How Does Alcohol Abuse Differ From Alcoholism?

There is a fine–and not-so-fine–line between alcohol dependence (or “alcoholism” or “alcohol abuse”) and heavy drinking or excessive alcohol consumption. For those of us wondering whether we have a drinking problem, it is hard to distinguish whether our binge drinking–which is often culturally celebrated and acceptable in the United States–is evidence of alcohol misuse or just good American fun.

According to the 2021 National Institute on Alcohol and Alcoholism, 60.0 million people aged 12 and older, and not just young adults but older people, reported binge drinking in the past month. The same national survey did not account for the alcohol problems that come with binge drinking. The same national survey did not account for the alcohol problems that come with binge drinking, nor for how these problems when compounded, can turn into problem drinking when the drinking itself begins to become the solution to problems caused by the drinking. The formulation of this mindset is that fine but blunt line between heavy alcohol use and what can become physical dependence on alcohol to cope with life.

The term “alcoholism” does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Instead, the diagnostic criteria for the medical condition “Alcohol Use Disorder” as “a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following [criteria], occurring within 12 months” and provides the following criteria which one can use to assess their past year and how much alcohol was involved in it.

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use, failing to fulfill significant role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by alcohol.
10. Tolerance, or needing increased amounts of alcohol to achieve intoxication, or having a diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, or the characteristic withdrawal syndrome for alcohol and drinking alcohol (or taking a benzodiazepine) to relieve or avoid alcohol withdrawal symptoms.

Regardless of whether any or all of these criteria fit the picture of your particular drinking, all studies point to the fact that long-term excessive drinking can exacerbate any and all health conditions, create legal problems, bring on frequent memory loss and social issues, put one in high-risk situations, invite mental health issues, and other serious health problems, such as heart disease, liver disease, liver cirrhosis, high blood pressure, and cardiovascular disease.

Additionally, those with some form of alcohol abuse are at higher risk for substance abuse or other drug use.

A good measure to gauge whether you are a social drinker or a heavy drinker is what you consider the standard drink, which is about 12 ounces of regular beer (at about 5% alcohol), 5 ounces of wine (about 12% alcohol) and 1.5 ounces of distilled spirits (about 40% alcohol), and how many of those you have in one sitting. Moderate drinking is considered to have about 5 standard drinks per week. Heavy drinking more than 8 standard drinks per week.

But what is a good measure to gauge whether you are a heavy drinker or an alcoholic…a person who has an alcohol use disorder?

Addiction has the signature of involving behaviors that inspire a craving, and the person who acts on that craving is not able to stop themselves even as negative consequences of the behavior begin to result. This is essentially a pattern that worsens as the addiction progresses.

Family members may start to notice and encourage the person to stop, then set ultimatums, then act on those ultimatums, and still, the excessive drinking continues. Pregnant women who are heavy drinkers can take a break from their behavior. Alcoholic pregnant women cannot stop drinking even if they know it places their child at risk of fetal alcohol syndrome.

An alcoholic will also undergo, at a certain point in their drinking, physiological changes in their bodies that transform intense cravings for alcohol into alcohol dependence. When someone crosses this line, they will experience physical withdrawal symptoms when they stop drinking.

The negative impact is that an alcoholic will often use alcohol to deal with the alcohol withdrawal symptoms, entrapping them in the vicious cycle of addiction that sometimes only professional help–or a treatment plan from medical professionals can help.

If, in reading this article, there is a feeling in your gut you may be on either the edge of heavy

drinking and alcoholism, a good short-term treatment plan for yourself would be to talk

with people you trust about it, especially if you know any sober alcoholics personally. Reach out to these people and listen to their stories. If you relate and are curious about what they did to get sober, try to stop drinking with their methods for a short period of time, and see if your life gets better. Chances are it might, and either way, staying connected with those who really understand what it’s like to have an alcohol use disorder can play an important role in your health and journey of self-awareness, even if you don’t identify with having the disorder yourself.

If you don’t know anyone personally or are too shy to reach out, another way to confidentially and privately gauge your drinking through the Alcohol Use Disorders Identification Test–which is a screening tool based on data from the World Health Organization used to determine whether your alcohol use contains in it evidence of hazardous behaviors that lean toward a form of alcohol abuse.

Luckily for alcoholics and heavy drinkers in this day and age in the United States, there are so many support groups and treatment options today compared to decades ago when alcohol misuse was demonized and misunderstood.

If you want to stop drinking today, you can find in a short period because there are medical professionals who will help you, groups such as Alcoholics Anonymous to attend regularly, or a treatment facility with group therapy and inpatient treatment. Any of these methods can help, and there is no one way to retreat or improve the harmful use of alcohol.

Perhaps the only wrong way to treat a harmful use of alcohol is to drink more alcohol over it, which is a short-term solution for many that can turn into a long-term solution with unimaginable negative impacts, as noted above.

One feature of alcohol dependence that is important to mention is that there need be no

identifiable reason why someone’s drinking progresses because there are various factors that coincide with moving someone into a state of alcohol dependence. Often there are

stories about “why” the underlying cause for the drinking started that are not accessible until the person is sober and able to sit back and assess how they had gotten to that point.

But it is not required to understand how one started drinking to stop drinking. Stopping usually has to happen before one can understand why the drinking started.

Some alcoholics start drinking like anyone else in situations when as young adults, there is peer pressure and a desire to fit in. Others may distinctly remember drinking alone to cope with difficult family situations–including but not limited to emotional and sexual abuse.

Others may even have started drinking later in life out of curiosity and then found this curiosity turned into a craving regularly for the effect alcohol has on their minds.

Just as there are different ways of diagnosing alcohol use disorder and substance use disorder, there are different ways, according to medical professionals, of treating these disorders. Some find regular talk therapy helpful, particularly the style of cognitive behavioral therapy, in which the therapist helps a patient break down overwhelming problems (which alcohol abuse can create if not the number cause of) into five areas (situations, thoughts, emotions, physical feelings, and actions), reflecting on how those areas relate to each other, and then engaging in pragmatic methods to use this awareness to stop negative thought cycles.

Some prefer to unpack and process the details of their behavior while drinking with a private therapist. However, due to cost and preference, others may prefer group therapy.

Arguments have been made, too, that due to the overwhelming shame associated with addiction and substance abuse disorders, group therapy can be more beneficial than private therapy because one is exposed to the great reality that they are not alone in their pain, their embarrassment, or in the actual details of the stories about the negative impact of their behavior and the baffling continuation of the addictive behavior anyway.

Some medical professionals have personal experience with addiction, and they usually stand out to others who may come across as condensing or cold and clinical. With group therapy, there is always such an enriching variety of perspectives that the personality of the provider or therapists ceases to be an obstacle to learning about the nature of addictive behavior and learning practical tools–much in the style of cognitive behavioral therapy–to heal from and interrupt the thought cycles that perpetuate it.

Ultimately, if you are wondering whether you are an alcoholic, it does not matter the amount of alcohol you drink or have drank in the past year, but what matters is what alcohol does to your body.

• Once you drink, are you able to comfortably stop drinking?
• Or, do you have half of your mind preoccupied with your next drink or that you won’t have one?
• If you stop drinking, what are the social factors of this decision?
• Do you feel like you suddenly don’t know what to do with your time?

These are questions no medical professional can answer for you, but they are not questions that need to be answered alone.