The Difference Between Alcohol Abuse and Alcohol Dependence

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

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

Who Is an Alcohol Abuser?

It is still sometimes useful to clarify the distinctions between abuse and dependence. Alcohol abusers can be defined as those who continue to drink despite recurrent social, interpersonal, health, and legal problems as a result of their alcohol use.

Who Is Alcohol Dependent?

People who are alcohol-dependent 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" a hangover.
• 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.

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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.

How Much Is Too Much?

Are your drinking habits safe, risky, or harmful? Are you abusing alcohol or alcohol dependent? Looking at the aforementioned symptoms can give you an idea of how your drinking may fall into harmful patterns and indicate whether or not you have a drinking problem.

Alcohol Withdrawal Symptoms and Treatment

If you are alcohol-dependent and decide to change your life and quit drinking, you can expect to experience withdrawal symptoms. These discomforts usually peak 24 to 72 hours after your last drink, but they may last for weeks, according to information from the National Institutes of Health.

Those with mild to moderate symptoms may be able to 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