SINGAPORE, April 20 — She had her first taste of alcohol in her early teens. By 20, Clare was an alcoholic and on the way to drinking herself to death.

“Right from the beginning, I knew I drank differently from other people. It wasn’t your regular social drinking. I was chasing an effect, but the more I drank, the more that effect eluded me. It was a mental obsession and I could not stop it,” said the wellness coach, now 35, who requested that her full name not be used.

At 25, she suffered a major heat stroke related to excessive drinking. A few years later, she hit rock bottom.

“Your body tells you when it is breaking down,” said Clare.

“I knew I was at the bottom — the dehydration was severe, the numbness, the shakes and the anxiety that came if I wasn’t drinking constantly. The way I was going, I was going to end my life anyway so I decided to give Alcoholics Anonymous (AA) Singapore a shot.”

What Clare had thought was a long shot saved her life. Through AA’s 12-step recovery programme, as well as support from her husband and AA members, Clare eventually ended her longstanding drinking addiction, and turned her life and her husband’s sanity around.

“I told myself to give it a week, then it became a month, a year… Eventually, I didn’t want to kill myself anymore. I started showing up for life,” she said.

April is Alcohol Awareness Month. By sharing her experience, Clare hopes to raise awareness on alcohol abuse among women, which is a growing problem in Singapore.

Alcohol abuse is the second-most common mental disorder in Singapore among the other conditions assessed, and it is on the rise, according to the Singapore Mental Health Study conducted in 2010 and 2016.

Me too: More women drinking heavily and dangerously

Among Singapore women, the lifetime prevalence of alcohol abuse increased from 1.2 per cent of the population in 2010 to 1.7 per cent in 2016, according to the studies.

The uptrend has also been documented in earlier studies.

According to a local study on alcohol consumption trends between 1992 and 2004, an increase in frequent drinking was found to be most pronounced among Singapore women aged 18 to 29. The study was published in the journal Alcohol and Alcoholism in 2007.

At the Institute of Mental Health’s National Addictions Management Service (Nams), the number of new patients with alcohol use disorders has gone up.

Women make up 15 per cent of new patients with alcohol use disorders, said Dr Guo Song, a senior consultant at Nams.

Nams’ youngest female patient was only 13 years old when she sought treatment — a sobering reminder that alcohol use disorders can hit underaged drinkers.

“The patients we see at Nams for alcohol use disorders, whether men or women, usually have a chronic history of heavy alcohol consumption. Often, they are unable to control their alcohol use despite having encountered negative consequences,” said Dr Guo.

Women alcoholics less likely to seek help

A representative of AA Singapore, which has women-only sessions, estimated that about 30 per cent of alcoholics seeking help are women. However, he said the figure is likely an underestimate as women are less likely to come forward to seek help for their drinking problems.

“I don’t think fewer women have the problem than men. In Singapore, there are lots of cultural reasons why people don’t turn up for (AA) meetings. It can be particularly hard for women — they may be judged more harshly by society for their drinking problem,” said AA Singapore’s representative.

Their spouses may be victims of their addiction, but may also be less willing to come forward to seek help.

“I know several men who have been subjected to abuse by their spouses who have been drinking. You can’t tell anyone, so what do you do?” said AA Singapore’s representative.

While Eleanor Ong, a psychotherapist at The Relational Counselling Studio, sees more male alcoholics, this could be because women are more likely to seek out support elsewhere — through friends or informal support groups, for example — rather than go down the healthcare route, she said.

Many alcohol abusers also tend to be “high-functioning”, which makes it easier for them to hide or deny having a drinking problem in the early years. Despite her heavy drinking, Clare said she was somehow able to continue with her job and everyday life.

“I didn’t lose my husband, my job, my home. It was so easy to just go on drinking,” she said.

Women alcoholics get it worse

A health crisis awaits when excessive drinking in women remains an under-recognised and under-detected problem.

While there is no difference in the diagnostic criteria for alcohol use disorders in men and women, women are generally more vulnerable to the adverse effects of alcohol than men and find it harder to quit, said Dr Guo.

Adverse effects can be physical or psychosocial, such as liver problems or sexual or physical abuse.

Women get drunk more easily than men when they drink the same amount of alcohol, due to differences in body structures and hormones.

“Generally, women weigh less and have less water in their bodies. As alcohol tends to disperse more in body water, this means that a woman’s blood alcohol concentration will tend to be higher than a man’s, putting her at a greater risk of harm,” Dr Guo explained.

According to him, some neuroscience studies indicate that the development of addiction in women is faster than in men. Their physical and psychosocial functioning also deteriorate faster.

Studies suggest that women who are addicted to alcohol have a higher prevalence of concurrent psychiatric disorders such as depression, anxiety or borderline personality disorder, said Dr Guo.

“These comorbid disorders may make women vulnerable to alcohol addiction, where they use alcohol to cope with their emotions. However, this may in fact render them susceptible to developing drinking problems or alcohol addiction,” he said.

People may start abusing alcohol for various reasons. Along with income growth and social interactions, there are more chances to consume alcohol, which many view as a recreational beverage, said Dr Guo.

Other reasons why alcohol dependence may start include poor coping skills, peer influence and easy availability of alcohol.

Studies show that people with immediate family members with addictive disorders have a higher chance of developing alcohol addiction, he added.

At its core, however, alcohol addiction is the same as any form of addiction and “a bigger problem than just a matter of willpower”, said Ong.

“In addiction, the prefrontal cortex (the part of the brain that enables rational decisions) somehow goes a bit offline. The logical part of the brain that tells you, ‘If I continue drinking, my husband is going to leave me’ no longer really works,” said Ong.

Routes to sobriety

Anyone who develops an addiction would find it hard to quit and professional help is often warranted, said Dr Guo.

“Although we see fewer women seeking treatment for alcohol use disorders than men, treatment is equally effective for men and women,” he said.

At Nams, treatment for alcohol use disorders consists of the use of pharmaceutical drugs and psychosocial support by a multidisciplinary team.

Patients who are chronically dependent on alcohol may need inpatient treatment for detoxification and rehabilitation, said Dr Guo. They will also need post-discharge follow-up to prevent a relapse.

Treatment is a highly individualised process, and there is no particular correct way to treat an alcohol addiction, said Ong.

Support groups can help. “Support groups such as AA have been proven to help many people, which is why it is available in so many countries. However, while some people feel that it works, others don’t. The goal we have for our clients with alcohol addiction is that they eventually find support beyond therapy,” said Ong.

In cases where the alcoholic herself is in denial or not ready to seek help, her loved ones may have to seek professional help on how to do it, said Ong.

“As the addict progresses in her addiction, often, the loved ones also progress in their level of rescuing, enabling and protecting from consequences. Until someone breaks the cycle, both are on the trajectory of going downhill,” she said.

Today, Clare has broken that vicious cycle. She has not consumed a single drop of alcohol in the last six years, and now has a one-and-a-half year-old daughter who occasionally accompanies her to AA meetings.

Encouraging other alcoholics to seek help, Clare said: “There is a solution out there. You are not alone.” — TODAY