Blurred Lines: Alcohol Abuse or Addiction?

At some point or another, most people who have experienced a blackout or made poor choices while drinking have asked themselves, “Do I have a drinking problem?”

Defining Alcohol Abuse and Dependence

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships or ability to work. Abusers of alcohol still have some ability to set limits for themselves, but their drinking habits affect their lives in a negative way. People who abuse alcohol do not always become dependent on it, but they are at a higher risk of developing a problem. Symptoms of alcohol abuse include:

• Neglecting responsibilities at work, school or home
• Drinking in dangerous situations (while driving or operating machinery, mixing with prescription drugs, etc.)
• Facing legal problems directly related to alcohol (DUI, drunk and disorderly conduct, etc.)
• Continued drinking despite relationship problems caused or worsened by drinking

Those who are dependent on alcohol, sometimes referred to as alcoholics or those with alcohol addictions, experience the same negative effects of alcohol abuse and also have a physical or mental dependence on it. Symptoms of alcohol dependence include:

• Strong cravings for alcohol
• Continued use despite repeated physical, psychological or interpersonal problems
• The inability to limit drinking
• Tolerance (requiring increased amounts of alcohol to achieve the same effects)
• Experiencing withdrawal when the effects of alcohol wear off
• Drinking more or for longer than intended, despite not wanting to

The New Spectrum of Alcohol Use

Diagnosing a drinking problem is not as black and white as it used to be. Instead of “problem drinker” and “alcoholic” there’s now the Alcohol Use Disorder (AUD) — previous editions of the DSM classify alcohol abuse and alcohol dependence as two separate disorders. However, the most recent edition (DSM-V) combines the two under this one condition.

The new AUD diagnosis measures drinking problems on more of a spectrum. On one end you have the moderate drinker: a man who has 2 or less drinks per day or a woman who has 1 or less. Moderate drinkers are considered to use alcohol in a relatively healthy manner. On the opposite end is the alcohol dependent. In between, there are different levels of alcohol use disorder.

The severity of one’s alcohol use disorder is defined by 3 subclassifications: mild, moderate and severe. To determine the level of AUD, there are 11 criteria to consider. If a person manifests at least 2 of the symptoms in a 12-month period, they have AUD. The presence of 2-3 symptoms indicates mild AUD; 4-5 symptoms is moderate; 6 or more is severe. The symptoms are similar to those previously set to distinguish between alcohol abuse and dependence, but also include:

• There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
• A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects
• Recurrent alcohol use in situations in which it is physically hazardous

Under this new umbrella disorder, new drinkers, like teens and college students who binge drink, could be grouped alongside seasoned alcoholics. In an article for TIME, Dr. Allen Frances, former chair of the DSM-IV task force, expressed his concern for the impact such a diagnosis could have on youth.

Although the spectrum/continuum concept is the best way to study alcoholism, it is not the best way to label people who have problems with alcohol,” says Dr. Frances. “The DSM-5 decision to lump beginning drinkers with end stage alcoholics was driven by researchers who are not sensitive to how the label would play out in young people’s lives.

Recovery is Possible for Everyone

Labels aside, alcohol abuse at any stage or age can be dangerous. Whether you have mild AUD or are struggling with severe alcohol dependence, there are a multitude of treatment and recovery options available. From inpatient/outpatient rehab to alternative therapies to mutual aid support groups, finding the program that works best for your individual needs is key. The right treatment and the support of family and friends will give you the best chance at a successful recovery.

Want to know more about treatment for alcohol use disorders? Click here.