Alcohol Dependence vs. Alcohol Abuse: What's the Difference?

Until the publication of the 5th edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), problems with substance use were generally divided into "abuse" and "dependence." The DSM-5 combined these categories into a single diagnosis of "substance use disorder," measured on a continuum from mild to severe.

This change was made to challenge the idea that abuse was a mild and early phase of the illness and dependence was a more severe manifestation. In reality, abuse can be quite severe.

While the two are no longer differentiated in the DSM, it can still be helpful to understand their original definitions. This article discusses alcohol dependence, alcohol abuse, and the key differences between them.

What Is Alcohol Dependence?

Alcohol dependence was originally defined as a chronic medical condition characterized by experiencing symptoms of withdrawal when the person stops consuming alcohol. To avoid experiencing withdrawal symptoms, the person has to keep consuming alcohol.

People who have a dependence on alcohol exhibit some or all of the following characteristics.

• Alcohol tolerance: Needing to drink increasing amounts over time to achieve previous effects. For example, you used to drink three cocktails every night, but now you need five to get the feeling you're looking for.​
• Withdrawal symptoms: Experiencing physical symptoms, such as insomnia, tremors, and mood swings after going for a short period without drinking.
• Drinking to relieve or avoid withdrawal symptoms, such as drinking to stop the shakes or to "cure" hangovers.
• Awareness of the compulsion to drink or craving for alcohol, regardless of whether you admit it to others.
• Drinking larger amounts or over a longer period than intended and making unsuccessful efforts to cut down.
  

What Is Alcohol Abuse?

Alcohol abuse was defined as a condition in which a person continues to drink despite recurrent social, interpersonal, health, or legal problems as a result of their alcohol use. A person who abuses alcohol may also be dependent on alcohol, but they may also be able to stop drinking without experiencing withdrawal symptoms.

According to a study published in the journal Preventing Chronic Disease, 90% of people who abuse alcohol are not alcohol dependent. This included people who engaged in excessive drinking and binge drinking. However, the study did find that people who engaged in binge drinking more often were also more likely to be alcohol dependent.

What Is Alcohol Use Disorder?

People who use alcohol excessively may have alcohol use disorder. Signs of the condition include characteristics that were previously labeled as either abuse or dependence. Some common symptoms include:

• Drinking more alcohol over a longer time than the person intended
• Wanting to cut back on drinking but being unable to do so
• Spending a lot of time obtaining alcohol, consuming it, and then recovering
• Alcohol use interferes with a person's ability to function normally in important areas of their life
• Strong cravings for alcohol
• Giving up important activities because of alcohol use
• Using alcohol in situations where it may be hazardous
• Continuing alcohol consumption despite negative consequences
• Experiencing tolerance, or a need to drink more to experience the same effects
• Experiencing symptoms of withdrawal when alcohol use is reduced or stopped

Those with moderate to severe alcohol use disorders generally require outside help to stop drinking. This could include detoxification, medical treatment, professional rehab or counseling, and/or self-help group support.

Changing Terminology

The official move away from the terms "abuse" and "dependence" in the DSM-5 is also reflective of a shift in how professionals talk about alcohol and substance use. The language used in the past often served to stigmatize people who are affected by alcohol use disorder, and research has shown that the terminology used does, in fact, influence how the person with a substance use disorder views themselves as well as how others view them.

Terms like "abuse," for example, may imply that the behavior is intentional and controllable and therefore a personal failure rather than a symptom of a disease. Referring to this condition as alcohol use disorder is more accurate and less stigmatizing. It also emphasizes that the condition is a diagnosable, chronic, and relapsing brain disease, not a moral or personal failure.

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How Much Is Too Much?

Are your drinking habits safe, risky, or harmful? Could your alcohol use be a sign of abuse or dependence? Looking at the symptoms mentioned above can give you an idea of how your drinking may fall into harmful patterns and indicate whether or not you have a drinking problem.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that heavy alcohol use involves drinking four or more drinks a day (or more than 14 a week) for men and more than three drinks a day (or more than seven drinks a week) for women.

NIAAA defines binge drinking as consuming five or more drinks for men and four or more drinks for women in two hours or less.

Alcohol Withdrawal Symptoms

If you have developed alcohol dependence and decide to quit drinking, you can expect to experience withdrawal symptoms. According to information from the National Institutes of Health, these discomforts usually peak 24 to 72 hours after your last drink, but they may last for weeks.

Those with mild to moderate symptoms may receive treatment in an outpatient setting. You should ask a loved one to stay with you during this process, and you may need to visit a clinician for daily monitoring.

If you have moderate to severe symptoms of alcohol withdrawal, you may require inpatient treatment at a hospital or substance abuse facility. Symptoms of severe alcohol withdrawal include:

• Fever
• Hallucinations
• Seizures
• Severe confusion
• Unstable vital signs

Treatment

A doctor may also prescribe medications to help you manage withdrawal symptoms and support you in your effort to stop drinking. Benzodiazepines can help alleviate withdrawal symptoms while naltrexone may help you manage alcohol cravings.

Before you decide to stop drinking, talk to a healthcare provider to determine what treatment options are available and whether you would benefit from medical supervision during detox. If you have been consuming alcohol heavily for an extended period, quitting on your own has the potential to be dangerous.

Delirium tremens is a symptom of severe alcohol withdrawal that can be potentially fatal. Contact emergency services immediately if you experience symptoms such as fever, involuntary muscle contractions, seizures, delusions, hallucinations, or rapid mood swings as you withdraw from alcohol.

Summary

Alcohol dependence and alcohol abuse were two designations previously recognized in the DSM-IV. Today, they have been combined and are known as alcohol use disorder. While no longer separate diagnoses, it can be helpful to understand the differences between the two. "Dependence" refers to being unable to stop drinking without experiencing withdrawal symptoms while "abuse" refers to continuing to consume alcohol despite adverse consequences.

A Word From Verywell

If you think you might have an alcohol problem, discuss it with a healthcare provider. They can offer advice on how to approach your treatment and assist you with the process of detoxing, withdrawing, and recovering from alcohol use disorder. Everyone's experience with alcohol is different, but effective treatments are available, whether your condition is mild, moderate, or severe.