Millions of women in the U.S. engage in drinking behavior that poses a substantial risk to their health and well-being, particularly young women in their late teens and early twenties. Addiction researcher Audrey Klein, PhD., joins host William C. Moyers to take a closer look at what's behind the increased rates of binge and heavy drinking among women, why addiction progresses more rapidly for women than men, and what kinds of medical, mental health and other complications are associated with hazardous drinking for women. Klein also addresses the shame factor: Women typically wait longer than men to seek help for addiction, resulting in a more severe progression of the disease.
0:00:16 William Moyers
Greetings and welcome to the Hazelden Betty Ford Foundation Let's Talk Podcasts. I'm your host, William Moyers, and I've worked for the organization since 1996. However before that I was a patient at Hazelden and so I am an alum and thus that makes me a man in long-term recovery from addiction to alcohol and other drugs. Thanks for joining us and listening in on our series of podcasts conversations with my colleagues about the important issues related to prevention, research, treatment and recovery. Today we're talking about women and alcohol. And my special guest is Dr. Audrey Klein. Dr. Klein is the executive director of the Butler Center for Research at Hazelden Betty Ford. She joined Hazelden in 2007. She has a PhD in Experimental Psychology and her Masters in Cognitive Psychology. And believe it or not, she also has an MBA. And so before we get started in our conversation today, Dr. Klein, I have to ask you, with your interest in all things Psychology, why the MBA?
0:01:21 Dr. Klein
You know William that is a great question. Thank you for having me, it is absolutely wonderful to be talking with you today. I am absolutely passionate about the field of addiction and people that are providing treatment for addiction constantly challenging ourselves to create new ways to treat patients. New products, new resources, new tools. So in order to be able to do that and help both my current organization and other organizations focusing on addiction, to—to be innovative and to be thinking and implementing new ideas for patients, I figured I better beef up my business acumen a little bit.
0:02:03 Dr. Klein
I was trained as a scientist, I am a scientist at my core, but I have a really strong interest in business and business strategy and how to really get really good evidence-based tools and products out to people with mental health issues. I don't know if that answers your question, but—[laughs]
0:02:21 William Moyers
That answers it. That's good. And not only that, but for a scientist as somebody with an MBA you certainly are passionate about the subject so I've always respected your not just your acumen, but your passion for addiction treatment and research and I wish, I wish you could share just a little bit more if you would on your role as the executive director of the Butler Center for Research. What do you mean, research in addiction treatment?
0:02:45 Dr. Klein
A lot of people ask that. So, way back in the day, several decades ago, a couple of the guys that founded Hazelden Betty Ford Foundation felt very strongly that if you are providing services to help patients get better, you are obligated to do ongoing evaluation and measurement. Are your services having an impact? If patients are coming to you and wanting to get better, is that in fact the case? Science and research allows us to precisely measure how our patients are doing so we can look at—at what were they struggling with, how are they doing, before they came to Hazelden Betty Ford and got help versus how are they doing afterward? We also know that recovery from addiction is a lifelong illness. It's something that the person is always working on. So we need to look at how people are doing after they leave treatment.
0:03:47 Dr. Klein
The Butler Center for Research was started up all those years ago to do ongoing research to study the impact of treatment services. And it's one of the main things that we still do to this day. So I'm able to lead a team that engages in all those patient outcomes research efforts.
0:04:07 William Moyers
Perfect. And actually your expertise is part of another podcast that we have with Dr. Marvin Seppala on outcomes.
0:04:15 Dr. Klein
0:04:15 William Moyers
And so for our viewers and our listeners, if you're interested in outcomes as it relates to addiction treatment, you wanna make sure that you tune into that podcast as well. Today we're talking about women and alcohol, Dr. Klein. Why is it that we have to differentiate women and alcohol compared to everybody else and alcohol?
0:04:33 Dr. Klein
So that could be an extremely long answer. It's got a couple of different parts. I'll try to keep it fairly brief, William. The first and the most important reason is that women are at risk more than men for a number of things that relate to alcohol use and heavy drinking. A lot of people don't realize that women are more seriously, physically impacted by drinking. So if you take a man and you take a woman and they're even equal weight, if they drink a given amount of drinks, says three drinks in a two-hour period, a woman will be more physically affected in a negative way compared to the man. So—so alcohol will increase a woman's likelihood of getting liver damage, heart attacks, strokes. So all of those physical health conditions that we know are strongly linked to heavy alcohol use, for some reason women are way more likely than men to develop those conditions when they drink heavily. So that's the first thing.
0:05:43 Dr. Klein
The second thing is that alcohol and binge drinking, heavy drinking, drinking to intoxication or to get drunk, those have historically happened way more often with men. Right? And you even hear people make comments about oh drinking is still more accepted among men. And for a very long time, the difference between the rates or the frequency of hazardous drinking in men was much higher than in women. That gender gap is quickly starting to close.
0:06:17 William Moyers
I didn't realize that.
0:06:18 Dr. Klein
It is. And actually for millennials and very young people, it's not a gap at all. So young millennial women are drinking heavily like when you look at heavy or binge drinking, which binge drinking for women is four or more drinks in a sitting, for men it's five or more drinks in a sitting or on one occasion. When you look at frequent binge drinking, millennial women are doing it just as frequently as men. So those are a couple of reasons. The other reason and you know this very well, William, people that walk through the doors of Hazelden Betty Ford Foundation have developed a substance use disorder where they really need help to get better. The risk of developing an alcohol use disorder for anybody increases exponentially the more heavily you drink. Right? So if you start drinking heavily and you keep drinking heavily, your chances of becoming addicted to alcohol really increase. Women progress much more quickly than men once they start drinking heavily into an alcohol use disorder. That phenomenon is called telescoping. So sometimes you hear that term. Telescoping is describing that impact. It's very well established. And people will ask, well why is that? Why do women progress more quickly? And the theories and the evidence point to a couple of different things.
0:07:53 Dr. Klein
Physiologically our bodies contain less water and more fatty tissue. And all of those factors contribute to how alcohol impacts the body. So again, women are more likely to reach intoxication when they drink, alcohol lingers in women's bodies longer because they don't metabolize it and get it out of the body as quickly as men. So all of those factors most likely just make women more at risk. For both those physical consequences, brain damage, so the brain gets damaged more easily in women with long-term alcohol use. But also that progression to addiction happens much more quickly. One of the things that I really wanted to talk to you about is just getting those facts which are really well established facts out there to women so that they know. Because it's so important if you're worried about your drinking and you have concerns or you have concerns for a loved one or a friend, education is very powerful. You have to know how at risk you are, how is this impacting you or the person that you care about.
0:09:10 William Moyers
So where does somebody find that accurate evidence-based information on women and alcohol?
0:09:20 Dr. Klein
That's another fantastic question. So I would caution the people that are watching this look at your sources really carefully. The Internet is wonderful, there's a ton—what did we do without it, right? There's a ton of good information on the web. But you need to look at the website and the source of the information that you're looking at. I would like to direct people to Hazelden Betty Ford—
0:09:45 William Moyers
0:09:46 Dr. Klein
If they're interested. If you go on the web page and go to Education, you will—click on Education, you will see the Butler Center for Research. If you go to our page, we have a ton of great information. One of the—the pieces of information on there is a research update. Which is a four-page summary of some data that we collected very recently in collaboration with Healthy Women, another nonprofit, on women's alcohol use and attitudes. People can access and read that research update, we have a ton of other research updates that summarize what we know about different topics related to addiction. But there's also a ton of great resources out there. SAMHSA, that's an abbreviation S-A-M-H-S-A, is a governmental organization that puts out a ton of great information about drinking and the risks of heavy drinking and then NIDA is the National Institute on Drug Abuse. NIAAA is the National Institute on Alcoholism and Alcohol Abuse. Those are all federal agencies that do a ton of great things and generate reports and do surveys and collect and report out information to help people keep themselves healthy around alcohol use.
0:11:09 William Moyers
So I'll pause right here and just say the website is www.hazeldenbettyford.org and then you click the tab for Education and then you click the link to the Butler Center for Research to get that information. You talked about the physiology and some of the perspectives about women and alcohol. Talk to us about the consequences and how the consequences for women are different than the consequences for men.
0:11:34 Dr. Klein
That's another great question. So we mention the physical aspect William and again, a lot of people don't realize, women when they drink heavily over a prolonged period of time, will experience, they have a much greater risk of experiencing those really terrible health conditions that are associated with drinking. Alcohol-induced Hepatitis. So this isn't, you know, Hepatitis that people are born with or they get from other means. This is directly related to alcohol use, the liver gets very inflamed and diseased from use. Women's risk is way higher for that. Cirrhosis, liver cancer, breast cancer, is a huge risk for women even that drink at moderate levels. There's also a bunch of risks associated with being a victim of accidents or crime. They're at a lot of risk compared to women that don't drink to be victims of violence, victims of accidents, homicide—
0:12:41 William Moyers
0:12:42 Dr. Klein
Sexual assault. So with the sexual assault, even if it's not assault, even if it's a consensual act, a lot of times the frontal lobe when you drink a lot, the frontal lobe functions that are in the front of your brain that are responsible for good behavior and good decision-making, that goes out the window. So a lot of times women will engage in some risky sexual behavior, unprotected sex, those sorts of things that put them at additional health risks.
0:13:12 WILIAM MOYERS
But, we hear the health benefits of moderate alcohol use. Is that true?
0:13:16 Dr. Klein
So that's where definitions become reality, which becomes really important. So, there's some evidence, and I wish my friend Marv Seppala were here 'cause he could keep me honest on this. I think I'll do okay. There's evidence from the AMA and from other organizations that very light drinking can be beneficial. And by light drinking I'm talking about a glass of wine, you know a day, probably not even a day; every once in a while. Moderate drinking—who even knows what that is? That's something that it depends on who you ask. When I'm talking you to you today, I'm talking about heavy drinking, which again is multiple drinks in a given—on a given occasion, you know within an hour or two. That is not good for you. There's no study that says it's really great to pour four to five drinks, whether you're a man or a woman, but especially if you're a woman, into your body, and continue to do that day after day, week after week. So, quantity and frequency is all the difference when we're talking about alcohol use. Safe alcohol use is very light, very infrequent use. And so where—where we at Hazelden Betty Ford become really concerned, not just for the folks that we see, but for everybody in our communities, is when people don't always understand what is heavy, or hazardous, or "at risk" drinking. And if I'm engaging or somebody I love is engaging in this behavior over any period of time, that's where the risk of all these other things really starts to become a reality for some individuals.
0:15:12 William Moyers
I just wanna remind our viewers and our listeners that we're—our guest today is Dr. Audrey Klein—she's the executive director of the Butler Center for Research at Hazelden Betty Ford Foundation. Dr. Klein, you've talked about the implications of serious drinking on women, and the physiological dynamics of it. Can we talk just a little bit about treatment? What about treatment? Is it different for women than it would be say for men?
0:15:40 Dr. Klein
That is a complex question. So I'm gonna answer it this way. The best treatment is the treatment—is a treatment modality that's evidence-based, meaning that is has been scientifically proven. There's a lot of—of treatment types of treatment that are available to providers who are treating patients, that work, that produce good outcomes. Which of those things works for which type of person can vary. So I always like to steer people that ask that gender related question away from gender. 'Cause it isn't—do women need you know different treatment than men? Every person should have individualized treatment that directly addresses their situation and their reality. So the best treatment is evidence-based, it's scientifically proven, but once that person seeks services and seeks help, people should really be working with that individual to pick a variety of really good evidence-based treatment practices that will closely relate to what that individual has.
0:16:55 Dr. Klein
Now having said all of that, women come to treatment with some concerns and some issues that tend to relate to being a woman. So—so the thing that I wanna bring up to folks is we know that there's a very high correlation between any substance addiction and a co-occurring mental health problem.
0:17:18 William Moyers
0:17:19 Dr. Klein
Right. So people with anxiety disorders, people with extreme debilitating anxiety issues, people with depression, that struggle with clinical depression, some of the patients that we see have both. So there's a very strong link between substance use and misuse and having a mental health condition. So women have a way higher likelihood of having an anxiety—you probably knew I was gonna say this—of an anxiety or a mood disorder than men. So that's another thing that's really important. If you're treating women for addiction, you have to be addressing those mental health concerns that they're having as well. And we know there's a strong evidence in literature and research-based showing that if you treat both, it's really important to have good outcomes.
0:18:16 Dr. Klein
The other thing William that I wanna add with treatment that can happen even before treatment—there's a whole area of Psychology called social norms. And that's a real psychology term. So the layperson term for that is beliefs about what other people are doing, right?
0:18:34 William Moyers
0:18:36 Dr. Klein
So social norms are beliefs that a person has about what other people are doing. Social norms about drinking behavior are really important in terms of how a person thinks about their own drinking, and that's a huge thing that we try to help educate patients about. It is not normal to drink a lot of alcohol all the time. And if you see other people, if you're engaging in that—in that drinking behavior—and you're surrounded by other people that are doing the same thing, you're more likely to think it's normal. Oh you know everybody else is drinking the way I do, all my friends drink like this, so I'm okay. So part of treatment too is to really help people recognize that the frequency of very heavy drinking if you look at the general population is pretty—it's not really common. But when people are surrounded by folks that are doing that, they can have distorted beliefs that then may, you know, just it—they might be more likely to think hey I'm not in trouble, I'm really okay. Because a lot of other people are doing this too.
0:19:51 Dr. Klein
So breaking through those perceptions, helping people to understand accurately the prevalence or the—the how common the behavior is that they're engaging in and how harmful it can be, to us at Hazelden betty Ford, is really wouldn't you say a prerequisite almost—
0:20:09 William Moyers
0:20:10 Dr. Klein
Of really moving forward with them in admitting that they have a problem with addiction and getting better.
0:20:17 William Moyers
We have just a couple of minutes Dr. Klein before we wrap it up. I know there are gonna be some people who are listening to this podcast who are listening because they themselves as women are struggling with alcohol. And they probably don't know where to turn or they're scared or they feel like as the primary caregiver of their children, they need to focus on that and not on getting well. What's your counsel? And I know you're not a clinician per se, but what is—what is your counsel to somebody who might—a woman who might be listening or viewing this today, as it relates to getting help?
0:20:51 Dr. Klein
Yes. So my—my biggest advice, my strongest advice to everybody would be ask someone for help. So if anybody remembers anything from our conversation, please ask for help. We would like people to reach out to us, we would very much like to help somebody who's struggling or has a loved one who's struggling, but people—a lot of people see their general practitioners, they can ask their doctor to talk about them. Get screened for alcohol use problems. If somebody's seeing a mental health therapist for some—some issues that they're having in their personal life, a—tell someone. So my biggest message is tell someone who is in the health care field, tell them that you're worried. My other advice would be try not to be afraid. Because the thing that we have not touched on William that's so critical that our survey revealed that we did is that women feel a lot of shame. About ha—admitting that they have an addiction problem. Over 50 percent of women that completed our survey said that they would be afraid to tell anybody that they had an alcohol problem because people would think less of them and they said that they felt that way and that—that that was stronger with women than men. So I feel like people would look down on me more because I'm a woman as opposed—
0:22:22 William Moyers
0:22:23 Dr. Klein
So, the stigma, though we're working on it and we're trying to alleviate it, is alive and well. I would also really caution people to look very critically at—at the media and advertisements that are coming. Some of these advertisements William I really get very concerned and frustrated. People are marketing. Companies are marketing alcoholic beverage and wine and boxed wine and lollipops and all kinds of—alcohol-based lollipops—drink, be cool, this is the successful women, woman of 2017. You can handle all your responsibilities and of course you wanna have some drinks at the end of the day. It's very concerning to us at Hazelden Betty Ford that more and more you're seeing marketing and advertising really glorifying alcohol use because that's a factor that again can contribute to these distorted social norms that can increase the likelihood that people will you know engage in more drinking or maybe somebody's borderline and maybe having a problem. And—and that's just a factor that might tip them closer to really developing a drinking problem. So, please consumers—people that are consumers that are going to the grocery store that are consuming food and beverage—please just look at these advertisements with a critical eye and really be aware of the risks because it's really important to just keep that awareness very high.
0:24:05 William Moyers
Thank you, Dr. Klein. You know you've been around since '07 so I've watched you and you are—been just a remarkable advocate and committed researcher to accuracy and the statistics and all those numbers behind this elusive illness, addiction. I've always admired you for that. But you the way you articulate the issues and your passion for treatment and for recovery, is—it's admirable. And so I wanna thank you for bringing your expertise and your passion to our program today.
0:24:42 Dr. Klein
Thank you for having me William; it's always a pleasure.
0:24:44 William Moyers
You're welcome. And thanks to all of our viewers and our listeners in this series of Let's Talk Podcasts on brought to you by the Hazelden Betty Ford Foundation. I'm William Moyers and we'll see ya another time. Thank you.