated mental health disorders like anxiety and depression. One effective alcohol prevention strategy targeting women could start with mental health awareness. Teaching women how to recognize the signs of anxiety and depression, and then help them to identify how and where to get help would hugely reduce the onset of female alcohol misuse. If women understood the emotions they are experiencing are actually symptoms of a condition that can be treated, they may be more likely to address them with a healthcare professional, instead of thinking that’s just the hand they were dealt and cope independently and unregulated with alcohol. Education is power, and teaching women what to look out for, both for themselves and for the women in their lives around them, could stop a lot of damage before it starts.  

Rob Turrisi, professor of biobehavioral health and prevention research at Pennsylvania State University, featured in Drink, has developed a handbook for effective parental interventions concerning drinking.  This handbook is meant to capitalize on the concept that knowledge is power and communication is key. Young people are particularly vulnerable to alcohol misuse, because the regulatory part of their brain is has not yet reached full maturity. This means an effective prevention strategy is parents sitting down with their college bound students and preparing them for the dangers ahead. Turrisi states that this prevention strategy is more effective with young girls than young boys. Because it’s less effective for boys does not mean that the prevention strategy is not working for girls, it means that another strategy should be identified to help males.

Another important part of successful alcohol prevention is to help make people aware of what other things they may be at higher risk for when under the influence. This differs for men and women. Women are at higher risk of sexual assault, STDs, and having a child born with fetal alcohol syndrome. Men, who typically occupy higher level professional positions are more at risk for getting fired or losing status and position. They’re also more likely to be arrested for assault than women while under the influence of alcohol. Effective prevention strategies will help people make internal pro/con lists and help them evaluate if abusing alcohol is worth the potential outcomes, but first you must make it personal for them, make them feel invested, give them a reason to listen. After you’ve gotten their attention, it is important to educate them, and empower them to successfully commit to the prevention strategy. 

The Consequence of Turning a Blind Eye 


While there are some general, yet quantifiable, differences between males and females in terms of biology and physiology, there are seemingly endless dichotomies between these two genders in terms of social norms and expected behaviors. From preferences to habits, from tendencies to relationship expectations – we’ve created cultural binaries and placed men and women on opposing sides. This results in measurable differences that have real impacts on physical, mental, and emotional health. 

We know about how alcohol has varying physiological afflictions on these two sexes, but we haven’t yet adequately considered the different approaches required to address how men and women must approach recovery. Because women are “less likely to seek treatment” for an alcohol use disorder and instead “tend to seek care in mental health or primary care settings,” women are immediately at a disadvantage when it comes to addressing dependence and addiction (Gender and Use of Substance Treatment Services). Part of this is due to a heavier stigma placed upon women when it comes to substance abuse – leading women to not only avoid such a diagnosis but also be less able to recognize one – and it seriously damages a woman’s ability and likelihood to recover. 

In order to address this disparity, we must recognize the ramifications not only presented by physiological divergence, but also those created by an arbitrary, two-sided culture. By seeking equality, we fail to achieve equity. Our response must be to acknowledge these distinctions while they continue in light of gender-specific norms. We must accept the unique needs of different cohorts – be they by gender identity, ethnicity, or the unpredictable nature of individuality. 

As it relates to women in need of treatment for alcohol use disorders, a crucial next step in improving care and outcomes would be to collaborate with mental and primary healthcare providers. If women are failing to see the addiction within their anxiety or depressive symptoms, they must be defined. Mental and primary healthcare providers should receive additional training on recognizing alcohol use disorder in women of all ages, and they should have appropriate and specialized referrals they can make. In this way, we address one of the first and most crucial obstacles – helping people to recognize that they have an unhealthy and toxic relationship with alcohol.  

Sober Curious: Are you curious?

Chris Marshall had a rocky past with alcohol. As is written in a recent feature posted on NPR, he drank throughout much of his teen years, receiving a DUI at the age of 16. After he got sober and become a substance abuse counselor, he realized that it was hard for freshly sober people to rejoin the ‘real world’ after completing treatment or rehabilitation.

It’s one thing to stay sober in an environment with no alcohol, but how do you resist a night out with friends at a trendy restaurant? Alcohol is everywhere, ingrained in much of our social, evening, and weekend activities, and it can be difficult to still feel social without its consumption—whether you are recovering from alcohol addiction or not.

Enter: sober curious. A new trend making its way through cities and countries, being sober curious can vary in meaning depending on who you ask. For some, it is a way to explore a permanently sober lifestyle. For others, it simply means incorporating more alcohol-free days and activities into their routine.

Marshall explored this idea and created a new nightlife option for sober curious folks, named the Sans Bar in Austin, TX. Since its inception, the bar has become a traveling pop-up bar making its way throughout the US, visiting various cities and encouraging more alcohol-free activities. In the video below, you can see Marshall demonstrating a few sans-alcohol drinks that his customers enjoy.

Personally, the Topo Chico with raspberry sounds right up my alley.

But the question is, is it sustainable? Can sober curious go from a grassroots effort to a cultural phenomenon, without the stigma of “not drinking” tied to it? Although I do think certain trends pass through for a season, I believe sober curious can withstand the test of our generation. Why, you ask? Because our society is trending towards health, prevention, and wellness in all areas of our life. A report published in 2018 by Nielsen reported that 67% of Americans say they will be prioritizing healthy or socially conscious food purchases in 2018. Although this data does not focus on alcohol drinking specifically, it does highlight the growth in general health and wellness consumption trends in the US market.

Credit: The Nielsen Company. February 7, 2018.

And it is no secret that alcohol is bad for us. As stated by the Centers for Disease Control and Prevention (CDC), excessive alcohol use over time can cause high blood pressure, heart disease, stroke, liver disease, certain types of cancer, learning and memory problems, mental health problems, social problems, and more. Americans are concerned with what they are putting in their body, and I think this timing of the sober curious trend is conducive to continued growth. And as you can see above, healthy, non-alcoholic beverages are on the rise.

As if that wasn’t convincing enough, Instagram reveals even more. Accounts focused on living sober or being alcohol-free have gained popularity recently, some—like Sober Girl Society and Sober Nation—amassing over thirty thousand followers each. There is even a post on Sober Girl Society’s page specifically referencing the sober curious trend, and asking her followers to define what it means to them.

I feel strongly that being sober curious can become a regular, run of the mill way of life for many. I feel the timing is right, and the opportunity to melt the hardened stigma around not drinking is here. But the trend won’t grow on its own! We need to do our part to show support for these spaces. Request them in your area, patronize events/activities that purposefully are alcohol-free, or simply do your part in making those without alcohol comfortable in drinking situations.

With our help, sober curious can become the new sober normal.  

Alcohol Prevention Strategies: Needed for Both men and Women



Excessive alcohol use is responsible for approximately 88,000 deaths in the united states each year and $249 billion in economic costs in 2010. Excessive alcohol use includes

  • Heavy drinking (defined as consuming 8 or more alcoholic beverages per week for women or 15 or more alcoholic beverages per week for men)
  • Binge drinking (defined as consuming 4 or more alcoholic beverages per week for women or 5 or more drinks per occasion for men)
  • Any drinking by pregnant women or those younger than age 21.

The strategies listed below can help communities create social and physical environment that discourage excessive consumption thereby, reducing alcohol-related fatalities, costs and other harms. (


Some of the recommendations are-

  • Regulations of alcohol outlet density– alcohol outlet density refers to the number and concentration of alcohol retailers (such as bars, restaurants, liquor stores) in an area. Reducing the alcohol outlet density is one of the strategies to reduce alcohol sales and consumption by people.
  • Increasing alcohol taxes – alcohol excise taxes may include wholesale, excise, or sales taxes, all of which affect the price of alcohol. Taxes can be levied at the federal, state, or local level on beer, wine or distilled spirits. (
  • Dram shop liability – Dram shop liability, also known as commercial host liability, refers to laws that hold alcohol retail establishments liable for injuries or harms caused by illegal service to intoxicated or underage customers.
  • Maintaining limits on days of sale – states or communities may limit the days that alcohol can legally be sold or served.
  • Maintaining limits on hours of sale – states or communities may limit the hours that alcohol can legally be sold.
  • Electronic screening and brief intervention (e-SBI) – e-SBI uses electronic devices (e.g., computers, telephones, or mobile devices) to facilitate delivery of key elements of traditional screening and brief interventions. At a minimum, e-SBI involves screening individuals for excessive drinking, and delivering a brief intervention, which provides personalized feedback about the risks and consequences of excessive drinking. (
  • Enhanced enforcement of laws prohibiting sales to minors – Enhanced enforcement programs initiate or increase compliance checks at alcohol retailers (such as bars, restaurants, and liquor stores) for laws prohibiting the sale of alcohol to minors
  • Screening and brief intervention for excessive drinking in clinical settings – Screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings can identify people whose levels or patterns of alcohol consumption do not meet the criteria for alcohol dependence, but place them at increased risk of alcohol-related harms.11
  • Additional alcohol policies – other policy areas such as laws and regulations related to the minimum legal drinking age and sales to underage youth, privatization or monopolization of alcohol control systems, monitoring of alcohol outlet densities. Restriction in these areas make alcohol less available. (


According to me, the prevention strategies should not be different for men and women.

Also by the UK’s new alcohol guidelines advise that men and women shouldn’t drink more than 14 units of alcohol a week.

Earlier the British drinkers presented a higher threshold for men but now the alcohol guidelines are same for men and women. So, what was the evidence that the limits shouldn’t take gender into account. The different risk factors faced by men and women are apparent at higher levels of consumption-what we now call “drinking with increasing risk”.

That is, men who regularly drink more than three or four units a day and women who regularly drink more than this or three units a day. But at levels of consumption lower than this, these differences are not as clear cut. (

The new guidelines present the message that there is no “safe” level of alcohol consumption but stop short of recommending abstention as the best policy. In fact, the Sheffield data shows that for both men and women drinking up to seven units a week, spread across three or more days, actually has a protective effect on death from an alcohol-related health condition. For men the benefit is very small (a 0.1% improvement), compared with over 2% for women.
















Alcohol Harm in Women

The harm alcohol can cause women has been proven, but it is still widely unknown amongst people, hence, the growing amount of women who are consuming alcohol. Because women’s bodies absorb more alcohol than men, it takes a longer time for the body to metabolize and rid the body of it, so there is a greater risk for long-term health problems.

The CDC reports that 46% of adult women reported drinking in the last 30 days, and 12% of women reported binge drinking 3 times per month–averaging 5 drinks per binge. Women may have adverse health outcomes from these behaviors related to reproduction and fertility, liver disease, brain function, heart function, an increased risk of cancer, and an increased risk of sexual assault. 

The relationship between alcohol consumption and breast cancer has also been heavily researched. The Susan G. Koman website reports that from an analysis of 53 studies, it was found that for each alcoholic beverage consumed each day, the relative risk of breast cancer increased 7%. Some may argue that there has been proven benefits for the heart with drinking alcohol, but as this article states–is this a fair trade when the risk of breast cancer is also increased? With such overwhelming evidence that there is a relationship between alcohol consumption and breast cancer (and other diseases), how can we make sure women are receiving the message that alcohol is harmful to our health? 

Doctors should get involved, and ask screening questions about alcohol use. Doctors should be able to educate women on the adverse health outcomes of alcohol consumption.

Brief interventions have been proven to reduce drinking alcohol among women. These interventions were performed in clinical settings and healthcare services, and the study showed that there was an decrease in both the number of days alcohol was consumed and the amount. The effectiveness of these brief interventions was noted to be related to the impact on reproductive health and the lower social acceptance of female consumption.  However, young people are less interested in having babies now more than ever. We also know it is becoming increasingly acceptable for women to consume alcohol.

This article discusses the cultural shift and how pop culture seems to “celebrate women who drink rather than warn against it.” This makes it difficult to identify what kind of interventions would be successful. 

There have been public campaigns against harmful substances such as tobacco and e-cigs, as well as campaigns against drunk driving and texting while driving.  Perhaps a campaign about the gender-specific effects of alcohol on women would be helpful. I, for one, have these campaigns in the back of my mind when I see people smoking cigarettes or texting while they are driving. It is a tricky issue because some may see this kind of campaign as an attack on women. Most importantly, I believe conversations like those tweeting #GSUwhyshedrinks must continue, as awareness is key for solving this growing issue. 

One Shot of Sober Curious, Please.

The Beginnings

There is a new trend taking off and it will leave you in the dust if you do not catch on: The Sober Curious movement. In a nutshell, “sober curious” or “sober sometimes” means when an individual has consumed alcohol in the past and does not like the way it makes them feel, but that individual is not completely done consuming alcoholic drinks. Confusing right? Splitting up the two words might make more sense.

Sober- not drunk, or not affected by alcohol; abstaining from alcohol.

Curious- eager to learn or know; inquisitive; prying.

Combining both words, we get, someone who identifies as sober curious means they are interested in the idea of abstaining from alcohol or staying sober, sometimes. The sober curious movement creates a culture for people to feel comfortable in their sobriety. Often the first response to someone denying to drink is “what’s wrong with you”, “come on, just have one”, or “you’re boring”. These typical responses are negative and can be corrupting to an individual who is trying to recover from their alcohol dependence. Additionally, negative words towards turning down a drink can lead to irresponsibility when consuming alcoholic drinks, including binge drinking, underage drinking, and risky behavior while drinking.


Social Media Presence

People have practiced sober curiosity long before the term was coined. Remember the post you use to see on Facebook every start to a new year? After an extensive holiday season of eating good and drinking long, your social media friends might have gone to their news feeds to express their sober start to the New Year and challenge their friends to join in on the movement. This public health campaign is better known as “Dry January”.

When a research study conducted in 2016 followed participants of the “Dry January” sober movement, results showed 82% of the participants said they felt like they accomplished more, 62% had better sleep habits, and 49% of the participants stated they lost weight while staying sober. These social media sober challenges did not end at just January, the challenges continued into other months such as “Dry July” and “Sober September”.


In recent years, sober social groups and communities have begun to gain recognition. On Instagram, @ASoberGirlsGuide, @SoberGirlSociety, and @TherapyForWomen are just a few examples of unique accounts that are tailored towards living a sober lifestyle and encouraging sober curiosity. Sober Girl Society has over 40 thousand followers, all inspiring to live healthier lives. Not too long ago, the Sober Girl Society provided a post for her followers to discuss in the comments what being sober curious meant to them. Reading through the comments, I could tell that the discussion was meaningful and educating to the followers. Sober Girl Society is providing a safe space for individuals, specifically women, to ask question, seek help, and build a community that encourages sobriety and independence from alcohol.






Culturally Acceptable

Although practicing sober curious behavior is not recommended for people who are alcohol dependent, the sober curious movement has sparked ideas for alcohol dependent communities to join in on the culture. Non-alcoholic bars are popping up everywhere. Owner of the sober bar, Sans Bar in Austin, Texas, Chris Marshall has been sober for the past 12 years. He opened Sans Bar to provide a comfortable place where people can socialize, eat drink non-alcoholic drinks, and meet other sober friends. The feedback from Sans Bar has been so accepting that Chris has taken his sober bar on the road. Chris has opened other sober bars in Kansas City and Massachusetts, and has also hosted pop-up bars in popular cities such as New York and Washington D.C.  

Additionally, Ruby Warrington, author of the book “Sober Curious: The Blissful Sleep, Greater Focus, Limitless Presence, and Deep Connection Awaiting Us All on the Other Side of Alcohol.”, is also the co-founder of a posh New York City venue called Club SÖDA NYC. Just like Warrington, Club SÖDA NYC is a sober curious social community offering a list of non-alcoholic drink options for consumption.

I believe the sober curious initiative will gain cultural acceptance the more people learn and understand the meaning behind the movement. Proof of the acceptance is in the abundance of social media pages and groups promoting the movement, as well as the communities providing sober atmospheres.  The interesting thing about being sober curious is that there is no right or wrong answer as to how much you identify with it. The way everyone expresses their sobriety is unique and personal to themselves. There also is no shame associated with the movement. People can drink, both alcoholic and non-alcoholic, without the having to answer questions, nor feel embarrassment.



Do we need to consider gender differences when developing prevention strategies for excessive alcohol consumption?

The negative consequences of alcohol consumption are harmful to both men and women. This could not be overstated, as there are numerous studies in the literature documenting the risks associated with alcohol consumption.   Excessive alcohol consumption leads to alcohol dependence and abuse, but overtime it can lead to the development of chronic diseases

Given the high costs of excessive alcohol consumption and the concern of alcohol abuse and dependence to both people and society, evidence-based approaches for preventing harmful alcohol use are key. Are these prevention strategies different for men and women? What do you all think?

Some strategies could be targeted towards both sexes however, definitely without a doubt there needs to be strategies focused only for women. Why is this so?

Most importantly, women are more vulnerable to negative effects of alcohol than men. As noted in the literature alcohol is metabolized differently in women than men and women continue to be at a higher risk for serious health consequences when compared to men. There is evidence from studies that for equivalent doses of alcohol, women are more vulnerable than men to tissue damage and the onset of certain diseases such as cirrhosis of the liver and physical alcohol dependence (1). In addition, it is found from studies that women often start drinking at an older age, yet the progression from first drink to alcohol dependency progresses much more quickly in women than in men (2). This phenomenon is known as telescoping (3).Further, we all know that excessive alcohol consumption by pregnant women is a risk behavior for Fetal Alcohol Spectrum Disorders and other adverse pregnancy and birth outcomes, including miscarriage and stillbirth.

What are some of these prevention strategies targeted for women?

Well, before we think about these, we should first try to determine the reasons why women drink in the first place? According to studies reviewed in the literature, the experience of a negative effect such as anxiety, depression and violence against women serves as cue for alcohol consumption in women. Prevention strategies must focus on targeting the underlying risk factors related to excessive alcohol use such as mental health component of anxiety and depression and offer support to women who are victims of violence. This may in-turn cause the reduction of alcohol use among women.

Another prevention strategy is to make women aware of risks of alcohol use. However, education and awareness strategies on Alcohol and its related risks use must be given at a time for women in their adolescence period as this can contribute to behavior change thereby enabling opportunities to encourage delaying the use of alcohol. This prevents excessive alcohol consumption among women which can also delay all potential risks associated for young women when using alcohol.

An American College of Obstetricians and Gynecologists Committee Opinion recommends alcohol use screening for all women seeking obstetric-gynecologic care, including counseling patients that there is no known safe level of alcohol use during pregnancy, and recommends that women who are pregnant or who might be pregnant be advised to avoid alcohol use.

1. Kalant H. Absorption, diffusion, distribution and elimination of ethanol: effects on biological membranes. In: Kissin B, Begleiter H, eds. The biology of Alcohol ism, vol 1. Biochemistry. New York: Plenum Press, 1971.
2. Cyr MG, McGarry KA. Alcohol use disorders in women. Screening methods and approaches to treatment. Postgrad Med.2002; 112:31-32,39-40,43-47.
3. Greenfield SF, Manwani SG, Nargiso JE. Epidemiology of substance use disorders in women. Obstet Gynecol Clin North Am.2003; 30:413-446.