Alcohol addiction in women: an overview of risks and causes

To toast, to eat, to wind down—oh, just because. There are many reasons to drink alcohol. And also many not to. Because consumption carries risks: Alcohol addiction is a serious illness that can affect anyone—and isn't always recognized.

There are a few peculiarities, especially for women: The effects and dangers are sometimes different for them than for men. How so? And what can be done then? Addiction medicine specialist Professor Falk Kiefer and author and blogger Mia Gatow, who "freed" herself from alcohol and writes about it in her book "Rausch und Klärung," provide answers.

On the one hand, there are biological factors: Women generally have a lower tolerance for alcohol than men . According to Kiefer, this is because they are, on average, smaller, have less body volume, more fat and less water in their bodies, and metabolize alcohol more slowly.

As a result, women reach a higher blood alcohol concentration for the same amount of alcohol consumed, and the toxic effects of alcohol are more pronounced and last longer, explains Kiefer. And: "The risk of subsequent illnesses is already increased in women at approximately half the amount of alcohol consumed compared to men," says the addiction medicine specialist.

These include:

• depressive moods
• Anxiety disorders
• Hormonal disorders
• heartburn
• stomach ulcers
• Dependence

In addition, "the period from the onset of problematic drinking to addiction is clearly shorter," says Kiefer. This is often referred to as the so-called telescope effect. Alcohol is therefore more toxic for women.

Social factors also play a role: In the past, alcohol consumption was socially less acceptable among women than among men. This has changed – now women, especially in certain age groups, are increasingly drinking like men. They've essentially "caught up."

Mia Gatow describes this "conformity movement" as follows: "We work as much as men. We separate career and private life, just like men do. We earn, at least theoretically, almost as much money—and we drink like men. Also to relax, because we have just as much stress." In her book "Rausch und Klärung" (Intoxication and Clarity), she describes how she recognized her alcohol problem and why and how she became sober.

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"The main reason people become addicted is that alcohol is addictive," says Mia Gatow. There are also contributing factors: She had "perfect conditions for addiction."

"For me, it was all a coincidence. I come from a drinking family. So my family environment taught me that." Alcohol was always there, and that's why it was pretty invisible.

Her work environment in the nightlife scene, later in her mid-twenties, was also heavily influenced by alcohol and drugs. "When I was no longer involved in that party life, my drinking eventually—in my 30s—became a bit more bourgeois and perhaps a bit more fashionable." Nevertheless, there were still quite a few people in her circle who supported it. "Like the rest of society, really," says Gatow. "I was essentially embedded in a world my entire life where drinking was unconditionally supported."

Kiefer explains: "Unfortunately, everyday banality prevails. In a society where everyone drinks, there's no need for drama to join in."

Drinking alcohol is a learned behavior, and almost all of them have their first experiences with alcohol in adolescence or as young adults. They may learn that "alcohol can relax and make some things a little easier"—but most also notice the negative consequences.

In the following years, excessive drinking often plays a minor role because it simply doesn't fit: People are then preoccupied with family, life planning, and career. "All of this is generally incompatible with heavy drinking, which is a good thing," says Kiefer. Most people then drink only occasionally.

Alcohol often becomes an issue when the "opportunity to drink" arises again. "Or when there are problems that alcohol supposedly provides short-term relief for," says Kiefer. It also occurs during life transitions, such as midlife, when stresses at work, in relationships, and in connection with children arise – an issue for women, too. Many then remember the effects alcohol can have. "And slip into it because of the feeling 'somehow this is doing me good right now.'"

Drinking as self-care, as the "Wine Moms" on Instagram demonstrate? That's what can happen, says physician Kiefer. Drinking a glass of wine—perhaps with other mothers—and thinking: "I always have to perform at my best and be there for the kids. But I'm also human and need time for myself." This is how so-called "functional use" begins.

Kiefer reports that alcohol is also a form of self-medication, for example, for anxiety disorders or depression – and "sometimes such mood disorders or mental illnesses also arise during a certain phase of life." Another important factor: alcohol is comparatively cheap and available practically everywhere.

Not necessarily by how much you drink. "If you want to measure the severity of alcohol dependence, it's hardly based on the reported amount of alcohol consumed," explains Kiefer.

"The most important criterion is the negative consequences you're willing to accept." If it's difficult to abstain from alcohol—"if you realize there are things that would go better if you didn't drink, but you drink anyway. Then you already have an alcohol problem," says the doctor.

Mia Gatow explains: "For ten years, I had convinced myself that I needed to drink less." She thought she had to drink "normally"—that is, like other people. "Like the alcohol industry always sells it, that everyone can do it." And anyone who can't do that has a kind of personal weakness. "Although, of course, that's not true at all."

In fact, this can even be symptomatic of an alcohol addiction: “If you find that you are consciously trying to control your alcohol consumption because you are afraid of drinking too much, this can be a sign of problematic drinking behavior,” writes the Health Knowledge Foundation.

This can lead to harmful consumption: "We normally base our behavior on positive and negative consequences," says Kiefer. People who go jogging, for example, have learned that it makes them feel better. "But if you sprain your ankle, you'll take a break and not go running with it. In a figurative sense, however, people with problematic alcohol consumption do exactly that, in very small steps."

So you drink, even though it might have unpleasant consequences. Kiefer gives an example: "If you say, I actually have something to do tomorrow, but today is a nice celebration, so I'll drink two more glasses of wine. If I don't perform at 100 percent tomorrow, but at 90 percent, that's okay, too." According to the addiction specialist, this indicates an alcohol problem—a relatively minor one.

"If you have a major alcohol problem, you say, 'I actually decided to only drive with a blood alcohol level of zero, but one beer is okay.' And when the problem gets even worse, you say, 'Nobody will catch me. And I'm actually still able to drive,'" says Kiefer. The escalation of this—it's all about the alcohol: "Okay, if I can't drive to and from the party now, then I'll just drink at home—and skip my friends."

Even if you haven't reached that point, Kiefer advises getting an overview of your own alcohol consumption. Very few regular drinkers have one. A drinking diary documents when, how much, and why you drank – available as a download from the Health Knowledge Foundation, for example. Or take a look at the empty bottles you throw away each week – this can also bring a problem to your attention.

And then? When Gatow realized she couldn't control her consumption and "drink normally," she essentially "capitulated." "Once I let go of the idea that I could control my drinking, it was relatively easy for me to get sober." She managed it on her own and, above all, with the help of a support group.

Anyone who feels their drinking behavior has gotten out of hand can visit addiction counseling centers – a low-threshold option for finding support, says Kiefer. They operate independently of health insurance companies and assess symptoms and offer recommendations without the goal of making a medical diagnosis. "You can get information and assess whether your behavior is problematic without immediately considering rehab or lifelong abstinence."

Another good contact: your family doctor. "They can and should provide support, regardless of whether you have been diagnosed with alcohol dependence," says Kiefer. "There are connections between alcohol and conditions such as sleep disorders, gastritis, or diabetes, and these can be treated much better if you reduce or completely stop drinking alcohol." Of course, family doctors can also diagnose an addiction based on physical and psychological symptoms.

Both general practitioners and addiction counseling centers can help those with relevant symptoms begin addiction treatment. This may, but does not necessarily, involve an inpatient hospital stay.

Mia Gatow lists other options and advises: "I would always say, look into everything you can find. There are groups like Alcoholics Anonymous, the Good Templars, the Blue Cross, and even special women's groups. There's a growing community on Instagram that shares ideas." There are also paid programs, anti-alcohol coaches, clinics, and short- and long-term therapies. "Depending on the severity of your addiction and your personality, you'll find something that suits you."

"When you go into treatment, you can actually assume that people will help you. I've found the addiction support system full of helpful, open-minded people," says Gatow, who regularly speaks with those affected and experts on the "Soda Klub" podcast.

For Gatow himself, it was Alcoholics Anonymous (AA) – a self-help group. "Being understood and accepted, talking about it with people who have gone through the same thing, are the biggest factors for me." No one would think to say, "Pull yourself together" or "Just drink less."

The important thing, according to Kiefer, is: "This is an illness." It's not about a lack of willpower. Many people – including those affected – aren't entirely clear about that. Stigma and shame add to the burden, says Gatow: "They don't seek help because they want to hide their problems – especially from themselves." It's still the case that "an average of ten years pass between the first sign of addiction and the step of seeking help. And that can be life-threatening."

Anyone who feels their drinking might be problematic needn't fear. "You can solve alcohol problems and even outgrow an addiction," says Kiefer.

And it's worth it: for your health, your psyche, your relationships, and your personal freedom—or even your integrity, as Gatow says. "When I'm sober, I can truly take responsibility." She felt "more alert, stronger, and even more relaxed" pretty quickly after quitting. "Then you have the resources to heal yourself again."

This text was updated on May 13, 2025.

RND/dpa