Alcoholism Vs Alcoholic: What's The Real Difference?

Alcoholism and alcoholics are terms often used to describe a condition that involves drinking alcohol excessively or uncontrollably to the point that it negatively affects one's life or health. However, the clinically accepted term used by doctors and mental health professionals is Alcohol Use Disorder (AUD). AUD is a mental health condition characterized by symptoms such as drinking too much alcohol in one sitting, drinking alcohol too frequently, or being unable to control one's alcohol consumption. It is considered a brain disorder and can range from mild to moderate to severe. While alcoholism is no longer a diagnostic term, it is still used colloquially to describe alcohol dependence or physical reliance on alcohol.

Alcohol Use Disorder (AUD) vs Alcoholism

Alcoholism and Alcohol Use Disorder (AUD) are often used interchangeably, but they are not exactly the same thing. Alcoholism is a colloquial term for a medical condition known as AUD, which is characterised by an impaired ability to stop or control alcohol use despite adverse consequences.

Alcohol Use Disorder (AUD)

Alcohol Use Disorder is a medical condition that can be mild, moderate, or severe. It is defined by a person's impaired ability to stop or control their alcohol consumption despite the negative impact on their health, safety, and personal relationships. AUD encompasses conditions such as alcohol abuse, alcohol dependence, and alcohol addiction. It is considered a brain disorder, and the changes in the brain caused by alcohol misuse can perpetuate the disorder and make individuals vulnerable to relapse.

The risk factors for developing AUD include genetic predispositions, family history, and environmental influences. Mental health conditions, such as depression, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD), are also associated with an increased risk of AUD. Additionally, drinking at an early age and the amount, frequency, and speed of alcohol consumption can contribute to the development of AUD.

AUD can be treated with evidence-based approaches, including behavioural therapies, mutual-support groups, and medications. Treatment options may vary depending on individual needs, and severe cases may require inpatient medical treatment or residential rehabilitation.

Alcoholism

Alcoholism is not a recognised medical diagnosis, but rather a colloquial term used to describe a person's problematic relationship with alcohol. It is often associated with a loss of control over drinking and negative consequences on health, relationships, and social functioning.

While the term "alcoholism" is widely used, it may not capture the full range of symptoms and severity associated with AUD. The term "alcohol use disorder" is preferred in medical contexts as it provides a more comprehensive understanding of the condition and its impact on an individual's life.

In summary, while alcoholism and AUD are related concepts, AUD is the medical term used to describe a range of symptoms and severity associated with problematic alcohol use. Understanding the distinction between the two terms is important for accurate diagnosis, treatment, and addressing the stigma associated with alcohol-related disorders.

Alcohol abuse, dependence, addiction and alcoholism

Alcohol abuse, dependence, addiction, and alcoholism are all terms used to describe problematic drinking. Alcohol use disorder (AUD) is the medical term for the condition, which is characterised by an impaired ability to stop or control alcohol consumption despite adverse consequences. AUD is considered a brain disorder, and it can range from mild to severe.

Alcohol abuse refers to the misuse of alcohol that interferes with different areas of a person's life. This can include spending a lot of time drinking or recovering from hangovers, repeatedly trying to reduce alcohol intake, failing to meet obligations, giving up important activities, drinking in hazardous situations, continuing to drink despite health problems, and experiencing withdrawal symptoms. Abuse may imply that the behaviour is intentional and controllable, which is why the term AUD is preferred as it is less stigmatising and emphasises that it is a diagnosable disease.

Alcohol dependence involves an inability to quit drinking. Individuals with alcohol dependence may experience a kindling effect, where each subsequent withdrawal episode is more severe than the previous one due to neuroadaptations. This can lead to more intense psychological symptoms of withdrawal and an increased risk of seizures.

Alcohol addiction is a chronic relapsing disorder associated with compulsive alcohol drinking, loss of control over intake, and negative emotional states when alcohol is unavailable. Addiction can be understood as a repeating cycle with three stages: incentive salience, negative emotional states, and executive function. Each stage is linked to specific regions of the brain. Progressive changes in the brain's structure and function due to repeated alcohol consumption contribute to habit formation and compulsive use.

Alcoholism is a colloquial term for AUD. It is often used interchangeably with alcohol dependence, but it can also refer to the moderate to severe end of the AUD spectrum. Treatment for AUD includes behavioural therapies, mutual-support groups, and medications such as naltrexone and acamprosate. Abstinence from alcohol has been found to be the most stable form of remission for recovering alcoholics.

The CAGE questionnaire and other tests

The CAGE questionnaire is a screening tool that clinicians use to help diagnose alcoholism. It is a set of four questions that can be answered with a simple yes or no. The questions focus on cutting down, annoyance at criticism, guilty feelings, and eye-openers (drinking first thing in the morning to steady nerves or get rid of a hangover). Two "yes" responses indicate that further investigation is needed. While the CAGE questionnaire is effective in detecting alcohol-related problems, it may not be as accurate for people with less severe alcohol issues, white women, or college students.

Other tests are available for detecting alcohol dependence and include the following:

• Alcohol Dependence Data Questionnaire (ADDQ): This is a more sensitive diagnostic test than the CAGE questionnaire, helping to distinguish between alcohol dependence and heavy alcohol use.
• Michigan Alcohol Screening Test (MAST): This is a widely used screening tool for alcoholism, especially in court settings, to determine appropriate sentencing for alcohol-related offences like driving under the influence.
• CIWA-Ar: This tool objectifies alcohol withdrawal symptoms to guide therapy decisions and facilitate efficient interviews.

Additionally, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides criteria to assess and determine the severity of Alcohol Use Disorder (AUD). AUD encompasses conditions like alcohol abuse, dependence, addiction, and alcoholism. It is characterised by impaired control over alcohol use despite adverse consequences. Severity is assessed based on the number of matched criteria: mild (2-3 criteria), moderate (4-5 criteria), and severe (6 or more criteria).

Treatment options for AUD and alcoholism

Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD encompasses the conditions that some refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism. AUD can be mild, moderate, or severe.

Treatment for AUD and alcoholism typically includes several different kinds of behavioural therapies, medicines for detox and/or treating AUD, and mutual-support groups.

Behavioural Therapies

Behavioural treatments, also known as alcohol counselling or talk therapy, are provided by licensed therapists and are aimed at changing drinking behaviour. Examples include:

• Brief interventions: Short, one-on-one or small-group counselling sessions that provide information about drinking patterns and potential risks, helping patients set goals and make changes.
• Cognitive-behavioural therapy (CBT): Helps patients identify feelings and situations that lead to heavy drinking, teaching coping skills and changing thoughts that cause the desire to drink.
• Motivational enhancement therapy: Helps build and strengthen the motivation to change drinking behaviour, involving around four sessions over a short period.

Medication

Three medications are approved by the U.S. Food and Drug Administration to help reduce or stop drinking and prevent relapse: naltrexone (oral and long-acting injectable), acamprosate, and disulfiram. Naltrexone blocks receptors in the brain that make one feel good when drinking alcohol, reducing cravings. Acamprosate helps avoid alcohol after quitting by reducing cravings. Disulfiram causes unpleasant symptoms like nausea and skin flushing when drinking alcohol, discouraging alcohol consumption.

Mutual-Support Groups

Mutual-support groups provide peer support for stopping or reducing drinking. Group meetings are often available in most communities at low or no cost and can be valuable when combined with medical treatments.

Other Considerations

• Exercise: Exercise is a great way to manage stress, which can be a trigger for alcohol consumption.
• Know Your Triggers: Understanding the circumstances that trigger the urge to drink can help prevent relapse.
• Relapse: Relapse is common, and should be viewed as a temporary setback, providing an opportunity to learn more about triggers and improve coping skills.
• Inpatient Treatment: For severe cases, inpatient medical treatment or residential rehabilitation may be recommended.

Brain changes and relapse

Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD is considered a brain disorder and can be mild, moderate, or severe.

Alcohol is a dual reinforcer, as it can both activate the brain's reward processing system and reduce the activity of the brain's systems that mediate negative emotional states such as stress, anxiety, and emotional pain. Repeated, excessive use of alcohol can lead to addiction, which is associated with reduced reward function and increased activation of brain stress systems. The process of becoming addicted is thus accompanied by a shift in drinking motivation from positive reinforcement to negative reinforcement, during which drinking is motivated by attempts to reduce the emotional discomfort of acute and protracted withdrawal.

The kindling effect, which occurs in people with alcohol use disorders, refers to the phenomenon whereby each subsequent withdrawal syndrome is more severe than the previous episode. This is due to neuroadaptations that arise from periods of abstinence followed by re-exposure to alcohol. The kindling effect leads to persistent functional changes in brain neural circuits and gene expression. It also results in the intensification of psychological symptoms of alcohol withdrawal.

The brain changes caused by alcohol misuse perpetuate AUD and make individuals vulnerable to relapse. Negative emotional states, or hyperkatifeia, are a leading cause of relapse in AUD. The discomfort or misery felt during withdrawal, including negative emotional states, often triggers a relapse. The brain becomes motivated to continue drinking to reduce this discomfort.

Medications can facilitate healthy brain changes and help people cut down or quit drinking. Three non-addictive medications, acamprosate, naltrexone, and disulfiram, are FDA-approved to treat AUD. Acamprosate helps prevent relapse by acting to blunt the activity of glutamatergic neurocircuits, which drive the emotional discomforts of anxiety, irritability, dysphoria, and insomnia. Naltrexone, an opioid receptor antagonist, reduces the pleasurable effects of alcohol by interfering with its effects on opioid peptide activity in the basal ganglia circuitry. Disulfiram, on the other hand, does not work on brain circuitry but instead interferes with alcohol metabolism by preventing the breakdown of the toxic alcohol metabolite acetaldehyde.

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