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Alcohol Abuse Vs. Alcoholism: What’s The Difference?

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 28, 2019

While alcohol abuse and alcoholism are terms often used interchangeably, they carry significantly different meanings. The information below provides an overview of alcohol abuse, alcoholism, and how they relate to a recently developed diagnosis: alcohol use disorder (AUD)

Alcohol Abuse: What Is It?

Alcohol abuse can be explained as the misuse of alcohol in such a way that it negatively affects someone’s life in a number of ways. Some examples of this may be:

  • failure to maintain responsibilities at work, school, or home
  • drinking while driving, or other dangerous situations
  • drinking that turns into repeated legal problems
  • deterioration of relationships that are impacted by continued drinking

Some characteristics of alcohol abuse include binge drinking or heavy drinking. Binge drinking is the consumption of multiple alcohol beverages (five or more for men, four or more for women) within a two-hour period. This type of excessive drinking can cause more brain damage than drinking the same amount over a longer period of time.

Continued alcohol abuse can lead to alcoholism, but alcoholism exhibits various other symptoms that are in addition to symptoms of alcohol abuse.

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Alcoholism: How Is It Different Than Alcohol Abuse

Alcoholism is also referred to as alcohol dependence. This is a chronic, lifelong disease in which the body is physically dependent on alcohol in order to feel “normal”. Any reduction in alcohol intake is likely to result in withdrawal symptoms. A person struggling with alcohol dependence will usually drink daily and need help to stop drinking.

Some of the signs of alcohol dependence are:

  • craving alcohol
  • unable to limit drinking
  • failed attempts to stop drinking
  • needing more alcohol to have the same effects (tolerance)
  • emergence of withdrawal symptoms when not drinking
  • continued use regardless of recurring physical, psychological and personal problems

How Are Alcohol Abuse And Alcoholism Related?

The most significant distinction between alcohol abuse and alcoholism is that most people who abuse alcohol are not always dependent on alcohol. Those individuals usually do not feel the compulsive cravings for alcohol, nor do they experience moderate or severe withdrawal symptoms typically associated with dependence.

However, people who regularly abuse alcohol run a high risk of developing alcoholism. Continually exposing the body to alcohol can result in the body developing a tolerance and becoming dependent on alcohol, which are key factors in alcoholism.

Alcohol abuse and alcohol dependence (alcoholism) have always been connected. However, they were distinctively different diagnoses until the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) was published in 2013. This manual combined the the two into one diagnosis, currently referred to as an alcohol use disorder, with mild, moderate, or severe symptoms.

What Is An Alcohol Use Disorder?

According to the DSM-IV, an alcohol use disorder is clinically defined as, “a problematic pattern of alcohol use leading to clinically significant impairment or distress”. The definition continues to outline examples of AUD to determine severity of the disorder.

A person struggling with an AUD experiences some of the following in the last year:

  • drinking for longer than intended or in higher amounts
  • unsuccessful attempts to control or reduce alcohol consumption
  • long periods of time spent drinking, obtaining, or recovering from alcohol
  • craving alcohol
  • unable to fulfill obligations due to alcohol use
  • continuing to drink after inability to fulfill obligations
  • repeated alcohol consumption in unsafe or hazardous situations
  • giving up activities to drink alcohol instead
  • continuing to drink after knowledge that it is negatively affecting one’s health
  • developing tolerance
  • experience symptoms of withdrawal

The DSM-IV also requires the clinician to specify how severe the AUD is, and provides the following guidelines:

  • Mild (two or three symptoms present)
  • Moderate (four or five symptoms present)
  • Severe (six or more symptoms present)

Who Is Dependent On Alcohol?

There are other factors that may lead a person to examine if they, or their loved one, is struggling with alcohol dependence. While these factors may not indicate an AUD in every person, these are additional clues that may warrant a closer look:

  • only drinking a specific brand or type of beverage every night
  • restricting social activities to only those that serve alcohol
  • needing to increase the amount of drinks to feel the same
  • being self-aware to the compulsion to drink alcohol
  • drinking to ease withdrawal symptoms

Alcohol Withdrawal Symptoms

Withdrawal symptoms from alcohol dependence can range from irritating to fatal. Anyone struggling to stop drinking alcohol should seek proper supervision, such as a medically supervised detox program.

Some symptoms of alcohol include (ranging from mild to severe):

  • sweating
  • loss of appetite
  • nausea
  • nervousness
  • shakiness
  • restlessness
  • anxiety
  • irritability
  • vomiting
  • increased heart rate
  • headache
  • insomnia
  • tremors
  • disorientation
  • seizures
  • delirium tremens

Utilizing programs like these can help alleviate the discomfort associated with withdrawal, and medical staff is available to intervene at any point. The detox facilities are equipped with methods and medications to assist through the detox process.

How Can I Tell If I Drink Too Much?

What are your drinking habits? Are you drinking in excess or every day? Refer to the information above and compare your alcohol habits.

If you think your drinking patterns are similar, that could be a good indication that you may benefit from exploring further. It is possible that an alcohol abuse treatment program could help break those unhealthy habits from becoming a bigger problem in the future.

Centers for Disease Control and Prevention - Fact Sheets - Binge Drinking

Medline Plus - Delirium Tremens

National Institute on Alcohol Abuse and Alcoholism - AUD: A Comparison Between DSM-IV and DSM-5

National Institute on Alcohol Abuse and Alcoholism - Alcohol Use Disorder

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