A general practitioner specializing in addiction, Dr Pierre Taraud follows dozens of patients each month at the Center for care, support and prevention in addiction (CSAPA), located at 26, rue Richelieu, in Tours. In this center, which offers outpatient consultations, almost 80% of patients have alcohol as their first or second harmful product.
You are not talking about alcoholism, but about alcohol use disorders…
Dr Pierre Taraud: “It’s very important. Because to say that someone is an alcoholic is to define them by their product. This is exactly the opposite of what we do in addiction. »
Are women less affected?
“They represent a quarter of patients because they are less screened and come less to the centers. Women use alcohol less than men but consumption is starting to converge: if alcohol consumption is falling in the general population and among men, it continues to increase among women. And even among non-precarious women. Being a well-established woman, with a job, a family, does not protect you from alcohol. »
Dr Pierre Taraud, addictologist at the addiction care, support and prevention center (CSAPA).
© (Photo NR, Cécile Lascève)
Do women consume more in secret?
“In women, it starts in a less festive way and at a more advanced age. We are talking about a peak in consumption at age 20 for men and 27 for women. They have solitary consumption, more for the anxiolytic side. They complain less about it. I have known patients with families without anyone knowing. Consumption is more visible among men because it is more socially accepted. »
Are the ravages of alcohol greater in women?
“They drink less and start later, but the problems this causes arrive faster and earlier. Men die more than women from alcohol, but a woman who drinks dies faster than a man. Women develop cirrhosis, cognitive disorders and heart disease more quickly […] even with less consumption than a man. And there is no concept of threshold. The more you drink, the worse it gets. One drink per day increases the risk of breast cancer by 12%. With two glasses of 24%. Alcohol is a class A carcinogen.
Are there biological reasons that put women at greater risk?
“The liver breaks down ethanol into acetaldehyde, which is even more toxic. This will, in turn, be degraded by an enzyme that is less efficient in women. This enzyme is even absent in 10% of the population in France, as in a large part of the Asian population. These people don't tolerate alcohol well, they turn red, they feel bad… Less corpulent, women also have a different distribution of water and fat. They don't have enough water to dilute the alcohol. Blood alcohol levels rise faster and fall more slowly. There are also hormonal reasons which are involved but which are poorly understood. As women are historically less concerned, research has not been carried out…”
What do they drink?
“Statistically less wine. Strong alcohol, beer. But the difference in consumption is less about gender than about budget. The precarious workers drink beers at 8 or 10 degrees, the cheapest. »
How are they supported?
“There are no treatment centers dedicated specifically to women, which can be a barrier to care. Sometimes they may not feel comfortable. In some centers, there are still discussion groups between women. Post-traumatic stress, depression and anxiety affect women more and are very present with addictions, it is relevant that they have this privileged space. »
Is abstinence always the obligatory step?
“This strategy, which has been put forward for a long time, obscures a large proportion of patients who are not capable of it. We have moved away from this dogma, even if it can be a good weapon. Today, we are adapting, helping people take their complexity into account. »
Blood shared with the fetus
This is the other injustice for women: alcohol interferes with pregnancy, causing fetal alcohol spectrum disorders (mental delays, learning difficulties, etc.) including fetal alcohol syndrome (with facial dysmorphism ) is just the tip of the iceberg. “Here again, we have shown that there is no threshold effect, specifies the doctor. The mother shares blood with the fetus which does not have a liver to handle alcohol. There is therefore no such thing as consumption without risk. We must therefore ensure zero alcohol during pregnancy, and researchers say even when we are of childbearing age… But we must be careful: if we stigmatize women too much, they will say even less that they drink and we will see them even less in consultation. »
