Alcohol abuse and addiction affect people differently based on dozens of different factors: gender, age, education, environment, lifestyle, mental health, socioeconomic status, and even areas of residence. The reasons why a person might start drinking too much can cover any number and combination of these categories, and successful and effective treatment programs take all these variables into account.
Comparing Men and Women
One of the biggest points of comparison between the demographics of alcohol use is that of men versus women. The Addiction journal was one of many to ask this question; in 2010, it published an article on the patterns of “gender and alcohol consumption,” and reported that men tended to drink more and at higher volumes than women. The researchers behind the findings looked at seemingly simple questions, like whether there are standard differences between the rate and frequency with which men and women drink. Past studies have shown that men drink larger quantities of alcohol than women and that men “experience more behavioral problems related to their drinking” than women.
But women do have risk factors of their own that men do not have to take into consideration. Because the female metabolism breaks down alcohol more slowly than the male counterpart, a woman who consumes the same of alcohol as a man will have a higher blood alcohol content, even if they both drink at the same rate and for the same period of time. In explaining why addiction is different for women, the Herald-Dispatch noted that women also tend to be smaller than men (in terms of height and weight) with relatively smaller muscles and bones, all of which can put women at risk for developing a drinking problem ahead of men whose bodies are biologically capable of handling more alcohol before problems kick in.
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Women also have more mental health risk factors to deal with than men. The National Institute of Mental Health points out that women are 70 percent more likely to experience depression than men, and women are twice as likely to develop an anxiety disorder, according to the Anxiety Disorders Association of America.,  Both conditions are triggers for unhealthy alcohol use, as people (and the women who are more susceptible to developing such conditions) increase their drinking rates to cope with their mental health stress.
Risk Factors and Treatment for Men
Men have their own risk factors. In 2010, the Biological Psychiatry journal found that when men consume an alcoholic beverage, their brains produce higher amounts of dopamine (the chemical neurotransmitter responsible for regulating feelings of pleasure, reward, and anticipation) than women experienced. This is one of “several biological mechanisms” that differentiate the different vulnerabilities of men and women when it comes to alcohol abuse.
Since men and women drink for different reasons and are affected by alcohol abuse in different ways, treatment for problematic drinking has to speak to those differences. The Substance Abuse and Mental Health Services Administration notes that women have many factors that prevent them from seeking professional help. Women tend to earn less than men, so they may not be in a financial position to pay out of pocket for their expenses; women are also expected to continually maintain their family obligations, even during treatment, so some women will opt to stay at home with their children even if it means their drinking continues unchecked. These problems also extend to men, but women usually feel the stress of these decisions more.
Overcoming Barriers to Recovery
A treatment plan for a woman in recovery will take all of this into account. For example, some treatment centers offer daycare and afterschool programs so mothers in treatment can stay close to their children. There may also be scholarships offered for eligible female clients or other similar ways to incentivize women who have drinking problems to look beyond their perceived barriers and to draw them into a treatment program.
Men have their own barriers to treatment, but theirs are different. For the male psyche, admitting to a personal failure to control drinking and the need for outside help can be a difficult pill to swallow. Some men fear loss of respect from their peers or their family if they have to seek treatment, and the American Journal of Drug and Alcohol Abuse reports that a number of men only check into a treatment program because of a court order or because they were given a professional or personal ultimatum.,
In order to engage with men who may be reluctant to make the emotional and mental commitment to treatment, an effective rehabilitation program will use approaches like group therapy sessions. The effect of other male clients talking about their difficulties with alcohol will create a safe, comfortable, and familiar space for a male client to share his own story. While there may be some hesitancy about showing vulnerability in the presence of women, a treatment program that addresses the nuances of the masculine perspective will encourage male clients to share their experiences and perspectives more openly and insightfully with other men.
Women also tend to respond well to single-gender group therapy sessions but more so because groups consisting exclusively of women are usually more nurturing and comforting compared to male group therapies, which tend to focus on traditional notions of male identity, like strength and leadership.
Regardless of the perspective, treatment for men and treatment for women should be designed to create a gender-aware space where a client feels at their most comfortable to talk about what the alcohol abuse has done and to learn about how life can be enjoyed and rebuilt without drinking.
Alcohol Use, Addiction, and Treatment for LGBT People
The LGBT population of America has alarmingly high rates of alcohol addiction, in large part due to the stress that comes from discrimination. The Center for American Progress writes that even though there are no standardized statistical measurements on the rate of substance abuse in gay and transgender populations, conservative estimates figure that as much as 30 percent of LGBT people abuse substances, such as alcohol and other drugs, compared to only 9 percent of the general population. Gay, lesbian, bisexual, and transgendered people often face daily challenges because of their sexual orientation and/or their gender identity, including familial rejection, unfair housing and employment practice, and limited healthcare options. The National Alliance on Mental Illness explains that LGBT people are three times more likely to experience periods of major depression or generalized anxiety disorder, often related to fear of coming out, fear of rejection, or fear of threats to their wellbeing because of their orientation or identity.,
With such pressure, many gay and transgendered people turn to drugs and alcohol to moderate their stress, alleviate their depression, and bond with friends, romantic partners, and sexual partners who are experiencing the same problems. While such a practice is commonplace among heterosexual populations, the issues faced by various LGBT communities around the country result in such populations having alarmingly high rates of alcohol and drug abuse, according to findings from the Centers for Disease Control in October 2016.
One of the biggest challenges facing LGBT people when it comes to receiving treatment for their alcohol abuse problems is that there is insufficient cultural competency in the healthcare system, which acts as a barrier to a vulnerable population, whether implicitly or explicitly. Even if they do seek out help from such services, the care they receive is usually inappropriate or irrelevant (that is, it does not adequately address the LGBT perspective). “LGBT addiction is not the same as straight addiction,” points out The Advocate, explaining that some treatment centers have not updated their materials or trained their staff on how to understand what gay and transgendered people go through as part of their personal journeys. The danger of applying “generic approaches to addiction” (created for and by heterosexual people) can mean that LGBT patients feel left out or that their alcohol use problems are not being taken seriously by the staff.
To that effect, the Substance Abuse and Rehabilitation journal found that past forms of substance abuse outreach have often grouped treatment of LGBT people with heterosexual women; “historically,” says the journal, “clinical treatment programs were designed to meet the needs of the sexual majority population” (i.e., straight men), and there were insufficient programs to meet the needs of specific sexual minorities (i.e., women and LGBT people). While there were enough treatment programs to go around for men, LGBT people and women were forced to share resources, even though gay and transgender clients have higher rates of family rejection and lack of social support, and significantly different experiences of stigma and minority stress (the negative effects experienced by individuals of a marginalized social group).
A treatment center has to be fluent in the individual needs of LGBT patients, argues The Advocate, or else it risks failing the gay and transgendered people who come to it for help, unwittingly contributing to their depression, and deepening their dependence on alcohol. One solution might be to redirect gay men and women to a facility that is better equipped to deal with the uniqueness of the LGBT experience.
Comparing Rural and Urban Alcohol Rates
In writing about “Alcohol use patterns among urban and rural residents,” the Alcohol Research: Current Reviews journal explained that geographic location has an effect on the rates of alcohol use disorder. Social and cultural factors are also relevant when taking geography into account, which further impacts the rate of drinking among respective residents and the corresponding treatment statistics.
The journal describes conditions like the availability of alcohol, norms for typical drinking behaviors, characteristics of demographics, and economic status as all playing a role in influencing drinking rates across urban and rural areas. Past studies have found that suburban residents tended to be more abstinent than rural and urban residents, but rural drinkers “were significantly more likely than suburban drinkers to report exceeding the recommended daily drinking limits.” Rural men would consume more than four drinks in one sitting; rural women would consume more than three drinks in one sitting. Similarly, people in urban settings were more likely than their suburban counterparts to have more than 14 drinks in a typical week for men and more than seven drinks in a typical week for women.
When it came to problematic drinking, rural drinkers were more likely than suburban drinkers to report an episode of alcohol use disorder in the previous year at 15.1 percent to 11.6 percent. Fourteen percent of urban drinkers reported having such a problem.
The researchers noted that rates of alcohol use tend to be higher in urban regions than in rural regions. Rates of alcohol use disorder are similar for both urban and rural residents.
The Balance between Needs and Service
The Substance Use & Misuse journal writes that there are barriers to alcohol abuse treatment in both rural and urban regions. In cities and big population centers, for example, “the treatment needs often outweighed the availability of services.” Treatment facilities in urban areas are typically challenged by a lack of funding and the challenges of serving a very heterogeneous client population, but they can offer services that are much more diverse and flexible when compared to treatment options in rural places. For example, rehab centers in urban regions can provide auxiliary services that are vital for clients to receive comprehensive care while rural centers might not be able to offer both detoxification and mental health services, or the treatment staff may not be trained to respond to the specialized treatment needs of women, LGBT people, or immigrants.
The journal points out that because rural areas need increasing substance abuse treatment and resources, there is a growing focus on how to deliver treatment in rural settings. Such regions often lack basic services and healthcare infrastructure, leading them to become “disproportionately disadvantaged.” There also tends to be fewer facilities for residents to use, and the vast distances or rugged terrain of rural areas means that accessing those facilities, especially in an emergency, can act as a barrier to treatment. Past research has shown that shorter travel distances are positively associated with longer residential periods and greater completion rates;, while an urban metro area may have public transit for low-income clients, such a luxury is not generally available in a smaller town.
Comparing Religious and Nonreligious People’s Rate of Alcohol Abuse
Religious belief (and the lack thereof) accounts for many factors in the different demographics of alcohol use, addiction, and treatment. The American Journal of Orthopsychiatry (which covers topics on the branch of psychiatry related to the study and prevention of mental health disorders) noted that religious belief tends to be a reliable protector against lifetime alcohol use as well as the use of other chemical substances. However, a sample comparison of religious and nonreligious Mexican and Mexican American preadolescents revealed that adolescents who did not have a religious affiliation reported rates of substance abuse that were comparable to those who did when researchers controlled their findings for religious belief.
In general, past research has identified that religion usually has a “protective effect against substance use,” often by providing practitioners with social and personal support to minimize the compulsion to use alcohol in times of stress. Being a member of a religious community also creates an environment of accountability, wherein adherents may not want to fall below the acceptable standards of membership. Lastly, a religious perspective of right and wrong (good behavior and bad behavior) may help to protect members against engaging in actions that threaten their perceived wellbeing or the wellbeing of others, such as crime, sexual promiscuity, or substance abuse.
In 2001, the National Center on Addiction and Substance Abuse noted that religious belief can provide people with feelings of security and stability. For younger people (adolescents), this translates to a “protective effect on important life outcomes,” such as a healthier sense of ego and prosocial behavior. A study of high school seniors conducted in the 1990s found that religious students were least likely to engage in risky behavior, and their religious convictions were the “most powerful predictor” of the chances of their engaging in risky behavior. Other research has demonstrated that both adults and adolescents who consider religion important in their respective lives “are less likely to use tobacco, alcohol and illicit drugs.”
Religion in Alcoholics Anonymous
Religious belief plays a central role in Alcoholics Anonymous, the largest aftercare support system in the world. The famous 12-Step methodology is explicitly based on Christian principles (half of the steps make an explicit reference to the Christian idea of God), so much so that Alcoholism Treatment Quarterly writes that spiritual belief, or the belief in a higher power, “is an integral part of Alcoholics Anonymous.” The researchers writing in the journal reported that of a study of 587 men and women enrolled in an AA program for a year, 40 percent of attendees said they were either unsure of their belief in a higher power or outright had an identifiable religious belief; 25 percent of the respondents were secular (i.e., had no religious belief). All went to at least one AA meeting, and three years after their first meeting, they were interviewed by the researchers again. Some members reported a “spiritual awakening” as the result of their recovery practices and demonstrated “the highest odds of continuous sobriety,” but religious self-identification was not associated with significantly higher odds of sobriety.
Alcoholics Anonymous has enjoyed widespread support for its pioneering of the 12-Step philosophy, but the strong spiritual lean of the program has made it unpopular among those who object to the religious overtones or the lack of evidence-based methodology. A researcher at the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addictions told Vox that what studies have been conducted on AA’s notoriously private practices have yielded that approximately a third of the people who attend meetings maintain recovery from alcohol addiction, another third “get something out of the treatment but not enough for full recovery,” and the final third do not receive any tangible benefit.
For people who are not religiously inclined, there are secular alternatives to the spiritual overtones of Alcoholics Anonymous. Other programs might not even use the 12 Steps at all, focusing on other methods like SMART Recovery. Regardless of the nature of the program, it is vital that a client in recovery receives some form of aftercare support, after formalized therapy has concluded. Being engaged with a community of recoverees and allies (whether in a secular or faith-based setting) provides affirmation and accountability, and greatly reduces the chances and damage of relapse.
Comparing Generational Alcohol Use Rates
The so-called generation war between millennials (loosely defined as those born after 1980) and Generation X (loosely defined as those born between 1965 and 1980) has taken on many forms, but one significant difference is how the two generations approach alcohol use, abuse, and treatment.
For example, Fortune magazine wrote in 2016 that millennials drank almost 160 million cases of wine the previous year, far outpacing the drinking patterns of any other generation. The Wine Market Council reported that millennials consumed 42 percent of all the wine drunk in 2015 while Generation Xers drank just 20 percent. The fact that more younger people are drinking “has helped boost the overall surge in high frequency drinkers,” people who drink wine on multiple occasions in a single week. The influx of more millennial drinkers contributed to the percentage of high-frequency drinkers among the legal drinking-age population rising from 7.9 percent to 13.9 percent between 2005 and 2010.
Millennials vs. Baby Boomers vs. Generation X
However, older generations are drinking more on their own as well. Reporting on a study conducted by a consumer data provider, VinePair noted that baby boomers (those born between 1946 and 1964) purchased 46 percent of wine in the United States in 2015 while people in the Generation X bracket tend to try different drinks and have a broader palette for alcohol. Millennials, on the other hand, try to get the most value for their dollar by choosing an alcoholic beverage based on the alcohol by volume content and flavor innovation.
The different age dynamics between the generations affect the reasons individual members of the generations drink to the point of abuse and speaks to how treatment programs should help them address these issues. Baby boomers, for example, grew up in an age when there was less information about the harmful psychological effects of alcohol, and they might not understand why their drinking is considered problematic by modern standards. Additionally, as baby boomers age, they may drink more to alleviate the physical stress of aging as well as to cope with the loneliness of infrequent family visits and more friends and family members of similar ages passing away. Members of the Generation X generation face many of the same challenges: growing old and growing up in an era of wider acceptance of unhealthy drinking practices.
Alcohol abuse treatment will have to take these factors into consideration, perhaps by providing education to older clients who may struggle with the idea that the alcohol they widely enjoyed in their younger days has a cumulatively dangerous effect, especially as they get older. Treatment should also take the healthcare needs of older clients into account; for example, if the clients are on medications for age-related concerns or if declining mental facilities might prohibit some therapeutic approaches.
Do Millennials Drink Less?
According to some research, millennials have notably reduced rates of alcohol abuse because “it’s what the older generation did.” A nonscientific survey in the United Kingdom found that a growing number of younger people look down on intoxication, considering it “embarrassing” or even “pathetic.” Only one in ten respondents said that getting drunk was “cool.” Speaking to the Telegraph, one of the people behind the survey noted that while Generation X would often drink to bury their problems, millennials tend to be more open about their personal struggles and are less compelled to use alcohol to self-medicate.
The Telegraph noted that as many as 42 percent of people who identify as millennial say they drink less alcohol than they did three years ago, partly due to financial reasons.
Of course, there are millennials who struggle with alcohol abuse, and it is important that they find treatment programs that speak to their place in life. Many millennials do not have the financial security that their parents had at a comparable age, which might be a barrier to treatment and might be a source of stress and anxiety that feeds the alcohol dependence. Those who have jobs have mental health problems unique to their generation, such as a greater work-life imbalance, which their parents and bosses may not appreciate or take seriously, further exacerbating the problem.
A treatment center could work around this by offering scholarships or payment plans targeted to the 18-34 demographic, or job skills training courses (or referrals) to help newly sober clients apply their recovery principles in a healthy work setting. Much like programs for older clients, there could be similar educational courses for the parents and family members of millennial clients, whereby they learn about the challenges facing millennials, such as a higher cost of living, and how to be more sensitive to these problems in order to create a more conducive home environment for recovery.
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