Alcohol Dependence: Are You An Alcoholic?

Alcohol abuse and alcohol dependence are not the same thing, but both are often referred to as alcoholism. Alcohol abuse refers to continuing to drink excessively even though it creates problems in a person's life, including health, relationship, and work-related issues. Alcohol dependence, on the other hand, is defined by a physiologic dependence on alcohol from consistent, heavy use, resulting in withdrawal symptoms when the person stops consuming alcohol. While the terms abuse and dependence are no longer differentiated in the DSM-5, it is important to understand their original definitions to recognize the signs of alcohol misuse and provide appropriate treatment.

Alcohol abuse vs. dependence

Alcohol abuse and alcohol dependence are not the same thing, but both are commonly associated with "alcoholism". Alcohol abuse refers to the continued use of alcohol, often excessively, despite the social, interpersonal, health, or legal problems it causes. It can take the form of binge drinking or more moderate drinking associated with unhealthy habits or repercussions. Alcohol abuse does not usually result in physical withdrawal symptoms.

Alcohol dependence, on the other hand, is characterised by a physiological dependence on alcohol from consistent, heavy use. Those with alcohol dependence exhibit a high tolerance for alcohol and experience withdrawal symptoms such as insomnia, tremors, and mood swings when they stop consuming alcohol. They continue drinking to avoid these unpleasant symptoms.

People who abuse alcohol may also be dependent on alcohol, but they may be able to stop drinking without experiencing withdrawal symptoms. According to a study, 90% of people who abuse alcohol are not alcohol-dependent. However, the same study found that people who engaged in binge drinking were more likely to be alcohol-dependent.

The terms "alcohol abuse" and "alcohol dependence" are no longer differentiated in the DSM, and professionals now refer to this condition as Alcohol Use Disorder (AUD). This shift in terminology is intended to reduce the stigma associated with alcohol-related conditions and emphasise that the disorder is a diagnosable, chronic, and relapsing brain disease rather than a moral or personal failure. AUD can be mild, moderate, or severe, and it is characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

If you or someone you know is struggling with alcohol abuse or dependence, it is important to seek professional help.

Physical withdrawal symptoms

Alcohol abuse and alcohol dependence are not the same thing but are commonly thought of as "alcoholism". Alcohol abuse refers to continuing to use alcohol, often excessively, despite the negative impact on one's health, relationships, and work. Alcohol dependence, on the other hand, is defined by physiological dependence on alcohol from consistent, heavy use. Those with alcohol dependence experience withdrawal symptoms when they stop consuming alcohol and have to keep consuming alcohol to avoid these symptoms.

Alcohol withdrawal refers to a set of symptoms that can develop when a person who has been drinking heavily on a regular basis suddenly stops drinking alcohol. These symptoms can range from mild to severe, with the most severe being life-threatening. Symptoms tend to occur within 8 hours after the last drink but can also occur days later. They typically peak by 24 to 72 hours but may persist for weeks or even months.

Some common physical withdrawal symptoms include:

• Insomnia
• Tremors
• Mood swings
• Fatigue
• Hallucinations
• Delirium tremens (DTs)

The risk of severe alcohol withdrawal is increased by factors such as heavy daily alcohol use, age greater than 65, a history of DTs or seizures, coexisting health conditions, dehydration, electrolyte imbalances, brain lesions, and abnormal liver function.

Alcohol use disorder (AUD)

Alcohol abuse and alcohol dependence are not the same thing but are commonly thought of as "alcoholism". Alcohol abuse refers to continuing to use alcohol, often excessively, even though it creates problems in a person's life, including health, relationship, and work-related consequences. Alcohol abuse can take the form of binge drinking or more moderate drinking that is associated with unhealthy habits or repercussions. Alcohol abuse was defined as a condition in which a person continues to drink despite recurrent social, interpersonal, health, or legal problems as a result of their alcohol use.

Alcohol dependence, on the other hand, is defined by physiological dependence on alcohol from consistent, heavy use. Physical alcohol dependence is characterized by obsessive thoughts about alcohol use and intense cravings to drink despite the consequences. If you are physically dependent on alcohol, you may feel like it is a central part of your life and that you are unable to function or survive without it. Alcohol dependence was originally defined as a chronic medical condition characterized by experiencing symptoms of withdrawal when the person stops consuming alcohol. To avoid experiencing withdrawal symptoms, the person has to keep consuming alcohol.

A person’s risk for developing AUD depends in part on how much, how often, and how quickly they consume alcohol. Alcohol misuse—defined as drinking in a manner, situation, amount, or frequency that could cause harm to the person who drinks or to those around them—over time increases the risk of AUD. Other factors that increase the risk of AUD include drinking at an early age, genetics, and family history of alcohol problems. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to be diagnosed with AUD, an individual must meet at least two of the following criteria within a 12-month period:

• Drinking larger amounts or over a longer period than intended and making unsuccessful efforts to cut down.
• Experiencing withdrawal symptoms such as insomnia, tremors, mood swings, and nausea after going for a short period without drinking.
• Drinking to relieve or avoid withdrawal symptoms.
• Having an intense craving for alcohol.
• Spending a lot of time obtaining alcohol, consuming it, and then recovering.
• Continuing to drink despite alcohol affecting one's ability to function normally in important areas of their life.

Binge drinking

Alcohol abuse and alcohol dependence are not the same thing, but both are commonly referred to as "alcoholism". Alcohol abuse refers to continuing to drink excessively even though it creates problems in a person's life, including health, relationship, and work-related issues. Alcohol abuse can take the form of binge drinking, which is consuming large quantities of alcohol occasionally. Binge drinking is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a pattern of drinking that brings blood alcohol concentration (BAC) to 0.08% or 0.08 grams of alcohol per decilitre or higher. For a typical adult male, this corresponds to consuming five or more drinks in about two hours, and for a typical adult female, it is four or more drinks in the same time frame. Binge drinking increases the risk of acute harm such as blackouts, overdoses, unsafe sexual behaviour, and unintentional pregnancy. It also increases the likelihood of potentially deadly consequences, including falls, burns, drownings, and car crashes.

Alcohol dependence, on the other hand, is defined by a physiologic dependence on alcohol from consistent, heavy use. A person with alcohol dependence is unable to stop drinking without experiencing symptoms of withdrawal such as insomnia, tremors, and mood swings. They continue drinking to alleviate these unpleasant symptoms. It is important to note that a person who abuses alcohol may also be dependent on alcohol, but they may be able to stop drinking without experiencing withdrawal symptoms. Research has shown that 90% of people who abuse alcohol are not alcohol-dependent.

While the terms "alcohol abuse" and "alcohol dependence" are no longer differentiated in the DSM, understanding their original definitions can provide insight into the nature of excessive drinking. Alcohol misuse, which includes binge drinking and heavy alcohol use, increases the risk of alcohol use disorder (AUD). Binge drinking, in particular, has been associated with a higher risk of developing AUD. This risk typically increases as the amount of alcohol consumed increases, and even one episode of binge drinking can have detrimental effects on health.

Treatment options

Alcohol abuse and alcohol dependence are not the same thing, but both are often referred to as "alcoholism". Alcohol dependence is defined by a physiologic dependence on alcohol from consistent, heavy use. Those with alcohol dependence experience withdrawal symptoms when they stop consuming alcohol, and they have to keep consuming alcohol to avoid these symptoms.

There are various treatment options available for alcohol dependence, and it is important to remember that there is no one-size-fits-all solution. Behavioural treatments, led by healthcare providers, aim to change drinking behaviour through counselling. There are also currently three medications approved in the United States to help people stop or reduce drinking and prevent a return to drinking. These medications, prescribed by a primary care provider or other healthcare provider, may be used alone or in combination with counselling. One such medication is disulfiram, which discourages drinking by causing unpleasant symptoms when alcohol is consumed.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines recovery as a process through which an individual pursues both remission from AUD and cessation from heavy drinking. Abstinence may be the only option for sustained recovery for some individuals. Regular check-ups with a treatment provider can help to deter drinking during times when individuals may be at greater risk of a relapse.

The NIAAA also provides an online tool called the Alcohol Treatment Navigator®, which helps individuals find the right treatment for them. SAMHSA’s National Helpline also provides a free, confidential treatment referral and information service for individuals and families facing mental and/or substance use disorders.

Frequently asked questions