When it comes to alcohol-related conditions and disorders, various terms get thrown around and often used interchangeably. There seems to be much confusion about the difference between alcohol abuse and alcohol dependence in particular. Part of the reason for this is that they were once officially classified by the American Psychiatric Association (APA) as separate disorders, but have recently been integrated, reclassified, and renamed.

In 2013, the APA made some changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).  In the fourth edition (DSM-IV), alcohol abuse and alcohol dependence were considered two different conditions. In the fifth edition, however, they were combined into a single disorder measured on a continuum from mild to severe. The term “alcohol use disorder” now refers to the pattern of alcohol use that results in problems with alcohol.

Despite these official changes in the DSM-V, the terms “alcohol abuse” and “alcohol dependence” are still widely used today, so it’s important to understand they mean. Take a look below for information about the difference between the two.

What is Alcohol Abuse?

Alcohol abuse refers to a pattern of drinking alcohol that does not stop despite negative results. It is also considered an early stage of alcohol dependence. According to the DSM-IV, alcohol abuse was diagnosed when one or more of the following criteria were met in a 12-month period.

Criteria for Alcohol Abuse

• Drinking or being sick from drinking interferes with daily life or causes trouble with work, school, or family

• Engaging in risky behavior while or after drinking, including:

  • Driving

  • Using machinery

  • Swimming

  • Unsafe sex

  • Other dangerous activities

• Continued drinking despite resulting relationship difficulties with family or friends

• Experiencing repeated legal problems from drinking

  • Arrests

  • Held at the police station

  • Other legal problems

What is Alcohol Dependence?

Alcohol dependence refers to the physical and psychological dependence on alcohol.  According to the DSM-IV, anyone meeting three or more of the following criteria in a 12-month period was diagnosed with alcohol dependence.

Criteria of Alcohol Dependence

• Increased alcohol tolerance (needing to drink more to get the desired effects or less effective with the same amount)

• Drinking more or longer than intended

• Persistent desire or unsuccessful efforts to cut back or stop drinking

• Experiencing withdrawal symptoms when effects wear off, including:

  • Difficulty sleeping

  • Shakiness

  • Restlessness

  • Nausea

  • Sweating

  • Racing heart

  • Seizures

  • Hallucination

• Spending a lot of time thinking about drinking, drinking, or recovering from the effects of drinking.

• Giving up social, occupational, or recreational activities in order to drink

• Continuing to drink despite psychological problems such as depression, anxiety, or despite physical health problems

Alcohol Use Disorder

As mentioned above, DSM-V integrated alcohol abuse and alcohol dependence into a single disorder, which is now referred to as alcohol use disorder. The criteria for each of the previous diagnoses have been combined into one list of 11 items (with a couple of changes). The changes include:

• Elimination of legal problems as a criteria

• Addition of craving as a criteria

Alcohol use disorder is diagnosed when 2 of the 11 criteria are met during the same 12-month period. The disorder is considered:

• Mild with 2 to 3 symptoms present

• Moderate with 4 to 5 symptoms present

• Severe with 6 or more symptoms present

Help is available for alcohol issues with addiction clincial trials

There is nothing inherently wrong with alcohol, but if you find that you’re having trouble drinking a moderate amount, or that you’re relying on alcohol to have a good time in social situations, then you may be at risk for alcohol abuse or alcohol dependence.  It is possible to live an alcohol-free life, and there is an abundance of resources available to help you achieve a healthy, sober lifestyle. If you or someone you love is struggling with alcohol, reach out and ask for help today. Give us a call at (858) 784-7867.