Alcohol Abuse and Alcoholism:

When does drinking become problem drinking?

Alcohol abusers, or problem drinkers, are people who clearly drink too much on a regular basis. Their alcohol use is self-destructive or can present a danger to others, but they are able to set limits and establish some measure of control over their drinking.

When alcohol abuse progresses to alcoholism, also called alcohol addiction and alcohol dependence, the drinker loses control of the amount they drink, and they cannot stop using alcohol despite the severe physical and psychological consequences of excessive drinking.

Signs and symptoms: alcohol abuse vs. alcohol dependence

Alcohol ABUSE:  How can I tell if I have a problem with alcohol?

Some of the common symptoms of alcohol abuse include the following:

Signs and symptoms of alcohol ABUSE
Health	Continuing to drink even though you have health problems that are affected or caused by your drinking
Financial issues	Paying bills late; collection agencies calling Inability to keep track of your money
Legal issues	Driving while under the influence (DUI)
Risky behavior	Putting yourself or others in danger
Employment or school	Continuing to drink even though you realize your job or education is in jeopardy Missing work or school, or going in late due to alcohol use
Family and friends	Feeling annoyed when other people comment on, or criticize your drinking habits Feeling remorse or guilt after drinking Associating with questionable acquaintances or frequenting out of the ordinary locations when drinking
Social life	Scheduling your day around drinking Focusing recreational activities around obtaining alcohol, drinking or recovering from alcohol use    Drinking alone or in secret

Alcohol DEPENDENCE:  How serious is my drinking?

When does alcohol abuse become alcohol dependence?

Many of the signs and symptoms of alcohol abuse overlap with the signs and symptoms of alcohol dependency. There is a fine line between the two, but the crossover occurs when the person becomes  dependent on alcohol. An alcoholic is unable to control their drinking, they have built up a tolerance to alcohol which over time requires them to drink larger quantities of alcohol in order to obtain the same effect, and they will usually experience withdrawal symptoms when they don't drink.

Signs and symptoms of alcohol DEPENDENCE
Cravings	Strong and overwhelming desire to drink alcohol at a specific time or the next morning Creating a ritual of having drinks before, with, or after dinner, and becoming annoyed when this pattern is disturbed or questioned
Tolerance	A tendency to drink more than intended to feel the same effect, or being unable to stop drinking once you start to drink alcohol Consuming a large quantity of alcohol without appearing intoxicated
Effects on memory and motivation	Not remembering conversations or commitments; sometimes referred to as a "blackout" Losing interest in activities and hobbies that were once pleasurable

Effects of alcohol abuse and addiction

Health and behavior effects of alcohol abuse

Short-term alcohol use can have these effects depending on the quantity of alcohol you consume: 

• Loss of inhibition and  impaired judgment
• Dizziness,  blurred vision and slurred speech
• Uncoordinated movements and increased reaction time
• Unconsciousness and even death

Long-term alcohol use can cause serious health complications which can affect virtually every organ in your body. The Australian Northern Territory government site provides a comprehensive graphic representation of the long-term effects of the use of alcohol on your body. (Scroll down to see the diagram.)

Social effects of alcohol abuse

Alcohol abuse and alcohol addiction have a major impact on society. The effect is seen in decreased job productivity and attendance; increased healthcare costs; and frequently plays a part in the escalation of situations involving domestic violence and violent crimes.

U.S. alcohol-related deaths reported in 2006:

• Automobile fatalities: 41%
• Teenage deaths: 25% of all automobile fatalities 
• Homicides: 31%
• Boating accidents: 20%

Alcohol screening questions: abuse vs. dependence

Alcohol abusers, or problem drinkers, are people who clearly drink too much on a regular basis and whose alcohol use is self-destructive or can present a danger to others, but they still demonstrate the ability to set limits and establish some measure of control over their drinking.

Alcohol ABUSE screening questions
Would you answer yes to one or more of the following during the past 12 months?
Have you, more than once, driven a vehicle while you were drinking, or after having had too much to drink? Have you gotten into situations while drinking, or after drinking, that increased your chances of getting hurt—like swimming, using machinery, walking in a dangerous area, or near heavy traffic? Have you continued to drink even though you knew it was causing you trouble with your family or friends? Have you gotten into physical fights while drinking, or right after drinking? Have you had a period when your drinking—or being sick from drinking—often interfered with taking care of your home or family, or caused job or school problems? Have you gotten arrested, been held at a police station, or had any other legal problems because of your drinking?

When alcohol abuse progresses to alcoholism, also called alcohol addiction or alcohol dependence, the drinker loses control of the amount they drink and cannot stop using alcohol despite the severe physical and psychological consequences of excessive drinking.

Alcohol DEPENDENCE screening questions
Adapted from: National Institute on Alcohol Abuse and Alcoholism
Would you answer yes to three or more of the following during the past 12 months?
Have you had times when you ended up drinking more than you meant to, or kept on drinking for longer than you intended? Have you, more than once, wanted to, or tried to stop or cut down on your drinking but found you couldn’t? Have you found that you have to drink much more than you once did to get the effect you want, or that your usual number of drinks has much less effect on you than it once did? When the effects of alcohol are wearing off, have you had trouble sleeping, or experienced physical symptoms such as shaking, feeling nervous, nauseous, restless, sweating or rapid heartbeat? Have you sensed things that aren’t really there, felt bugs crawling on your skin, or had seizures? Have you taken a drink or used any drug or medicine (other than over-the-counter pain relievers) to avoid having bad after-effects of drinking, or to get over an after-effect of alcohol use, or hangover? Have you continued to drink even though you knew it was making you feel depressed or anxious, causing a health problem or making one worse, or has caused a blackout?  Have you had a period when you spent a lot of time drinking, being sick, or getting over the negative after-effects of drinking? In order to drink, have you given up, or cut down on activities that were important to you, interesting or pleasurable?

I realize I have a problem, what do I do now?

Related links for alcohol abuse and alcoholism

General information about alcohol abuse and alcoholism

National Institute on Alcohol Abuse and Alcoholism - Defines moderate drinking and drinking levels (NIAAA).

Alcoholism  – Differentiates alcohol abuse from alcohol dependence, identifies signs and symptoms of a  drinking problem, and lists causal factors for, and effects of alcohol abuse. (Mayo Clinic)

Alcohol Dependence (Alcoholism) – Detailed list of signs and symptoms of alcohol dependence. (University of Michigan)

Screening for alcohol abuse and alcoholism

Alcoholism: Screening and Diagnosis – General information on the types of screening tests for alcohol abuse and alcohol dependence. (Mayo Clinic)

 “How much is too much?” – Quick, handy screening test for excessive alcohol use. (Boston University School of Public Health)

Social use, abuse, and addiction – Differentiates between social alcohol use, alcohol abuse, and alcohol dependence. (Alcoholanddrugabuse.com)

Effects of alcohol abuse and alcoholism

Diagram of damage to the human body after long-term alcohol use – Scroll down to diagram of the body identifying how long-term use of alcohol affects your body. (Northern Territory Government Dept. of Health & Community Services)

Alcohol-related fatality statistics - Statistics of alcohol-related deaths in 2006. (AlcoholStats.com)  

Deborah Cutter, Psy.D., and Robert Segal, M.A., contributed to this article. Last modified on: 1/30/08.