The Difference Between Alcohol Abuse and Alcohol Dependence

In non-clinical settings, use of the terms alcohol abuse and alcohol dependence commonly refer, rather generically, to the problematic use of alcohol. While these terms are often used interchangeably, there are significant differences between them. Each is a specific diagnosis that describes a type of problematic drinking. A third term, alcoholism, is also widely used in reference to severe drinking, but it is not a formal clinical term or diagnosis. The word alcoholism is commonly used within the 12 Step community of Alcoholics Anonymous and is considered a layman’s term.

Both alcohol abuse and alcohol dependence are distinct types of mental health diagnoses more specifically known as alcohol use disorders. The diagnoses are given if specific and negative consequences of alcohol use have occurred for the drinker. When the criteria in each diagnosis are compared, their differences are notable; each indicates a very distinct disorder.

A simplified difference between alcohol abuse and alcohol dependence is that abuse describes the early stages of alcohol dependence. Dependence is a more complex and chronic condition. Therefore, while both indicate the consequences of problematic drinking, abuse has fewer symptoms. Essentially, alcohol abuse lays the groundwork for alcohol dependence in the life of the drinker and diagnostically.

Abuse occurs when there is a pattern of one or more alcohol-related negative consequences such as:

• recurring role failure related to the use of alcohol — failing to fulfill obligations and responsibilities associated with one’s role within work, school or home because of drinking

• recurring use of alcohol in situations that could be physically dangerous — for example, driving or operating machinery while using alcohol

• recurring legal problems that are alcohol-related — public intoxication, driving while under the influence or disorderly conduct, for example

A person is said to abuse alcohol when the drinking, and the recurring negative consequences of drinking, have occurred within the same 12 month period. Additionally, in order for an individual to be diagnosed as having alcohol abuse, he or she must continue to drink despite having had such alcohol-related problems.

On the other hand, the diagnostic requirements for alcohol dependence are far more comprehensive. Alcohol dependence is generally considered to be an alcohol-related illness with physiological symptoms. Unlike alcohol abuse, the diagnosis of dependence addresses symptoms of alcohol tolerance and alcohol withdrawal. The diagnostic criteria of alcohol dependence include:

• evidence of a change in tolerance for alcohol—drinking may increase to achieve intoxication, for example

• withdrawal symptoms—hangovers, tremors, shakes, etc

• the desire to stop or decrease use

• unsuccessful efforts to stop or decrease use

• preoccupation with alcohol use

• negative consequences of drinking

• continued drinking despite negative consequences or the desire to stop

Diagnostically, alcohol dependence overrides the diagnosis of alcohol abuse. That is, one cannot clinically be considered to have alcohol dependence and alcohol abuse at the same time. This is because alcohol abuse is a necessary precursor to alcohol dependence–one must establish a pattern of harmful drinking before becoming dependent upon alcohol. Additionally, once the progression from alcohol abuse to alcohol dependence occurs, an individual is considered to have alcohol dependence whether drinking or not.

The illness of alcohol dependence can be in various stages of activity or remission and consequently, the diagnosis of alcohol dependence is typically used whether an individual continues to drink or not. Of the two alcohol use disorders — abuse and dependence — only alcohol dependence specifies how active the disorder is. For example, the diagnosis of alcohol dependence can be expanded to include the following throughout the lifetime of a person who has this illness:

• alcohol dependence in early full remission — no symptoms of dependence or abuse have occurred for at least one month, but less than one year

• alcohol dependence and early partial remission — some symptoms of dependence or abuse have been present for at least one month or less than a year

• alcohol dependence in sustained full remission — no symptoms of abuse or dependence appear at any time during one year or longer

• alcohol dependence and sustained partial remission — some symptoms of abuse or dependence are present for one year or longer

Additionally, the diagnosis of alcohol dependence can be given as the following:

• alcohol dependence with physiological dependence

• alcohol dependence without physiological dependence

• alcohol dependence in a controlled environment

The use of these last three terms further clarifies how the illness of dependence is experienced at any given time. For example, an individual may drink to the point of becoming physiologically dependent upon a particular amount of alcohol to prevent withdrawal. The effects of withdrawal in such a case can range from mild discomfort to medical distress.

On the other hand, a person may be alcohol dependent without requiring a certain amount of alcohol to prevent withdrawal. In order to qualify for the diagnosis of alcohol dependence, physiological dependency is not required.

Alcohol dependence in a controlled environment indicates that a person may have been unable to drink because alcohol was not available. This term is frequently used when an individual has been hospitalized or incarcerated. This is an example of how the illness of alcohol dependence is considered to be present even when an individual is not drinking.

Notably, the diagnosis of alcohol abuse does not include any references to physiological dependence or remission. These are exclusive to the diagnosis of alcohol dependence. They clearly indicate that dependence is considered an illness and that it is far more complex than abuse.

In summary, alcohol abuse and alcohol dependence are closely related in the lives of people with problematic drinking. Alcohol abuse is the clinical warning sign that the illness of alcohol dependence could develop. It is a significant and necessary part of the larger picture of dependence.

Treatment for both alcohol abuse and alcohol dependence involves abstinence. Once an episode of alcohol abuse is treated successfully, however, the term is no longer used as a current diagnosis. At times, the term alcohol abuse by history will be used to indicate that an individual has had previous problems with alcohol and may be susceptible to these in the future. Once an incident of alcohol abuse is over, however, one is not still considered to have an alcohol use disorder.

Alcohol dependence is significantly different. Successful treatment of dependence does not eliminate the diagnosis. Even in abstinence from alcohol use, an individual is still considered to have the illness of alcohol dependence. The illness is considered, in sobriety, to be in a type of remission.