Читать книгу Drink: The Deadly Relationship Between Women and Alcohol - Ann Johnston Dowsett - Страница 13

One mojito, two mojitos, three mojitos … FLOOR!

—POPULAR BIRTHDAY CARD

Alcohol is ubiquitous in our society. It’s hugely linked to our notions of celebration, sophistication, and well-being. It’s how we relax, reward, escape—exhale.

Know your wines? You’re affluent. Know your vodkas? You’re hip. Know your coolers, your shots? You’re young and female.

Alcohol abuse is rising in much of the developed world—and in many countries, female drinkers are driving that growth. This is global: the richer the country, the fewer abstainers and the smaller the gap between male and female consumption. The new reality: binge drinking is increasing among young adults—and women are largely responsible for this trend. What has not been fully documented, understood, or explored is that while women have gained equality in so many arenas, we have also begun to close the gender gap when it comes to alcohol abuse.

Women’s buying power has been growing for decades, and our decision-making authority has grown as well. The alcohol industry, well aware of this reality, is now battling for our downtime—and our brand loyalty. Wines with names like Girls’ Night Out, MommyJuice, Mommy’s Time Out, Cupcake, and yes, Happy Bitch; berry-flavored vodkas, Skinnygirl Vodka, mango coolers, Mike’s Hard Lemonade: all are aimed at us.

When it comes to alcohol, we live in a culture of denial. With alcoholics representing just a tiny fraction of the population, it’s the widespread normalization of heavier consumption that translates to serious trouble. In the Western world, the majority of us drink. And the top 20 percent of the heaviest drinkers consume roughly three-quarters of all alcohol sold. Episodic binge drinking by a large population of nondependent drinkers has a huge impact on society.

Most of us understand the major role that excessive alcohol use plays in family disruption, violence, and injury. Death? When compared to illicit drugs, there are many more deaths due to alcohol. According to Robert Brewer, leader of the alcohol program at the National Center for Chronic Disease Prevention and Health Promotion at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, excessive drinking is the third leading preventable cause of death in the United States, after smoking and a combination of bad diet and inactivity. By conservative estimates, it’s responsible for roughly 80,000 deaths each year: of those, 23,000 are female. Of the 23,000, more than half are related to binge drinking. For women, binge drinking is defined as four or more drinks on one occasion in the past month; for men, it’s five.

According to a recent CDC Vital Signs report, female binge drinking is a serious, underrecognized problem: almost 14 million American girls and women binge drink an average of three times each month, typically consuming six drinks per bingeing episode. Meanwhile, one in five high school girls binge drinks. Among those who consume alcohol, the prevalence of those who binge drink rises from roughly 45 percent of those in their first year of high school to 62 percent of those in their senior year.

Women most likely to binge drink: those between the ages of 18 and 34 (in other words, those in their prime childbearing years), and those with higher household incomes. Binge drinking not only increases the risk of unintended pregnancies: if pregnant women binge, their babies are at risk of sudden infant death syndrome and fetal alcohol spectrum disorders. Meanwhile, for all women, binge drinking increases the risk of breast cancer, heart disease, and sexually transmitted diseases, among other health and social problems. “People who binge drink tend to do so frequently,” says Brewer. “Most people who drink too much aren’t addicted to alcohol. Most of these people are not dependent. What’s the big picture? This is a major public health problem.”

The United States is not alone in naming alcohol abuse a major health challenge. In Britain, Prime Minister David Cameron has declared binge drinking a national “scandal.” Deaths from liver disease have risen 20 percent in a decade. Last year, Britain’s chief medical officer, Dame Sally Davies, pronounced: “Our alcohol consumption is out of kilter with most of the civilized world.” In a recent report by the Organisation for Economic Co-operation and Development, British girls were cited as the biggest teenage drinkers in the Western world: half of fifteen-year-olds said they had been drunk twice in the past year, as compared with 44 percent of British boys the same age.

Says Sir Ian Gilmore, past president of the Royal College of Physicians: “In the thirty years I have been a liver specialist, the striking difference is this: liver cirrhosis was a disease of elderly men—I have seen a girl as young as seventeen and women in their twenties with end-stage liver disease. Alcohol dependence is setting in when youngsters are still in their teens. This mirrors what we saw with tobacco, when women caught up with men on lung cancer.”

If leaders in Britain are concerned, so too is much of the world. In 2010, the World Health Organization passed its landmark Global Alcohol Strategy, with 193 signatories. In the developed world, where noncommunicable diseases pose the greatest health threat, alcohol abuse is moving much higher on the health-risk agenda, and will continue to do so.

Is alcohol the new tobacco? In many ways, it is: a multibillion-dollar international industry dealing with market-friendly governments, enjoying a virtually unrestricted market for advertising, despite growing evidence that the substance has significant health risks.

In fact, recent research has revealed that alcoholism is a more serious risk for early mortality than smoking—and more than twice as deadly for women than men. German researchers found that compared with the general population, alcohol-dependent women were 4.6 times as likely to cut their lives short. The rate for men: 1.9 times higher than the general population. On average, both women and men died roughly twenty years earlier than those who were not dependent on alcohol.

“It is just like Virginia Slims,” says David Jernigan, director of the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health. “Alcohol is a carcinogen, and it’s particularly risky for women. Breast cancer is the poster child for that position. But the alcohol industry is selling young women on the notion that only really, really good things happen when there’s alcohol. And to have really, really good things happen, you have to drink.”

I came of age in the seventies, a heady time for women in North America. Smack-dab in the middle of second-wave feminism, my baby-boom peers and I headed off to university in our miniskirts and tie-dyed T-shirts, assured by Gloria Steinem and a host of others that the world was ours for the taking. We could, in Steinem’s words, “grow up to be the men we wanted to marry.”

Not for us the confining roles of our fifties mothers, harnessed to aprons, and what seemed like cookie-cutter lives. Not for us the quiet desperation, the Valium, the acquiescence.

And for me? Not the path of my mother. Sitting in my dorm room at Queen’s University, unpacking my things—a brand-new copy of Joni Mitchell’s Blue, a not-so-new edition of A Room of One’s Own—I was unequivocal on one point: my life was going to look different. Very different. (Of course, it already did: I had rose-colored aviator glasses custom-made for this new chapter. I kid you not.)

If there was one trap I was determined I would never fall into, it was alcoholism. Risky drinking? Maybe. It was frosh week. There were keg parties and buckets of what we called Purple Jesus in my immediate future. I was five minutes from meeting my first serious boyfriend. Most conveniently, the legal drinking age had just been changed to eighteen, my age exactly.

But alcoholism? Never. Three times my family circled the residence, eager to get one last glimpse of me before they headed home. Not once did I look out the window. Not because I didn’t love them, but because I did. Too much: I was deeply entwined in the family drama. I was ready to set out alone.

I was in good company: my whole generation wanted to start fresh. This was the school year of 1971–72. Politically, we were well steeped in the My Lai Massacre, just a heartbeat from Watergate. Ramparts was still alive and well on the newsstands, and the first issue of a new women’s magazine was having its debut: it was called Ms.

Nothing, we were certain, would ever be the same. And frankly, nothing was—especially if you were female. Ours was the generation that would have it all: careers, families, freedom of expression, equal rights. Fulfillment on every level.

Did we have it all? With courage, endless creativity, and gusto, we certainly tried. Without a blueprint, many of us established excellent careers while raising children and nurturing marriages, juggling deadlines, child care, and housework. We experimented with full-time, part-time, flextime, and freelance work, nannies, day care, and shared babysitters, home offices, and virtual offices.

In many cases, our marriages were strained, and failed. Mine certainly did.

Could we have it all? Could we be the mothers we wanted to be and rise to the top? Many of us said yes—albeit sequentially. Or with enough help. Others said no, ditch the cape. The jury was out.

Today, more than thirty-five years after I graduated, women outstrip their male counterparts in postsecondary participation. “We Did It!” crowed a cover of the Economist, featuring Rosie the Riveter. “Women’s economic empowerment is arguably the biggest social change of our times,” trumpeted the article. An enormous revolution, with enormous ramifications. As the magazine warned, dealing with the social consequences of this victory will be one of the great challenges of the next fifty years.

More than forty years after Steinem helped launch a revolution, the debate rages on: can women have it all? These days, there are two powerful women at the microphone, offering a rich diversity of advice: Sheryl Sandberg, chief operating officer of Facebook and author of Lean In: Women, Work, and the Will to Lead; and Anne-Marie Slaughter, the first female director of policy planning in the U.S. State Department, a Princeton professor, and author of a persuasive Atlantic magazine cover story, “Why Women Still Can’t Have It All.”

In 2011, Forbes magazine called Sandberg the fifth most powerful woman in the world. For today’s young working woman, Sandberg may indeed be the most powerful, period. Long before Lean In appeared in bookstores this year, millions had checked out her 2010 TED Talk, in which she offered women prescriptive advice on how to reach the C-suite. While calling today’s women lucky, Sandberg cites the sorry news that women are not making it to the top of any profession anywhere in the world. Numbers say it all. Of the Fortune 500 companies, only twenty-one are led by women. Of 195 independent countries in the world, all but seventeen are led by men. Meanwhile, in the United States, two-thirds of married male senior managers have children, while only a third of their female counterparts can make the same claim.

While offering her prescriptions for change, Sandberg comes clean about some of the most difficult truths for working women. Top among these: while success and likability are positively correlated for men, the opposite is true for women. Saying a woman is “very ambitious is not a compliment in our culture,” writes Sandberg. “Aggressive and hard-charging women violate unwritten rules about acceptable social conduct. Men are continually applauded for being ambitious and powerful and successful, but women who display these same traits often pay a social penalty. Female accomplishments come at a cost.” Finally, she shares, “When reviewing a woman, the reviewer will often voice the concern, ‘While she’s really good at her job, she’s just not as well liked by her peers.’”

I say: bless her for telling it like it is. She confronts and exposes some tough truths, among them: women need to smile more than men when negotiating for a raise. Smile, and continue to smile.

In fact, I think of her comments when I speak to Daisy Kling, a third-year Queen’s student, currently on a transfer to Britain’s Durham University. “Sexism is invisible, but it’s real,” says Kling. “Girls have more pressure on them to behave a certain way. You think you have the same rights as boys, so it’s hard to understand why you feel held back. But there’s a lot of pressure on girls to act ninety different ways at once: you have to be smart, you want people to take you seriously, you have to be attractive—but not too attractive, not slutty. You have to have experience, but not too much experience.”

Sandberg’s well-trademarked advice is aimed, in many ways, at Kling’s generation. It amounts to this: lean into the boardroom table, not back; don’t decide to “leave before you leave”—in other words, to opt out of the fast track before you’ve even had children; and make your partner a real partner. Her focus is what she calls the “Leadership Ambition Gap,” and she’s determined to help women eliminate the internal barriers that keep them from the corner office. All valuable, bracing stuff—especially for those about to embark on a professional journey.

Neither Sandberg nor Slaughter airbrushes the truth. As I write this, Slaughter’s book has yet to be published. But I know from reading her Atlantic piece, and her New York Times review of Lean In, that her take and mine are aligned. This is a woman who admits to the complexities of long-distance parenting a troubled fourteen-year-old son. She confesses that “juggling high-level government work with the needs of two teenage boys was not possible.” Says Slaughter: “Having it all, at least for me, depended almost entirely on what type of job I had.” In other words, she believes there are times when you have to lean back. And while Slaughter’s version of leaning back means trading one high-octane superstar position for an illustrious second, you have to love her candor.

As a young professional, I could have used both Sandberg’s and Slaughter’s advice. As I said, there was no blueprint back in 1977, when I started my career, two weeks after my wedding. When I gave birth in 1984, the term “second shift” had yet to be popularized. And when I proposed job-sharing to my editors at Maclean’s magazine—job-sharing with the talented Canadian author, editor, and journalist Val Ross, no less—I was turned down. To them, the idea was too unwieldy, preposterous.

Motherhood changed my priorities. Before I had Nicholas, I gladly stayed at work all Saturday night when a political leadership race demanded that we close the magazine on a Sunday morning. After I became a mother, the trade-offs got tougher.

Here is what I learned: I had to create my own exits, and my own opportunities. I wanted to know my son as a toddler, and as a teenager, too. To be the mother I wanted to be, I would make compromises at work. To be the professional I wanted to be, I would make compromises at home. With those decisions came many blessings, and a couple of deep disappointments.

As a mother, I have worked full-time, part-time, and flextime: I have stayed at home and enjoyed a journalism fellowship year back at university. I did the latter when my son was two. In other words, I experimented with it all, and tried to time it well. I was entertainment editor of Maclean’s, Canada’s national newsmagazine, with a young son, and I was a vice principal of McGill University, with that same son at university himself. I could not have done the second job with a younger child.

When I look back, I see that I followed well what Sandberg advocates. I leaned in, hard. I did not leave before I left. And I made my partner a true partner: my husband and I separated when Nicholas was five, but we continued to share all daily duties related to our son, and all of the pleasures, too. As an independent television producer, based close to Nicholas’s school, Will was able to respond to midday emergencies in a way I was not. We were no longer husband and wife, but we functioned beautifully as a family, and we still do. Early on, I decided I would rather have my family than a financial settlement. As a result, we didn’t let lawyers get in the middle of our arrangement. We started having family dinners once a week, from the very beginning; that grew to taking shared trips with our son, and sharing cottage time. It was a novel arrangement when it began, less so now. In the end, we shared everything. The more we shared, the more smoothly things went.

Over the years, I won five National Magazine Awards for my work, and multiple others. I didn’t travel a lot, but when there was a speaking engagement, I was free to go. Still, there were many opportunities I chose to forgo. More than once, the London bureau of the magazine was up for grabs. I could never apply, much as I wanted to. And I knew that without a more diverse résumé, I was unlikely to be selected as editor of the magazine, a job I once dearly wanted.

In 2001, when I threw my hat in the ring, I was not chosen. I remember being encouraged to interview for the position. My immediate response: “They aren’t going to choose a woman.” To which came the less-than-resounding “You don’t know that.” But I did. I knew it in my bones. Actually, what I knew was they weren’t going to choose me.

After several rounds of rigorous interviews, the publisher poked his head in my office one noon hour. “We won’t be pursuing your candidacy any further,” he said, standing in the doorway, an awkward look on his face. I was eating a salad at my desk: mid-forkful, I received this news. I couldn’t help but wonder: Would they tell a man this way? Wouldn’t they invite him in for a short talk? Who knows, but I was scalded. An insider was chosen, and on his first day he invited me into his office. He asked me what I wanted: I said a magazine column. From there I developed a writing voice, one that gave birth to this book. It’s a twisty road.

So much of this comes down to pacing, balance, and juggling—and choices. I took my career seriously; I took being a mother seriously; and for more than a decade, I took being a lover seriously as well. I had a full-time job, a vibrant speaking career, a deep connection with my son, a fabulous relationship with Jake. Always, there were trade-offs. I didn’t write my column as often as I should have, in those years when Nicholas was at home. Most nights I got home late: too often, I was trundling in with groceries after seven o’clock, cooking fast for a hungry boy. In a long-distance relationship, Jake had to do too much of the traveling in the winter months. Everyone compromised. And somewhere along the line, I would surprise myself by drinking too much, using alcohol as a shock absorber.

Which isn’t to say that I wasn’t deeply happy with all my individual roles—mother, lover, editor, writer, speaker, daughter, sister, friend, ex-wife. But I always felt like I was failing somewhere, and I probably was. I didn’t see enough of Caitlin, Jake’s daughter, and that became a deep regret. More often than not, I felt stretched between multiple duties.

Most working mothers do. According to Wharton School of Business economists Betsey Stevenson and Justin Wolfers, women are less happy today than their predecessors in the 1970s, both in absolute terms and relative to men. No wonder. Between 1979 and 2006, the workweek of the typical middle-income American family increased by roughly eleven hours. According to a 2011 study by the Center for Work and Family at Boston College, 65 percent of fathers believed that both parents should contribute equally as caregivers for their children—but only 30 percent of the fathers actually did so.

For me, all the juggling took its toll. Certain disappointments at work were bruising. Menopause hit: anxiety and depression reared their ugly heads. Somewhere along the line, my occasional evenings of drinking too much morphed into drinking on an almost nightly basis. When Nicholas left for university, when the marathon was over and the house was empty, I was lonely: it was then that my evening glass of wine turned into two or three, which eventually became three or four in Montreal.

On this, I am not alone.

Preeminent American alcohol researcher Sharon Wilsnack, of the University of North Dakota, believes we are now witnessing a “global epidemic” in women’s drinking. In 2011, Katherine Keyes, now an assistant professor at Columbia University, reviewed thirty-one international studies of birth-cohort and gender differences in alcohol consumption and mortality. Her conclusion? Those born after the Second World War are more likely to binge drink and develop alcohol-use disorders than their older counterparts.

Sitting in her office, her two-year-old son’s face beaming by her computer, Keyes gets specific: “Those born between 1978 and 1983 are the weekend warriors, drinking to black out. In that age group, there is a reduction in male drinking, and a sharp increase for women.” Meanwhile, women who are in their forties and fifties have a very high risk in terms of heavy drinking and weekly drinking. “We’re not saying, ‘Put down the sherry and go back to the kitchen,’” says Keyes. “But when we see these steep increases, you wonder if we are going to see a larger burden of disease for women.”

In many countries, the answer is yes. Take Britain, for instance, the Lindsay Lohan of the international set.

Most important, Keyes’s study points to the critical role of societal elements in creating a drinking culture. “Traditionally, individual biological factors have been the major focus when it comes to understanding alcohol risk,” says Keyes. “However, this ignores the impact of policy and environment.”

The environment is challenging: witness the rise in alcohol marketing, the feminization of the drinking culture. Women need a break. They feel they deserve a break. And if drinking is about escape, it is also about entitlement and empowerment. Says Keyes: “Those in high-status occupations, working in male-dominated environments, have an increased risk of alcohol use disorders.” In fact, the one protective factor for women is what Keyes calls “low-status occupations.” She puts on her coat, getting ready to head home for the evening. “As gender role traditionality decreased, the gender gap in substance abuse decreased as well. And the trajectory for female alcohol abuse now outpaces that of men.”

In fact, women with a university degree are almost twice as likely to drink daily as those without. “I ask myself every day if I’m an alcoholic,” says one rising corporate star, a graduate of Queen’s University, who wishes to go unnamed. “I’m thirty-two, and I drink every night. All my friends drink every night. We wouldn’t dream of skipping a day. We haven’t had our kids yet, and we all drink the same way we did in university.”

Says Katherine Brown, director of policy at Britain’s Institute of Alcohol Studies: “Young professional women drink a lot more than women in manual and routine jobs—what you call blue collar. Is it marketing, keeping up with the machismo, children?” Brown believes that a crucial driver is the norms of the university years. “It’s an alcohol-soaked environment,” she says. “At the university I went to—Exeter—Carlsberg was a sponsor of events held on campus. The focus was on getting really, really drunk and the most horrendous things used to happen. It was an alcogenic environment—sporting events, pub crawls, often carrying a bucket around for those being sick. All social events revolved around drinking, and acting the fool was celebrated. Now, it’s the ‘done’ thing for a city woman to come home after a stressful day and open a bottle of wine. Is it the Sex and the City generation? Who knows. Nobody questions it.”

Walk into most social gatherings and the first thing you’re asked is “Red or white?” In fact, we live in a culture where knowing your wines is a mark of sophistication. And thanks to media reports of the past several years, we have happily absorbed the news that drinking has its health benefits. For many, red wine ranks up there with vitamin D, omega-3s, and dark chocolate. If one glass is good for you, a double dose can’t do much harm, can it? Actually, a double dose has its drawbacks. The largest health benefit comes from one drink every two days.

Which raises a simple question: why are we aware of the dangers related to trans fats and tanning beds, and blissfully unaware of the more serious side effects associated with our favorite drug? It’s a headscratcher, to say the least.

Last year, a study in the respected journal Addiction challenged the broadly accepted assumption that a daily glass of red wine offers protection against heart disease. Says Jürgen Rehm, director of social and epidemiological research at Toronto’s Centre for Addiction and Mental Health and coauthor of the paper: “While a cardioprotective association between alcohol use and ischemic heart disease exists, it cannot be assumed for all drinkers, even at low levels of average intake. And, the protective association varies by gender—with higher risk for morbidity and mortality in women.”

Alcohol is a carcinogen, and the risks of drinking far outweigh the protective factors. For some time there has been a clear causal link between alcohol and a wide variety of cancers, including two of the most frequently diagnosed: breast and colorectal. Rehm asks a simple question: “What would the breast cancer rate be without alcohol?”

Women have many other physical vulnerabilities when it comes to drinking. “Politically, we are equal,” says Dr. Joseph Lee, medical director of the renowned Hazelden Center for Youth and Families in Plymouth, Minnesota. “But hormonally, metabolically, men and women are different—and this has implications for tolerance and physical impacts over the long run.”

Women’s vulnerabilities start with the simple fact that, on average, they have more body fat than men. Since body fat contains little water, there is less to dilute the alcohol consumed. In addition, women have a lower level of a key metabolizing enzyme, alcohol dehydrogenase, which helps the body break down and eliminate alcohol. As a result, a larger proportion of what women drink enters the bloodstream. Furthermore, fluctuating hormone levels mean that the intoxicating effects of alcohol set in faster when estrogen levels are high.

The list goes on. Women’s chemistry means they become dependent on alcohol much faster than men. Other consequences—including cognitive deficits and liver disease—all occur earlier in women, with significantly shorter exposure to alcohol. Women who consume four or more alcoholic beverages a day quadruple their risk of dying from heart disease. Heavy drinkers of both genders run the risk of a fatal hemorrhagic stroke, but the odds are five times higher for women.

Gender is a strong predictor of alcohol use. One groundbreaking project is GENACIS—Gender, Alcohol and Culture: An International Study. With forty-one participating countries, this project offers an extraordinary opportunity to improve our understanding of how gender and culture combine to affect how women and men drink. Sharon Wilsnack, who oversees the GENACIS project, is also the lead author of the world’s longest-running study of women and drinking, the National Study of Life and Health Experiences of Women. Between 1981 and 2001, she and her team interviewed the same women every five years. One of their findings: the strongest predictor of late-onset drinking is childhood sexual abuse. Says Wilsnack, “It has an increasingly adverse pattern over the course of women’s lives.”

Depending on a woman’s stage in life, there are specific considerations of which to be aware. If you’re female and adolescent, this is your brain on alcohol: consume four drinks and you will leave yourself vulnerable to compromising your spatial working memory. Binge drinking in adolescence can interrupt normal brain cell growth, particularly in the frontal brain regions critical to logical thinking and reasoning. In short, it damages cognitive abilities—especially in female teens. Says researcher Lindsay Squeglia, lead author of a study in Alcoholism: Clinical & Experimental Research: “Throughout adolescence, the brain is becoming more efficient, pruning. In female drinkers, we found that the pre-frontal cortex was not thinning properly. This affects executive functioning.”

“Are the girls trying to keep up with the boys?” asks Edith Sullivan, a researcher at the Stanford University School of Medicine. “Quantity and frequency can be a killer for novice drinkers. Adding alcohol to the mix of the developing brain will likely complicate the normal developmental trajectory. Long after a young person recovers from a hangover, risk to cognitive and brain functions endures.”

Sullivan, who has done a lot of work with the brain structure of alcoholics, is certain that what is known as “telescoping” is real: “As they develop alcoholism, women seem to develop dependence sooner than men. Drink for drink, it is worse for females.”

“It is the issue affecting girls’ health—and it’s going sideways, especially for those thirteen to fifteen.” This is the voice of Nancy Poole, director of research and knowledge translation at the British Columbia Centre of Excellence for Women’s Health. “And the saddest thing,” says Poole, “is alcohol is being marketed as girls’ liberation.”

Perhaps we’re told too many fairy tales when we’re children. From the time we’re very young, we’re drip-fed popular culture’s notions of what will bring us happiness: being thin, being beautiful, being sexy—all these, we are told, will lead to love and success and acceptance. We already know that unrealistic images of slimness have damaged a generation. Now the alcohol industry is conspiring to drip-feed us the notion that cocktails will deliver us happy endings, rescuing us from the great modern scourges of loneliness, exhaustion, and boredom.

We need a wake-up call. For now, the first job must be jump-starting a dialogue, a fact-sharing mission. Three years ago, when I won a journalism fellowship to investigate the issue of women and alcohol, I was invited to describe my project at a media night at the University of Toronto. “I can only presume that Ann will be taking a look at First Nations women,” said the worldly man introducing me. His intentions were good, but his comment was off the mark.

Last June, I had what looked to be a golden opportunity to pose some questions to Gloria Steinem. The event: a fortieth birthday party for Ms. magazine. I waited in line for my chance, but my audience was short. “Alcohol?” Steinem looked dismissive. “Alcohol is not a women’s issue.”

Perhaps not in the past—but times have changed. Whether it’s a matter of escape, empowerment, or entitlement, alcohol has become a women’s issue. When it comes to risk, environment and policy are key drivers of our behavior. For now, our only choice is to take a hard look at both, and face the facts. The alcohol business, like the tobacco business beforehand, has taken aim at the female market, and scored. Risky drinking has become normalized, and not all young women will mature out of it. In fact, many—like myself—may mature into it.

Here are the questions we need to be asking. Has alcohol become the modern woman’s steroid, enabling her to do the heavy lifting necessary in an endlessly complex world? Is it the escape valve women need, in the midst of a major social revolution still unfolding? How much of this is marketing, and how much is the need to numb?

As a culture, we’re living in major denial. It’s time for an adult conversation. It’s time for the dialogue to begin.