Attitudes to daily drinking are changing as more evidence emerges that the ideal level of consumption is probably none at all.
The horrified mothers belong to a group that have even earned their own entry in the crowdsourced online urban dictionary: wine mums (or moms to Americans) are defined as “women, usually mothers, who sip wine throughout the night and sometimes post on social media about it. The main focus of a wine mum is to stay classy and share intriguing quotes.”
A Facebook trawl will reveal some of those witticisms: “Darling, size does matter … when it comes to your wine glass”; “The most expensive part of having kids is all the wine you have to drink” and “I’m looking for a wine that pairs with my kids being home all day.” There are even baby jumpsuits bearing the words: “I’m the reason Mummy needs wine.” Last month, Netflix began streaming the comedy film Wine Country, directed by Amy Poehler, which follows a group of middle-aged women on a Californian wine-tasting tour. Drunkenness, casual sex and drama ensue.
But the widespread and socially acceptable wine-drinking culture of middle-class New Zealand mothers appears to gloss over the harm done to them – and their children – by alcohol.
It has long been assumed that moderate drinking is largely risk-free. But research by public-health physician and epidemiologist Jennie Connor and colleagues at the University of Otago has revealed that a substantial proportion of women diagnosed with breast cancer were drinking at what is regarded as a socially acceptable or safe level: up to two standard drinks a day. A glass or two of wine while the kids play at a friend’s house, or with dinner each weeknight, is all it takes to increase risk.
One of the imponderables is the meaning of the phrase “standard drink”. A researcher’s standard glass of wine is 100ml – so a bottle is 7½ glasses. But Connor says women who report having one or two wines a day are probably having three standard drinks, “and this group is known to under-report their drinking more than women who drink more than that”.
Connor, who was lead author of a 2013 report “Alcohol-attributable burden of disease and injury in New Zealand”, says peer pressure to drink can be “very strong and unthinking”.
“Many will say, ‘What about the mental-health benefits?’ Scottish psychiatrist RD Laing described drinking as ‘a way of coping that makes you less able to cope’. When people are stressed or distressed, most of the effective responses are good for your health – such as exercise and making more time for constructive social relationships. Drinking makes change less likely to happen.”
The study, commissioned by the Health Promotion Agency (HPA), found that about 60% of all alcohol-attributable cancer deaths in New Zealand women are from breast cancer. “We estimated [that drinking was a cause in] 71 breast cancer deaths in 2007 and 65 in 2012, and about a third of these were associated with drinking less than two drinks a day on average,” Connor says.
“Although the risk of cancer is much higher in heavy drinkers, there are fewer of them, and many alcohol-related breast cancers occur in women who are drinking at levels that are currently considered acceptable.”
Moderate alcohol use for healthy adults means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men under 65. One more standard drink a day will increase breast cancer risk by 10%, says Connor, “whether it is two drinks a day rather than one, or six drinks rather than five”.
She says the evidence that breast cancer risk rises with even moderate drinking is strong. “Particularly for breast cancer, [drinking less] alcohol is one of the few things we can choose to do to lower the risk.” (The risk is also reduced by having children young, having more children and breastfeeding them, but most women won’t choose what Connor calls “a reproductive strategy” to lower risk.)
Alcohol also causes weight gain, so everyday drinking plays a big role in putting on the kilos. For some, the volume drunk will also increase over time, especially at times of stress “when you need to have your wits about you”.
“Many regular drinkers at this level tell themselves and each other stories, such as, ‘I’m a better parent when I’m more relaxed’ and ‘I don’t need to change because it’s harmless/healthy.’ But we should not kid ourselves that this is modelling good drinking behaviour for children, because this is not. Even if you drink a relatively small amount of alcohol, if you do it frequently, they still absorb your model. And it’s true that you are dependent on this lifestyle, if not on the alcohol itself.”
The Global Burden of Disease study is a comprehensive global collaborative project using the work of 1870 researchers in 127 countries. Its fourth and most recent report, published in 2016, shows that there is no such thing as a safe level of drinking.
It found that alcohol was implicated in 2.8 million deaths internationally and was the leading risk factor for premature mortality and disability in the 15-49 age group, where it accounted for one in five deaths. Among those aged 50 and over, cancers accounted for 27% of alcohol-attributed deaths in women and 19% in men. “Our results show the safest level of drinking is none,” the study concluded.
Massey University researcher Taisia Huckle was a co-author of a paper, published last year, on drinking patterns in nine countries, including New Zealand. It showed that men typically drank more heavily and regularly than women, and that “high-frequency” drinking was greater in wealthier countries, particularly amongst older people. New Zealanders, with an average of 90 drinking occasions in six months, were second-highest for drinking frequency.
Despite the fact men typically drink more, and more often, the Health Promotion Agency points out that when women and men drink the same amount of alcohol, women have higher blood-alcohol levels, so they get drunk faster and can suffer lethal alcohol poisoning at a lower dose. That’s mainly because women are smaller than men and have a higher fat-to-water ratio – so they have less fluid in their bodies to distribute the alcohol and it has more contact with the brain and other organs. And because the available fluid to process alcohol reduces with age, the effect of each drink becomes greater. As a result, women are more likely to develop alcohol-related problems that are mistakenly attributed to ageing, such as depression, sleep disruption, poor diet, heart failure and falls. They are also likely to have less of the enzyme needed to break down alcohol in the liver.
For all that, and because of their lower consumption, the annual number of women whose deaths are attributable to alcohol is half that of men. But the HPA also says women are more likely than men to suffer the harmful effects of other people’s drinking.
Journalist and mother Lotta Dann stopped drinking seven years ago after realising it had become her No 1 coping tool. She has written two books, Mrs D Is Going Without and Mrs D is Going Within, about giving up alcohol and her strategies for coping with life alcohol-free, and she says booze in supermarkets is just one of the “crazy world of mixed messages” that women face.
“We read in the paper that a major worldwide study has found there’s no healthy level of alcohol consumption, then pop down to our local supermarket and it’s sitting innocently there.” Dann, 47, who stopped after realising she was drinking “for every and any occasion, mood, emotion or event”, says abstinence hasn’t been tough. “It’s totally doable. I was so fearful when I quit that all the fun would end, and I’d be miserable and bored forever. But that’s far from the truth. I love my alcohol-free life and wouldn’t trade it for anything.”
Dann is working on a third book – the working title is Wine O’Clock Is a Crock – about women and alcohol. “I want to unpick the whole ‘wine-mum’ culture and examine the different ways alcohol can affect a woman’s life.”
She believes that more women are beginning to think about their drinking, but it’s difficult for them to do anything about it because often they are in social groups that champion it and they’re worried about putting themselves outside that norm. She says many women who are still drinking heavily and habitually fear being ostracised by their social group if they quit.
“It’s just become almost a total acceptance that we need wine in order to mother, that mothering is so difficult that wine is the natural reward or lubricant to help us with that job. It does a huge disservice to us.
“It’s everywhere. Online, there’s a huge wine-mum culture on Facebook and the like, where people are sharing these funny memes and stupid jokes that are making it totally accepted – funny and normalised. It is hard to be a mum: it’s tiring, pressured and lonely and when you have those realities mixed with an environment that champions booze at every turn, why wouldn’t you [drink]?
“Now I’m sober, I look back at what I considered normal. Sometimes the only walk in the day that I would take with my baby was down to the local dairy to get a bottle of wine and that was my outing. I thought that was normal and fine, but when I look back now, I shudder. I was really reliant on it and my drinking increased when I got home because I felt disconnected from the world and it was my way of feeling adult and normal. And it is normal because everyone’s doing it.”
Sydney epidemiologist Gideon Meyerowitz-Katz, who specialises in chronic disease, said it’s impossible to know from alcohol research if moderate drinking causes people to be healthy, “or if it’s just that the people who drink moderately in our society are rich and well-off, and that’s what is making us think that moderate drinking is good”.
Meyerowitz-Katz cites work published in 2016 from the New Zealand Longitudinal Study of Ageing, an interdisciplinary group that does research projects related to health and ageing. It divided people into never, moderate and heavy drinkers and found moderate drinkers were the healthiest of all. But when the researchers from Massey University added a control for socio-economic status, the beneficial effects of moderate drinking disappeared.
However, moderate drinking has been associated with a reduced risk of heart disease. According to Harvard Health’s 2016 report “Women’s Health: Fifty and Forward”, small amounts of alcohol increase “good” HDL cholesterol, improve insulin sensitivity and reduce inflammation. Wine, in particular, contains plant substances called flavonoids, which have demonstrated anti-inflammatory and anticancer activity in laboratory experiments. But, for women, the benefits of alcohol vanish with a second drink. At more than one drink a day, the risk of breast, brain and stomach cancers increases, as does the risk of high blood pressure and strokes. Higher levels of consumption can lead to pancreatic cancer, liver disease and neurological disorders.
The evidence for total abstinence is much clearer in pregnancy. In this country, between 600 and 3000 children are born each year with alcohol-related brain damage. There’s no known safe level of alcohol exposure for a developing fetus; adverse effects can occur with just one drink a week.
The HPA recommends that pregnant women abstain from alcohol, and in the US, the Centers for Disease Control and Prevention (CDC) released new recommendations in February that reiterated the need for pregnant women to abstain, but added that “women who could be pregnant” should also refrain from drinking. Social media commentators suggested this could potentially mean all women of childbearing age need to abstain from alcohol until menopause.
The official line is that women should consume no more than four standard drinks on any single occasion, and men no more than five, to reduce the risk of injury. To reduce long-term health risks, the HPA recommends women have no more than two standard drinks daily, and men no more than three, and both groups should have two alcohol-free days a week. That adds up to 10 standard drinks of 10g of alcohol a week for women and 15 standard drinks a week for men.
If that sounds miserly, spare a thought for the British. In January, England’s chief medical officer, Sally Davies, released new alcohol guidelines that recommended no more than 14 units of alcohol a week (one British alcohol unit equals 8g or 10ml of pure alcohol). Davies warned there was no completely safe level of regular alcohol consumption.
Those modest guidelines were received with headlines such as the Guardian’s, “The state needs to butt out of Britain’s drinking habits”. But the English won’t get any sympathy from Doug Sellman, director of the National Addiction Centre at the University of Otago’s Christchurch School of Medicine and Health Sciences. He says New Zealand’s guidelines should be halved.
Connor’s group has called for tougher mandatory labelling of alcohol, after noting in a study published in the peer-reviewed Australasian journal Drug and Alcohol Review that warning labels were “highly deficient”. For instance, although 80% of alcoholic beverages had pregnancy-related warnings, these were predominantly on beer – a product mainly marketed to men. They called on the Government to take population-based measures to limit alcohol harm through marketing, pricing and accessibility controls.
Unsurprisingly, the industry-funded Alcohol Beverages Council believes that’s unnecessary. Executive director Nick Leggett says that what is needed is more education, starting younger. “We teach kids about sex and how to drive a car, but too often people go into the world without being sensibly educated about alcohol.”
Dann, who runs Mrs D’s blog on the Drug Foundation’s Living Sober website, says the women who post to it have many things in common. “The main one is that you can really hide it. You can be miserable and stuck and appear to be fine. They come on our site anonymously and start telling us things that no one has known, even loved ones in their family, because it goes on in your head. Unless your life is really starting to fall apart, you can appear fine, even if you are getting sloppy drunk sometimes because that’s not considered abnormal in our society. It’s a very lonely place to be.”
This article was first published in the June 15, 2019 issue of the New Zealand Listener.