It was a regular morning, nearly a decade ago, when Karla Adkins glanced in the rearview mirror of her car and noticed the whites of her eyes had turned yellow.
At the age of 36, she was working as a physician liaison for a hospital system on the South Carolina coast, fostering relationships among doctors. Privately, she had been battling heavy drinking since her early 20s, using alcohol as a coping mechanism for her anxieties. Understanding that the yellowing of her eyes was a sign of jaundice, Adkins was aware of the implications. However, her primary fear was not the diagnosis of alcohol-related liver disease.
"Honestly, my biggest fear was someone telling me I could never drink again," admitted Adkins, a resident of Pawleys Island, a coastal town located approximately 30 miles south of Myrtle Beach.
Despite her concerns, the consequences of her drinking soon became evident. Within 48 hours of that moment in front of the mirror, she found herself hospitalized, grappling with liver failure. "It happened so quickly," Adkins recounted.
Historically, alcohol use disorder has disproportionately affected men. But recent data from the Centers for Disease Control and Prevention on deaths from excessive drinking shows that rates among women are climbing faster than they are among men. The Biden administration considers this trend alarming, with one new estimate predicting women will account for close to half of alcohol-associated liver disease costs in the U.S. by 2040, a $66 billion total price tag.
It's a high-priority topic for the Department of Health and Human Services and the Department of Agriculture, which together will release updated national dietary guidelines next year. But with marketing for alcoholic beverages increasingly geared toward women, and social drinking already a huge part of American culture, change isn't something everyone may be ready to raise a glass to.
"This is a touchy topic," said Rachel Sayko Adams, a research associate professor at the Boston University School of Public Health. "There is no safe level of alcohol use," she said. "That's, like, new information that people didn't want to know."
Over the past 50 years, women have increasingly entered the workforce and delayed motherhood, which likely has contributed to the problem as women historically drank less when they became mothers.
"Parenthood tended to be this protective factor," but that's not always the case anymore, said Adams, who studies addiction.
More than 600,000 people in the U.S. died from causes related to alcohol from 1999 to 2020, according to research published in JAMA Network Open last year, positioning alcohol among the leading causes of preventable death in this country behind tobacco, poor diet and physical inactivity and illegal drugs.
The World Health Organization and various studies have concluded that no level of alcohol consumption is safe for human health. Even light drinking has been associated with health issues such as hypertension, coronary artery disease, and an increased risk of breast and other cancers.
During the COVID-19 pandemic, binge-drinking was significantly exacerbated as individuals turned to alcohol to cope with stress, according to George Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. This trend is particularly noticeable among women, who are more likely to use alcohol as a stress-reliever compared to men.
Furthermore, women are often the target of gender-specific advertising for alcoholic products. The popularity of rosé sales and low-calorie wines has surged in recent years. A recent study published by the International Journal of Drug Policy highlighted that the alcohol industry frequently uses "pinking of products" as a strategy to appeal to the female demographic.
Another factor influencing alcohol consumption among women is the rise of "mommy wine culture" on social media, where drinking to cope with the challenges of motherhood is normalized. There is a common misconception that as long as alcohol is consumed in moderation, it poses no harm.
Research indicates that memes and online videos may have an impact on women's drinking behaviors, prompting further investigation. A study conducted by experts revealed that women without children at age 35 face the highest risk of binge-drinking and alcohol use disorder symptoms among all age groups of women. This risk has been increasing for both childless women and mothers over the past two decades.
These influences, along with societal pressures to conform, can make discussions about excessive drinking challenging. "It's a very taboo topic," stated one researcher.
According to Stephanie Garbarino, a transplant hepatologist at Duke Health, many patients are unaware of the health implications of their drinking habits. "Often, they didn't know there was anything wrong with what they're doing," she noted, highlighting a rise in liver disease cases among younger individuals.
Experts in public health and addiction are concerned about the increasing costs associated with alcohol-related liver disease in women. In 2022, women represented 29% of the total costs linked to the disease in the U.S., a figure expected to rise to 43% by 2040, as projected in a recent analysis published in the American Journal of Gastroenterology.
National dietary guidelines recommend limiting alcohol intake to one drink per day for women. These guidelines are set for a five-year review next year.
In 2023, Canada released guidance suggesting that consuming more than two alcoholic beverages per week could pose health risks. This sparked controversy when comments to the Daily Mail hinted that U.S. guidelines might follow suit. A CDC report in February proposed that raising alcohol taxes could help reduce excessive alcohol consumption and related deaths. However, Koob's office declined to comment on such potential policies.
This issue hits close to home for Adkins, who now works as a coach helping predominantly women quit drinking. The pandemic inspired her to share her story of surviving liver failure in a book. Despite living with cirrhosis, she will celebrate a decade of sobriety this September.
"The incredible thing is, there's not much lower than where I was," Adkins reflected. "My goal is to shift the conversation."
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