It can be difficult to differentiate between social alcohol
use and alcoholism without fully understanding the specific behaviors that
delineate a diagnosable drinking disorder. The Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) outlines the different mental health
diagnoses that determine problematic alcohol and addiction. Understanding these
disorders can help you recognize any maladaptive drinking patterns in your
life, or the life of someone you love.
Alcohol Dependence:
Alcohol dependence is the ongoing use of alcohol despite it
causing repeated distress in the drinker’s life. It is the official diagnosis
given to an alcoholic, or someone suffering from alcoholism. Dependence,
according to the DSM-IV, is marked by 3 or more of the following 7 symptoms in
one 12-month timeframe:
- The need for greater amounts of alcohol to become intoxicated, or consuming the same amount of alcohol with less side effects than previously experienced. This criterion essentially refers to one’s tolerance, but does not mandate that a high tolerance positively correlates with alcohol dependence. It is instead important to focus on how a person’s tolerance has changed.For example, someone who used to feel drunk after drinking four beers and now needs eight or ten to achieve that same level of intoxication is likely consuming a more excessive amount of alcohol than he or she once was. The same is true of a person who used to feel inebriated after four drinks, and now does not experience any side effects of alcohol when consuming those same four beverages.
- Experiencing withdrawal symptoms or needing to continue consuming alcohol to avoid feeling withdrawal symptoms. Have you ever had uneasy hand tremors after abstaining from otherwise heavy drinking behavior? Does your significant other have difficulty sleeping when they don’t drink, or vomit repeatedly after a night of indulgence? These are just a small handful of examples that could indicate alcohol withdrawal.
- Drinking larger amounts of alcohol or drinking the same amount over a longer period than originally intended. This measure refers to the concept of drinking through the night despite the party being long over or consuming an excessive amount of alcohol in one sitting. Do you find yourself regularly finishing a full bottle of wine with dinner, or drinking a 12-pack of beer more nights than not? If so, it may be an indication of alcohol dependence.
- A persistent desire or unsuccessful efforts to diminish alcohol use. This speaks to the cliché of “I’m not addicted because I can quit anytime I want.” Are you sure that you can? Is it possible to spend two weeks without drinking alcohol? Have you told yourself you won’t drink one weekend but then found that an occasion or stressor arises that you just can’t go through without a drink? These are questions to keep in mind when considering one’s dependence on alcohol.
- Drinking has caused a reduction or total cease of social, occupational or recreational activities. Repeatedly calling out of work because you’re hung over or still drinking, avoiding socializing with friends to drink, and missing family engagements due to alcohol use are just three scenarios that fall under this criterion.
- A great deal of time is spent obtaining, using, or recovering from the effects of drinking. Basically, how much of your life is consumed by drinking? Taking an hour drive to get to an open liquor store, spending several hours of the day and several days a week drinking, or spending excessive hours or days feeling hung over are some behaviors often displayed by alcoholics.
- Continued alcohol consumption, despite having a persistent or recurrent physical or psychological problem that is likely to be caused or worsened by drinking. Drinking when you have an ulcer, cirrhosis of the liver, or other mental or physical ailment that is negatively effected by alcohol suggests that consuming this substance is more important than your own well-being. Prioritizing alcohol over personal health is a common indicator of alcohol dependence.
When considering whether you or someone you love suffers
from alcohol dependence, test yourself with the above criteria and see if these
symptoms are exhibited.
Alcohol Abuse:
If someone is displaying problematic behavior due to their
alcohol use but has never met the criteria for alcohol dependence, it is
possible that they are suffering from alcohol abuse. Alcohol abuse is defined
in the DSM-IV as drinking patterns that cause significant impairment in the
user’s life and is diagnosed based on the occurrence of one of the following
four symptoms in a 12-month period:
Failing to fulfill major obligations at work, school, or
home due to recurrent alcohol use
Essentially, how is drinking alcohol negatively impacting
the user’s life? Repeated absences from work or school and/or performing poorly
when there, and neglecting household chores or family members due to alcohol
use are prime examples to consider regarding this criterion.
Recurrent alcohol use in situations in which it is
physically hazardous
If, for example, you are driving or using heavy machinery
while under the influence of alcohol, you suffer from alcohol abuse.
Recurrent alcohol-related legal problems
Getting arrested for drunk driving, receiving police
citations for alcohol-related conduct or getting arrested while under the
influence of alcohol are examples of legal problems related to alcohol abuse.
Continued drinking despite having recurrent social or
interpersonal problems caused or worsened by alcohol
Consider if your alcohol use is having a negative effect on
your relationships. This may include fighting with a significant other, arguing
with friends, and getting into altercations with people while under the
influence of alcohol, or relating to alcohol.
It is important to note that when any of the above symptoms
are also experienced with changes in tolerance, withdrawal, or compulsive
efforts to obtain alcohol, the person is suffering from alcohol dependence and
not alcohol abuse.
Alcohol-Induced Disorders:
There are several other DSM-IV disorders that don’t meet the
criteria for abuse or dependence, but certainly indicate overuse of alcohol and
often go hand-in-hand with the above diseases.
Alcohol withdrawal occurs within several hours or days after
a reduction of drinking heavily or drinking for a prolonged time. According to
the DSM-IV, withdrawal is marked by two or more physical symptoms, including
autonomic hyperactivity (e.g., sweating or pulse rate greater than 100),
increased hand tremors, insomnia, nausea or vomiting, transient visual,
tactile, or auditory hallucinations or illusions, psychomotor agitation,
anxiety, seizures.
There are several diagnoses categorized under
“alcohol-induced…,” which essentially refers to mental health disorders that
have been caused by alcohol use. Examples of these include alcohol-induced
psychotic disorder, alcohol-induced anxiety disorder, and alcohol-induced
dementia.
Drinking is such a subjective experience because each drink
affects each body differently so with the most basic of terminology, the Center
for Disease Control and Prevention (CDC) defines binge drinking as consuming
enough alcohol to bring the blood alcohol concentration (BAC) level to 0.08% or
more. This number typically correlates to 5 or more drinks for men or 4 or more
drinks for women, generally within about 2 hours.
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