The release of the new Amy Winehouse biopic Back to Black in U.S. theaters on May 17, 2024, reignites scrutiny on the late singer’s tumultuous relationship with alcohol and drugs. In July 2011, Winehouse was found dead in her London apartment, with her death classified as “death by misadventure”—a euphemism for accidental death linked to reckless behavior. Her blood alcohol level was a staggering 0.416 percent, over five times the U.S. legal limit for intoxication, prompting a later coroner’s report to label the cause of death as “alcohol toxicity.” Fast forward nearly 13 years, and binge drinking remains a critical public health crisis in both the U.K. and the U.S. Around 1 in 5 U.S. adults report binge drinking weekly, averaging seven drinks per session—far exceeding the legal intoxication threshold of 0.08 percent, which translates to about four drinks for women and five for men within a two-hour window.
The COVID-19 pandemic has exacerbated this issue, leading to a staggering 41 percent increase in “heavy drinking” incidents among women. Adult women in their 30s and 40s are driving this surge, raising binge drinking rates without any signs of slowing down. Despite ongoing research into substance use disorders, the specific links between women’s health and binge drinking remain poorly understood. As a neurobiologist, I study the intricate chemicals and brain regions implicated in alcohol addiction, focusing on how binge drinking alters neuropeptides—signaling molecules crucial for decision-making and risk-taking—in animal models. My lab aims to decipher how substances like alcohol impact these brain systems before addiction sets in, paving the way for better prevention and treatment methods.
Though problematic alcohol use has likely existed since alcohol itself, it was only in 2011—the same year Winehouse died—that the American Society of Addiction Medicine reclassified substance addiction as a brain disorder. Today, we refer to it as alcohol use disorder instead of the outdated term “alcoholic.” Significant strides have been made in understanding how substances, including alcohol—a drug in its own right—affect the brain. While people often consume alcohol for the pleasure it provides—like bonding over drinks with friends—this can quickly devolve into cycles of excessive drinking and withdrawal. All forms of alcohol consumption pose risks, but binge drinking is particularly perilous, as it can trigger a harmful cycle that alters brain function.
For many, drinking leads to “hangxiety”—a mix of anxiety and discomfort accompanying a hangover. The repeated cycle of intoxication and withdrawal fosters a relentless loop that often leads to relapse. What starts as a source of enjoyment morphs into an effort to escape negative emotions. With each binge, the brain’s reward centers shift focus toward stress and anxiety responses. This progression—from pleasure to withdrawal to cravings—disrupts neural communication pathways. Alcohol impacts various neurotransmitters and receptors, complicating our understanding of its effects. My lab’s research zeroes in on how alcohol influences neuron communication within the prefrontal cortex.
Neurons serve as the brain’s messengers, transmitting electrical and chemical signals throughout the body. In our animal models of binge drinking, we’ve observed that certain neuron types struggle to communicate effectively, with some effects being permanent. Even after prolonged abstinence, normal neuron interactions may not resume, indicating that the neurobiological roots of addiction can take hold long before individuals or their loved ones recognize a problem. While genetic and biological factors play a role in individual susceptibility, women are especially vulnerable. They often face more severe health repercussions from alcohol use, such as liver disease, cardiovascular problems, and various cancers. Alarmingly, middle-aged women now exhibit the highest rates of binge drinking, with even moderate alcohol intake increasing the risk of serious health issues, including digestive, breast, and pancreatic cancers, as well as premature death.
The rising prevalence of alcohol use disorder among women highlights an urgent need for research and treatment tailored to their unique circumstances. Historically, women have been underrepresented in biomedical research, a gap that only began to close in 1993 when the National Institutes of Health mandated inclusion of women in clinical studies. It wasn’t until 2016 that sex was recognized as a critical biological variable in federally funded research. Excluding women from studies leaves a significant void in our understanding of health, disease, and alcohol addiction. Compounding this issue is the evidence that addictive substances interact with fluctuating sex hormones like estrogen and progesterone. Research indicates that high estrogen levels, such as those before ovulation, can enhance the rewarding effects of alcohol, potentially driving up binge drinking.
Yet, the interplay between these natural biological cycles and the unique factors affecting women’s health and alcohol addiction remains poorly understood. The call for more research into women’s health is gaining traction, and substantial federal investment in this area is crucial for developing better prevention and treatment strategies. While women like Amy Winehouse may have battled addiction both publicly and privately, the growing recognition of addiction as a brain disorder could unlock new avenues for effective treatment for those impacted.