Alcohol Abuse Vs Alcohol Dependence

These two words are often used interchangeably, however, when it comes to an alcoholic, there is a huge difference between them.  The Diagnostic and Statistical Manual, 4th Ed (DSM IV) defines the criteria that separates alcohol abuse from alcohol dependence.

Alcohol Abuse
A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:
  1) Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
  2) Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).
  3) Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
  4) Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).
These symptoms must never have met the criteria for alcohol dependence.

Alcohol Dependence
A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:
  1) Tolerance, as defined by either of the following:
     a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
     b) Markedly diminished effect with continued use of the same amount of alcohol.
  2) Withdrawal, as defined by either of the following:
     a) The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).
     b) Alcohol is taken to relieve or avoid withdrawal symptoms.
  3) Alcohol is often taken in larger amounts or over a longer period than was intended.
  4) There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.
  5) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
  6) Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  7) 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 the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

What the two terms boil down to is this:

Alcohol abuse is repeated use of alcohol to a point of it causing adverse consequences, yet continuing to use it despite those consequences. The individual does not develop a tolerance or withdrawal because the drinking usually takes the form of a one night binge. He or she also often has a criminal record related to alcohol (i.e. DUI).

Alcohol dependence is seen in a person that has built up tolerance over time due to continual ingestion of alcohol. This person will often develop withdrawal symptoms within 24 hours if restricted from alcohol. This person will often be unable to quit drinking for extended periods of time and will relapse back in to a state of intoxication. The behavior, if not interrupted or stopped, will usually affect their social and work life.

Alcohol abuse differs from alcohol dependence in behavior. The individual that succumbs to alcohol abuse will usually have a one night binge and will sober up the next day suffering through the headache and general feeling of crap. The alcohol dependent will drink until passing out the first day, then continue to drink upon waking up the next day and persist in that cycle until it is somehow interrupted. The interruption may be in the form of simply running out of liquor, or it may be in the form of a family member that forces him or her to become sober for a certain time period.

It should be noted that the DSM V that is to be published in May of 2013 will no longer include these terms. The distinct categorization of abuse and dependence will be eliminated and replaced with a single diagnosis, ‘Alcohol Use Disorder.’ This subject is discussed in further detail here.


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