One of thousands of women who responded to an informal Internet survey O conducted about alcohol consumption, Laurel had recently stopped drinking for weight and health reasons. She is not alone in her concern. Some 36 percent of the more than 5,000 women who answered our questions said they were afraid they might be drinking too much; 52 percent said they think about stopping.
Our research reveals that many women wrestle with the same nagging questions: Is alcohol affecting my health? How do I know if I have a problem? Will I feel better if I stop? Problem is, there may be as many answers to these questions as there are people who ask them.
How much is too much? That depends on what you're most afraid of. If it's alcoholism, it's safe to say that limiting yourself to a maximum of one drink per day (for instance, a 5-ounce glass of wine or 12 ounces of beer) will keep most women out of the danger zone. Those who are pregnant have a good reason not to drink at all: Most experts counsel-total abstinence, although some obstetricians allow their patients an occasional glass of wine or beer with dinner. Keep a drinking diary: Many people find they are well within safe levels (75 percent of the women in our poll reported having fewer than four drinks per week).
Does this mean that if you drink two glasses of wine a night you're a little bit alcoholic? Absolutely not. People metabolize alcohol differently. The stout Winston Churchill could probably handle many more drinks than, say, the bone-thin Audrey Hepburn. "Some people can have two glasses of wine a night and not suffer consequences. For others, the same amount can compel them to overindulge," says Arnold M. Washton, Ph.D., director of the Center for Addiction Psychology in Manhattan and author of Willpower's Not Enough. Many factors can predispose a person toward alcohol abuse, among them familial attitudes, psychological history and friends' drinking habits.
The key to recognizing a problem is determining whether drinking has a detrimental effect on your life. "If you're merely a social drinker, you won't end up regretting anything you did or said," says Washton. Habitually making inappropriate comments, acting out sexually, driving dangerously, blacking out or waking up sick because of alcohol are signs of a serious problem, no matter how infrequently a person drinks.
Alcoholism is generally diagnosed by what some experts call the Three C's: control, compulsion and consequences. Any woman who always drinks more than she intends to, is preoccupied with drinking and suffers negative consequences from it has a problem that requires professional help. "If those behaviors are present, red flags go up for me," says Nancy Jarrell, a family therapist and addiction specialist at Sierra Tucson, a psychiatric hospital in Arizona. "A typical justification is 'I only drink after five o'clock'—but what happens after five is out of control."
People who are not alcoholic should be able to follow their own rules. "The acid test of whether someone is dependent is to see if they can cut back on their drinking for 90 days," says Washton. "It's about setting up guidelines and seeing whether you can stick to them."
Estrogen seems to be the culprit. Studies have shown that alcohol temporarily increases estrogen concentrations in the blood, and elevated estrogen levels are associated with breast cancer. This effect has been shown to be more pronounced among women using estrogen replacement therapy. While additional studies are needed, the message is clear: "Avoiding alcohol is one way a woman can reduce her risk of breast cancer," says Michael J. Thun, M.D., head of epidemiological research for the American Cancer Society.
Postmenopausal women, however, often have a greater risk of dying from heart disease or stroke than from breast cancer. One drink a day (especially red wine) has been shown to reduce the risk of cardiovascular disease by up to 40 percent. The net result is that people who consume a glass of alcohol per day may live longer than nondrinkers. Because every woman must weigh the costs and benefits of drinking based on her own family history, age and risk of disease, it is impossible to make - a blanket statement about how much is too much.
There are, of course, other health consequences to consider. Alcohol is primarily processed in the liver (which puts that organ at the greatest risk), but it can also work its way into the reproductive system, the skin, eyes, bones, breasts, breast milk and the fetus. "Because alcohol is a very small molecule, just slightly bigger than water, it can get inside every cell," says Sheila Blume, M.D., a psychiatrist who has researched alcohol's effects on women. "Almost any organ in the body can be affected." And then there is the troubling, if not life-threatening, matter of weight gain. A four-ounce glass of wine contains about 120 calories, a shot of vodka packs 105, and 12 ounces of beer has 150. You'd think twice about ordering crème brûlée for dessert but nothing of downing three drinks with dinner.
The good news (and by now you need some) is that drinking in and of itself does not lead directly to alcoholism. "Most people who start smoking socially will become addicted, but the same isn't true of alcohol," says George E. Vaillant, M.D., author of The Natural History of Alcoholism and director of research in the department of psychiatry at Brigham and Women's Hos-pital in Boston. In that sense, drinking is more analogous to food than it is to a drug. Some people feel obese when they gain an inch at the waistline, while others don't. An individual must determine the right level of consumption for herself.
For most people, experimentation comes in the teens and early twenties. "I was into partying in college, where drinking and socializing went hand in hand," says Brittany Marr, a 23-year-old from Boulder, Colorado. "Though I had a good time, I was tired and lacked the desire to eat well and exercise. Finally, I cut back and started to feel like myself again."
Many women feel they can drink less than they used to. "I noticed my inability to recoup. Instead of a few hours to get rid of my hangover, it took a couple of days," says Robin Stefko, 36, who e-mailed from Marion, Illinois, to tell us that she now alternates drinks with glasses of ice water and no longer wakes up feeling as though she's been "hit by a semi-truck." Being able to drink less than before is, in fact, a good sign. People with drinking problems generally develop a higher tolerance for alcohol.
Loosening up and having fun were by far the most frequently cited reasons for drinking in the O poll. "When I drink I feel social and fun! Very much the opposite of my sober self," says Kristy Bales, 30, of Seattle. Fortunately, Kristy has strong internal controls. "Alcohol has almost become sacred to me; I like to share it with friends on special occasions."
Every culture has its means of achieving altered states of consciousness. Drinking is our accepted mode of transport from the daily grind into some other realm. But it certainly doesn't qualify as the healthiest pastime. It all comes down to that old adage Everything in moderation. Follow the example of Brittany Marr: "I've learned to balance drinking with living a healthy life, where it's okay to have a glass of wine but also know when to say no. Then I can wake up the next morning and hit the trails of Boulder."
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