Improper malolactic fermentation generates the toxic byproducts thought to cause hangover symptoms, Professor Jin said.

Durban - Recent research in the UK reveals that affluent, middle-aged women, many with beautiful homes and families, are drinking more than any other social group.

A study by data company Caci found that two out of three “ladies who lunch” in prosperous areas drank more alcohol than any other social group. In fact, two-thirds drank more than the recommended limit, compared with 28.9 percent nationally.

While there is no matching study in South Africa, experts say alcohol abuse by middle-aged women is a worrying trend here too.

“Women tend to develop alcohol problems later in life than men,” says Carol du Toit, director of the South African National Council on Alcoholism and Drug Dependence in Durban, “and for many middle-aged women, drinking is part of their business and social life. They appear to be leading normal lives, running their homes and maybe working, but they are secretive. They drink at home and choose drinks like gin or vodka that do not smell. They are sometimes called ‘wardrobe alcoholics’ because of their secretiveness.”

This is fuelled by society’s condemnation of women who abuse alcohol. While a drunk man may be branded a clown or a fool, a drunk woman, particularly a mother, is viewed with revulsion. This also encourages the rest of the family to collude in the secrecy, until the problem drinking can no longer be hidden, says Du Toit.

Westville psychiatrist Dr Jack Krysztofiak agrees.

“For many middle-aged and middle-class women, the daily use of alcohol has become a social norm,” he says. “Many couples share a bottle of wine or two over dinner. Long weekend lunches often include excessive drinking.

“This pattern of alcohol use leads to rather insidious metabolic and behavioural changes which are not immediately associated with drinking. Gradual increase in weight, poor sleeping, slow and groggy mornings, tiredness, poor performance at work, moodiness, depressed mood and general feelings of being unable to cope are frequent complaints caused by moderate daily drinking. Relationship problems, arguments and particularly aggression are commonly caused by alcohol use.”

More women than men are treated with antidepressants, sleeping pills and mood stabilisers, and Krysztofiak says in this group, alcohol use frequently leads to inappropriate, risky behaviour followed by inability to recall an event.

“Despite drinking these women continue to function very well and hence do not recognise their use of alcohol as harmful. In fact the suggestion of limiting drinking is often met with resistance. In many of these cases an abnormal liver function test is a wake-up call.

“If after an evening a woman has a bottle of wine and does not feel tipsy, then perhaps it is time to cut down on daily drinking.”

Physiology plays a role too. According to DrinkIQ, an alcohol information initiative, women are generally smaller and therefore more likely to feel the effects of alcohol more quickly.

They also produce less alcohol dehydrogenase, the enzyme responsible for breaking down alcohol.

Levels of blood alcohol content differ around the time of the menstrual cycle, as the body retains more fluid. On average, women have between 10 and 15 percent more water content than men, and during their periods, water retention is even higher.

According to Professor Denis Viljoen, chairman of the Foundation for Alcohol Related Research, alcohol molecules can enter the brain within half an hour and, when there are higher amounts of water in the body, the effects of alcohol are longer lasting.

Viljoen says when a woman has one drink, it will have the same effect as two drinks for the average size man. Women may drink less but experience the same level of impairment.

“Another consideration is that women absorb up to 30 percent more alcohol into their bloodstreams than men of the same height and weight who drink the same amount of alcohol. Women can develop liver damage and other alcohol-related health problems more quickly than men, even though they may be drinking less.”

The World Health Organisation’s guideline is two glasses per day for women; three glasses per day for men; four glasses a day on special occasions only and 0 glasses if you are under 18, pregnant or driving.

South Africa’s Department of Health in not so specific. Its Food Based Dietary Guidelines state: “If you drink alcohol, drink sensibly.”

Adrian Botha of the Industry for Responsible Alcohol Use says women need to know their personal limits when it comes to consuming alcohol.

“You need to be aware of the numerous factors that could cause your personal limits to shift, including the physiological differences between men and women.”

A women’s psychological make-up makes them prone to depression. “Drinking lifts their spirits and numbs their pain – and the problem escalates,” says Botha.

Treatment of alcohol abuse needs to be holistic to ensure a good outcome. This would involve treatment by professionals and self-help groups such as Alcoholics Anonymous.

“Recovery is a life-long process making aftercare an essential part of the treatment,” says Du Toit.

Christopher Moon, an addiction counsellor at the South Coast Recovery Centre in Ramsgate, says recovery is affected by many factors, including the patient’s history of abuse, relationships, whether they have multiple addictions or psychiatric disorders.

“Generally the relapse rate for alcohol is dependent on the number of previous treatments,” he says.

“We find that the relapse rate is higher for a first treatment attempt than those who have previously attempted treatment.

“The length of treatment plays an important role in the rate of relapse.

“Our experience is that shorter-term treatment interventions seem to yield poorer results than longer-term interventions.”


Case study: ‘It was a relief to know I was not alone’

Durban wife and mother Jane*, 55, describes herself as an “upper middle class” woman who had, and did, it all. Active at her son’s prestigious school, she owned a gym and appeared to have what other women envied: a loving husband and son, successful business, a toned body and boundless energy.

But her driven personality and obsession with success, led her into the grip of what she describes as a “terrible disease”, alcoholism.

“I have an obsessive personality,” she explains. “As a child I danced, played sport and exercised, pushing myself to the limit. I was competitive, strove to be perfect and developed anorexia in my teens, which I overcame, but quickly filled the void with bulimia which I had until my early thirties.

Jane married in her late twenties, had a son and ran a successful gym, but feelings of inadequacy dogged her. Drinking numbed her pain.

In her mid-thirties, her sister and niece died in a car accident and she turned to alcohol. The devastation of losing two people she loved sent her into a downward spiral.

“I would have a glass of wine in the evening and my husband would think nothing of it. He didn’t know I drank in the day. I couldn’t wait for him to go to work so I could drink.”

She also chose friends who drank – they would meet in the mornings and sup away – a silent sisterhood.

“There were others who did this too… I didn’t feel so bad,” she said.

She sold her gym and tried to work as a personal trainer, but would miss appointments to drink. She drank in the middle of the night, hiding bottles in the garden. She raided the locked booze cabinet, topping up the bottles with tea. Much energy was spent on covering her tracks.

But despite her secretiveness, many people knew, including the headmaster and teachers. Many parents forbade her from lifting their children.

“I refused to call myself an alcoholic. I was in denial. There were weeks when I was fine, but it never lasted. I carried on with life – I was a functional alcoholic.”

She was admitted to hospital and treated for depression.

“Depression was not the problem. The problem was all the years of baggage that I needed to work through. The obsession with perfection, having an alcoholic father, striving to be better all the time and never feeling good enough.” The continuous fear of failure never disappeared.

She worried about the effect on her young son who never brought friends home.

In her early forties, things hit an all-time low. Her life was rocked by a hijacking, followed shortly by a bank robbery, and this fuelled her addiction. Her husband tried everything to stop the abuse of alcohol. Her parents got involved. Friends tried to stop her drinking. Nothing worked.

“My husband started talking divorce. The lawyer said I would lose everything. The doctors said I might die if I didn’t stop drinking but I didn’t care – that is how cunning, baffling and powerful alcohol addiction is.”

She was referred to a counsellor, whom she manipulated, and focused only on how she could get her next drink.

“For nine months, things were a blur. I was reed-thin and my skin was bruising from the onslaught of alcohol. My whole life had become unmanageable and the dark hole was getting deeper and deeper. I have since been told that, at that point, I had just six months to live.”

On May 4, 2003, she had a spiritual experience in the middle of the night.

“I was engulfed in light and I felt at peace for the first time in years.”

She was also in great pain and asked her husband to phone a treatment centre. She went to a centre in the Eastern Cape.

“It was a relief knowing I was not alone and that there were others in a similar state. I relished facing up to my demons and every day brought a new reality of how I had got to where I was. It was tough to be brutally honest and I had to start unravelling my past. I realised I had been wearing a mask for years and had blamed everyone else for my drinking.

“The first 18 months of recovery were difficult as I had to set a new foundation for my life ahead.”

Jane joined Alcoholics Anonymous and went on to their 12-step programme, going to meetings up to four times a week, also seeing an addiction counsellor.

“I lived for the meetings and did everything they told me to do. The programme is spiritual. You can only stay sober with the help of a higher power and I live the 12-step programme in every area of my life, every day. It is the only way I can stay sober.”

This month, Jane celebrated 3 770 days of sobriety, one day at a time. She still goes to meetings and is involved in mentoring newcomers. She has a sense of peace, but is aware that the recovery rate from alcoholism is only five percent and that staying sober requires work.

“I have a disease that will be with me till the end, and to pick up a drink is to die. AA has given me the tools to stop the chaos and I take one day at a time.”

* Not her real name.


Useful numbers:

Lulama: 031 202 2241 [email protected]

Alcoholics Anonymous: 031 301 4959 or 031 765 7897

South Coast Recovery Centre: 039 314 4777 - Daily News