Abuse or Dependence?

Q: What is the difference between alcohol abuse and alcohol dependence?

A:Alcohol abuse is described as any “harmful use” of alcohol.

The Diagnostic and Statistical Manual of Mental Disorders IV describes alcohol abusers as those who drink despite recurrent social, interpersonal, and legal problems as a result of alcohol use. Harmful use implies alcohol use that causes either physical or mental damage.

Those who are alcohol dependent meet all of the criteria of alcohol abuse, but they will also exhibit some or all of the following:

  • Narrowing of the drinking repertoire (drinking only one brand or type of alcoholic beverage).
  • Drink-seeking behavior (only going to social events that will include drinking, or only hanging out with others who drink).
  • Alcohol tolerance (having to drink increasing amounts to achieve previous effects).
  • Withdrawal symptoms (getting physical symptoms after going a short period without drinking).
  • Drinking to relieve or avoid withdrawal symptoms (such as drinking to stop the shakes or to “cure” a hangover).
  • Subjective awareness of the compulsion to drink or craving for alcohol (whether they admit it to others or not).
  • A return to drinking after a period of abstinence (deciding to quit drinking and not being able to follow through).

Typically, those drinkers who are diagnosed as only alcohol abusers can be helped with a brief intervention, including education concerning the dangers of binge drinking and alcohol poisoning.

Those who have become alcohol dependent generally require outside help to stop drinking, which could include detoxification, medical treatment, professional rehab or counseling and/or self-help group support.

These symptoms can give an idea how drinking may fall into harmful patterns and indicate whether or not there’s a drinking problem.

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Symptoms

By Mayo Clinic staff

Alcoholism symptoms include:

  • Being unable to limit the amount of alcohol you drink
  • Feeling a strong need or compulsion to drink
  • Developing tolerance to alcohol so that you need an increasing amounts to feel its effects
  • Having legal problems or problems with relationships, employment or finances due to drinking
  • Drinking alone or in secret
  • Experiencing physical withdrawal symptoms — such as nausea, sweating and shaking — when you don’t drink
  • Not remembering conversations or commitments, sometimes referred to as “blacking out”
  • Making a ritual of having drinks at certain times and becoming annoyed when this ritual is disturbed or questioned
  • Losing interest in activities and hobbies that used to bring you pleasure
  • Irritability when your usual drinking time nears, especially if alcohol isn’t available
  • Keeping alcohol in unlikely places at home, at work or in your car
  • Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel “normal”

People who abuse alcohol may have many of the same signs and symptoms as people who have full-blown alcoholism. However, if you abuse alcohol but aren’t completely addicted to it, you may not feel as much of a compulsion to drink. You may not have physical withdrawal symptoms when you don’t drink. But alcohol abuse can still cause serious problems. As with alcoholism, you may not be able to quit drinking without help.

If you’ve ever wondered whether your drinking crosses the line into alcohol abuse or dependence, ask yourself these questions:

  • If you’re a man, do you ever have five or more drinks in a day? One standard drink is equivalent to 12 ounces (354.9 milliliters) of beer, 5 ounces (147.9 milliliters) of wine or 1.5 ounces (44.4 milliliters) of 80-proof spirits.
  • If you’re a woman, do you ever have four or more drinks in a day?
  • Do you need a drink as soon as you get up?
  • Do you feel guilty about your drinking?
  • Do you think you need to cut back on how much you drink?
  • Are you annoyed when other people comment on or criticize your drinking habits?

If you answered yes to even one of these questions, you may have a problem with alcohol.

When to see a doctor
If you feel that you don’t have control over your drinking, talk with your doctor. See your doctor even if you don’t think you have alcoholism, but you’re concerned that you might be drinking too much or that alcohol may be causing problems in your life. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous.

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Because denial is a frequent characteristic of alcohol abuse and alcoholism, you may not feel like you need treatment. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to family members, friends or co-workers when they ask you to examine your drinking habits or to seek help.

Some recent research indicates that even social drinking can have both immediate and possibly long-range deleterican have both immediate and possibly long-range deleterious effects on the body. According to Dr. Peter Stokes, a psychobiologist at Cornell University Medical College, the liver becomes fatty and therefore less efficient after only a few weeks of downing three or four drinks a night. But in the early stages, at least, the condition can be reversed by abstinence. More moderate imbibing—two drinks a night with meals, say—almost certainly does no harm to most people. New studies link drinking to heart-muscle damage and deterioration of the brain. Research by Dr. Ernest Noble of the University of California at Irvine shows that alcohol inhibits the ability of the brain cells to manufacture proteins and ribonucleic acid (RNA), which some researchers believe play a role in learning and memory storage. After 20 or 30 years, says Dr. Noble, two or three drinks a night on an empty stomach may impair a person’s learning ability. Both Stokes and Noble cite studies showing premature and irreversible destruction of brain cells after years of heavy drinking.

Such frightening studies of the results of drinking have not yet been accepted throughout the medical profession, but the physical effects on an alcoholic of very heavy drinking are beyond dispute. A pint of whisky a day, enough to make eight or ten ordinary highballs, provides about 1,200 calories—roughly half the ordinary energy requirement—without any food value. As a result, an alcoholic usually has a weak appetite and often suffers from malnutrition and vitamin deficiency. The slack cannot be taken up by popping vitamin pills; heavy alcohol consumption impairs the body’s utilization of vitamins. At the same time, excessive intake of alcohol also affects the production and activity of certain disease-fighting white blood cells, giving the alcoholic a particularly low resistance to bacteria.

Inevitably, the alcoholic develops a fatty liver, and his chances of developing cirrhosis, a condition in which liver cells have been replaced by fibrous scar tissue, are at least one in ten. A severely damaged liver cannot adequately manufacture bile, which is necessary for the digestion of fats; as a consequence, the alcoholic often feels weak and suffers from chronic indigestion. This may be made worse by gastritis, which is caused by alcohol irritation of the sensitive linings of the stomach and small intestine. The troubles of a heavy drinker do not end there, and through damage to the central nervous system and hormonal imbalance, alcohol may even cause impotence.

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