Alcohol as part of ‘care practices’ in White British women’s everyday personal relationships

With heavy drinking on the rise in England and elsewhere, it is important to understand the context for alcohol consumption in order to design appropriate interventions. A new study in BMC Women's Health looks at the role of alcohol in care relationships for women in the North East of England.

In Britain, drinking alcohol is a common practice among White British women; in 2016, just over half of this population had consumed alcohol in the last week. While most White British women keep their consumption within the recommended safe limits, patterns of heavy drinking associated with long and short term health and social harms have increased in the last 40 years.

Studies have shown that women consume more alcohol in private (e.g. their own and others people’s homes) than in public settings (e.g. pubs and bars) and that heavy drinking can occur in couple relationships as well as non-family relationships (including friends, neighbours and work colleagues). Increased understanding of the meanings that alcohol has for women could help with developing appropriate and relevant interventions for heavy alcohol use.

The study

Our work explored one context for women’s alcohol use: in relation to stress. It was conducted in the North East of England where White British women have some of the highest levels of heavy episodic drinking in the country. We conducted one-to-one qualitative interviews with twenty-six women aged 24-67 years with a range of relationships statuses and from different socio-economic backgrounds.

None of the participants were in treatment for alcohol misuse, but their narratives suggested they drank at a range of levels, from irregular consumption to heavy regular consumption. We gathered data on the women’s experiences of stress, drinking practices generally and drinking practices in relation to stress.

Thematic analysis and the application of Feminist Ethics of Care Theory helped to identify ‘care practices’ as one key theme in the data. This illustrated that they lacked opportunities for receiving care amongst their caregiving and paid work responsibilities. Overall, the key finding is that alcohol was incorporated in ‘care practices’ as a way of enabling care for self and care with others in their couple relationships, when alone and in non-family relationships.

The findings – alcohol and care practices in different relationships

Some women spent a lot of time alone at home, either because they lived alone, because they were single mothers or because their partners were frequently out. While often reflecting that they would rather be with others, these women described drinking as one way of caring for themselves when no options for human care were available. Penny, who at the time of interview had grown-up children, described a regular drinking practice alone when her children were younger:

‘(My husband) was out a lot at work, he was having to, you know, he was a Director of a company, . . . You didn’t have very much time for yourself and you probably, I probably did have a glass of wine when I was cooking the tea, because it might well have been that I was on my own more.’

Drinking at home alone was not acceptable to all women and some said they did not like to drink alcohol when their children were in the house.
© zinkevych / Getty Images / iStockq

Although they always considered their responsibilities to others first, drinking regularly in a controlled way was acceptable to Penny and some other women. However, drinking at home alone was not acceptable to all women and some said they did not like to drink alcohol when their children were in the house, as this was perceived to be putting themselves above their children. More commonly, women spoke about drinking in their couple relationships and with non-family members.

The couple relationship, which can come with greater expectations of care than other relationships, dominated many of the women’s accounts. For some women in the sample, paid work and unpaid caregiving in families meant they had little time to spend with their partner. Jane, a woman with three children aged under 10 years, explained a regular drinking practice with her husband. This example is representative of other participants’ accounts:

‘. . . it’s a drink just to drink because it’s Friday, do you na what I mean? Just sit with him and spend some adult time with him. . . . Ya na, after having three kids, I’ve learnt . . .  we have to make time for each other.’

A number of women like Jane had little freedom to leave the house with their partners, due to child care responsibilities and limited finances, so they were restricted in what they could do to demonstrate care for each other. Drinking together and spending time together at home was one way they did this.

Other participants who had more flexibility or financial resources to drink outside the home described practices of drinking in public settings (sometimes alongside other activities such as a meal) in a similar way. Drinking together played a role in helping to maintain the women’s relationships but could contribute to sometimes regular and sometimes irregular heavy drinking practices.

The data highlighted that non-family relationships can also be an important source of care for women. Drinking in these relationships offered opportunities for care, in particular emotional support, which was sometimes absent or limited in their couple and other family relationships. Nina was a single professional woman who lived alone who said she preferred not to drink alone at home. She described the value of a regular Friday night heavy drinking practice with her friends in the following way:

‘If I’ve had a really, really bad week, by Thursday I’ll be . . . at the end of my tether, and I’ll know that on Friday . . . I know there’s a group of people who will just listen to me go, how crap my week has been . . . ’

Other participants described practices of drinking in public settings (sometimes alongside other activities such as a meal)

Nina gained care in this practice that she did not gain anywhere else. Her account resembled some of the accounts of the mothers of dependent children who described the value of drinking practices with friends for providing care that was limited in their family and sometimes paid work roles.

The data also suggested that the women modified their drinking practices to fit in with their own and each other’s family roles and responsibilities. One participant spoke about drinking regularly and heavily at her friend’s house because her friend was a single mother and could not drink out of the house. Overall the data demonstrated the importance of sometimes heavy drinking with non-family for providing opportunities for care in their everyday lives.

What does this mean for intervention development?

This is a small study which may not be able to be extrapolated to a wide population. However, inferences can be made from the findings about approaches to intervention development. The key implication of the study is that interventions need to consider that both women’s own need for care and their responsibilities to others are important in their drinking practices. Addressing this lack of care by providing alternative ways for women to care for themselves and to gain social support might be valuable.

These approaches are at odds with the current approaches which are often based on individual behaviour change and see alcohol use as separate from women’s wider everyday lives and relationships.

View the latest posts on the BMC Series blog homepage