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Alcoholism: Alcohol addiction and abuse

Reviewed by Mary T. Johnson

clear shot glass on wooden table

What Is Alcoholism?

Alcoholism is chronic, problematic drinking that continues despite the devastating effects it has on a person’s life. It is a chronic illness with both genetic and environmental factors.

Oftentimes, people who suffer from alcoholism persist in drinking despite failed romantic relationships, family dysfunction, lost jobs, and other negative consequences. 

Although alcoholism is the most well-known drinking issue, it isn’t the only one. Many people have problems with alcohol that fall short of alcoholism, but still interfere with their daily lives. These problems include alcohol addiction, problem drinking, excessive drinking, and binge drinking.

Are Alcoholism and Alcohol Addiction the Same Thing?

Yes. Terms like alcoholism and alcohol addiction are typically used to refer to a person who experiences symptoms of addiction (cravings, withdrawal, etc.) in their relationship with alcohol. 

However, you won’t find “alcoholism” or “alcohol addiction” as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Instead, both terms fall under the diagnosis of alcohol use disorder (AUD). As a diagnosis, AUD encompasses a variety of alcohol-based conditions, including alcohol abuse and alcohol dependence. (Alcoholism and alcohol addiction are typically considered synonymous to alcohol dependence.)

Is Alcoholism a Substance Addiction or Behavioral Addiction?

Addictions aren’t limited to alcohol and drugs. They consist of a variety of behavioral addictions that can also have detrimental consequences in your life. Unlike substance addictions, behavioral addictions are not about consuming a drug that causes a pleasurable neurological response. Instead, people with behavioral addictions get the pleasurable neurological response from repeating patterns of behavior that become destructive.   Addiction has many characteristics, most notably tolerance and withdrawal symptoms.

Some of the most common behavioral addictions include gambling and sex. Other behavioral addictions are shopping, playing video games, working, and even eating. When these types of behavior rise to the level of being destructive and negatively impacting your life, it is an addiction.

Contrary to popular belief, alcoholism isn’t only a substance addiction. Since drinking is often associated with social gatherings, it’s also a behavioral addiction. When someone with alcoholism enters a social setting, they may feel compelled to drink because they associate drinking with being social. This coupled with the addiction to the pleasurable feelings associated with drinking, make alcoholism both a substance and behavioral addiction.

What Is Considered Excessive Drinking?

Drinking in moderation can be perfectly healthy and normal. There are many people who have a beer or glass of wine with dinner, or who enjoy cocktails as a part of a full and healthy life. However, there are also people whose only relationship with alcohol is through parties, friends, and unhealthy drinking choices.

When someone drinks more than recommended, they are developing an excessive drinking pattern. There are two types of excessive drinking: binge drinking and heavy drinking. Both of these types of alcohol abuse can have negative health consequences.

What Is Binge Drinking?

25.8% of Americans1 aged 18 or older admit to binge drinking. Even worse, 90% of underaged drinking2 for people between the ages of 12 and 20 qualifies as binging. Binge drinking is when you consume a large number of drinks in a short period of time. For women, binge drinking is having four drinks or more in a single setting, and for men it is having five drinks or more in a single setting. 

Oftentimes, binge drinking occurs in social settings: at parties, in bars or clubs, at weddings or other large celebrations. The goal of binge drinking is usually to become intoxicated, which isn’t a sign of alcoholism by itself, but it can be a sign that you are beginning to have a problem with alcohol that can escalate to the level of alcoholism.

While celebrations play a role in binge drinking, some people engage in it to self-medicate their mental health disorders. People who suffer from depression, anxiety, or other mental health disorders can find short-term relief from being under the influence of alcohol or other drugs.

What Is Considered a Normal Amount of Drinking?

In order to make sure you’re making smart choices about drinking, you need to understand the amount of alcohol in a standard drink. While a beer usually comes in a single serving sized can or bottle, wine and liquor usually come in bottles with several servings. 

An easy way to remember how much alcohol is in a serving size is by memorizing that 12 ounces of beer = 5 ounces of wine = 1.5 ounces of liquor. Despite the large differences in volume, these measurements all have an equal amount of alcohol, and therefore an equal effect on your blood alcohol level. (It is, however, important to note that with the popularity of brew pubs, these beers can vary considerably in alcohol content.)

In addition to understanding the amount of alcohol in each type of alcoholic beverage, it’s also important to know how many drinks are within a healthy range. These metrics vary between men and women. Moderate drinking for women is one drink or less each day, while it is two drinks or less each day for men.

Different cultures have different attitudes towards drinking. Some cultures abstain from drinking alcohol altogether. These are usually religious communities or people who abstain because of the devastating consequences alcohol has had on their loved ones. 

Other cultures embrace drinking and encourage it during celebrations, dinner, or other gatherings. A person’s culture most likely has a strong influence over their attitude toward drinking and what they consider normal. Their family of origin may also play a role in attitudes regarding alcohol. These may be positive or negative influences. 

Signs of Alcoholism

The signs of alcohol addiction can be obvious, but there are many times when the signs are much more subtle. If you’re concerned that you or a loved one may be suffering from alcoholism, here are some of the most common signs:

  • Spending more money on alcohol than you should
  • Being unable to control the frequency or amount of alcohol you drink
  • Behavior changes after drinking
  • Experiencing cravings for alcohol
  • Prioritizing drinking over responsibilities

Alcoholism Symptoms

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) characterizes alcoholism as alcohol use disorder. The DSM-5 uses the following symptoms to diagnose all alcohol use disorders:

  • Drinking more than intended
  • Failing to stop drinking or drink less
  • Spending a lot of time drinking or recovering from hangovers
  • Being unable to think of anything else due to alcohol cravings
  • Continuing to drink despite personal relationships suffering
  • Skipping out on hobbies and activities to drink instead
  • Participating in activities or getting involved in situations that are a health risk or cause injury after drinking
  • Experiencing depression, anxiety, or worsening health conditions, and continuing to drink anyway
  • Having an increased tolerance to alcohol that leads to drinking more to achieve the same effect
  • Suffering withdrawal symptoms when sobering up after drinking

Using these criteria, 14.5 million Americans3 aged 12 and older were diagnosed with alcohol use disorder (AUD) in 2019. 

Diagnosing the severity of AUD requires the presence of a certain number of these symptoms within a 12-month period. A medical provider can confirm mild AUD with two to three symptoms and moderate AUD with four to five symptoms. People who are suffering from severe AUD experience six or more symptoms.

Effects of Alcohol Addiction

Short-term Effects

The short-term effects of alcohol can take a toll on the body. Most of these effects can cause a chain reaction with long lasting effects. Here are some of the most common short-term effects:

  • Injuries from drunk driving, drowning, and other accidents while under the influence
  • Violent outbursts resulting in assault, homicide, or even suicide
  • Participating in risky sexual behaviors
  • Miscarriage
  • Harm to an unborn fetus
  • Alcohol poisoning

Long-term Effects

While the short-term effects can lead to long lasting consequences from injuries or other complications, there are also long-term effects that alcohol abuse has on the body. These effects can include:

  • High blood pressure
  • Heart disease
  • Stroke
  • Liver disease
  • Cancer
  • Dementia and other memory issues
  • Psychosis 
  • Depression
  • Anxiety

Why Do People Get Addicted to Alcohol?

Alcohol addiction happens for a lot of different reasons. People who have a family history of alcohol addiction, an addiction to another substance or behavior, or a history of trauma are more likely to develop alcohol addiction.

People often develop drinking problems to help them cope with mental, emotional, or physical health issues. These problems can begin in childhood or as a person gets older. Self-medicating mental health disorders, or escaping the emotional pain of a dysfunctional home environment, are common reasons people begin drinking. Hereditary alcoholism increases the risk that this self-medicating behavior will devolve into AUD.

Alcohol and Mental Health: How They Affect Each Other

The psychological effects of alcohol addiction cannot be understated. There’s a direct relationship between mental health and alcohol abuse, especially when depression and anxiety are involved. Mental health disorders like these can cause someone to abuse alcohol. 

At the same time, alcohol abuse can cause the onset of or exacerbate mental health disorders. As a result, people who abuse alcohol can find themselves caught in a vicious cycle, with their mental health causing their alcohol abuse and vice versa. 

Treatment for Alcoholism & Alcohol Abuse

Most people consider alcoholism a lifelong condition. However, sobriety is possible. Recovery takes determination as well as a good support system and professional therapy.

Many people who successfully overcome their alcohol addiction participate in rehabilitation programs. These can be inpatient or outpatient, but in all cases they include work with a therapist. A therapist’s role in a patient’s recovery is to help them identify the reasons for their drinking and develop better coping mechanisms to help them withstand withdrawal symptoms and avoid relapsing. 

Therapy can be done on an individual basis, but many people in recovery find group therapy to be helpful. Other members in the group help hold each other accountable and serve as a support system. 

Whether you or a loved one are ready to enter a rehabilitation program, or you’re still exploring options, connecting with a therapist can help you or someone you know choose the right path. If you would like help finding a therapist, check out our directory. If participating in group therapy as an anonymous member is of interest, there are Alcoholics Anonymous (AA) groups4 across the globe. Simply search for one in your area and show up. For immediate help and support for you or a loved one, you can reach out to SAMHSA’s National Helpline5 at 1-800-662-HELP (4357).

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The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.