A Chat With Gabrielle Glaser, Author Of Her Best-Kept SecretSWe've always heard more about male alcoholics than female ones — It's only recently that this study of wine being abused by Gen X women came out, and I could have told you that years ago. And I'm not counting the myriad pieces on college girls binge drinking, because the drinking is framed as almost incidental. Subject: College girls. Verb: Binge drinking. Not Subject: Female alcoholics.

There's been very little written, or even studied, about what happens when these women leave college: the prevalence of closeted long-term addicted female alcoholics who also happen to be executives, wives or moms who appear to have it all under control. Powerful memoirs like Caroline Knapp's Drinking: A Love Story and Smashed: Story of A Drunken Girlhood by Koren Zailckas have helped women acknowledge their own problems, but the dearth of practical advice tailored to female alcoholics is massive.

This is where Gabrielle Glaser comes in. A journalist for The New York Times and elsewhere, after lengthy historical and sociological research on women and alcohol, she's coming out with Her Best-Kept Secret: Why Women Drink And How They Can Regain Control, in which she reveals that AA may not necessarily be the best solution for some women.

Did men in history have any particular feelings or bias towards their wives/daughters’ excessive drinking? When did it become acknowledged that women could be alcoholics?

It wasn't even until the 1970s that a female grad student at Harvard noticed that women hadn't even been included included in alcohol studies — out of tens of thousands of studies, she found six lousy ones that said anything about women. I kept looking for treatment research data from periods earlier than the 90s and kept hitting walls. Finally I sent an email to the branch of the government that keeps such data, the Substance Abuse Mental Health Services Administration, and learned that the reason I couldn't find it was because it didn't actually exist! Nobody had actually thought to consider that women were different from men when it came to the physical and psychological effects of alcohol — or how they might respond to treatment if they did develop a problem.

This book isn't an anti-drinking book, but I was really curious about how we got from Carry Nation smashing saloons with her axe to Girls Gone Wild in just a few generations. For the most part, each generation of women has a different relationship to alcohol than the one before her. Sometimes it's an extreme reaction, and sometimes it's just slightly different.

Do women become alcoholics for different psychological reasons than men do?

A lot of researchers use the new term "alcohol use disorder" now, which encompasses a wide range of alcohol use. You can drink too much on frequent occasions and want to cut back and be on the mild end of the spectrum, or drink too much all the time and be severely alcohol-dependent on the opposite end. In the book I wrote about people who are mostly worried about where they might land, but not having physical symptoms of alcohol dependence. So, to answer: women are about twice as likely to be diagnosed with anxiety and depression as men, and they're therefore more likely to try to medicate those conditions with alcohol. They are also more likely to have been sexually abused or have had an eating disorder, which are two other risk factors for everybody, but since more women suffer from those, that places a disproportionate number of psychological risk factors on women.

Also: Modern society has a hell of a lot of stress. There's a lot of pressure to have the perfect career, meet the perfect partner, raise the perfect kid, get that perfect kid into the right school, take care of aging parents while managing all the above plus a home (who is doing the laundry and grocery shopping?) — all while you might consider asking your doctor about Juvederm. It's a lot. When my grandmother was still alive in the early 2000s she used to crack jokes about "core exercises." She thought everyone was talking about apples.

How do you think women should handle dating when they’ve decided to stop drinking? I’ve been on dates where I’ve said that I don’t drink anymore and guys look at me like I just told them I had no vagina.

It depends on how comfortable you feel, if you are trying to abstain, being around someone who likes to drink a lot. I think you'll be able to see if it's someone who just likes to drink normally, or someone who really likes to get hammered. If someone looks at your not drinking as a deal breaker, that might indicate just how important alcohol is in that guy's life. Not trying to be coy, but it might be a red flag. A lot of people don't drink — for religious reasons, because they don't like it, because they're on meds that interact badly with alcohol or because they have a physical condition that makes it risky.

How does a young, upwardly-mobile woman in a big city determine if she’s an alcoholic? It’s harder than it sounds — there’s functional alcoholism, as you obviously know — and even business meetings often include drinks. It’s so normalized, and it’s hard to have perspective when you’re in it, if that makes sense.

Do you mean, by "alcoholic," that you're physically and psychologically dependent on alcohol? There I would have to refer to one of my expert docs, Mark Willenbring. He used to be the head of treatment research at the National Institutes for Alcohol Abuse and Alcoholism. He suggests that if women (and men) can answer yes to these questions, it makes sense to find an evidence-based intervention that fits them best: "Do you set limits and repeatedly go over them? Do you have a persistent desire to quit or cut down and are unable to do it? Do you have frequent physical consequences, such as nausea or headaches, after time spent drinking?"

One of your major talking points (and one that has been a controversial revelation to a lot of people) is that AA might not work for women as well as men. Elaborate on that.

AA's founders were white, middle-class males. The world was their oyster, but alcohol was something over which they lacked control. The steps involve surrendering your ego and self-will to God, as well as scrutinizing your character flaws. That was a clinical and psychological milestone for men at that particular time and place. But most women who drink too much aren't suffering from powerful egos, or a lack of awareness of their flaws. Many researchers say that women feel better when they're empowered to make healthy changes in their lives, whether that's abstaining or moderating.

In addition, I found a lot of evidence that AA is not always a safe place for women. My research found that sexual abuse among AA old-timers toward newcomers is ongoing and systemic. Internal documents from an AA trustee note that this is an entrenched problem, and a study in one peer-reviewed journal shows that it happens to the majority of women who attend. AA groups abroad have recognized the problem, and issued behavioral guidelines for their groups. [There is also] profile of an AA whistleblower, Monica Richardson, who tried to change the organization from within and got nowhere. The number of women who've written to me since the book was out to say that this has happened to them is overwhelming, and the [people] who deny it really take me by surprise. It feels very 1950s.

I understand that cognitive dissonance is uncomfortable. It's understandable that people want to reject information that conflicts with beliefs they hold dear. But even the saddened trustee - with whom I spoke at length for my book — told me that women have been getting raped in AA for a long time. Instituting changes, he told me, was like trying to turn a battleship on a dime.

When I began doing research for this book, I assumed it was the best place to go because that's what people did. I saw it on TV and read about it in books. I knew people who were in it. But for research, I started looking into what worked best for women. And by research, I mean research. I delved into the science, and talked to dozens of experts around the country. I read reports conducted globally. I interviewed people in AA, I interviewed people who had left AA. I attended about 10 meetings so I could get a feel for what went on there — not to draw conclusions based on my observations. I backed those up with numbers, including AA's own membership surveys. One 2000 survey, published in the Alcoholism Treatment Quarterly, found that of 100 people who attend on January 1, only 5 will still be attending on Dec. 31. That comes from AA's own figures. It's data.

What are some alternatives to AA for women that aren’t as pricey as inpatient rehabs?

There are lots of them. There is Smart Recovery, which is a group that uses evidence-based practice as a model for its members. There is Women for Sobriety, and there's a group called Moderation.org, for folks who need a science-based approach to cutting back. Then there is HAMS, a harm reduction group, which is a method embraced by health agencies and clinicians around the world. We think of it is "needle exchange" only, but really every day we practice harm reduction. Seat belts are harm reduction. Gloves when you're pulling ivy is harm reduction. Drinking at home and never driving is harm reduction.

I'm not saying that's for everyone, but we need to broaden our ideas about what recovery is. It doesn't have to be one-size-fits all. There are also medical options — medications that are generic — nobody is making money off of these, so I'm not advocating for Big Pharma here — that help cut cravings. Our own government spent $30 million to find that one method — the drug naltrexone, combined with visiting a doctor who can talk to you about your drinking, is the most effective method for reducing alcohol abuse. Under our new health care laws, this sort of treatment will be covered.

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