While women are climbing the professional ranks, when it comes to alcohol, they still fare worse than men. And worryingly, doctors are seeing a rise in the number of female alcoholics, writes Nell Raven
HEAVY DRINKING WAS once seen as a macho pursuit, and only tough men with tough livers were considered up to the job. But it appears that women are fast catching up.
Doctors at Hong Kong's only publicly run alcohol dependence clinics say they're seeing more female patients, and most of them are career women.
'In the past two years, we've seen more women of a higher professional class, and nine out of 10 are Chinese,' says Dr Lam Ming, senior medical officer at Tuen Mun Alcohol Problems Clinic (TMAPC) and Castle Peak Hospital.
In 2000-01, only two new patients at TMAPC were women, accounting for just 4.7 per cent of all new cases. One was a housewife and one was retired.
By 2003-04, there were 10 new female cases, making up 18.2 per cent of cases. Six were in the work force, with two in administration and managerial positions.
During the past two decades, a growing number of women have entered the workforce in Hong Kong. Between 1991 and 2001, for example, their numbers rose by more than 20 per cent, and the average pay for single women rose above that of their male counterparts, according to the Population Census 2001.
But some experts say they're concerned that offices are becoming breeding grounds for a new generation of female problem drinkers.
'These days, it's a common sight to see a lot of women in Lan Kwai Fong and Wan Chai drinking and smoking,' says Chinese University of Hong Kong psychiatrist and alcohol expert Professor Lee Sing.
'Women now have the financial independence to afford good drinks and wine, and after work, they may go with their colleagues to the pub. But, with certain risk factors, we know that a proportion of those who drink regularly may develop problem drinking or alcohol dependence.'
Lee says the cases seen at TMAPC are the tip of the iceberg. 'Those in stressful professions such as banking, sales or health care are most at risk of becoming problem drinkers, because they use the sedative properties of alcohol as a means of soothing their anxiety,' he says. 'But the great majority of people who attend hospital authority psychiatric clinics are lower, or lower-middle class. Opening hours are nine to five, so many working women wouldn't be able to attend. I believe there are many, many more professional women out there who have a drinking problem.'
A significant rise in excessive drinking among women has been noted with concern in many other parts of the world, including Britain, where alcohol abuse is now the biggest killer of women, and the US.
'For many decades, the incidence of alcohol and other drugs problems has been significantly higher in men,' says Lee. 'But in many parts of the world, we're now seeing a higher rate of increase in women. Advertising agencies have begun targeting women with female-friendly products.'
Drinking isn't yet as serious a social problem in Hong Kong as in some other parts of the world. Almost half the population are non-drinkers. A 1988 Chinese University survey found that only 9 per cent of men and 0.6 per cent of women had become problem drinkers at some point. By comparison, in Britain, 15 per cent of women and 27 per cent of men exceeded the recommended levels every week.
However, problem drinking among both sexes appears to be on the rise in Hong Kong. Cases of alcohol dependence syndrome - the most severe form of addiction - rose from 787 in 2000 to more than 2,400 in 2001 and 2002.
According to the government, sensible drinking is defined as 14 units a week for women and 21 for men, with at least two dry days. A unit roughly equals a small glass of wine, or half a pint of beer. It's recommended that these limits are lowered for those who lack enzymes to break down alcohol. Symptoms of the deficiency - estimated to affect as many as half of all Asians - include a quickened heart-beat, a sensation of heat in the stomach, muscle weakness and facial flushing.
Although most drinkers stick well within the limit, a small minority discover that a sociable activity can spiral out of control.
'The occasional drink becomes a nightly habit as a means of feeling good,' says Lee. 'Then, it becomes an aid for sleeping. Over time, if you use alcohol regularly, there's both psychological and physiological dependence.
'You have withdrawal symptoms such as restlessness, anxiety and insomnia. The more you drink, the worse these get, so you tend to drink more. At the same time, your body adapts to the alcohol intake, so you have to drink more to get the same effect.'
Women may be more at risk of developing addiction than men. 'Studies show that alcohol problems are highly associated with depression, and worldwide, mood disorders are always more common in women,' says Lee. 'Women may, therefore, be more prone to using alcohol as a means of soothing depression.'
Problem drinkers are most commonly categorised as alcohol abusers, meaning they continue to drink in spite of physical, mental, social or legal problems.
Those with a more serious problem may become alcohol dependant. Symptoms include increased tolerance, withdrawal, lack of control over the amount drunk, drinking taking precedence over other activities, and a failure to cut down.
Alcohol abuse wreaks havoc on the body and mind. Physical risks include stomach ulcers, hepatitis, cirrhosis, cancers and obesity. Mentally, it can cause depression, psychosis, dementia and suicidal and violent tendencies. But for women, there are extra complications that make the stakes arguably higher.
Although women in more competitive professions may feel compelled to help their male colleagues prop up the bar, their bodies are less able to cope. With the same alcohol intake, the concentration in their blood will be up to 30 per cent higher, says Lam, of the Tuen Mun clinic. And being drunk can lead them into dangerous situations.
In the long term, women alcoholics also suffer greater health damage.
'Compared with men with similar drinking duration and severity, studies have shown women have an earlier onset of cerebral atrophy [brain shrinkage] and perform worse in cognitive tests,' says Lam. 'They are also more prone to alcohol depression. Studies have found the condition in half of female problem drinkers, compared with a third of males.'
The effect on the families of women alcoholics may be more extreme, too. 'Women are still the main carers for children in most families,' says Lam. 'For every mother who drinks, we have to be on the lookout for cases of child neglect and abuse. Heavy drinking during pregnancy, for instance, can cause foetal alcohol syndrome.'
Excessive drinking by both sexes takes a major toll on society, with the burden on the medical system, and the economic cost of absenteeism and accidents. In a British study, alcohol-dependant patients were nine times more likely to die in a given time period than their peers.
Lee says anyone worried about their drinking should seek help immediately. 'We know that for any drug or alcohol problem, the most effective treatment is early intervention and prevention. The longer the behaviour carries on, the more difficult it is to carry out detoxification and sustainable rehabilitation.'