Excessive drinking is the third leading cause of preventable death in the United States. It is responsible for roughly 23,000 deaths of American girls and women each year. Alcoholism is a more serious risk for early mortality than smoking, and it is more than twice as deadly for women than for men. Those statistics come from a new book by award-winning journalist Ann Dowsett Johnston. She takes an in-depth look at the psychological, social and workplace factors contributing to the growing problem of alcohol abuse among women. Johnston joins Diane to discuss the effects of alcohol addiction on her own life and society as a whole.

Guests

  • Ann Dowsett Johnston an award-winning journalist and former editor at Maclean's magazine and vice-principal at McGill University.

A Statement From The Distilled Spirits Council

Ms. Johnston’s statement suggesting that college binge drinking rates have been increasing for years is not supported by government data. The most recent data from two of the federal government’s leading longitudinal surveys, Monitoring the Future and the National Survey on Drug Use and Health, both report declines over the past decade in college binge drinking.

Read An Excerpt

Excerpted from “Drink: The Intimate Relationship Between Women and Alcohol” by Ann Dowsett Johnston. Copyright © 2013 by Ann Dowsett Johnston. With permission of the publisher, HarperWave.

Transcript

  • 11:06:55

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Some researchers believe we're now witnessing a global epidemic in women's drinking, and as a culture, we're living in denial. In 2011, Canadian journalist Ann Dowsett Johnston wrote a 14 part series on the closing gender gap in the world of risky drinking. In a new book titled, "Drink," she combines in depth reporting with her own personal story of recovery. Ann Dowsett Johnston joins me in this studio to talk about the relationship between women and alcohol.

  • 11:07:37

    MS. DIANE REHMI'll look forward to hearing your comments and questions. Join us, as always, by phone at 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. Ann, it's good to meet you.

  • 11:07:57

    MS. ANN DOWSETT JOHNSTONIt's such a joy to be here. Thank you.

  • 11:07:59

    REHMOh, I'm so glad to have you here. You know, when you wrote that 14 part series on women and alcohol, you did not disclose your own history, but then you went to your editor, who was going to work with you on your new book, "Drink," and you told her the truth about yourself. What was her response?

  • 11:08:32

    JOHNSTONAt first, there was a simple question. Do you ever have to work again? And I said, yes, indeed, I do. I'm a woman on my own in my fifties. And she said, then, I don't think you should disclose. I knew that this story had to be told. I had grown up with an alcoholic mother, a classic poster girl for the 60's, cross addicted to valium and cocktails. And I'd been curious about addiction my whole life. I also was determined I would never fall into it and I did.

  • 11:09:06

    REHMYou did. How did you?

  • 11:09:09

    JOHNSTONI was your classic professional, well educated woman. Big jobs, 30 years, award winning journalist. 30 years in the news magazine business, and then I became V.P. of Miguel University in Montreal. I had a wonderful career. I also was single mother, and I had a habit of pouring myself a glass of wine or two as I cooked dinner and got ready to oversee some homework. And for years, I did this, and for decades, it was fine.

  • 11:09:38

    JOHNSTONAnd then I hit a crunch in my fifties where I was in Montreal, I was very lonely, I was isolated and I was working very hard, and I medicated depression with alcohol. And that two or three glasses of wine became three or four or five.

  • 11:09:55

    REHMAnd that took you on a path to not being able to do your job, perhaps?

  • 11:10:05

    JOHNSTONWell, I call myself the poster girl for this generation, because I actually never missed work, never cracked up a car and told myself I wasn't an alcoholic because I didn't look anything like my mother who drank during the day and did all of the above. But the truth was I was in trouble with alcohol. I was working very hard and I was drinking and passing out near the end. I had a very short trajectory with extreme alcohol problems and knew where it could go and got myself to rehab. very quickly.

  • 11:10:37

    REHMGood for you. What memories do you have of your mother and your father?

  • 11:10:45

    JOHNSTONMy father, who did die of the disease three years ago joined my mother in retirement. His drinking was quiet and hidden. My mother's drinking was anything but quiet or hidden. She would drink during the day, sleep, and then would end up going through the evening and night hours absolutely ranting. She was an angry alcoholic, and I was the eldest of three children. It was a very difficult household to grow up in.

  • 11:11:17

    REHMSo, you're saying, in part, she took her anger out on you.

  • 11:11:21

    JOHNSTONYes. Yes. She took her anger out on the whole household. She was drinking, also, to medicate depression and loneliness, but her antics were quite different from mine. Quite gothic and surreal. And I was determined never to be this way. I was determined -- now, you mix valium with alcohol, you get a different kind of drinking, as you would know. And she, like so many women in the 60's and 70's was mixing valium and alcohol, was seen as mother's little helper and that was not an uncommon story then.

  • 11:11:54

    JOHNSTONI think my story is not uncommon now, which is a lot of professional, educated women are drinking more than they should and I'm trying to open a conversation about that subject.

  • 11:12:07

    REHMDo you think education has a role to play here, in terms of, you keep emphasizing that here you have these big jobs, lots of responsibility. Miguel University, education all around, and yet, you kept on drinking. Did education play a positive or a negative role?

  • 11:12:34

    JOHNSTONI think education can play a negative role, not that one shouldn't be educated. But I do think that the campus drinking culture is really feeding very negatively into a pattern right now where young women are not slowing down in their 20's or 30's or their 40's. We're seeing a very algogenic culture, very, very different, and it turns out if you look at the research around the world, the one thing that will protect you against drinking issues is a blue collar job.

  • 11:13:05

    JOHNSTONSo, this is a touchy area.

  • 11:13:07

    REHMInteresting. Interesting.

  • 11:13:08

    JOHNSTONIt's a touchy question, because from a feminist point of view, of course we want it all. But I raise the question in this book, is alcohol the new modern woman's steroid, enabling her to do the heavy lifting in a complex world? It's not an uncommon pattern, the one I fell into.

  • 11:13:28

    REHMYou know, it's interesting. I recall reading in your book that as you sat alone in your office at Miguel University with the windows open, you would hear the young people outside. You would hear the friendly banter and maybe even drunken banter going on among those kids and, perhaps, found yourself lonely, depressed and, in one way, wanting to join in.

  • 11:14:01

    JOHNSTONYou're absolutely right. I was very isolated, you know? I think when we make a move in our fifties to a new city, I was really unrealistic, not knowing how lonely I would be, and I was very lonely. It was lonely at the top. I found that a very big thing to do. I also had left journalism, which was a huge love of mine. Writing, expressing myself, I don't think we can every underestimate what happens to us when we leave our passion.

  • 11:14:29

    REHMAnd did you have colleagues? Did you have friends with whom you could speak or share the food, the alcohol, the conversation?

  • 11:14:44

    JOHNSTONNo, I didn't. Not really. There were several of us from different places, and there was one Dean of Medicine from New York City who was very generous to me and he recognized that I was getting into trouble. And he handed me a napkin with that wonderful Dorothy Parker quote, "I have a martini, two at the most, three I'm...how does it go? Four, I'm under the host. Three I'm under the table. Four I'm under the host."

  • 11:15:13

    JOHNSTONHe handed that to me and I put it in my journal and I knew it was time to stop drinking.

  • 11:15:17

    REHMAnn Dowsett Johnston and we're talking about women and alcohol. A threat, she sees, one that's growing among young, ambitious educated women. A problem throughout this country. Do join us. 800-433-8850. In fact, some experts are calling risky drinking among young women a global epidemic.

  • 11:15:53

    JOHNSTONYes. We are seeing an unbelievable closing of the gender gap in terms of risky drinking in all developed countries. The worst being Britain. We're seeing almost parody. Young women in their 20's dying of end stage liver disease, which is classically seen as an old man's disease. People in their teens presenting with alcoholism, full blown alcoholism. I call them the Lindsay Lohan of the modern developed world. They really have a problem, and alcohol in that country is extremely cheap, as it is in this country. Very cheap.

  • 11:16:33

    JOHNSTONOften you'll go into a gas station, it will be the cheapest thing, cheaper than water, cheaper than orange juice. So, from an alcohol policy point of view, some things are going terribly wrong. We have a feminized drinking culture with extraordinary products such as Skinny Girl Vodka, Girls' Night Out Wine, that kind of thing. Mummy Juice.

  • 11:16:55

    REHMI don't know about these products. Tell me about them.

  • 11:16:58

    JOHNSTONWell, it's fascinating. Sometime in the mid 90's, the spirits industry looked at the beer industry and said, we're losing the race. And they looked around the world and said, how are we gonna catch up? They invented alcopops, which are those pre-mixed vodka related drinks aimed at teens. Transitional drinks. Chick beer, as it's known. Think of Smirnoff Ice, and that's to train young women to love their Cosmos, love their vodka, grow up into vodka drinkers. And, in fact, the gamble paid off. We saw Smirnoff increase its sales 68 percent from 2000 to 2008.

  • 11:17:42

    JOHNSTONYoung women on campuses are playing drinking games, doing shots. Their boyfriends, who are much larger, are drinking beer. Who's drinking the stronger beverage? Definitely the young woman.

  • 11:17:53

    REHMAnd getting drunk that much more quickly, and, perhaps, losing control of behavior that much more quickly.

  • 11:18:05

    JOHNSTONYes, I mean, I say it's the number one date rape drug, which we all know it is. Alcohol. It's a real problem on campuses, and I don't know how we're gonna change the campus culture. We're also seeing a rise in drunkorexia, which is the mixture of eating disorders, also a female problem, eating disorders and risky drinking.

  • 11:18:26

    REHMAnn Dowsett Johnston. She's talking about the intimate relationship between women and alcohol in her new book, "Drink." I hope you'll join us. Questions, comments after a short break.

  • 11:20:02

    REHMAnd welcome back. If you're just joined us, Ann Dowsett Johnston is with me. She began her journey with alcohol and alcoholism many years ago. She saw her parents, both alcoholics. Her father died three years ago. Her moth, is she still alive, Ann?

  • 11:20:32

    JOHNSTONShe is still alive.

  • 11:20:33

    REHMDoes she know you've written about her?

  • 11:20:35

    JOHNSTONYeah, she certainly does. And she's been very brave. She came forward in this book at 84, so I'm very proud of her.

  • 11:20:43

    REHMDid she finally stop drinking?

  • 11:20:46

    JOHNSTONShe's a controlled drinker -- what we call a controlled drinker which is not where I would love her to be, but she's 84. She's her own woman.

  • 11:20:55

    REHMAnn's new book is titled "Drink: The Intimate Relationship Between Women and Alcohol." We're going to open the phones shortly. Here's a posting on Facebook which says, "Las time I checked, women have the exact same rights to the same bad habits that men do. Why should women be expected to not have similar drinking issues to men?"

  • 11:21:29

    JOHNSTONWomen are totally entitled to drink any way they want. This person is totally right.. However, we're democratically equal, we are not equal hormonally or metabolically.

  • 11:21:41

    REHMWhat do you mean by that?

  • 11:21:43

    JOHNSTONWe're missing a key enzyme that helps us digest alcohol -- or rather does not help us digest alcohol. We both get strokes, men and women. Women get them four times faster. Fifteen percent of breast cancer cases are related to alcohol. We just get into trouble with alcohol a lot faster than men do. And all I'm saying is, just like tanning beds and trans fats, you might as well know what the downside is.

  • 11:22:10

    REHMWhat is the enzyme that is missing in women that somehow creates a greater susceptibility to alcohol?

  • 11:22:24

    JOHNSTONNow, Diane, you're going to put me on the spot because it's a mouthful and I'm not going to be able to deliver it right now.

  • 11:22:32

    REHMAll right. You will after you...

  • 11:22:33

    JOHNSTONIt's in my book.

  • 11:22:34

    REHM...after you've checked your own book, you'll deliver the name of that enzyme. Becca Kaufman, our producer, may well be able to produce it for us. I was very, very interested in Gloria Steinem's reaction when you asked her about women and alcohol. Some feminism issue involved here.

  • 11:23:03

    JOHNSTONYes. I went up to her at a wonderful birthday party for Ms. Magazine last year in New York City and said, could we have a short talk about women and alcohol? And she looked at me very, very directly and said, alcohol is not a woman's issue. Food is a woman's issue, but women do not have trouble with alcohol. Went back to her after about an hour -- I was troubled by her response -- and said, you do a lot of work in the developing world. Are you not concerned that indeed big alcohol is really targeting women -- professional women in that world? And she paused and she said, well, that might be worth discussing, but I still don't see the connection.

  • 11:23:43

    JOHNSTONSo I was troubled by that response. I was very interested by that response. Clearly our values are very fuzzy around alcohol. We love alcohol. If a person has a problem, it's not us, it's the other. If we're drinking too much we're trying to be like the Italian or the French. We don't want to hear bad news about our favorite drug. I don't think we do.

  • 11:24:06

    REHMDo you think the changing workplace has contributed to the rise in the female intake of alcohol?

  • 11:24:17

    JOHNSTONThere's no doubt. If you look around the world at -- to use an old fashioned word -- the emancipation index between alcohol and alcohol overuse in women, there's no doubt there's a connection. Women feel entitled to a drink at the end of the day. They have every reason to want a drink if a man has a drink. I understand that. They just have to understand that they have some vulnerabilities -- physical vulnerabilities. Risky drinking is over nine drinks a week. And if you count your drinks and you drink two or three on a weekend, it can add up very quickly.

  • 11:24:53

    REHMAnd do you think that being in what was previously and primarily a male culture has changed that?

  • 11:25:05

    JOHNSTONOh yes, I think so. I think you see women now outnumbering men to a huge degree on -- in the post secondary world. You see women going toe to toe everywhere. There is just a sense that what they have we should have.

  • 11:25:23

    REHMSo what they have had have been those tables filled with men drinking. And now you're seeing tables filled with women drinking.

  • 11:25:36

    JOHNSTONOf course. Of course. This is a common -- I mean, think of book clubs, think of women gathering. This is -- the frat boys stereotype is dead. This is the new face. Think of "Bridesmaids" -- the movie "Bridesmaids." We're seeing a whole shift in television, movies, in books on women and drinking.

  • 11:25:57

    REHMWe talked about Gloria Steinem and her reaction. What's been the reaction to your book from women as you've gone around the country, perhaps talked about the book in your own country of Canada? What's been the reaction?

  • 11:26:17

    JOHNSTONAbsolute relief and heartwarming. I've been told many times I'm very brave to come out and name myself. So I hear that over and over again. It's a Bestseller in Canada. It's right at the top. And there has been a sense of, oh my goodness, we knew this, we know this. This is how we live. We think about it. Biggest question is, how do I know if I'm in trouble? How do I know if I'm an alcoholic or I'm at risk?

  • 11:26:46

    JOHNSTONAnd the easiest answer is, do you drink to entertain and relax or do you drink to numb a bad feeling? Do you drink, as I was doing, to self medicate depression and anxiety and exhaustion and loneliness? Is that what you're doing? You need to be honest with yourself and you need to count your drinks.

  • 11:27:03

    REHMAnd why do you come to that conclusion of nine drinks a week?

  • 11:27:10

    JOHNSTONThat is commonly understood data, but I won't say commonly understood by the public. When low risk drinking guidelines were announced in 2011 in Canada, people were really disturbed by that number nine. To many it doesn't seem very high.

  • 11:27:29

    REHMAnd to you?

  • 11:27:31

    JOHNSTONAnd to me it didn't seem high at all. I mean, if you have three or four drinks on a Friday night and on a Saturday night and you're definitely not going to drink certain nights during the week, well, there were many people I knew who were touting and saying, I’m in trouble.

  • 11:27:50

    REHMHere's an email from Chris who's listening online in Sudbury, Ontario who says, "It's funny how we still talk about the old man's club around the tables. In my home group there are consistently more women -- pardon me -- than men. The AA stereotype we often see on TV are rooms with old men and a few young women. But that image doesn't really square with reality. In my experience, the meetings I attend have plenty of women and they are full of range of age groups."

  • 11:28:40

    JOHNSTONAnd that is the really exciting thing. I've been sober for five years and I have to say, in the meeting that I attend of a mutual support group, you will see many strollers coming in. You will see many young women coming straight out of university. You'll even see the occasional teenager in her school kilt, her private school kilt. This is mind-blowing to me. More women than men definitely, not that old stereotype of years before.

  • 11:29:12

    JOHNSTONWe're seeing a real revolution. And you know the other thing I see with young people? Young people are proud of being sober. They're proud to have sobriety. That's not part of my age group. There's a lot of stigma still left.

  • 11:29:25

    REHMBut you talked about your mother and you talked about how proud you are that she is currently controlling her drinking. There are many people out there who say, I can stop anytime I want. I can have three drinks one night, five drinks another night and no drink the next night. I am in control. What do you say to them?

  • 11:29:56

    JOHNSTONI say to them, fabulous for you. If you actually can say I won't have a drink this week or next week and you can actually keep your word, more power to you. You probably are fine. But in my case I played that trick on myself and I failed. I failed royally. So you should know whether you can stop drinking and if you're in control is number one.

  • 11:30:19

    REHMAll right. Let's open the phones. We'll go first to Erin in Tallahassee, Fla. You're on the air.

  • 11:30:28

    ERINOh, good morning, Diane. Thank you for taking my call.

  • 11:30:31

    REHMSurely.

  • 11:30:31

    ERINAnd a good morning to your guest, Ann.

  • 11:30:34

    JOHNSTONGood morning.

  • 11:30:36

    ERINAnd I'm really excited. Whenever I see her, this topic comes up. You sound like you're about the same age as me. I'm 58. And just hearing you share about your growing up experience, sounds very much like mine. I had a mother who died at the age of 50 from her drinking. She didn't have the Valium, but the -- you know, I don't know how much your book talks about, too, how genetics plays a role.

  • 11:31:09

    JOHNSTONYes.

  • 11:31:10

    ERINBut in my family, you know, one-half Irish, one-half Ukrainian, we just saw a lot of this throughout our family on both sides. And my father also died at 68. I attribute a lot of it to his drinking, although he was what you would call a controlled drinker by (unintelligible) .

  • 11:31:29

    REHMUm-hum.

  • 11:31:31

    ERINI just wanted to also ask, I have noticed, you know, my -- what got me really looking at this was the strong connection having grown up in the '60. And I can heavily relate to Mad Men, the TV series. I was surprised that even though I seem to recognize that alcohol was starting to become a problem with me in my early 30's that I began to get into other things like exercise and quitting smoking.

  • 11:32:07

    JOHNSTONRight.

  • 11:32:08

    ERINBut there was still this terrible urge to connect to alcohol socially...

  • 11:32:14

    JOHNSTONRight.

  • 11:32:15

    ERIN...and emotionally.

  • 11:32:16

    JOHNSTONRight.

  • 11:32:16

    ERINAnd it wasn't until my youngest sister almost went the same as my Aunt Lil, almost died at the age of 40 from her drinking, that we both got into 12-step programs.

  • 11:32:29

    REHMWell, Erin, I'm awfully glad for you that in fact you did. I appreciate you're sharing that information with us. It does seem as though sometimes it takes a while and sometimes someone else can be helpful. And you're listening to "The Diane Rehm Show." I think we do have the name of that enzyme, dehydrogenase. Is that it?

  • 11:33:04

    JOHNSTONThat's totally it. Thank you.

  • 11:33:05

    REHMDehydrogenase. And let's go to Marcus in Houston, Texas. You're on the air.

  • 11:33:14

    MARCUSI was actually just calling -- I'm a biochemist and I was actually just calling to talk about that enzyme. It is alcohol dehydrogenase, that is correct.

  • 11:33:24

    JOHNSTONThank you.

  • 11:33:24

    MARCUSAnd women do have that enzyme. It's just expressed in different levels. So men express more of course. And then if you habitually drink alcohol, sometimes the body tends to make more of that. But in women sometimes that doesn't necessarily happen.

  • 11:33:42

    JOHNSTONRight.

  • 11:33:42

    MARCUSSo that's why alcohol has that greater affect in women because they can't metabolize it.

  • 11:33:47

    REHMAnd I would think, Marcus, that that would hold especially true for young women.

  • 11:33:55

    MARCUSYes, it varies. Genetically, you know, everybody's different.

  • 11:33:59

    REHMI see. Yeah.

  • 11:34:00

    MARCUSBut, yes, young women who have never been exposed to alcohol would definitely have a higher risk because they're not -- their body isn't having to produce that enzyme to metabolize the alcohol. So if they start off drinking these very heavy drinks then it's especially dangerous for them because they cannot metabolize it.

  • 11:34:23

    REHMYou heard earlier in the program Ann talk about the mixes that are not so easily available to young people as an introductory way to get into alcohol, Marcus. What do you think of those?

  • 11:34:45

    MARCUSWell, I think it's a great idea by the companies who are making that stuff. It's definitely helping them make money. But it's very dangerous. I think it's something that should be regulated a little bit more heavily just like the government's going after the tobacco companies for advertising to young children. I think we should definitely take a look at doing something like that with these alcohol companies that are making these enticing things that teenagers are very attracted to, like these fruity flavors and things like that that are kind of...

  • 11:35:20

    REHMSure. All right, Marcus.

  • 11:35:22

    MARCUS...like a gateway.

  • 11:35:23

    REHMThank you so much for your call. That's something that you are really pushing for, Ann.

  • 11:35:31

    JOHNSTONI'm pushing for a careful look at pricing of alcohol. I'm quite distressed. Federal taxes have not been raised since 1991 on alcohol in this country.

  • 11:35:43

    REHMWhy is that do you think?

  • 11:35:45

    JOHNSTONI think that the alcohol lobby big alcohol is extremely powerful in this country. We know it's very powerful in this country.

  • 11:35:55

    REHMWhat about in your own country?

  • 11:35:57

    JOHNSTONEnormous, but we have alcohol monopolies. So we have minimum price for alcohol, much more regulated by the government. That doesn't happen here. You see 220 billion in terms of costs annually, in terms of alcohol-related costs in the U.S., very, very dire situation. And when alcohol is that cheap, it's of course that much more accessible to a young person.

  • 11:36:26

    REHMSo when you're talking about the billions in cost you mean because of illness and health and that sort of thing.

  • 11:36:35

    JOHNSTONAnd policing.

  • 11:36:36

    REHMAnd yet we haven't raised taxes.

  • 11:36:39

    JOHNSTONNo. No. And there are many, many bright people who are battling this in this country.

  • 11:36:47

    REHMHow has the alcohol industry reacted to your statements, Ann?

  • 11:36:54

    JOHNSTONThey've had a terrible time with my statements and have fought me hard.

  • 11:36:58

    REHMThey've fought you hard.

  • 11:36:59

    JOHNSTONThey're starting to fight me hard.

  • 11:37:01

    REHMAnd what are you hearing from them?

  • 11:37:03

    JOHNSTONThere is a push to discredit some of my evidence. And luckily I've been able to back myself up.

  • 11:37:12

    REHMThat's very interesting. All right. We'll take a short break here. Ann Dowsett Johnston is with me. Her new book is titled "Drink: The Intimate Relationship Between Women and Alcohol."

  • 11:40:02

    REHMAnd welcome back. We're talking in this hour about women and alcohol. Ann Dowsett Johnston is a Canadian journalist who became vice president of McGill University. She has written a new book in which she talks about her own drinking problems. It's called "Drink: The Intimate Relationship Between Women and Alcohol." Just recently, Ann, you had a piece in The Wall Street Journal about campus drinking. Talk about that piece and the reaction you had from the alcohol providers, the industry.

  • 11:40:52

    JOHNSTONI was writing about campus drinking, particularly Vodka Sam who's a young woman who tweeted from her jail cell after she'd been arrested by police. This is a University of Iowa student who tweeted saying she was going to have her blood alcohol level tattooed on her shoulder. She was proud of it. It was epic. This is part of the culture that I'm fascinated by. Why the bragging and the pride in the drinking? And I talked about the levels of campus drinking and the fact that females have caught up with men. And in fact the alcohol industry took me on in terms of the rates of drinking on campuses saying that they've remained flat for years. And that just isn't true. It's not true and it's certainly not true in terms of the female population.

  • 11:41:48

    REHMYou said that they were using old data?

  • 11:41:51

    JOHNSTONYeah, they were using old data.

  • 11:41:54

    REHMThat's pretty extraordinary that they would come after you with old data. Are they not keeping their own stats?

  • 11:42:05

    JOHNSTONWell, I think they are keeping their own stats, but I think there will be pushback on this book.

  • 11:42:10

    REHMHere's an email from Ann who says, "My daughter in her 20s drinks vodka with her girlfriends. She drinks vodka because she says it's low in calories as opposed to beer or wine. I've talked to her about not drinking something so strong, but the pursuit of being skinny drives her choices."

  • 11:42:40

    JOHNSTONYes. This goes back to this habit of drinking as an extreme sport, which is we -- you don't pace yourself with water. You don't pace yourself with eating. You don't drink before -- eat before a date, you just drink. This generation doesn't drink and drive the way other generations did, but they pre-drink. They have a lot more alcohol. So have a few shots of vodka before you go out. Go out and spend the evening drinking vodka. And you can imagine what happens.

  • 11:43:11

    REHMHere's another from Twitter, "Ann says that 15 percent of breast cancer cases are related to alcohol. I'd like to hear more about this."

  • 11:43:25

    JOHNSTONYes. This is relatively new data. It comes from Jurgen Rehm from the Center of Addiction and Mental Health in Toronto. Also a very big figure on the international alcohol policy set. 15 percent of those cases are related to alcohol. And we need to know that even one drink can change your breast cancer vulnerabilities. People don't know that. Women don't know that. We tend to think of the good things like red wine and dark chocolate being equal. We think of that. But also alcohol doesn't have the same protective qualities for women as it does for men. We need to know that there really are differences, and they're serious ones. And we need to educate ourselves.

  • 11:44:14

    JOHNSTONIs tobacco -- are tobacco and alcohol equal? No, of course not. You can drink and be fine. But is the alcohol industry behaving the way the tobacco industry used to? Absolutely. Very aggressively, very targeting of women. Some have called this Virginia Slims in a bottle. And there is a targeting of a female drinker. And targeting is on social media, on Facebook, on Twitter. And you know how cheap it is to tweet.

  • 11:44:45

    REHMYou have said that taxes on alcohol have not been raised since 1991. In addition to addressing taxation, what else would you like to see happen?

  • 11:45:03

    JOHNSTONWell, you've got countries like South Africa, for instance, looking heavily at banning all marketing. You've got a country like France, a real leader, who years ago with their (unintelligible) said, we will not allow you to do lifestyle marketing of alcohol. You can put the bottle out there, but you can't make it look fun. You can't add people, et cetera. There are those that think alcohol companies should not be sponsors of sports events. I think as a culture we have to take a really hard look at what is happening on social media, because in social media the alcohol becomes a person. That person is interacting with you on Facebook. You're underage.

  • 11:45:44

    JOHNSTONYou go to, say, Smirnoff or Bacardi, and you're interacting and they're engaging you. And they're engaging you on your iPhone. Very, very interesting. This is called pull marketing. You're not sitting on your couch turning down a commercial. You're actually seeking out the product. So this is a very different kind of marketing, so I would see some marketing restrictions and accessibility restrictions. Should alcohol really be in gas stations and corner stores? I don't think so.

  • 11:46:13

    REHMAll right. Let's go to Ben in Hot Springs, Ark. Hi there.

  • 11:46:20

    BENHi, it's good to talk to you again. Let me just point out something. In the British Commonwealth, I believe this lady is from Canada, it is the same as England where they have never declared alcoholism as a disease. Whereas in our country, United States of America, our first surgeon general in 1792, Dr. Benjamin Rush, said, alcoholism is a disease. Now, I'm a recovering alcoholic with 31 years sobriety. I knew a woman named Diane Sheehan whose husband died of alcoholism. She was in recovery at 75, the day she died. I was with her.

  • 11:46:51

    BENHer best friend was Dorothy Parker, a journalist of some renown who died of alcoholism, but left all of her resources and all of her revenues to the National Association for the Advancement of Colored People, a wonderful woman who went -- now, here's the curious thing, Diane Sheehan helped with Eleanor Roosevelt and Wild Bill Donovan to start the OSS Group, which became, you know, the first group to go behind the life. She was an incredible woman. But I've known many, many women who, yes, it is the islets of Langerhans in the pancreas that does not produce this enzyme for both men and women. And we used to call it fire water. My grandmother was a Native American and Irish on my mother's side...

  • 11:47:28

    JOHNSTONRight.

  • 11:47:29

    BEN...so I had both of those genetic deficiencies working against me. I went to -- I go to two and three AA meetings a day. The women in our meetings, there are more -- they're anywhere from 18 to rather senior women.

  • 11:47:42

    REHMWow.

  • 11:47:42

    BENTwo of them in our group are habitual. That is they've been in prison so many times that if they go back again, they're there forever.

  • 11:47:48

    REHMAll right, sir. Thank you.

  • 11:47:49

    BENAnd I work with all these people.

  • 11:47:51

    REHMThank you so much for your call. He is really backing up everything you've said, Ann.

  • 11:47:59

    JOHNSTONI just want to say that it definitely has been named a disease in Canada, as it has in the United States. We tend to see it as a moral failing. It is not.

  • 11:48:12

    REHMThis is an interesting email from Rob, who says, "At my last physical my doctor asked about my drinking and smoking habits. I told her that while I've never smoked, I did enjoy three or four cocktails or glasses of wine on a fairly regular basis always in the evening. She only asked if I ever had problems getting up in the morning or going to work on time. She didn't seem to think it was a problem. Or if she did, she said nothing. Does that seem strange to your guest?"

  • 11:48:55

    JOHNSTONThat seems very, very strange. You know, there's common wisdom that doctors take whatever you say, you drink, and they double it, because almost everyone is in denial and modifies thinking they'll shock their doctor. So most doctors, most GPs double it. I'm surprised that this man's doctor did not challenge him a little further.

  • 11:49:19

    REHMAll right. And let's go now to Clara in Ann Arbor, Mich. You're on the air.

  • 11:49:29

    CLARADiane, I just want to say thanks for taking my call. This is very exciting.

  • 11:49:33

    REHMGood. I'm glad.

  • 11:49:35

    CLARAAnd I just was wondering, Ann, if you would talk a little bit more about how we can change the messages that are being sent to young women, particularly with feminism. Like, I know, you know, I'm in my early 40s, sad to admit, but I am. And my daughter is about to enter college next year, and I'm concerned that the messages that she's getting from the media and from just culture in general is that in order for her to compete and to build a career and to be accepted among her male peers, that she has to one up them because that seems to be sort of the vestige of the male culture that we're still challenged by.

  • 11:50:11

    CLARAHow do we change those messages? How can we, you know, what can we do individually and as a culture to, you know, do something about that?

  • 11:50:19

    JOHNSTONRight. Let me just say right off the top that the first thing you can do is have open conversations with her. And my generation, our generation of parents sometimes feels that they can't interfere that way, that kids will be kids and their opinion doesn't mean anything. Your opinion actually means a lot. There's a fellow named Rob Turrisi out of Penn State who has written a wonderful handbook for parents to speak to their sons or daughters in the last year of high school before they go off to campuses. Really important that you might check out his work. He's quite something.

  • 11:50:55

    JOHNSTONBut speak up, let them know about marketing, let them know they're the target of marketing, make them savvy about advertising.

  • 11:51:04

    REHMI think that is good advice. Heather wants more advice. She says, "I'd like your guest to talk about how she found the strength to stop drinking. I often think I'm drinking too much, but cannot make the decision to completely stop. I'm also surrounded by a community of friends in which everyone drinks."

  • 11:51:35

    JOHNSTONThat makes it so hard. You know, I was at a -- giving a breakfast talk last week. And I was also at a writers' festival. In both cases, women came up to me, both with tears in their eyes, saying a very similar thing, that they were surrounded by people drinking. In Canada we're having our Thanksgiving this weekend. And one of them said, I don't know how I'm going to face my family's celebration. It takes guts. It takes guts, and it takes desperation. I tried many, many times and was unsuccessfully, as I say in my book.

  • 11:52:08

    JOHNSTONAnd then I essentially hit a wall. Hit a wall of shame and humiliation and realized that I had no choice. It's a tough decision. I think you should begin by seeing if you can limit your drinking. I put stickers in a book for every day that I was -- I was successful, little monkeys to get the monkey off my back. And I think you should at the very least try and control your drinking. And I wish you enormous luck, and don't hesitate to get in touch with me if you'd like to.

  • 11:52:39

    REHMAnd you even tried a geographic cure.

  • 11:52:43

    JOHNSTONI tried the most common cure which is geographic. I will move to a new city and I will be different. And it's such a naïve thing to think, isn't it? I mean, just almost childish, childlike. I thought it would work. I thought if I didn't have alcohol in my home it would just be fine. What I didn't realize is the job I was moving into had, which was fundraising, a lot of alcohol in the job, number one. Number two, Montreal, the city I moved to, sells alcohol in the corner stores. It was an alcogenic society, let's just say that, and it was very hard.

  • 11:53:19

    REHMAnd you're listening to "The Diane Rehm Show." Many people say you have to hit that wall before you can stop. Do you recall the day that happened?

  • 11:53:35

    JOHNSTONYes, my bottom looked like this. I went to a fancy party given by my best friend, a black tie party. I danced and drank. Others danced and drank as well. Only I ended up in a women's washroom drunk at my wits end. And that night my best friend and my son confronted me about my drinking, and I made a decision to go to rehab. I was humiliated. And that was a low point. My son also gave me a Mother's Day card that said, "Happy Mother, she has whites in the whites of her eyes, and she's drinking Perrier, not wine." And that was a wakeup call.

  • 11:54:14

    REHMWow.

  • 11:54:15

    JOHNSTONWow.

  • 11:54:16

    REHMIt's quite a story, Ann, and I guess one question would be how long did it take you before you could stop putting those tabs into a book.

  • 11:54:33

    JOHNSTONIt took me about a year. It took me about a year between the time that I said, I will quit, to actually quitting.

  • 11:54:40

    REHMAnd were there relapses?

  • 11:54:42

    JOHNSTONAbsolutely there were relapses. Some very small, but each one taught me that I wasn't making it. I carried that Mother's Day card with me in my diary day-in, day-out. And when I headed to rehab, I tucked it away in my purse. It now sits proudly in my kitchen by my window for all to see. This is a portrait of a happy mother drinking Perrier, not wine.

  • 11:55:04

    REHMDid you at times feel as though the pain or the difficulty you were experiencing, the loneliness, the isolation, did you say to yourself, well, maybe it isn't worth it, I'll just keep medicating my loneliness?

  • 11:55:29

    JOHNSTONI actually had a terrible reaction. My reaction was I might as well die if I can't stop this. I was so bankrupt spiritually, emotionally, physically. And I had a high bottom, what is called a high bottom. I didn't, as I say, crack a car up or -- but I was passing out every night, and that's enough to dispirit anybody.

  • 11:55:51

    REHMWhen you say you were passing out every night, help me to understand what that means.

  • 11:55:58

    JOHNSTONBless you, Diane. If you can ask that question, you're a healthy woman. That means that you're not looking at the stars, you're not sober enough to read the good book that's by your bedside, and you're not saying good night to yourself in a way that is conscious. And that is no way to fall asleep. The one thing I noticed as soon as I hit rehab is that my reading habits were strong again, and as a writer that's key.

  • 11:56:25

    REHMNow, have you turned exclusively now to writing and have given up any of those other jobs that you did find isolating?

  • 11:56:43

    JOHNSTONYes, yes. I'm totally a writer. I'm also leading Canada's National Faces and Voices of Recovery Movement, which is wonderful.

  • 11:56:54

    REHMGood for you.

  • 11:56:56

    JOHNSTONThank you, Diane.

  • 11:56:57

    REHMNow, we will have your book featured on our website. How do people get in touch with you if they wish?

  • 11:57:10

    JOHNSTONI have a website, anndowsettjohnston.com. I'm on Twitter. I'm easy to find.

  • 11:57:18

    REHMAnn Dowsett Johnston, her book is titled "Drink: The Intimate Relationship Between Women and Alcohol." Congratulations.

  • 11:57:30

    JOHNSTONThank you so much, Diane.

  • 11:57:32

    REHMAnd thanks all for listening. I'm Diane Rehm.

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