Alcoholic vs Alcohol Abuser
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| Wed, 03-08-2006 - 7:36pm |
Alcoholism & Alcohol Abuse
by Peggy Elam, PhD

What is the difference between being an alcoholic and an alcohol abuser? Is the latter a "functioning alcoholic?" Do they both need the same kind of treatment?
-- J.

Technically, the difference between an alcoholic and an alcohol abuser is the difference between alcohol DEPENDENCE and alcohol ABUSE. Alcohol dependence (or alcoholism) is a more severe problem than alcohol abuse. However, alcohol abuse is also unhealthy, and it can develop into alcohol dependence.
The essential feature of both alcohol dependence and alcohol abuse is continued drinking despite significant alcohol-related problems. In alcoholics, the drinking pattern may include tolerance (the need for greatly increased amounts of alcohol to become intoxicated or to achieve the desired effect, or markedly diminished effects with continued use of the same amount of alcohol) and withdrawal (physiological, behavioral and cognitive changes that occur when the body levels of alcohol decline in someone who has maintained prolonged heavy drinking). Alcohol-dependent individuals will often drink to relieve or avoid withdrawal symptoms.
You don't have to demonstrate alcohol tolerance or withdrawal to meet diagnostic criteria for alcohol dependence -- although if you demonstrate both tolerance and withdrawal, you've got two of the three criteria required for a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (or DSM-IV), the "bible" of psychiatric diagnosis. An individual can be diagnosed as alcohol dependent if he or she demonstrates any three of the following (or one of the following if both tolerance and withdrawal are present):
-- He or she drinks in larger amounts or over a longer period than he or she planned.
-- He or she expresses a desire to cut down or control drinking, and has tried unsuccessfully to do so.
-- He or she spends a great deal of time obtaining alcohol, drinking or recovering from the effects of drinking.
-- He or she reduces or completely gives up important work or social activities because of alcohol use.
-- He or she continues to drink despite recognizing that drinking causes or worsens physical and/or psychological problems.
Alcohol abuse, in contrast, is characterized by a problematic pattern of drinking in which drinking causes recurrent and significant adverse consequences. Those consequences may include:
-- failure to fulfill major responsibilities such as work, school or domestic tasks
-- recurrent drinking in hazardous situations (such as while driving)
-- recurrent drinking-related legal problems (such as arrests for disorderly conduct while drinking)
-- continued drinking despite persistent or recurrent social or interpersonal problems caused or worsened by drinking (such as fights or marital arguments)
Perspectives on the appropriate treatment for alcoholics and alcohol abusers vary. The majority opinion is that alcoholics should stop drinking altogether, through addiction treatment programs or community support groups such as Alcoholics Anonymous or Rational Recovery. I suspect most mental health professionals would also recommend that an alcohol abuser with a family history of alcoholism stop drinking altogether, to avoid developing alcohol dependence.
Some psychologists, however, believe that alcohol abusers or "problem drinkers" can learn to modify their drinking to healthy levels, a process called "controlled drinking." Thus, they provide counseling and education to teach alcohol abusers skills to lessen their drinking and prevent adverse consequences. There is some controversy about controlled drinking, however, with many mental health professionals believing it may feed into the typical abuser's denial of having a real problem. 
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I am an alcohol abuser who is now moderating with pretty good success. Certainly I don't "abuse" like I used to. But I have a question. If alcohol abuse can develop into alcohol dependence, can alcohol dependence ever revert back to alcohol abuse then can the abuse be moderated, like in my case?
I don't know if I'm being clear. I'll make up a scenario. I abuse alcohol but have learned to moderate. What if I didn't learn to moderate and became alcohol dependent? Is there ever a chance that I would go back to being able to moderate? Or would my body's chemistry be changed forever? Or if I abstained for however long to get rid of the dependence could I go back to moderating?
So, once an alcoholic ALWAYS an alcoholic? Or can an alcoholic learn moderation. And once you have abstained, are you still alcohol dependent? And if you are no longer alcohol dependent, are you still labled an alcoholic?
Dr. Elam's Q&A confused me...lol.
Lucky
Hi Everyone,
This might be less confusing. While I appreciate Dr. Elam's erudite essay when we get right down to it alcoholic or alcohol abuser the bottom line is we are both drunks no matter what the psycho-babble labels us. Until we quit we are both drunks plain and simple.
Service in recovery,
Paul
Castaway
A Friend in Recovery
Paul
Well said Paul,
I agree these articles and numerous survery's can be confusing. Basically if alcohol is causing problems in someone's life then they have a problem. And these are problems beyond the yearly hangover after a big party. The thing that always made it make sense to me is that if you are thinking you have a problem or think about when you will drink/get alcohol etc......then you have a problem. People who do not have problems with alcohol do not consume their time thinking about it. They can take it or leave it. I too have taken evaluation tests or read articles or stories of others and have tried to rationalize my drinking behaviors....to make my behaviors seem normal etc, and to many they could be considered normal, but I do know that I have a problem with alcohol and that is why I come here. I too, don't ever want to think that I will never drink again, but most people do stop one day at a time and then those days add up. That is what I hope to see in my future.
just my 2 cents, Tracy
Quit getting drunk or quit drinking alcohol altogether? Certainly a person who was once a drunk and now moderates does not need to quit drinking altogether. Do you agree?
Lucky
Alcohol Dependance......."-- He or she drinks in larger amounts or over a longer period than he or she planned.
-- He or she expresses a desire to cut down or control drinking, and has tried unsuccessfully to do so."
This is actually addressed to Lucky, and I soooooo admire you trying to moderate, but I would like for you to keep in mind that you have come here several times to talk about your issues with abstaining and moderating. (Which I have applauded and responded to) And just ask me, I know every excuse in the book, but I could never moderate. 2-3 drinks at a time, 3 days a week I thought it was. 2-3 drinks...that is an appetizer for me! Still to this day I try to make excuses when I see people buying alcohol or consuming it on a "weekday" and I think they can, why can't I? Share with us Lucky because you have a lot of support here. Please post, we want to see how you are feeling. Tracy
HI Lucky,
Sure I agree with that statement. I, also, know this, that I attempted to moderate more times than I care to remember and until I quit I was getting sicker everday. Many folks have died attempting to moderate. Is it really worth that risk, to you? I think life is precious, a gift, and that it is the right thing to do treat our bodies, spirit and mind as my Creator intended. We'll all perish soon enough. Why rush it? I'm having too much fun.
Service in recovery,
Paul
Castaway
A Friend in Recovery
Paul
Tracy, You said it so well - if alcohol is causing problems, or if one spends his or her time trying to control alcohol, then it is already controlling the alcohol abuser/user/alcoholic!
Another wise person compared alcoholism to going from a cucumber to a pickle - once a pickle, always a pickle! There's no going back.
And yes, we stay sober one day at a time - you are right! Those days really begin to add up!
Well said, Tracy!
Leslie
POSSIBLE TRIGGER POST!!
Thank you, Tracy. I am very proud of myself right now. I have tried moderating in the past but withOUT a support network. Once I found out that there were others who successfully moderated (plus I was having health issues due to drinking) moderation this time around has been easier.
When I would read about AA they talked a lot about having tried moderating and failed. And I think a lot of AA'ers see my moderation as denile of a bigger problem (I read a post sarcastically wishing me luck).
Here's my real problem. I never took notice of my consumption before. Now I AM obsessed with it. I DO plan my drinking days and abstaining days. I DO think about where my next drink is coming from and how good it will taste. I am no longer just relaxed about pouring and drinking. But the difference here is that I am controlling my alcohol consumption. Alcohol is NOT controlling me.
I will keep posting here. And not just to keep saying, "Ha, look at me!" but also to say, "See, it's hard but I am trying."
Last week was the worst I've managed since the beginning of Feb. BUT, I've only been doing this since FEB! Practice, fail, practice, fail. It's how I learn.
Lucky
ANOTHER POSSIBLE TRIGGER POST!!!!!!!!!!!!!!!!!!!!
Paul, I understand that you have probably seen more than your fair share of failure stories. I hope (and at this point am 100% sure) that I am not one of them.
Yes, it is worth it to me to learn to moderate. If not just to show myself that I am strong and able to accomplish anything, but to have a relationship with a substance that DOES have health, social and personal benefits if taken in moderation. I love wine, liquor and beer. I love the festivities surrounding it. It's part of my life more than you can imagine. I won't part with alcohol but I WILL (and am succeeding at) moderate my behavior if it takes my entire life to learn how. It's not a painful journey for me. It's hopeful.
Lucky
HI Lucky,
I don't know what "ANOTHER POSSIBLE TRIGGER MEANS" but I want to extend my best wishes and goodluck to you, Lucky, on you quest. My efforts here are to attempt to help others by sharing my strength, hope and experience and thereby helping myself as well. Let us know how your doing and if we can be of any assistance. Thanks for sharing.
Service in recovery,
Paul
Castaway
A Friend in Recovery
Paul
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