GIRLS AND ALCOHOLISM: ENVIRONMENT HOLDS CLUES

Rachel's easy smile disappeared as she struggled to find the words to
describe her hurt.

"Next to all the good things about college," she said, "is still what I can
never get back from high school. It's from sophomore and junior year, when
I drank so much out of control.

"I got so drunk, compared with Jeff (her boyfriend). When I was 15, I
started drinking a lot. It was like we all went out, and it was like
competition. What happened, I never told anybody about, until I got to the
U. One of my roommates was crying, and she told me about her drinking, and
about how she got really drunk."

Rachel was silent. I noticed tears. "It was so crazy then because I drank a
lot, and I couldn't handle it. It was regular on the weekends. I'd fake
that I wasn't as wasted as I was.

"And now everything's fine at the U. You told me girlfriends were most
important, and they are. And I've got a boyfriend, Jim, I've been with for
a year and a half. It's pretty serious. He knows me pretty well. We talk
about everything. He doesn't know," Rachel's tears resumed, "that I had sex
in high school, when I was very drunk.

The first time, Jeff raped me, when I slept over at his house. I remember
we were watching TV. It was late. I was out of it. He wasn't so out of it."

Rachel looked very sad. "It's not a moral thing. I just wish I still had
myself. I wish that I had been respectful and careful with my own body. I
wish that I'd waited until I was older, because now I realize that sex is
healthy when it has to do with the most important thing -- intimacy.

I wish I'd thought about my body being special but I treated it like a
drunk. Jeff did too. I missed the chance to treat myself, and the man I
love, very specially.

"Jim doesn't know that" Rachel looked at me, and mumbled.

"It's good to be able to say that but it's so sad. I can't get that back. I
wish I'd waited."

I felt terrible for this intelligent, sincere young woman, even though I'd
heard similar reports from others. Certainly a normal and successful
university sophomore, she had grown up a lot since her parents brought her
to me for help when she was in high school. Yet, she ached as she recalled
her earlier years with alcohol. There was no way that she could undo what
had happened.

Rachel and I talked about girls and alcohol. Rachel told me about several
of her girlfriends, ages 19 and 20, who are alcoholics.

I told her about how the effects of alcohol are different for girls than
they are for boys.

Her eyes widened, and she looked interested. She challenged me to explain.

There are three times as many men (about 12 1/2 percent), as women (3
percent), who abuse, or are dependent on alcohol. Yet, the effect on
females is clearly powerful when we distinguish between two kinds of
alcoholism.

Genetics probably accounts for about half the incidence of alcoholism. This
cause, typically associated with conduct disorders, likely has more to do
with father-son, intergenerational links than with alcoholism in girls.

In my view, the other kind, environmentally determined alcoholism, accounts
for a higher percentage of alcohol-dependent females. (For example,
childhood sexual abuse and teen group drinking often precede or accompany
alcohol dependence in girls.) If we only consider environmentally
determined alcoholism, girls are far more vulnerable.

As Rachel described her tendency to feel "confused, impulsive, and
desperately needy" when she drinks with others, I realized she was
comparing herself with boys. Boys bought rounds of beer, or they typically
contributed other alcohol, when she was in high school. They essentially
drank equal amounts, together.

Rachel's words suggested an impossibility --that girls should be able to
tolerate alcohol as well as boys.

Girls' neurologic systems are more responsive to, and thus more impaired
by, a specific amount of alcohol as compared with boys.

Even after controlling for body weight, girls have higher blood levels of
alcohol than boys, given exactly the same amount of alcohol ingestion.

Thus, girls, because of natural factors, are normally more intoxicated than
boys, after drinking together.

Rachel and I have known each other for a long time. She was disappointed
with me, and surprised, that I had never told her these facts.

First, she told me that she was certain that, even at a young age, she
would have approached drinking very differently, had she known these facts.
Then she suggested that I "write all of this in one of the newspaper
columns that high school girls read." I am following her recommendation.

Dr. Schwarzbeck is assistant clinical professor of psychiatry at the
University of British Columbia and is on the faculty of the University of
Washington Medical School. He can be reached at schwarzbeck@msn.com.