Alcohol Abuse vs. Alcoholism: How Are They Different?

Separating alcohol abuse from alcoholism isn’t always easy. Even doctors can struggle to determine if someone fits the diagnostic criteria for alcoholism or is simply struggling with alcohol abuse. 

But know that anyone struggling with alcohol can get treatment. With a professional’s help, you can develop a healthier future that doesn’t involve drinking excessively or at all. 

What Is Alcoholism?

Alcoholism is officially called alcohol use disorder (AUD). People say about 18 million Americans have this condition.[1] Their drinking causes distress and harm to themselves and others. It’s a compulsive behavior that they can’t stop.

AUD is characterized by the following three symptoms:[1]

• Cravings: People with AUD think about their next drink almost all the time. Those thoughts can be so powerful that they’re impossible to ignore. 
• Lack of control: Once people start drinking, they are unable to quit. They may say they’ll have just one glass. But when it’s empty, they want another. 
• Low mood: When people aren’t drinking, they feel anxious and irritable. 

Is Alcoholism a Chronic Condition? 

Experts consider alcoholism a brain disorder caused by lasting changes caused by drinking. Those brain alterations can perpetuate drinking and make people likely to return to alcohol, even when they don’t want to.[2]

Treatment can help people control their cravings and live with their altered brain cells. With time, people can stop drinking. But the underlying condition will remain, and people must be ready to deal with relapse triggers. 

How Do Doctors Diagnose AUD?

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to assess their patients for alcoholism. 

Testing involves a series of questions. The more times people say “yes” to those questions, the more severe the condition. But agreeing to between two and three of them merits an AUD diagnosis. 

The following questions are part of the diagnosis process. They all begin with the words “In the past year, have you”:[2]

• Ended up drinking more than you intended to?
• Tried to cut back or stop drinking but couldn’t more than once?
• Spent a lot of time drinking or recovering from it?
• Wanted to drink so much that you couldn’t think about anything else?
• Found that alcohol is interfering with your ability to care for your home or perform at work or school?
• Continued to drink even though it causes social trouble?
• Limited time spent on things you felt were important so you could drink?
• Gotten into situations while drinking that increased your chances of getting hurt?
• Continued to drink even though you were depressed or anxious? 
• Had memory loss due to drinking?
• Had to drink more to get the effect you wanted?
• Experienced withdrawal symptoms when your drinks wore off? 

What Is Alcohol Abuse?

Alcohol abuse can look different to different people. But experts say it typically involves binge drinking or heavy drinking.[3]

Binge drinking is defined as consuming the following amounts on a single occasion:[3]

• 4 or more drinks for women 
• 5 or more drinks for men 

Heavy drinking is defined as consuming the following amounts per week:[3]

• 8 or more drinks for women 
• 15 or more drinks for men 

Is Alcohol Abuse a Chronic Condition? 

Experts don’t consider alcohol abuse a chronic condition. Most people who drink to excess are not alcoholics.[3] 

People who abuse alcohol can change their drinking habits for the better and cut back on how much alcohol they consume. The brain changes associated with AUD just haven’t happened yet. 

How Do Doctors Diagnose Alcohol Abuse?

Sometimes doctors use questionnaires to discuss alcohol with their patients. In studies, researchers said close to 3% of doctors held these conversations during routine appointments.[3]

There is no diagnostic questionnaire for alcohol abuse, but doctors might ask their patients how they feel about their drinking. They might also ask if their patients need help in cutting back on drinking. 

Key Differences Between Alcohol Abuse & AUD 

Both alcohol abuse and AUD can be life-threatening. For example, researchers say people who develop alcohol abuse account for the majority of cases of alcohol disability and death.[5] But alcoholism is the more serious of the two conditions. 

AUD is characterized by an uncontrollable urge to drink, accompanied by severe withdrawal symptoms when people try to quit.[6] People who abuse alcohol can opt to change their ways without experiencing severe problems. People with alcoholism can develop withdrawal symptoms, including seizures. They need help to recover. 

When Alcohol Abuse Becomes Alcoholism

People who abuse alcohol can develop alcoholism in time. If they don’t change their drinking habits, brain cells can change enough that they lose control over alcohol altogether. 

Researchers say recurring alcohol exposure can change the structure and function of the brain. Those alterations compromise a person’s ability to control their relationship with drinking. They can’t control when they stop, start, or quit. Those structural changes can persist even when the person stops drinking.[7]

Anyone with alcohol abuse issues should be aware of this progression. Treatment can help you develop new patterns and habits so AUD doesn’t develop. You can stop the problem before it worsens.

Getting Treatment for AUD 

People with AUD can benefit from a comprehensive program that treats the condition with multiple tools. The following three items are typically included in most alcohol rehab programs: 

Talk Therapy 

Counselors can help people understand why they use alcohol and what they can do to stay sober. Two types of counseling are typically used:[8]

• Cognitive behavioral therapy: Counselors help people change their thought patterns and behaviors. By identifying triggers that lead to alcohol abuse, you can spot and deal with them in healthier ways.
• Motivational enhancement therapy: Counselors help participants boost strengths and feel compelled to change. This often motivates behavioral changes that lead to a healthier life without alcohol. 

Sometimes, sessions are held between a counselor and one client. But sometimes, they hold group sessions with many people at once. 

Support Groups 

Alcoholics Anonymous and other support groups bring together people with AUD in a safe space. Learn about what has (and hasn’t) worked for others and lean on them for help when times get tough. 

Medications 

Drugs like acamprosate and disulfiram are approved by the U.S. Food and Drug Administration to help people recover from AUD. They are typically provided in concert with the other tools in rehab programs.[8]