The CWHS found that the prevalence of binge drinking among adult women in California was 9.3%. This is similar to findings from national surveys of the US population in which 7.3% to 11.8% of women reported drinking five or more drinks on an occasion in the past month [2, 23, 24].
Compared to women who did not binge drink, binge drinking women were less likely to be pregnant, and more likely to smoke cigarettes and to describe themselves as only in fair or poor health. These results agree with those from other studies that pregnancy is associated with less binge drinking whereas smoking is associated with more binging on alcohol [25, 26]. One survey found that 38% of young women reported smoking as the main reason for drinking . Young women who both binge drank and smoked were especially likely to report depressive symptoms .
We found that about 13%–14% of the women in this sample had symptoms of depression or overwhelming stress, whereas symptoms of PTSD were less common and symptoms of anxiety were reported by 22% of women. Having symptoms of depression, stress, PTSD, and anxiety were each associated with binge drinking. The association between depression and alcohol misuse has been relatively well-documented in the literature. For example, analyses of the Canadian National Population Health Survey found an association of major depression and binge drinking among women . In a sample of 121 alcohol-dependent women, 31% were diagnosed with depression, and 46% with anxiety, suggesting that women often alleviate stress through drinking . Consistently, we found that women's self-reports of poor mental health, and having perceived the need for and utilized help for mental health problems in the past year, were associated with binge drinking.
As expected, binge drinking was associated with adverse experiences both in adulthood and in childhood. For adult victimization by intimate partner violence or sexual assault in particular, drinking is often a maladaptive means of coping with the traumatic aftermath [31–34]. When victimization by such traumatic events is chronic, binge drinking may be explained by PTSD symptoms [35, 36]. That is, alcohol may be used to medicate PTSD-related sleep difficulties, hyperarousal, and other symptoms [37, 38].
Victimizing childhood experiences have been consistently linked to problems in childhood that extend into adulthood [39–41]. For example, there was a strong association between adverse childhood experiences such as physical and sexual assault and drug abuse in young women . In addition, longitudinal studies found that mothers' depressive symptoms and history of victimization predicted poorer behavioral outcomes among the children, and that the risk of child behavior problems increased with the number of areas B substance use, mental health, or domestic violence B in which the mother reported difficulties [43, 44]. Although the CWHS did not assess respondents' recollections of their psychiatric symptoms in childhood, possibly, those whose mothers had psychiatric difficulties or victimizing experiences had more dysfunction in childhood that then persisted into adulthood. Unfortunately, increased rates of binge drinking associated with childhood and adult victimization may increase the risk for re-victimization .
Even after adulthood factors were considered, the childhood experiences of having lived with someone who abused substances (22.3% of the sample did so) or who was mentally ill (16.8% did so) were still associated with binge drinking. Problematic alcohol use is known to be influenced by problematic parental drinking and a family history of alcoholism . While alcoholism has distinct biological and genetic influences [46–48], parental heavy-drinking norms and approval of, or lack of attention to, offspring drinking are also important correlates of risky drinking behaviors and poorer drinking outcomes [49–51]. The risk conferred by living with a dysfunctional adult suggests possible benefits of family-oriented medical and mental health care. Whether providers are initially focused on the adult or the child, there is the potential to help disrupt intergenerational alcohol misuse by considering the entire family or at least the parent-offspring dyad.
Importantly, we found that adverse childhood experiences represented by living in the midst of others' or one's own difficult life circumstances retained independent associations with women's binge drinking and was not mediated by poorer mental health status in adulthood. Thus it may not always be enough to intervene only with binge drinking, or even with the depression and anxiety also associated with binge drinking. Rather, providers working with binge drinkers should consider asking whether adverse childhood experiences have occurred (in this sample, one-half of women lived with an ill or victimized person in their childhood home, and one-third were personally abused or assaulted as children), and then addressing any consequences of such adverse experiences if they have taken place. Research on trauma-focused therapy for women who were victimized in childhood that has shown promise for improving mental health symptoms [52–54] needs to be extended to alcohol and drug outcomes.