For some women, the day never gets better than when the cork eases out of the Chardonnay. Long gone are the days when a real lady wasn’t “supposed” to drink. We live in an age of boozy book clubs and fizzy pink cocktails and the Facebook group “OMG, I So Need a Glass of Wine or I’m Gonna Sell My Kids.” A 2010 Gallup poll found that two-thirds of women drink, a higher percentage than at any time in the past 25 years. And while women are more open about their excess than they’ve ever been before, what they often hide is the extent of their problem—and the pain of it.

In Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control,  reporter Gabrielle Glaser looks at why we’re drinking so much and what we should do about it. She questions the monopoly that AA holds in the recovery community, and builds a case that “thirteenth stepping” —the program’s term for members hitting on other members—has created an unsafe environment for women. Started by two men in the 1930s and ballooning to a current tally of about two million members, AA is an astonishing American success story. But as the big book itself states, “In therapy for the alcoholic, we surely have no monopoly.” Seventy-five years after that book came out, our understanding of alcohol and the science of drinking has deepened. Is it time to think beyond the Twelve Steps?

Books about drinking problems are usually written by people who have them. But you don’t. How did you decide to write this?

I was relocating my family from Oregon, where I’d been a newspaper reporter, to the New York area in 2008. The bottom had fallen out of the economy. I’d been a reporter for 25 years, and I couldn’t get a job and I was miserable. I found myself drinking more than I should have. It was masking my anxiety, but it was also rendering me less functional in the evening.

I went to lunch with an editor friend, and we started talking about how women were drinking more. She had a situation like I had—she’d gone through a rough divorce, but we’d both been able to pull ourselves back. She said, ‘Write me a proposal.’ So I did, and it landed on her desk the same day as the toxicology report for a woman who’d had a horrible accident on the Taconic Parkway (Diane Schuler, who died along with seven others). It really resonated as a topic of national conversation. This wasn’t Girls Gone Wild; it was middle-aged mothers, struggling in secret. The most telling thing about this terrible accident is that her family insisted she did not have a drinking problem. 

What were some of the most shocking statistics about women and drinking that you found?

One was the rate of women getting help. From 1992 to 2007, just a span of 15 years, the number of women in their 40s and 50s who sought treatment for alcohol abuse nearly trebled. And the number of women who arrived at the hospital for over-intoxication, or near poisoning, rose significantly. 

So American women are drinking more than ever. But are they drinking more than women in other countries?

We know they’re drinking differently. A woman in Madrid or Barcelona is going to have a glass of wine or two at lunch. At dinner, she’ll have another small glass of beer. That’s technically three drinks. But it’s not three drinks at home, by herself, because she’s frazzled, she’s had a bad day, she has aging parents, her job stress is taking her over the top. Kids are doing fewer chores than ever before and who picks up that slack? The mother. In traditional households where the man has a more demanding job, the household chores fall to the woman. No one else has correlated that to drinking, but I will. I know, because I’ve been there. 

Women are under a lot of pressure for other reasons, too. Pressure to stay sexy and young-looking. We’ve achieved more power in the workplace, but there wasn’t an equal and opposite pressure-valve release.

Oh, absolutely. Your eyelashes need to be longer. You can get fillers. Cream whitener for your arms. Hair extensions. Rejuvenating facials and injections. Young, young, young. It’s enough to drive anyone to drink. 

In the book, don’t you say something about how over-drinking is basically a rich country problem?

No, wealthy, affluent women have this problem. But what a really smart psychologist and historian concludes is that it results from the fraying of our communities. It happened when we moved far away from our support network. You see it in societies where there’s been rapid urbanization. It doesn’t happen in traditional societies. He argues that the disease theory [of alcoholism] hasn’t worked for us in terms of treatment. It’s a societal problem that is the result of losing our extended families, our religious institutions. I have to say that makes a huge amount of sense to me.

One surprising thing about the book was its focus on the recovery process, and Alcoholics Anonymous in particular. Was that something you set out to do, or did it evolve from your research?

One hundred percent, it evolved. I thought the book was going to be a straightforward trend book. I started going to open meetings of AA. As someone who had suffered from depression and gone to therapy, I was perplexed by how some of it might work for women. I went to several women’s-only meetings, and I was struck by how deep the longing for the drink was. It seemed like these women had quit with a gun to their heads. And then I went to mixed meetings, and men tried to pick me up. And I thought: Well, that’s weird. 

I had absorbed the popular notion that if you had a problem with drinking, you needed to go to AA. I didn’t know there was a whole body of studies looking at medicine in treating alcohol dependence. Or that other countries treated alcohol dependence differently. The Twelve Steps are a very American way of treatment.

I put my name out on a few blogs about drinking and in a newsletter for an alternative treatment center that offers a non-Twelve Step approach. I was alarmed by the number of women who called, emailed and wrote about how much they had been damaged by AA. I don’t say this lightly.

It’s tricky to write about AA, because we’re talking about such a large number of people. And one of the keystones of it is anonymity. So it strikes me that people who do talk about the organization are those who are not in it, or who have difficulty with it. 

I think that if it works for someone, that’s fantastic. But one thing I wanted to point to is the number of people who have reached out to me as I was researching and who have continued to reach out to me and said, ‘This is my experience.’ 

It hasn’t always been so great for women. Some people have said, ‘But it’s a microcosm of society.’ Well, my answer to that is, ‘AA in Great Britain and AA in Australia understood that sexual predation were very much a part of the scene’ and they have issued safeguards encouraging people to call the police if they see anything untoward. I’m not clear on why that can’t be taken up here and adapted. 

I certainly know a lot of people that AA has helped, though, and they often talk about looking for any excuse not to stick it out. I wonder if  you feel there’s any danger in writing a book like this that could turn people away from a program that might actually save them?

I write from the point of view of science and what the numbers show, which is that 12-step programs are near the bottom of the rankings in terms of efficacy. From the Cochrane Review to the COMBINE study to the more recent graph of effective treatments, the 12-step treatments have been surpassed. In the book, I also use AA's own numbers, which show a 5% success rate. If abstention and meetings work for someone, that's fantastic. But for the vast majority of people for whom they don't, there are other options. And that's what I describe—a new way of thinking about what alcohol abuse really means. I try to avoid the word "alcoholic," which most alcohol researchers have avoided for the past 30 years.

One of my friends, their kid was just released from a facility, and he killed himself. He was told he wasn’t allowed to use medications for bipolar disorder because he wouldn’t be sober. So I know the organization has helped people. But I have evidence of it not helping others. And we are a culture that has adopted it as the first line of treatment.

Psychopharmacology is an interesting topic. The big book was written in the 1930s and certainly doesn’t say anything about anti-depressants. But my understanding is that many groups consider pharmaceuticals to be fine.

Maybe that’s the case in a major city where people are exposed to new and different ideas. But I happen to know a friend of the family and she said this kid was told by his sponsor. So maybe it depends on who you’re sponsored by. And you might have an old-timer who is really draconian. These sponsors can be a support, but they’re not medical professionals. 

Well, I think you’re getting into the core strength and weakness of AA: It’s people helping people.

But when those people are overriding what medical professionals say, then I think it can be a problem.

The public information person at AA told me that I had grown a dangerous path of grass in my head from those three weeks I was over-drinking. She said, ‘If you don’t watch it, you’re going to end up hitting bottom.’ I wanted to be respectful, but I almost snorted with laughter. What? It’s a progressive disease? What is your evidence for that? So that made me want to take on how we, as a nation, came to this idea that you have to hit bottom. That’s when I really did take on the history of [E.L. Jellinek’s “Addiction and Recovery”] graph, and interpreting it to mean it applies to everyone. Well, no, it applies to 98 white guys who filled out a survey in 1946. That was the best that science and society could offer at the time, but we’ve moved beyond that. If you got diagnosed with breast cancer in 1970, you had to have a radical mastectomy. We have different options now. 

I wanted to show that there’s a vast range of treatments for women who have alcohol problems. Alcohol abuse disorder shouldn’t be as scary as it used to be, just as breast cancer isn’t as scary as it was in 1970. And yet we still say: You’re an alcoholic, you have a disease, you have to go to a church basement for the rest of your life. I want to get away from that idea.

I think it’s very odd that we can discuss all the ways to lose weight. If you are off carbs, everyone understands that. If you need to go for a morning walk, and need support, everyone understands that. It’s important for people not to hide in shame. People can rewire their brains. Not everyone, but a lot of people. And return to drinking moderately. 

Sarah Hepola is the personal essays editor at Salon.com. She is writing a memoir about her own drinking, Blackout, which will be released by Grand Central Publishing in 2015.