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More women are drinking themselves sick. The Biden administration is concerned.
When Karla Adkins looked in the rearview mirror of her car one morning nearly 10 years ago, she noticed the whites of her eyes had turned yellow.
She was 36 at the time and working as a physician liaison for a hospital system on the South Carolina coast, where she helped build relationships among doctors. Privately, she had struggled with heavy drinking since her early 20s, long believing that alcohol helped calm her anxieties. She understood that the yellowing of her eyes was evidence of jaundice. Even so, the prospect of being diagnosed with alcohol-related liver disease wasn’t her first concern.
“Honestly, the No. 1 fear for me was someone telling me I could never drink again,” said Adkins, who lives in Pawleys Island, a coastal town about 30 miles south of Myrtle Beach.
Allison Duff
But the drinking had caught up with her: Within 48 hours of that moment in front of the rearview mirror, she was hospitalized, facing liver failure. “It was super fast,” Adkins said.
Historically, alcohol use disorder has disproportionately affected men. But recent data from the Centers for Disease Control and Prevention on deaths from excessive drinking shows that rates among women are climbing faster than they are among men. The Biden administration considers this trend alarming, with one new estimate predicting women will account for close to half of alcohol-associated liver disease costs in the U.S. by 2040, a $66 billion total price tag.
It’s a high-priority topic for the Department of Health and Human Services and the Department of Agriculture, which together will release updated national dietary guidelines next year. But with marketing for alcoholic beverages increasingly geared toward women, and social drinking already a huge part of American culture, change isn’t something everyone may be ready to raise a glass to.
“This is a touchy topic,” said Rachel Sayko Adams, a research associate professor at the Boston University School of Public Health. “There is no safe level of alcohol use,” she said. “That’s, like, new information that people didn’t want to know.”
Over the past 50 years, women have increasingly entered the workforce and delayed motherhood, which likely has contributed to the problem as women historically drank less when they became mothers.
“Parenthood tended to be this protective factor,” but that’s not always the case anymore, said Adams, who studies addiction.
More than 600,000 people in the U.S. died from causes related to alcohol from 1999 to 2020, according to research published in JAMA Network Open last year, positioning alcohol among the leading causes of preventable death in this country behind tobacco, poor diet and physical inactivity and illegal drugs.
The World Health Organization and various studies have found that no amount of alcohol is safe for human health. Even light drinking has been linked to health concerns, like hypertension and coronary artery disease and an increased risk of breast and other cancers.
More recently, the COVID-19 pandemic “significantly exacerbated” binge-drinking, said George Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, as people used alcohol to cope with stress. That is particularly true of women, who are more likely to drink alcohol because of stress than men, he said.
Chrissie Bonner
But women are also frequently the focus of gender-targeted advertising for alcoholic beverages. The growth of rosé sales and low-calorie wines, for example, has exploded in recent years. New research published by the International Journal of Drug Policy in February found that the “pinking of products is a tactic commonly used by the alcohol industry to target the female market.”
Also at play is the emergence of a phenomenon largely perpetuated by women on social media that makes light of drinking to deal with the difficulties of motherhood. The misperception of “mommy wine culture,” said Adams, is that “if you can drink in a normal way, a moderate way, if you can handle your alcohol, you’re fine.”
And while it’s unclear to what extent memes and online videos influence women’s drinking habits, the topic merits further study, said Adams, who with colleagues last year found that women without children at age 35 are still at the highest risk for binge-drinking and alcohol use disorder symptoms among all age groups of women. But over the past two decades, the research concluded, the risk is escalating for both childless women and mothers.
These factors at play, coupled with the pressure to fit in, can make excessive drinking a difficult conversation to broach. “It’s a very taboo topic,” Adams said.
And when it does come up, said Stephanie Garbarino, a transplant hepatologist at Duke Health, it’s often surprising how many patients are unaware how their drinking affects their health.
“Often, they didn’t know there was anything wrong with what they’re doing,” she said. She is more frequently seeing younger patients with liver disease, including men and women in their 20s and 30s.
And public health and addiction experts fear that alcohol-related liver disease among women will become a costly issue for the nation to address. Women accounted for 29% of all costs associated with the disease in the U.S. in 2022 and are expected to account for 43% by 2040, estimated a new analysis published in the American Journal of Gastroenterology in February.
National dietary guidelines advise women to drink no more than one alcoholic drink a day. Those guidelines are up for a five-year review next year by the USDA and HHS, which has called a special committee to examine, among other questions, the relationship between alcohol consumption and cancer risks. The report will be made public in 2025.
When Canada published guidance in 2023 advising that drinking any more than two alcoholic beverages a week carried health risks, Koob sparked backlash when his comments to the Daily Mail suggested that U.S. guidelines might move in the same direction. The CDC report published in February suggested that an increase in alcohol taxes could help reduce excessive alcohol use and deaths. Koob’s office would not comment on such policies.
It’s a topic close to Adkins’ heart. She now works as a coach to help others — mostly women — stop drinking, and said the pandemic prompted her to publish a book about her near-death experience from liver failure. And while Adkins lives with cirrhosis, this September will mark 10 years since her last drink.
“The amazing thing is, you can’t get much worse from where I got,” said Adkins. “My hope is really to change the narrative.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.
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Robert Towne, the Oscar-winning screenplay writer of “Shampoo,” “The Last Detail” and other acclaimed films whose work on “Chinatown” became a model of the art form and helped define the jaded allure of his native Los Angeles, has died. He was 89.
Towne “passed away peacefully surrounded by his loving family” Monday at his home in Los Angeles, his publicist Carri McClure, told CBS News in a statement. She did not provide a cause of death.
In an industry which gave birth to rueful jokes about the writer’s status, Towne for a time held prestige comparable to the actors and directors he worked with. Through his friendships with two of the biggest stars of the 1960s and ’70s, Warren Beatty and Jack Nicholson, he wrote or co-wrote some of the signature films of an era when artists held an unusual level of creative control. The rare “auteur” among screen writers, Towne managed to bring a highly personal and influential vision of Los Angeles onto the screen.
Alberto E. Rodriguez/Getty Images for AFI
“It’s a city that’s so illusory,” Towne told The Associated Press in a 2006 interview. “It’s the westernmost west of America. It’s a sort of place of last resort. It’s a place where, in a word, people go to make their dreams come true. And they’re forever disappointed.”
Recognizable around Hollywood for his high forehead and full beard, Towne won an Academy Award for “Chinatown” and was nominated three other times, for “The Last Detail,” “Shampoo” and “Greystoke.” In 1997, he received a lifetime achievement award from the Writers Guild of America.
“His life, like the characters he created, was incisive, iconoclastic and entirely (original),” said “Shampoo” actor Lee Grant on X.
Towne was born Robert Bertram Schwartz in Los Angeles and moved to San Pedro after his father’s business, a dress shop, closed down because of the Great Depression. His father changed the family name to Towne.
Towne’s success came after a long stretch of working in television, including “The Man from U.N.C.L.E” and “The Lloyd Bridges Show,” and on low-budget movies for “B” producer Roger Corman. In a classic show business story, he owed his breakthrough in part to his psychiatrist, through whom he met Beatty, a fellow patient. As Beatty worked on “Bonnie and Clyde,” he brought in Towne for revisions of the Robert Benton-David Newman script and had him on the set while the movie was filmed in Texas.
Towne’s contributions were uncredited for “Bonnie and Clyde,” the landmark crime film released in 1967, and for years he was a favorite ghost writer. He helped out on “The Godfather,” “The Parallax View” and “Heaven Can Wait” among others and referred to himself as a “relief pitcher who could come in for an inning, not pitch the whole game.” But Towne was credited by name for Nicholson’s macho “The Last Detail” and Beatty’s sex comedy “Shampoo” and was immortalized by “Chinatown,” the 1974 thriller set during the Great Depression.
“Chinatown” was directed by Roman Polanski and starred Nicholson as J.J. “Jake” Gittes, a private detective asked to follow the husband of Evelyn Mulwray (played by Faye Dunaway). The husband is chief engineer of the Los Angeles Department of Water and Power and Gittes finds himself caught in a chaotic spiral of corruption and violence, embodied by Evelyn’s ruthless father, Noah Cross (John Huston).
Influenced by the fiction of Raymond Chandler, Towne resurrected the menace and mood of a classic Los Angeles film noir, but cast Gittes’ labyrinthine odyssey across a grander and more insidious portrait of Southern California. Clues accumulate into a timeless detective tale, and lead helplessly to tragedy, summed up by one of the most repeated lines in movie history, words of grim fatalism a devastated Gittes receives from his partner Lawrence Walsh (Joe Mantell): “Forget it, Jake, it’s Chinatown.”
The back story of “Chinatown” has itself become a kind of detective story, explored in producer Robert Evans’ memoir, “The Kid Stays in the Picture”; in Peter Biskind’s “East Riders, Raging Bulls,” a history of 1960s-1970s Hollywood, and in Sam Wasson’s “The Big Goodbye,” dedicated entirely to “Chinatown.” In “The Big Goodbye,” published in 2020, Wasson alleged that Towne was helped extensively by a ghost writer — former college roommate Edward Taylor. According to “The Big Goodbye,” for which Towne declined to be interviewed, Taylor did not ask for credit on the film because his “friendship with Robert” mattered more.
The studios assumed more power after the mid-1970s and Towne’s standing declined. His own efforts at directing, including “Personal Best” and “Tequila Sunrise,” had mixed results. “The Two Jakes,” the long-awaited sequel to “Chinatown,” was a commercial and critical disappointment when released in 1990 and led to a temporary estrangement between Towne and Nicholson.
Around the same time, he agreed to work on a movie far removed from the art-house aspirations of the ’70s, the Don Simpson-Jerry Bruckheimer production “Days of Thunder,” starring Tom Cruise as a race car driver and Robert Duvall as his crew chief. The 1990 movie was famously over budget and mostly panned, although its admirers include Quentin Tarantino and countless racing fans. And Towne’s script popularized an expression used by Duvall after Cruise complains another car slammed him: “He didn’t slam into you, he didn’t bump you, he didn’t nudge you. He rubbed you.
“And rubbin,′ son, is racin.'”
Towne later worked with Cruise on “The Firm” and the first two “Mission: Impossible” movies. His most recent film was “Ask the Dust,” a Los Angeles story he wrote and directed that came out in 2006. Towne was married twice, the second time to Luisa Gaule, and had two children. His brother, Roger Towne, also wrote screenplays, his credits include “The Natural.”
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