Understanding the difference: Binge Drinking – Alcohol Abuse – Alcohol Dependence.
Alcohol problems occur at different levels of severity, from mild to life-threatening. Alcohol dependence is considered the most severe alcohol problem, and it can be life –threatening. There is a lot of confusion around alcohol use, progression of dependency and alcoholism. For many people alcohol problem starts with episodes of binge drinking: having five or more drinks in one session for men and four or more for women. Another definition for binge drinking is simply drinking to get drunk.
Binge drinking turns into alcohol abuse when someone’s drinking begins to cause problems in their life, but the person continues to drink in spite of the negative consequences, including social, interpersonal or legal difficulties. Alcohol abuse can result in missing time at school or work, neglecting relationships, neglecting responsibilities, or experiencing trouble at work, or with the law.
Alcohol abuse becomes alcohol dependence when drinkers begin to experience a craving for alcohol, a loss of control of their drinking, withdrawal symptoms and tolerance to alcohol, so that they have to drink more to achieve the same effect. Alcohol dependence is a progressive disease that includes a strong desire/need to drink regardless of consequences.
Early signs of alcoholism include frequent intoxication, an established pattern of heavy drinking, black-out drinking , personality change while drinking, (becoming angry or violent), or putting self or others in dangerous situations while intoxicated. The main symptom being the continued drinking in spite of recurring and ongoing problems (missing work, driving drunk, getting in trouble with the law).
Problems are usually first recognized by the friends and family of the drinker. They may try to help by talking to the drinker about the problem and encourage him to get help, but the denial does not allow the person to see what others are seeing. The drinker is unable to acknowledge a problem, and refuses to admit it, or link it as the source of current life-problems. Denial is so common in people with alcohol dependency that denial itself is a warning sign of alcoholism.
The Diagnostic and Statistical Manual of Mental Disorders, IV, defines alcohol abuse as drinking despite alcohol-related physical, social, psychological, or occupational problems, or drinking in dangerous situations; the manual lists the following symptoms of alcohol dependence:
- Neglect of Other Activities: The drinker’s alcohol use reduces or eliminates important social, work-related or recreational activities.
- Excessive Use: The drinker begins to consume larger amounts of alcohol over a longer period of time than intended.
- Impaired Control: The drinker makes repeated unsuccessful attempts to cut down or control how much he/she drinks.
- Persistence of Use: The drinker continues to consume alcohol despite knowing that his/her drinking is causing or contributing to a persistent or recurrent physical or psychological problem.
- Large Amounts of Time Spent in Alcohol Related Activities: The drinker spends an abnormal amount of time on activities involved with obtaining, using and/or recovering from the effects of alcohol.
- Withdrawal: When the drinker stops drinking for a short period of time, he/she experiences symptoms such as nausea, sweating, shaking or anxiety.
- Tolerance: The drinker needs increasing amounts of alcohol to achieve the same level of intoxication.
As a friend or family member trying to support a loved one with an alcohol abuse problem, you may offer taking them to a doctor and encouraging them to have an open discussion with their physician about the drinking habits. It is important to initiate that conversation with a physician, as research shows that alcoholism is rarely diagnosed during routine visits to the doctor (or even during hospitalizations). People with alcohol abuse disorders are diagnosed properly less than 30 percent of the time. Physicians routinely do not recognize the symptoms, and when they do, they may be reluctant to confront their patients about their drinking problems. As a family member, you may be the one to ensure that this important step takes place and hopefully begins the process of change.