Getting the Facts on Alcohol Abuse

Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for alcohol, loss of control, or physical dependence. In addition, alcohol abuse is less likely than alcoholism to include tolerance (the need for increasing amounts of alcohol to get "high").

Alcohol abuse is defined as a pattern of drinking that's accompanied by one or more of the following situations within a 12-month period:

• Failure to fulfill major work, school, or home responsibilities
• Drinking in situations that are physically dangerous, such as while driving a car or operating machinery
• Recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk
• Continued drinking despite having ongoing relationship problems that are caused or worsened by the effects of alcohol

In the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), alcohol abuse was defined as any harmful use of alcohol, meaning any physical or mental damage. The DSM-IV provided separate diagnoses for alcohol abuse and alcohol dependence. Alcohol abuse was any drinking despite recurrent social, interpersonal, and legal problems as a result of alcohol use.

Alcohol dependence was the diagnosis according to DSM-IV if the drinker met all of the above criteria plus exhibited any or all of the following symptoms:

• Narrowing of the drinking repertoire; for instance, drinking only one brand or type of alcoholic beverage
• Drink-seeking behavior such as only going to social events that will include drinking, or only hanging out with others who drink
• Alcohol tolerance, which means having to drink increasing amounts to achieve previous effects
• Withdrawal symptoms, which means 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

With the May 2013 publication of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association (APA), alcohol abuse and alcohol dependence are no longer diagnosed separately. The new DSM-5 combines these two disorders into one, called "alcohol use disorder," with sub-classifications of mild, moderate, and severe.

The DSM-5 provides a list of 11 symptoms of alcohol abuse disorders. Alcohol use disorder is considered mild if you exhibit two or three of those 11 symptoms, moderate if you display four or five symptoms, and severe if you display six or more symptoms on the list.

Although there is no longer an official diagnosis of "alcohol abuse," it's still a very real phenomenon and is defined in general as the continued use of alcohol despite negative consequences in your life. While alcohol abuse may be considered a less severe disorder compared to alcoholism, it's important to note that many effects of alcohol abuse are also experienced by alcoholics.