Bullies, Victims, and Bystanders

1. Types of bullies
2. Types of bully victims
3. Types of bully bystanders

"I'm 14 in March and I'm being bullied constantly. In nearly every class, I sit by myself because nobody wants to sit next to me. One of my few friends hangs around with other people because I think he is frightened if he is with me he will get bullied. I'm sick to death and sometimes I feel like killing myself. I wish I was dead."
Bullies do not randomly attack their peers; instead, they target a specific subgroup of students who are often victimized over the course of several years. Just like bullies, victims are a heterogeneous group. Olweus describes three types of victim: the passive victim, the provocative victim, and bully-victim (described [in previous section]).

Passive victims do not directly provoke bullies and represent the largest group of victimized children. They are socially withdrawn, often seem anxious, depressed, and fearful, and have very poor self-concepts. When compared with their non-victimized peers, passive victims have fewer if any friends, are lonely and sad, and are more nervous about new situations. This cluster of symptoms makes them attractive targets for bullies who are unusually competent in detecting vulnerability. In the early grades, initial responses to bullying among passive victims include crying, withdrawal, and futile anger. In later grades, they tend to respond by trying to avoid and escape from bullying situations (e.g., being absent from school, running away from home).

While there is evidence that some of the characteristics of passive victims precede and contribute to their victimization experiences, it is also clear that many of their personal attributes also result from being bullied. According to Swearer and colleagues (2001): "The victims' behaviors and emotional states may make them vulnerable to bullying. The bullying behavior towards them may perpetuate their issues with low-self-esteem, depression, anxiety, and loneliness, which may make them increasingly vulnerable to bullying."

Other researchers have described some subgroups that may be present within the broad category of passive victims:

Vicarious victims, or surrogate victims, either witness or hear about bullying incidents at school. They are victims of the school's climate of fear and worry about their own potential to become targets of bullying. As a result of this perceived vulnerability as well as concern about direct retribution from bullies, they choose not to help bullying victims or report bullying incidents even though they often feel sympathetic ? which often leads to feelings of guilt (Besag, 1989).

False victims represent a small group of students who complain frequently and without justification to their teachers about being bullied by their classmates. This behavior seems to be a bid for attention and sympathy from the teacher. This is problematic for two main reasons: 1) these children should learn that there are legitimate ways to get attention, and 2) teachers who may be unsympathetic about the problem of bullying could use this behavior as an excuse to ignore all complaints about bullying (Besag, 1989).

Perpetual victims are those victims who are bullied all of their lives. While "perpetual" refers to the duration of bullying rather than a subgroup of victim, it is interesting to consider the possibility that some children may develop a victim mentality whereby the victim role becomes a permanent part of their psyches (Elliott, 1993).

Provocative victims represent a small group of children who often behave in ways that arouse negative responses from those around them, such as anger, irritation, and exasperation. They possess a cluster of characteristics that are likely to disrupt a classroom and lead to social rejection by peers, including irritability, restlessness, off-task behavior, and hostility. Although they are a distinct subgroup, provocative victims often display characteristics of other groups of children as well ? including pure bullies (i.e., they have elevated levels of dominant, aggressive, and antisocial behavior and low levels of tolerance for frustration) and passive victims (i.e., they are socially anxious, feel disliked by others, and have low self-esteem).
Nathan, aged 10, was described by his class teacher as a child who lived "on the edge of his nerves," never still, and with "his brain disconnected from his mouth." The latter trait made it likely that he would make loud remarks about other children's appearance or their work that would make them angry. He would then say to them, "What are you going to do about it then?" whereupon two or three of them might show him, violently. Nathan was described as the most unpopular child in the school, as the one "everybody loves to hate" (Randall, 1997, p. 94).

It is important to keep in mind that students who fall into this category may possess a disability of some sort (e.g., a learning disability, attention deficit disorder) that contributes to their provocative behavior. In addition to helping these young people deal with the consequences of their victimization, it would also be helpful to assess the potential causes of their challenging behavior. If a disability is present, then an accurate diagnosis followed by targeted services could go a long way toward preventing further victimization.

Multiple factors contribute to a bully's selection of victim, including the complicated interplay of a bully's motivation, a victim's characteristics, and the specific circumstances of the bullying situation. For example, availability may be a key factor in victim selection if a bully simply wants to elevate his or her status with peers. However, if a bully is looking for some sort of tangible payoff, then he or she might choose a target who is known to have money and likely to be submissive. If a bully wants to display power, then he or she might target a provocative victim who is noted for fighting back ineffectively.
Athealth.com Sidebar: Children with ADHD, ODD, and other behavioral disorders are particularly vulnerable to low self-esteem. They frequently experience school problems, have difficulty making friends, and lag behind their peers in psychosocial development. They are more likely than other children to bully and to be bullied. Parents of children with behavior problems experience highly elevated levels of child-rearing stress, and this may make it more difficult for them to respond to their children in positive, consistent, and supportive ways.

Adapted from Exploring the Nature and Prevention of Bullying
www.ed.gov/admins/lead/safety/training
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Building Self-Esteem: A Self-Help Guide - Contents:

1. Feelings of low self-esteem
2. Self-esteem and depression
3. Raise your self-esteem
4. Changing negative thoughts
5. Activities that build self-esteem

Activities That Will Help You Feel Good About Yourself

Any of the following activities will help you feel better about yourself and reinforce your self-esteem over the long term. Read through them. Do those that seem most comfortable to you. You may want to do some of the other activities at another time. You may find it helpful to repeat some of these activities again and again.

Make Affirming Lists

Making lists, rereading them often, and rewriting them from time to time will help you to feel better about yourself. If you have a journal, you can write your lists there. If you don't, any piece of paper will do.

Make a list of:

• At least five of your strengths, for example, persistence, courage, friendliness, creativity
• At least five things you admire about yourself, for example, the way you have raised your children, your good relationship with your brother, or your spirituality
• The five greatest achievements in your life so far, like recovering from a serious illness, graduating from high school, or learning to use a computer
• At least 20 accomplishments - they can be as simple as learning to tie your shoes, to getting an advanced college degree
• 10 ways you can "treat" or reward yourself that don't include food and that don't cost anything, such as walking in woods, window-shopping, watching children playing on a playground, gazing at a baby's face or at a beautiful flower, or chatting with a friend
• 10 things you can do to make yourself laugh
• 10 things you could do to help someone else
• 10 things that you do that make you feel good about yourself

Reinforcing A Positive Self Image

To do this exercise you will need a piece of paper, a pencil or pen, and a timer or clock. Any kind of paper will do, but if you have paper and pen you really like, that will be even better.

Set a timer for 10 minutes or note the time on your watch or a clock. Write your name across the top of the paper. Then write everything positive and good you can think of about yourself. Include special attributes, talents, and achievements. You can use single words or sentences, whichever you prefer. You can write the same things over and over if you want to emphasize them. Don't worry about spelling or grammar. Your ideas don't have to be organized. Write down whatever comes to mind. You are the only one who will see this paper. Avoid making any negative statements or using any negative words - only positive ones. When the 10 minutes are up, read the paper over to yourself. You may feel sad when you read it over because it is a new, different, and positive way of thinking about yourself - a way that contradicts some of the negative thoughts you may have had about yourself. Those feelings will diminish as your reread this paper. Read the paper over again several times. Put it in a convenient place - your pocket, purse, wallet, or the table beside your bed. Read it over to yourself at least several times a day to keep reminding yourself of how great you are! Find a private space and read it aloud. If you can, read it to a good friend or family member who is supportive.

Developing Positive Affirmations

Affirmations are positive statements that you can make about yourself that make you feel better about yourself. They describe ways you would like to feel about yourself all the time. They may not, however, describe how you feel about yourself right now. The following examples of affirmations will help you in making your own list of affirmations:

• I feel good about myself.
• I take good care of myself. I eat right, get plenty of exercise, do things I enjoy, get good health care, and attend to my personal hygiene needs.
• I spend my time with people who are nice to me and make me feel good about myself.
• I am a good person.
• I deserve to be alive.
• Many people like me.

Make a list of your own affirmations. Keep this list in a handy place, like your pocket or purse. You may want to make copies of your list so you can have them in several different places of easy access. Read the affirmations over and over to yourself aloud whenever you can. Share them with others when you feel like it. Write them down from time to time. As you do this, the affirmations tend to gradually become true for you.

You gradually come to feel better and better about yourself.

Your Personal "Celebratory Scrapbook" And Place To Honor Yourself

Develop a scrapbook that celebrates you and the wonderful person you are. Include pictures of yourself at different ages, writings you enjoy, mementos of things you have done and places you have been, cards you have received, etc. Or set up a place in your home that celebrates "you." It could be on a bureau, shelf, or table. Decorate the space with objects that remind you of the special person you are. If you don't have a private space that you can leave set up, put the objects in a special bag, box, or your purse and set them up in the space whenever you do this work. Take them out and look at them whenever you need to bolster your self-esteem.

Appreciation Exercise

At the top of a sheet of paper write "I like _____ (your name) because:" Have friends, acquaintances, family members, etc., write an appreciative statement about you on it. When you read it, don't deny it OR don't argue with what has been written, just accept it! Read this paper over and over. Keep it in a place where you will see it often.

Self-Esteem Calendar

Get a calendar with large blank spaces for each day. Schedule into each day some small thing you would enjoy doing, such as "go into a flower shop and smell the flowers," "call my sister," "draw a sketch of my cat," "buy a new CD," "tell my daughter I love her," "bake brownies," "lie in the sun for 20 minutes," "wear my favorite scent," etc. Now make a commitment to check your "enjoy life" calendar every day and do whatever you have scheduled for yourself.

Mutual Complimenting Exercise

Get together for 10 minutes with a person you like and trust. Set a timer for five minutes or note the time on a watch or clock. One of you begins by complimenting the other person saying everything positive about the other person for the first five minutes. Then the other person does the same thing to that person for the next five minutes. Notice how you feel about yourself before and after this exercise. Repeat it often.

Self-Esteem Resources

Go to your library. Look up books on self-esteem. Read one or several of them. Try some of the suggested activities.

In Conclusion

This guide is just the beginning of the journey. As you work on building your self-esteem you will notice that you feel better more and more often, that you are enjoying your life more than you did before, and that you are doing more of the things you have always wanted to do.

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Building Self-Esteem: A Self-Help Guide - Contents:

Feelings of low self-esteem
Self-esteem and depression
Raise your self-esteem
Changing negative thoughts
Activities that build self-esteem

Changing Negative Thoughts About Yourself To Positive Ones

You may be giving yourself negative messages about yourself. Many people do. These are messages that you learned when you were young. You learned from many different sources including other children, your teachers, family members, caregivers, even from the media, and from prejudice and stigma in our society.

Once you have learned them, you may have repeated these negative messages over and over to yourself, especially when you were not feeling well or when you were having a hard time. You may have come to believe them. You may have even worsened the problem by making up some negative messages or thoughts of your own. These negative thoughts or messages make you feel bad about yourself and lower your self-esteem.

Some examples of common negative messages that people repeat over and over to themselves include: "I am a jerk," "I am a loser," "I never do anything right," "No one would ever like me," "I am a klutz." Most people believe these messages, no matter how untrue or unreal they are. They come up immediately in the right circumstance, for instance if you get a wrong answer you think "I am so stupid." They may include words like should, ought, or must. The messages tend to imagine the worst in everything, especially you, and they are hard to turn off or unlearn.

You may think these thoughts or give yourself these negative messages so often that you are hardly aware of them. Pay attention to them. Carry a small pad with you as you go about your daily routine for several days and jot down negative thoughts about yourself whenever you notice them. Some people say they notice more negative thinking when they are tired, sick, or dealing with a lot of stress. As you become aware of your negative thoughts, you may notice more and more of them.

It helps to take a closer look at your negative thought patterns to check out whether or not they are true. You may want a close friend or counselor to help you with this. When you are in a good mood and when you have a positive attitude about yourself, ask yourself the following questions about each negative thought you have noticed:

• Is this message really true?
• Would a person say this to another person? If not, why am I saying it to myself?
• What do I get out of thinking this thought? If it makes me feel badly about myself, why not stop thinking it?

You could also ask someone else - someone who likes you and who you trust - if you should believe this thought about yourself. Often, just looking at a thought or situation in a new light helps.

The next step in this process is to develop positive statements you can say to yourself to replace these negative thoughts whenever you notice yourself thinking them. You can't think two thoughts at the same time. When you are thinking a positive thought about yourself, you can't be thinking a negative one. In developing these thoughts, use positive words like happy, peaceful, loving, enthusiastic, warm.

Avoid using negative words such as worried, frightened, upset, tired, bored, not, never, can't. Don't make a statement like "I am not going to worry any more." Instead say "I focus on the positive" or whatever feels right to you. Substitute "it would be nice if" for "should." Always use the present tense, e.g., "I am healthy," "I am well," "I am happy," "I have a good job," as if the condition already exists. Use I, me, or your own name.

You can do this by folding a piece of paper in half the long way to make two columns. In one column write your negative thought and in the other column write a positive thought that contradicts the negative thought as shown on the next page.

You can work on changing your negative thoughts to positive ones by:

• Replacing the negative thought with the positive one every time you realize you are thinking the negative thought.
• Repeating your positive thought over and over to yourself, out loud whenever you get a chance and even sharing them with another person if possible.
• Writing them over and over.
• Making signs that say the positive thought, hanging them in places where you would see them often - like on your refrigerator door or on the mirror in your bathroom - and repeating the thought to yourself several times when you see it.

Negative Thoughts:

• I am not worth anything.
• I have never accomplished anything.
• I always make mistakes.
• I am a jerk.
• I don't deserve a good life.
• I am stupid.

Positive Thoughts:

• I am a valuable person.
• I have accomplished many things.
• I do many things well.
• I am a great person.
• I deserve to be happy and healthy.
• I am smart.

It helps to reinforce the positive thought if you repeat if over and over to yourself when you are deeply relaxed, like when you are doing a deep-breathing or relaxation exercise, or when you are just falling asleep or waking up.

Changing the negative thoughts you have about yourself to positive ones takes time and persistence. If you use the following techniques consistently for four to six weeks, you will notice that you don't think these negative thoughts about yourself as much. If they recur at some other time, you can repeat these activities. Don't give up. You deserve to think good thoughts about yourself.

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Building Self-Esteem: A Self-Help Guide - Contents:

1. Feelings of low self-esteem
2. Self-esteem and depression
3. Raise your self-esteem
4. Changing negative thoughts
5. Activities that build self-esteem

Things You Can Do Right Away To Raise Your Self-Esteem

Pay attention to your own needs and wants.
Listen to what your body, your mind, and your heart are telling you. For instance, if your body is telling you that you have been sitting down too long, stand up and stretch. If your heart is longing to spend more time with a special friend, do it. If your mind is telling you to clean up your basement, listen to your favorite music, or stop thinking bad thoughts about yourself, take those thoughts seriously.

Take very good care of yourself.
As you were growing up you may not have learned how to take good care of yourself. In fact, much of your attention may have been on taking care of others, on just getting by, or on "behaving well." Begin today to take good care of yourself. Treat yourself as a wonderful parent would treat a small child or as one very best friend might treat another. If you work at taking good care of yourself, you will find that you feel better about yourself. Here are some ways to take good care of yourself:

• Eat healthy foods and avoid junk foods (foods containing a lot of sugar, salt, or fat). A healthy daily diet is usually:
  • Five or six servings of vegetables and fruit
  • Six servings of whole grain foods like bread, pasta, cereal, and rice
  • Two servings of protein foods like beef, chicken, fish, cheese, cottage cheese, or yogurt

• Exercise. Moving your body helps you to feel better and improves your self-esteem. Arrange a time every day or as often as possible when you can get some exercise, preferably outdoors. You can do many different things. Taking a walk is the most common. You could run, ride a bicycle, play a sport, climb up and down stairs several times, put on a tape, or play the radio and dance to the music - anything that feels good to you. If you have a health problem that may restrict your ability to exercise, check with your doctor before beginning or changing your exercise habits.
• Do personal hygiene tasks that make you feel better about yourself - things like taking a regular shower or bath, washing and styling your hair, trimming your nails, brushing and flossing your teeth.
• Get a physical examination to make sure you are in good health.
• Plan fun activities for yourself. Learn new things every day.
• Take time to do things you enjoy. You may be so busy, or feel so badly about yourself, that you spend little or no time doing things you enjoy--things like playing a musical instrument, doing a craft project, flying a kite, or going fishing. Make a list of things you enjoy doing. Then do something from that list every day. Add to the list anything new that you discover you enjoy doing.
• Get something done that you have been putting off. Clean out that drawer. Wash that window. Write that letter. Pay that bill.
• Do things that make use of your own special talents and abilities. For instance, if you are good with your hands, then make things for yourself, family, and friends. If you like animals, consider having a pet or at least playing with friends' pets.
• Dress in clothes that make you feel good about yourself. If you have little money to spend on new clothes, check out thrift stores in your area.
• Give yourself rewards. You are a great person. Listen to a CD or tape.
• Spend time with people who make you feel good about yourself - people who treat you well. Avoid people who treat you badly.
• Make your living space a place that honors the person you are. Whether you live in a single room, a small apartment, or a large home, make that space comfortable and attractive for you. If you share your living space with others, have some space that is just for you--a place where you can keep your things and know that they will not be disturbed and that you can decorate any way you choose.
• Display items that you find attractive or that remind you of your achievements or of special times or people in your life. If cost is a factor, use your creativity to think of inexpensive or free ways that you can add to the comfort and enjoyment of your space.
• Make your meals a special time. Turn off the television, radio, and stereo. Set the table, even if you are eating alone. Light a candle or put some flowers or an attractive object in the center of the table. Arrange your food in an attractive way on your plate. If you eat with others, encourage discussion of pleasant topics. Avoid discussing difficult issues at meals.
• Learn something new or improve your skills. Take a class or go to a seminar. Many adult education programs are free or very inexpensive. For those that are more costly, ask about a possible scholarship or fee reduction.
• Begin doing those things that you know will make you feel better about yourself - like going on a diet, beginning an exercise program or keeping your living space clean.
• Do something nice for another person. Smile at someone who looks sad. Say a few kind words to the check-out cashier. Help your spouse with an unpleasant chore. Take a meal to a friend who is sick. Send a card to an acquaintance. Volunteer for a worthy organization.
• Make it a point to treat yourself well every day. Before you go to bed each night, write about how you treated yourself well during the day.

You may be doing some of these things now. There will be others you need to work on. You will find that you will continue to learn new and better ways to take care of yourself. As you incorporate these changes into your life, your self-esteem will continue to improve.

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Building Self-Esteem: A Self-Help Guide - Contents:

Feelings of low self-esteem
Self-esteem and depression
Raise your self-esteem
Changing negative thoughts
Activities that build self-esteem

Self-Esteem, Depression, and Other Illnesses

Before you begin to consider strategies and activities to help raise your self-esteem, it is important to remember that low self-esteem may be due to depression. Low self-esteem is a symptom of depression. To make things even more complicated, the depression may be a symptom of some other illness.

Depression affects the body, mood, and thoughts. It affects the way a person eats and sleeps. It affects how a person thinks about things, and it affects a person's self perception.

Have you felt sad consistently for several weeks but don't know why you are feeling so sad, i.e. nothing terribly bad has happened, or maybe something bad has happened but you haven't been able to get rid of the feelings of sadness? Is this accompanied by other changes, like wanting to eat all the time or having no appetite, wanting to sleep all the time or waking up very early and not being able to get back to sleep?

If you answered yes to either question, there are two things you need to do:

• See your doctor for a physical examination to determine the cause of your depression and to discuss treatment choices

• Do some things that will help you to feel better right away like eating well, getting plenty of exercise and outdoor light, spending time with good friends, and doing fun things like going to a movie, painting a picture, playing a musical instrument, or reading a good book.

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Getting Help and More Information

• Alcoholics Anonymous (AA) World Services
  Phone: 212–870–3400Makes referrals to local AA groups and provides informational materials on the AA program. Many cities and towns also have a local AA office listed in the telephone book.
• Al-Anon Family Group Headquarters
  For locations of Al-Anon or Alateen meetings worldwide, call 888–4AL–ANON (888–425–2666), Monday through Friday, 8 a.m.–6 p.m. (EST)
  For free informational materials, call 757–563–1600, Monday through Friday, 8 a.m.–6 p.m.Makes referrals to local Al-Anon groups, which are support groups for spouses and other significant adults in an alcoholic person's life. Also makes referrals to Alateen groups, which offer support to children of alcoholics.
• National Association for Children of Alcoholics (NACoA)
  E-mail: [email protected]
  Phone: 888–554–COAS or 301–468–0985Works on behalf of children of alcohol- and drug-dependent parents.
• Substance Abuse and Mental Health Services Administration (SAMHSA)
  Phone: 877-726-4727, SAMHSA leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities., U.S. Department of Health and Human Services.
• National Council on Alcoholism and Drug Dependence (NCADD)
  Phone: 800–NCA–CALL (800–622–2255)Provides telephone numbers of local NCADD affiliates (who can provide information on local treatment resources) and educational materials on alcoholism.
• National Institute on Alcohol Abuse and Alcoholism (NIAAA)
  5635 Fishers Lane, MSC 9304
  Bethesda, Maryland 20892–9304
  Phone: 301–443–3860Offers a free 12-minute video, Alcohol: A Woman's Health Issue, profiling women recovering from alcohol problems and describing the health consequences of heavy drinking in women. Other publications also are available from NIAAA and feature information on a wide variety of topics, including fetal alcohol syndrome, the dangers of mixing alcohol with medications, family history of alcoholism, and preventing underage drinking. See "Additional Reading," below, for information on ordering NIAAA materials.
• Substance Abuse Treatment Facility Locator
  Phone: 800–662–HELP (800–662–4357)Offers alcohol and drug information and treatment referral assistance. (This service is provided by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.)

Additional Reading

• A Family History of Alcoholism: Are You at Risk?—offers easy-to-read information for anyone who is concerned about a family history of alcoholism. English version: NIH Publication Number 03–5340; Spanish version: NIH Publication Number 04–5340–S.
• Drinking and Your Pregnancy—explains how drinking can hurt a developing baby, the problems that children born with fetal alcohol syndrome have, how to stop drinking, and where to go for help. English version: NIH Publication Number 96–4101; Spanish version: NIH Publication Number 97–4102.
• Make a Difference: Talk to Your Child About Alcohol—offers guidance to parents and caregivers of young people ages 10 to 14 on preventing underage drinking. English version: NIH Publication Number 06–4314; Spanish version: NIH Publication Number 06–4314–S.
• Tips for Cutting Down on Drinking—offers a checklist for reducing drinking, including setting goals and keeping track, tips for handling the urge to drink, and learning how to say "no" to alcohol. English and Spanish versions: excerpted from NIH Publication Number 07-3769.

To order, write to: National Institute on Alcohol Abuse and Alcoholism, Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849–0686. The full text of all of the above publications is available on NIAAA's website.

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Source: NIH Publication No. 08–4956
Revised 2008

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Women and Problem Drinking

Fewer women than men drink. However, among the heaviest drinkers, women equal or surpass men in the number of problems that result from their drinking. For example, female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics, including deaths from suicides, alcohol-related accidents, heart disease and stroke, and liver cirrhosis.

Alcohol Abuse: An Individual Decision

A woman's genetic makeup shapes how quickly she feels the effects of alcohol, how pleasant drinking is for her, and how drinking alcohol over the long term will affect her health, even the chances that she could have problems with alcohol. A family history of alcohol problems, a woman's risk of illnesses like heart disease and breast cancer, medications she is taking, and age are among the factors for each woman to weigh in deciding when, how much, and how often to drink.

What Are Alcohol Abuse and Alcoholism?

Alcohol abuse is a pattern of drinking that is harmful to the drinker or others. The following situations, occurring repeatedly in a 12-month period, would be indicators of alcohol abuse:

• Missing work or skipping child care responsibilities because of drinking
• Drinking in situations that are dangerous, such as before or while driving
• Being arrested for driving under the influence of alcohol or for hurting someone while drunk
• Continuing to drink even though there are ongoing alcohol-related tensions with friends and family.

Alcoholism or alcohol dependence is a disease. It is chronic, or lifelong, and it can be both progressive and life threatening. Alcoholism is based in the brain. Alcohol's short-term effects on the brain are what cause someone to feel high, relaxed, or sleepy after drinking. In some people, alcohol's long-term effects can change the way the brain reacts to alcohol, so that the urge to drink can be as compelling as the hunger for food. Both a person's genetic makeup and his or her environment contribute to the risk for alcoholism. The following are some of the typical characteristics of alcoholism:

• Craving: a strong need, or compulsion, to drink
• Loss of control: the inability to stop drinking once a person has begun
• Physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking
• Tolerance: the need for increasing amounts of alcohol to get "high."

Know the Risks

Research suggests that a woman is more likely to drink excessively if she has any of the following:

• Parents and siblings (or other blood relatives) with alcohol problems
• A partner who drinks heavily
• The ability to "hold her liquor" more than others
• A history of depression
• A history of childhood physical or sexual abuse.

The presence of any of these factors is a good reason to be especially careful with drinking.

How Do You Know if You Have a Problem?

Answering the following four questions can help you find out if you or someone close to you has a drinking problem.

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

One "yes" answer suggests a possible alcohol problem. If you responded "yes" to more than one question, it is very likely that you have a problem with alcohol. In either case, it is important that you see your health care provider right away to discuss your responses to these questions.

Even if you answered "no" to all of the above questions, if you are having drinking-related problems with your job, relationships, health, or with the law, you should still seek help.

Treatment for Alcohol Problems

Treatment for an alcohol problem depends on its severity. Women who have alcohol problems but who are not yet alcohol dependent may be able to stop or reduce their drinking with minimal help. Routine doctor visits are an ideal time to discuss alcohol use and its potential problems. Health care providers can help a woman take a good hard look at what effect alcohol is having on her life and can give advice on ways to stop drinking or to cut down.

Research Directions

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a component of the National Institutes of Health (NIH), supports about 90 percent of the Nation's research on alcohol use and its effects. The goal of this research is to better understand the causes and consequences of alcohol abuse and addiction, and to find new ways to prevent and treat alcohol problems.

Finding out what makes some women drink too much is the first step to preventing alcohol problems in women. Scientists are studying the role of genetics and family environment in increasing or decreasing the risk of alcohol problems. They also are studying other features of a woman's life, such as the type of job she has; whether she combines family and work; life changes like marriage, divorce, and the birth and departure of children; infertility; relationship and sexual problems; and ethnic background.

Scientists want to know why women in general seem to develop long-term health problems from drinking more quickly than men. Researchers are examining issues like alcohol and breast cancer in women, and the extent to which alcohol may lower the risk of heart disease, and possibly osteoporosis, in some women.

Finally, research is helping determine how to identify women who may be at risk for alcohol problems, and to ensure that treatment will be effective.

The Office of Research on Women's Health (ORWH) serves as the focal point for women's health research at NIH. ORWH works in a variety of ways to encourage and support researchers to find answers to questions about diseases and conditions that affect women and how to keep women healthy, and to establish a research agenda for the future. ORWH encourages women of all racial and ethnic backgrounds to participate in clinical studies to help increase knowledge of the health of women of all cultures, and to understand the health-related similarities and differences between women and men. The office also provides opportunities and support for the advancement of women in biomedical careers.

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Source: NIH Publication No. 08–4956
Revised 2008

Page last modified or reviewed by athealth on January 29, 2014

Drinking Among Older Women

As they grow older, fewer women drink. At the same time, research suggests that people born in recent decades are more likely to drink—throughout life—than people born in the early 1900s. Elderly patients are admitted to hospitals about as often for alcohol-related causes as for heart attacks.

Older women may be especially sensitive to the stigma of being alcoholic, and therefore hesitate to admit if they have a drinking problem.

Consequences of Unsafe Drinking

• Older women, more than any other group, use medications that can affect mood and thought, such as those for anxiety and depression. These "psychoactive" medications can interact with alcohol in harmful ways.
• Research suggests that women may be more likely to develop or to show alcohol problems later in life, compared with men.

Age and Alcohol

Aging seems to reduce the body's ability to adapt to alcohol. Older adults reach higher blood levels of alcohol even when drinking the same amount as younger people. This is because, with aging, the amount of water in the body is reduced and alcohol becomes more concentrated. But even at the same blood alcohol level, older adults may feel some of the effects of alcohol more strongly than younger people.

Alcohol problems among older people often are mistaken for other aging-related conditions. As a result, alcohol problems may be missed and untreated by health care providers, especially in older women.

Staying Well

Older women need to be aware that alcohol will "go to their head" more quickly than when they were younger. Also, caregivers need to know that alcohol may be the cause of problems assumed to result from age, such as depression, sleeping problems, eating poorly, heart failure, and frequent falls.

The National Institute on Alcohol Abuse and Alcoholism recommends that people ages 65 and older limit their consumption of alcohol to one drink per day.

An important point is that older people with alcohol problems respond to treatment as well as younger people. Those with shorter histories of problem drinking do better in treatment than those with long-term drinking problems.

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Source: NIH Publication No. 08–4956
Revised 2008

Page last modified or reviewed by athealth on January 29, 2014

Drinking Among Women in Young and Middle Adulthood

Young women in their twenties and early thirties are more likely to drink than older women. No one factor predicts whether a woman will have problems with alcohol, or at what age she is most at risk. However, there are some life experiences that seem to make it more likely that women will have drinking problems.

Heavy drinking and drinking problems among White women are most common in younger age groups. Among African American women, however, drinking problems are more common in middle age than youth. A woman's ethnic origins—and the extent to which she adopts the attitudes of mainstream vs. her native culture—influence how and when she will drink. Hispanic women who are more "mainstream" are more likely to drink and to drink heavily (that is, to drink at least once a week and to have five or more drinks at one time).

Research suggests that women who have trouble with their closest relationships tend to drink more than other women. Heavy drinking is more common among women who have never married, are living unmarried with a partner, or are divorced or separated. (The effect of divorce on a woman's later drinking may depend on whether she is already drinking heavily in her marriage.) A woman whose husband drinks heavily is more likely than other women to drink too much.

Many studies have found that women who suffered childhood sexual abuse are more likely to have drinking problems.

Depression is closely linked to heavy drinking in women, and women who drink at home alone are more likely than others to have later drinking problems.

Stress and Drinking

Stress is a common theme in women's lives. Research confirms that one of the reasons people drink is to help them cope with stress. However, it is not clear just how stress may lead to problem drinking. Heavy drinking by itself causes stress in a job and family. Many factors, including family history, shape how much a woman will use alcohol to cope with stress. A woman's past and usual drinking habits are important. Different people have different expectations about the effect of alcohol on stress. How a woman handles stress, and the support she has to manage it, also may affect whether she uses alcohol in response to stress.

Consequences of Unsafe Drinking

• The number of female drivers involved in alcohol-related fatal traffic crashes is going up, even as the number of male drivers involved in such crashes has decreased. This trend may reflect the increasing number of women who drive themselves, even after drinking, as opposed to riding as a passenger.
• Long-term health problems from heavy drinking include liver, heart, and brain disease; suppression of the immune system; and cancer.
• Because women are more likely to become pregnant in their twenties and thirties, this age group faces the greatest risk of having babies with the growth and mental impairments of fetal alcohol syndrome, which is caused by drinking during pregnancy.

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Source: NIH Publication No. 08–4956
Revised 2008

Page last modified or reviewed by athealth on January 29, 2014

Drinking Among Adolescent Girls

Despite the fact that drinking is illegal for anyone under the age of 21, the reality is that many adolescent girls drink. Research shows that about 37 percent of 9th grade girls—usually about 14 years old—report drinking in the past month. (This rate is slightly more than that for 9th grade boys.) Even more alarming is the fact that about 17 percent of these same young girls report having had five or more drinks on a single occasion during the previous month.

Consequences of Unsafe Drinking

• Drinking under age 21 is illegal in every State.
• Drunk driving is one of the leading causes of teen death.
• Drinking makes young women more vulnerable to sexual assault and unsafe and unplanned sex. On college campuses, assaults, unwanted sexual advances, and unplanned and unsafe sex are all more likely among students who drink heavily on occasion—for men, five drinks in a row, for women, four. In general, when a woman drinks to excess she is more likely to be a target of violence or sexual assault.
• Young people who begin drinking before age 15 have a 40-percent higher risk of developing alcohol abuse or alcoholism some time in their lives than those who wait until age 21 to begin drinking. This increased risk is the same for young girls as it is for boys.

Alcohol's Appeal for Teens

Among the reasons teens give most often for drinking are to have a good time, to experiment, and to relax or relieve tension. Peer pressure can encourage drinking. Teens who grow up with parents who support, watch over, and talk with them are less likely to drink than their peers.

Staying Away From Alcohol

Young women under age 21 should not drink alcohol. Among the most important things parents can do is to talk frankly with their daughters about not drinking alcohol.

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Source: NIH Publication No. 08–4956
Revised 2008

Page last modified or reviewed by athealth on January 29, 2014