Women and Alcohol: The Importance of Brief Intervention in Primary Health Care, by Janaina Soares

Alcohol consumption among women has increased in recent decades, becoming an important public health issue. Historically, alcohol use was more prevalent among men, but social, cultural, and economic changes have contributed to narrowing this gap. This scenario demands greater attention from health services, especially Primary Health Care (PHC), which serves as the main entry point to the health system and plays a strategic role in the early identification and management of risky alcohol use among women.

Effects of alcohol on the female body

According to Brazil’s Ministry of Health, one standard drink corresponds to approximately 10 grams of pure alcohol. In practice, this equals about 250 ml of beer, 100 ml of wine, or 30 ml of distilled spirits. In general, the higher the alcohol content of a beverage, the smaller the volume that corresponds to a standard drink.

For women, low-risk consumption is defined as up to one standard drink per day, with at least two alcohol-free days per week recommended. These intervals are important to reduce the development of tolerance—a phenomenon in which increasing amounts of alcohol are needed to achieve the same effects—which can contribute to progression toward dependence. For men, the low-risk limit is typically up to two drinks per day.

This difference is related to biological characteristics of the female body. In general, women have a lower proportion of body water, lower average body weight, and lower activity of the enzyme alcohol dehydrogenase in the gastric mucosa, which is responsible for part of alcohol’s initial metabolism. Since ethanol is distributed primarily in body water, these factors result in higher blood alcohol concentrations in women compared to men after consuming equivalent amounts.

Because of this greater systemic exposure, women are more vulnerable to alcohol’s effects and may develop health damage in a shorter period of time. Key consequences associated with alcohol use include liver and cardiovascular diseases, mental health disorders, increased risk of certain cancers, and significant impacts on reproductive health and pregnancy.

Consequences of excessive alcohol use

Beyond biological effects, alcohol consumption among women is also associated with important psychosocial factors. Work overload, violence, gender inequalities, psychological distress, anxiety, and depression can contribute to harmful drinking as a coping mechanism. In the context of pregnancy or reproductive planning, alcohol use poses additional risks, including adverse fetal outcomes such as fetal alcohol spectrum disorders.

Strategic tools for prevention

In this context, brief intervention is an effective, low-cost, and widely applicable strategy for preventing and reducing risky alcohol consumption. It is a structured approach, typically delivered in just a few minutes during a consultation, involving targeted counseling, personalized feedback on drinking patterns, and encouragement of critical reflection on the risks associated with alcohol use. It also includes collaboratively developing a menu of options to address risky behavior and strengthening the individual’s self-efficacy to promote change.

It is essential that this approach be conducted in an empathetic and nonjudgmental manner, fostering a trusting environment where individuals feel comfortable discussing their alcohol use and related challenges. The healthcare professional’s attitude should encourage open dialogue and active listening, helping individuals reflect on their behaviors and consider possible changes.

This strategy can be carried out by different members of the healthcare team and has strong evidence supporting its effectiveness in reducing alcohol consumption, particularly among individuals who have not yet developed dependence.

Brief intervention in Primary Health Care

In Primary Health Care, brief intervention can be integrated into routine women’s health visits, such as reproductive planning consultations, prenatal care, gynecological follow-ups, and health promotion activities. Systematic screening using standardized tools, such as the Alcohol Use Disorders Identification Test (AUDIT) or its abbreviated version (AUDIT-C), allows for the identification of risky drinking patterns and the direction of appropriate interventions.

Incorporating these strategies into PHC services contributes to more comprehensive care for women’s health, enabling not only early identification of harmful alcohol use but also strengthening the relationship between healthcare providers and patients. It also facilitates addressing other social and emotional determinants associated with alcohol use—such as caregiving burden, experiences of violence, psychological distress, and structural gender inequalities—promoting more holistic and gender-sensitive care.

Final considerations

Strengthening the capacity of Primary Health Care to conduct screening and brief interventions for alcohol use among women is a key strategy to prevent health problems, reduce harm, and promote better living conditions for the female population.