Arielle Cruz
Alcoholism and addiction are two sides of the same coin, both being forms of substance dependency. However, there are some key differences between the two. Alcoholism, or alcohol use disorder (AUD), is a medical condition characterised by an impaired ability to stop or control alcohol consumption despite adverse consequences. It is considered a brain disorder, encompassing conditions such as alcohol abuse, alcohol dependence, and addiction. AUD can be mild, moderate, or severe, with treatment options including medication and behavioural therapy. On the other hand, addiction can refer to a dependence on substances other than alcohol, which are often illegal. This distinction has led to different stereotypes and levels of stigma associated with addicts and alcoholics. For instance, addicts are perceived as being involved in more street crime and unable to maintain jobs compared to alcoholics. Despite these differences, the root causes of addiction and alcoholism may be similar, often stemming from emotional pain and a lack of coping strategies.
| Characteristics | Values |
|---|---|
| Definition | Alcoholism: Addiction to alcohol. Drug addiction: Addiction to any substance. |
| Usage | Alcohol is a legal substance, whereas drugs are mostly illegal. |
| Addiction | Alcohol addiction is a form of drug addiction. |
| Treatment | Alcohol addiction is treated at residential rehab facilities. |
| Social Stigma | Addiction to illegal substances is more stigmatized than alcohol addiction. |
| Prevalence | Alcohol addiction is more common than addiction to other drugs. |
| Causes | Both addictions are caused by emotional pain and a lack of coping strategies. |
| Impact | Both addictions have similar impacts on families, including insomnia, depression, anxiety, and despair. |
| Behavior | Addicts are more likely to be involved in street crime and unemployment than alcoholics. |
| Denial | Alcoholics and addicts are both in denial about their addiction. |
| Relapse | Alcohol addiction can lead to long-lasting changes in the brain that contribute to relapse. |
| Symptoms | Withdrawal symptoms for alcohol include physical and emotional effects such as sleep disturbances, pain, anxiety, and emotional pain. |
| Genetics | Genetics play a role in alcohol addiction, with hereditability accounting for approximately 60%. |
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What You'll Learn
Alcoholism vs. drug addiction
Alcoholism and drug addiction are two forms of substance abuse that can have similar symptoms and can be treated using similar techniques. However, there are some key differences between the two.
Alcoholism, or alcohol addiction, refers specifically to addiction to alcohol. It is characterised by an impaired ability to stop or control alcohol consumption despite adverse social, occupational, or health consequences. Alcoholism can have severe negative health and social consequences, including interference with personal relationships, heart and liver diseases, cancers, motor vehicle collisions, alcohol overdose, violence, homicide, and suicide. The repeated consumption of alcohol over time can lead to changes in the brain, resulting in habit formation and compulsive use. When a person who is addicted to alcohol stops drinking, they may experience withdrawal symptoms, including physical symptoms such as sleep disturbances, pain, and feelings of illness, as well as emotional symptoms such as dysphoria, irritability, anxiety, and emotional pain.
Drug addiction, on the other hand, is a generalised term that refers to addiction to any substance other than alcohol. This can include drugs such as marijuana, painkillers, cocaine, heroin, benzodiazepines, stimulants, and inhalants. Like alcoholism, drug addiction can have negative health and social consequences, and the specific consequences may vary depending on the type of drug being used. Drug addiction can also lead to changes in the brain that compromise brain function and drive the transition from controlled, occasional use to chronic misuse.
One key difference between alcoholism and drug addiction is the legal and cultural distinction between the two. Alcohol is legal in most places, while many drugs are illegal. As a result, there is often more social stigma associated with addiction to illegal drugs than with alcoholism. This can affect the way individuals and society perceive and respond to the two types of addiction. Additionally, the price differences between alcohol and illegal drugs can also contribute to the distinction between alcoholism and drug addiction.
Another difference is the availability of treatment options. Alcohol addiction is often treated in residential rehabilitation facilities, where individuals can receive a combination of detoxification, therapy, and other holistic treatment approaches. There are also mutual-support groups specifically for individuals struggling with alcoholism, such as Alcoholics Anonymous (AA). Drug addiction may also be treated in similar rehabilitation facilities, but there may be additional barriers to accessing treatment due to the illegal nature of some drugs. There are also mutual-support groups for individuals struggling with drug addiction, such as Narcotics Anonymous.
It is important to note that the terms "alcoholism" and "alcoholic" are considered stigmatising by some and are not commonly used in professional and research contexts. Instead, terms such as "alcohol abuse", "alcohol dependence", "alcohol use disorder" (AUD), or simply "alcohol addiction" are often used. Similarly, the term "addict" may be considered stigmatising, and individuals with a drug addiction may be referred to as having a "substance use disorder" or "substance dependence".
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Social stigma
Substance use disorders, including alcohol use disorder (AUD), are chronic and treatable medical conditions. However, individuals with these disorders often face social stigma and discrimination, which can negatively impact their health, well-being, and quality of care. Social stigma refers to the negative beliefs, attitudes, and stereotypes associated with a particular group, which can lead to labelling, stereotyping, and discrimination.
People with substance use disorders, including AUD, may experience stigma from various sources, including healthcare professionals, family, friends, and society as a whole. This stigma can manifest in the form of negative biases, judgemental language, and stereotyping, such as the belief that addiction is a personal choice reflecting a lack of willpower or a moral failing. For example, the use of terms such as "substance abuser" or "addict" can contribute to stigma and negatively impact individuals' self-perception and willingness to seek help.
The social stigma associated with substance use disorders, including AUD, can have detrimental effects on treatment outcomes and the quality of care received. It can create barriers to treatment, deterring individuals from acknowledging their problem, disclosing it to others, or seeking professional help. For instance, individuals with AUD may fear social judgment or professional consequences and may downplay or withhold information about their alcohol consumption to avoid stigma.
Additionally, stigma can interfere with the quality of care provided by healthcare professionals. Biases and negative attitudes towards individuals with substance use disorders can lead to poorer care, as demonstrated in a national survey of primary care providers, where stigmatizing attitudes affected the care provided despite an understanding of opioid use disorder as a treatable condition. Stigma can also contribute to racial disparities and other forms of discrimination, further impacting access to care.
To reduce social stigma and improve outcomes for individuals with substance use disorders, including AUD, it is essential to recognize these disorders as chronic and treatable medical conditions. Using non-pejorative, person-first language that focuses on the individual, rather than their condition, can help alleviate stigma. Additionally, creating visible social identities of recovery and meaningful activity, such as through community engagement and celebrations of recovery achievements, can challenge stigma and change societal attitudes and perceptions.
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Treatment options
Medication
Three medications have been approved by the U.S. Food and Drug Administration to help people stop or reduce their drinking and prevent a return to drinking: naltrexone (oral and long-acting injectable), acamprosate, and disulfiram. Topiramate and gabapentin can also decrease cravings in some people. Doctors can also prescribe medications to address alcohol withdrawal symptoms, which can be life-threatening, and make the process safer and less distressing.
Behavioural Therapy
Behavioural treatments, also known as alcohol counselling or talk therapy, are aimed at changing drinking behaviour. They are provided by licensed therapists and can include brief interventions, reinforcement approaches, treatments that build motivation and teach skills for coping and preventing a return to drinking, and mindfulness-based therapies.
Mutual-Support Groups
Mutual-support groups provide peer support for stopping or reducing drinking. Group meetings are available in most communities at low or no cost, and at convenient times and locations, including online. They can be especially helpful to individuals at risk of returning to drinking.
Inpatient and Outpatient Treatment
Treatment can be outpatient and/or inpatient and be provided by specialty programs, therapists, and healthcare providers. For severe cases of AUD, a healthcare provider may recommend inpatient medical treatment or residential rehabilitation.
Treatment for Co-Occurring Disorders
Many people with AUD have co-occurring mental health disorders such as depressive disorders, anxiety disorders, trauma- and stress-related disorders, other substance use disorders, and sleep disorders. It is important to seek treatment for any accompanying medical and mental health issues when addressing drinking problems.
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Causes and risk factors
Alcoholism is a complex disease, influenced by a multitude of factors that vary from person to person. There is no singular cause of alcoholism, but rather a combination of internal and external factors that contribute to the development of this addiction.
Biological Factors
Biological factors, including genetics, play a significant role in the development of alcoholism. Research suggests that about 50% of the risk of alcoholism is influenced by genetics. Individuals with a parent or sibling suffering from alcohol use disorder are three to four times more likely to develop the disorder themselves. Additionally, certain psychological conditions increase the likelihood of alcoholism. These include mental health issues such as depression, bipolar disorder, social anxiety, and other anxiety disorders.
Environmental Factors
Environmental factors, including social and cultural influences, also contribute to the risk of alcoholism. Peer pressure, social class, and abuse can all play a part in the development of alcohol addiction. The availability and accessibility of alcohol, as well as societal norms and policies, can further enhance the risk. Individuals who drink to cope with stress or self-medicate for mental health issues are more susceptible to alcoholism. Alcohol's ability to produce pleasurable feelings and blunt negative emotions can create a cycle of repeated use, leading to habit formation and eventual addiction.
Personal Factors
Personal factors, such as personality traits, also influence the likelihood of developing alcoholism. Certain personalities that pursue risks or seek social approval may be more prone to heavy drinking. Additionally, individuals who always want to be the ""life of the party" or struggle with shyness may drink heavily to fit social expectations or reduce discomfort. The expectations an individual has about drinking also play a significant role, as those with positive expectations about alcohol's effects are more likely to develop alcoholism.
Age and Gender
Age is another factor, with young people, especially those drinking during adolescence, being at a higher risk of developing alcohol use disorders later in life. Gender also plays a role, with men being more likely to suffer from alcohol addiction and women facing greater health risks from alcohol abuse. This difference may be due to variations in how men and women metabolize alcohol, with men tending to have a lower response, leading them to consume larger quantities and increasing their risk of addiction.
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Effects on the brain
Alcohol use disorder (AUD) is a condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health-related consequences. The development of AUD is influenced by individual genetic and environmental factors that interact at molecular, neuronal, and circuit levels.
Alcohol interferes with the brain's communication pathways, affecting its structure and function. It impairs the brain areas responsible for balance, memory, speech, and judgment, leading to a higher risk of injuries and other adverse outcomes. Chronic heavy drinking can impact regions of the brain involved in motivation, memory, decision-making, impulse control, attention, and other cognitive functions. It causes alterations in neurons, including reductions in their size. Adolescent brains are more susceptible to alcohol's detrimental effects, and misuse during this period can result in long-lasting changes in brain structure and function.
Alcohol produces pleasurable effects by increasing activity in brain systems related to reward processing. It activates opioid receptors in the nucleus accumbens, contributing to the pleasure associated with intoxication. Additionally, alcohol prompts the ventral tegmental area to send dopamine signals to the nucleus accumbens. Dopamine is crucial for associating alcohol and its related cues (people, places, or things) with the rewarding effects of consumption.
The brain's reward pathways are central to the development of addiction. When addictive substances reach the brain, they trigger an excessive response, causing a dopamine flood in the reward pathway. The brain remembers this surge and associates it with the substance. However, with chronic use, the brain's circuits adapt and become less sensitive to dopamine. As a result, achieving the desired pleasurable sensation becomes increasingly challenging, and individuals build tolerance, requiring higher substance quantities to attain the desired high.
Medications can facilitate healthy brain changes to help individuals reduce or quit drinking. Acamprosate, naltrexone, and disulfiram are FDA-approved treatments for AUD. Acamprosate acts on glutamatergic neurocircuits to prevent relapse by reducing the emotional discomfort of anxiety, irritability, dysphoria, and insomnia. Naltrexone, an opioid receptor antagonist, diminishes alcohol's pleasurable effects by interfering with opioid peptide activity in the basal ganglia circuitry. Disulfiram, on the other hand, does not target brain circuitry but instead interferes with alcohol metabolism by blocking the breakdown of the toxic alcohol metabolite acetaldehyde.
Long-term alcohol misuse can lead to alcohol-related brain damage (ARBD), a disorder characterised by progressive brain damage caused by regular binge drinking or drinking excessive amounts over several years. ARBD primarily affects individuals aged 40 to 50 and is more prevalent in men, although women tend to develop it at a younger age and with fewer years of alcohol misuse. It is associated with memory and thinking skill impairments and can lead to alcohol dependence. Treatment for ARBD involves addressing both the addiction and the related cognitive symptoms.
The brain's ability to recover from AUD is not yet fully understood, but studies suggest that abstinence from alcohol can lead to improvements and possible reversal of some AUD-induced brain changes. This recovery process may take months, and the extent of brain normalisation varies among individuals.
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Frequently asked questions
Alcoholics and addicts experience similar emotional states, such as insomnia, depression, anxiety and despair. However, some people differentiate between the two, noting that addicts are involved in more street crime and are more likely to be unemployed. Alcoholics topped addicts in a Latvian study on several emotional intelligence metrics, such as empathy and self-actualisation. Alcohol is also considered to be the most dangerous substance according to the Independent Scientific Committee on Drugs.
Alcoholism, also known as alcohol use disorder (AUD), is a common medical condition where a person has formed a mental reliance on and/or a chemical dependency on alcohol. Alcohol addiction is a chronic relapsing disorder associated with compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available.
An addict is someone who is addicted to drugs. Drug addiction, like alcohol addiction, is a form of substance dependency.
Treatments for alcoholics and addicts include medication, behavioural therapy, and mutual-support groups.
