Americans love to drink. There are more people in the United States who drink on a regular basis than there are people who do not drink at all, according to the National Survey on Drug Use and Health (NSDUH).
But alcohol consumption also carries significant risks. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), almost 88,000 people die every year due to alcohol-related causes.
A recent study estimates one in eight Americans abuses alcohol, a 50 percent increase since the start of the century. All these stats beg the question, “what’s the difference between moderate drinking, alcohol abuse, and alcoholism?”
Alcohol Abuse and Alcohol Dependency: No Longer Included in the DSM-V
The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s classification of mental disorders. The fifth edition (DSM-5) was published in 2013 and made changes in its common language relating to alcohol disorders.
The previous publication, the DSM–IV, described two distinct alcohol disorders, alcohol abuse, and alcohol dependence, with specific criteria for each. The DSM–5 integrates the two DSM–IV disorders, alcohol abuse, and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.
According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Alcohol Use Disorder is determined by the presence of eleven specific symptoms related to drinking.
Alcohol Use Disorder (AUD)
| Mild | Moderate | Severe |
| The presence of 2 to 3 symptoms. | The presence of 4 to 5 symptoms. | The presence of 6 or more symptoms. |
| •Alcohol is often taken in larger amounts or over a longer period than was intended. •There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. •A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. •Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. •Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. •Important social, occupational, or recreational activities are given up or reduced because of alcohol use. | •Craving, or a strong desire or urge to use alcohol. •Recurrent alcohol use in situations in which it is physically hazardous. •Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. •Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol. •Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. |
Alcohol Abuse vs. Alcohol Addiction (Control vs. Dependency)
Alcohol addiction and abuse are not the same. Alcohol addiction refers to a psychological and physical dependency on alcohol. Individuals who suffer from alcohol addiction may build up a tolerance to the substance, as well as continue drinking even when alcohol-related problems accumulate.
Alcohol abusers may not be addicted to alcohol. Abusers are typically heavy drinkers who continue drinking regardless of the results. They may not drink as often as alcoholics. They may demonstrate restraint and control. However, abusers of alcohol regularly demonstrate excess consumption that tends to lead to problems. Certain individuals who abuse alcohol may eventually become dependent on it.
Effects of Excessive Alcohol Use
| Short-Term Effects | Long-Term Effects | Other Concerns |
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Alcohol Abuse Statistics:
According to figures from the NSHUH and NIAAA:
| •Alcohol abuse problems cost the U.S. $249 billion in 2010. •Almost 25% of people age 12 or older were current binge drinkers in 2015. •Around 17 million adults can be classified as having an alcohol problem. | •Over 50% of people age 12 or older who received treatment for a substance use disorder in 2015 sought help for alcoholism. •7% of the U.S. population age 12 or older drank alcohol in 2015. •Almost 6% of all global deaths are due to drinking. |
Alcohol is responsible for one in 10 deaths among working-age Americans — from accidents as well as illnesses. There are almost 90,000 alcohol-related deaths in America every year. Excessive drinking, mainly binge drinking, costs some $250 billion a year in lost productivity, health care and other expenses.
Risk Factors for Alcohol Abuse:
Genetic Risk Factors
The following factors significantly increase the risk of alcohol-related problems:
| •Family history of substance abuse or addiction increases the genetic vulnerability. •Family history of excessive use increases availability, exposure to, and normalization of problematic use. | •A history of mental health problems can increase risk for use. •Early childhood abuse or trauma can also increase vulnerability to use. |
Social/Developmental Risk Factors
Generalized risk factors that predict problems in life, including, but not limited to alcohol use, should also be evaluated. General risk factors include:
| •Exhibit behavioral problems early in age, especially antisocial problems where the rights of others are violated. •Academic struggles and underperformance or underachievement | •Difficulty with socialization, including few friends, social isolation, poor social skills, or peer group that exhibit risk factors, including drug use. |
Risks Factors Associated w/ Use
Substance use-specific risk factors are the variables to monitor after someone has experimented or used drugs/alcohol. They include:
| •Age of first use. Teens who start drinking on a regular basis before age fifteen have five times the risk of developing alcohol abuse or addiction later in life than those who start drinking regularly after the legal age of twenty-one. | •Frequency of use. Has your child tried alcohol or marijuana once or twice, or has there been a prolonged period of regular use? •Use to achieve intoxication. |
Co-Occurring Disorders
Co-occurring disorders were previously referred to as dual diagnoses. According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH), approximately 7.9 million adults in the United States had co-occurring disorders in 2014. People with mental health disorders are more likely than people without mental health disorders to experience an alcohol or substance use disorder.
Common Consequences of Alcohol Abuse:
Alcohol enters your bloodstream as soon as you take your first sip. Alcohol’s immediate effects can appear within about 10 minutes. As you drink, you increase your blood alcohol concentration (BAC) level, which is the amount of alcohol present in your bloodstream. The higher your BAC, the more impaired you become by alcohol’s effects. These effects can include:
| •Reduced inhibitions •Slurred speech •Motor impairment •Confusion •Memory problems •Suicide and homicide have a strong correlation with: a) Drug intoxication b) Alcohol intoxication | •Concentration problems •Coma •Breathing problems •Death •Car crashes and other accidents •Risky behavior •Violent behavior |
Common Forms of Treatment:
People commonly think of 12-step programs or 28-day inpatient rehab when considering treatment options for alcohol problems. However, there are a variety of treatment methods currently available, and there is no one-size-fits-all remedy.
Treatment for alcohol use disorder (AUD) will greatly depend on how bad the alcohol problem is. Some folks are able to limit or eliminate their drinking with little help. They simply needed to recognize a growing problem. Others can cut back or eliminate with the help from a counselor.
Outpatient Therapy
Behavioral treatments are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.
Motivation Enhancing Therapy (also known as Motivational Interviewing or MI) was developed specifically to help folks address their substance use problems. Other modalities of therapy such as Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are regularly utilized in treating substance abuse and addiction and have strong empirical evidence of their effectiveness.
Intensive Out-Patient Programs
Intensive Outpatient Programs (or IOP) are more rigorous programs than traditional outpatient therapy sessions. IOP programs often are for a specific length of time (8, 12, or 16 weeks). Programs also include multiple group and individual therapy sessions each week, sometimes requiring anywhere from 6-10 hours of commitment each week.
IOP can also provide additional resources such as family support groups. But they also can include additional requirements (AA/NA meeting attendance, urine drug screens) that can result in discharge of the program if an individual fails to meet the requirements.
Most folks consider IOP programs when a) someone believes all the added services gives them the best chance to get sober, or b) it has been demonstrated that regular weekly outpatient services has not resulted in positive change.
Inpatient Rehab Treatment
Inpatient treatment programs are often considered when a person has struggled to maintain sobriety at an outpatient or intensive outpatient level. The biggest advantage of inpatient treatment is that a person is removed from their regular, daily stressors and triggers and focuses completely on their recovery. The drawback is the time and financial commitment.
Mutual-Support Groups
Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support.
Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.
For More Information, Visit the Following Websites:
American Psychological Association: Understanding alcohol use disorders and their treatment
National Institute on Alcohol Abuse and Alcoholism
Substance Abuse and Mental Health Services Administration
www.naadac.org 1-800-548-0497 |
www.helpstartshere.org (search for social workers with addiction specialties) |
Treatment Facilities
www.findtreatment.samhsa.gov 1-800-662-HELP |
Mutual-Support Groups
www.aa.org 212-870-3400 (check your local phone directory under "alcoholism") | www.moderation.org 212-871-0974 |
www.sossobriety.org 323-666-4295 | www.smartrecovery.org 440-951-5357 |
www.womenforsobriety.org 215-536-8026 |
Groups for Family and Friends
www.al-anon.alateen.org 1-888-425-2666 (for meetings) | www.adultchildren.org 310-534-1815 |
Information Resources
www.niaaa.nih.gov 301-443-3860 | www.nida.nih.gov 301-443-1124 |
www.nimh.nih.gov 1-866-615-6465 | www.samhsa.gov 1-800-729-6686 |