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Many people who consume alcohol regularly secretly wonder if they are an alcoholic. Although many people experience alcohol-related problems or concerns, it doesn’t necessarily mean that they are an alcoholic. Understanding the differences between alcohol abuse and alcoholism requires greater knowledge and discernment.
Unlike alcohol abuse, which is characterized by drinking that causes clinically significant impairment, alcohol dependence, or alcoholism, is a more severe disorder that must meet strict diagnostic criteria. According to the America Psychological Association (APA), alcoholism includes clinically significant impairment in addition to tolerance, withdrawal, and compulsive use. In this respect, it is a separate and distinct entity— one that leads to serious personal and socioeconomic consequences.
Alcohol’s devastating impact on society cannot be understated. The National Institute on Drug Abuse (NIDA) reports that in 2015, approximately 90,000 people died annually from alcohol- related causes. Of the 17 million Americans suffering from an alcohol use disorder (AUD), approximately seven percent received treatment within the past year. In other words, 93 percent of those suffering from clinically significant impairment did not receive professional help.
Other alarming findings include the following:
- According to the National Survey on Drug Use and Health (NSDUH), approximately 90 percent of those surveyed reported drinking at least once in their life. In the same survey, approximately 27 percent engaged in binge drinking within the past month.
- Approximately 625,000 adolescents suffer from AUD, and five percent of youth meet the same diagnostic criteria.
- Alcohol produces an average economic burden of $250 billion annually, with approximately three quarters of that figure related to binge drinking.
- Approximately 5 million people ages 12-20 reported binge drinking within the past month— an increase over previous years.
- Approximately 50 percent of liver disease-related deaths in individuals age 12 and older involved alcohol.
Casual drinking is a socially popular habit that is not problematic for certain people. As a result of genetics, excellent physical health, and a balanced approach to life (or all of these factors combined), they are able to indulge in recreational drinking without crossing the line into excessive and irresponsible behavior. What constitutes normal recreational drinking for certain people may be limited to two or three beers during happy hour on Saturday afternoons, or perhaps a couple of martinis on New Year’s Eve. For others, however, what is perceived as normal is actually immoderate and excessive. Two objective criteria exist that help distinguish between normal and excessive drinking:
- Binge Drinking – This common moniker for consuming excessive quantities of alcohol is defined as drinking five or more alcoholic beverages within two hours. In women, it is defined as drinking four or more beverages within the same period of time.
- Heavy Drinking – This is defined based upon age. For men under 65 years of age, drinking more than four alcoholic beverages in one day is considered heavy drinking or 14 per week. For both men and women 65 years of age or older, heavy drinking is defined as three or more alcoholic beverages per day or more than seven per week.
Once someone transitions from casual and occasional recreational indulgence to regular binge or heavy drinking episodes, they become physically and psychologically dependent on alcohol. In other words, their alcohol use has become a compulsion and no longer a mere urge.
Alcoholics frequently find that they are unable to make it through an entire day without a single drink, and become obsessively preoccupied with alcohol as their primary focus. At this point, brief lapses in between use or total cessation will result in withdrawal symptoms. Even in early stage alcoholics, withdrawal symptoms may be severe and include:
If left untreated, the symptoms of alcohol withdrawal can become debilitating and produce seizures, hallucinations, fever, coma or even death. This contradicts the socially pervasive idea of alcohol as a relatively harmless recreational beverage. It is, in fact, a highly dangerous, excessively abused legal poison.
Additional warning signs can be used to help determine whether someone meets the criteria for alcohol dependence. These include the following:
- Constant cravings for alcohol that interfere with normal functioning
- Loss of interest in social, professional, or recreational activities
- Continued alcohol abuse despite escalating consequences
- A deeply entrenched sense of guilt or shame associated with drinking
- Drinking upon waking first thing in the morning or considering a binge drinking session a meal
- Prioritizing alcohol above major responsibilities (work, family, church or community involvement, etc.)
RISK FACTORS AND SUBTYPES
Research has established a causal link between genetics and alcoholism. In people with strong family histories of alcohol abuse, they may be born genetically predisposed for susceptibility to the disease. Such individuals are more easily triggered by social and environmental triggers than in those without the same genetic wiring. Other people suffer from alcoholism that develops primarily as a result internal and/or external stressors. For example, in people who are employed in highly demanding jobs, suffering from interpersonal relationship problems, or beset by mental or physical health conditions, their risk factor is dramatically increased. A significant percentage of alcoholism is the result of a complex interplay between all of these contributing factors.
Just as there are multiple causes of alcoholism, there are also multiple subtypes of the disorder that are useful for clinical and diagnostic purposes. The following five subtypes are:
- Young Adult Subtype – This category is comprised of young alcoholics who exhibit low rates of family alcoholism or co-occurring mental illness and seldom seek help for their addiction. The “young adult subtype” accounts for approximately 32 percent of alcoholics in the United States.
- Young Antisocial Subtype – This category is comprised of alcoholics in their mid-twenties who display early onset drinking and alcohol problems. Within this subtype, which accounts for 21 percent of US alcoholics, over half come from families with a known history of alcoholism, and approximately half are believed to suffer from antisocial personality disorder (APD). Other mental health issues that commonly appear in this subtype are general anxiety and depression-related disorders, including bipolar disorder, and an unusually high prevalence of co-occurring substance use disorders (SUDs). Approximately one-third seek treatment for their alcoholism.
- Functional Subtype – This category is comprised primarily of middle-aged, well-educated alcoholics with families and jobs/careers. Approximately one-third suffer from family histories of multi-generational alcoholism, approximately one-quarter suffer from co-occurring anxiety and depression-related disorders, and approximately one half are smokers. This subtype accounts for approximately 21 percent of alcoholics in the United States.
- Immediate Family Subtype – This category is comprised primarily of middle-aged alcoholics, approximately 50 percent of whom come from families plagued by multigenerational alcoholism. Approximately half of these individuals suffer from clinically significant depression, and 20 percent suffer from bipolar disorder. Within this subtype, the majority of individuals smoke cigarettes and approximately 20 percent suffer from co-occurring SUDs. The “immediate family subtype” accounts for approximately 20 percent of alcoholics in the United States.
- Chronic Severe Subtype – This minor category is comprised of middle-aged individuals suffering from high rates of early onset alcoholism in addition to a strong family history of multigenerational alcoholism (80 percent). High rates of co-occurring mental health disorders including APD and criminality are also defining factors. Due to the severity of their alcoholism, and the resulting consequences, approximately two-thirds of “chronic severe subtype” alcoholics seek professional treatment. This category represents approximately nine percent of alcoholics in the United States.
For those individuals who may be suffering from an AUD but are not ready to be formally evaluated and diagnosed, understanding these five subtypes can provide an excellent window of insight into the development and progression of their alcoholism. It can also help normalize their experience and alleviate the heavy burden of guilt and shame that often accompany the disease.
Alcoholism requires early intervention and aggressive professional treatment— preferably as soon as possible following an official medical diagnosis. The following treatment options provide a basic guideline:
- Detox – Medical detox is the first critical step necessary in treating alcoholism. Detox programs are medically supervised, short-term, intensive programs designed to help rid the body of the accumulated toxins and stabilize physical and psychological functioning.
- Residential Treatment – Also known as inpatient treatment, this treatment model is based on round-the-clock clinical supervision and medically managed care. It is usually administered on a short-term basis, between 30 and 90 days, and combines medication-assisted treatment (MAT) with ongoing group and individual psychotherapy. Many addiction experts consider residential treatment the premier evidence-based treatment option for alcoholism.
- Partial Hospitalization Program (PHP) – This treatment designation is for individuals currently undergoing medical detox in a hospital setting. Upon successful completion of PHP, they usually transition to residential or outpatient treatment programs.
- Intensive Outpatient Treatment (IOP) – IOP features many of the same benefits and services as residential treatment, only on a non-residential basis.
- Outpatient Treatment (OP) – This treatment option is ideal for those with no remaining physical dependence on alcohol and strong social support systems. Ideally, outpatient treatment represents a final step in a comprehensive alcohol treatment plan that begins with detox, followed by residential treatment. Outpatient treatment may also be an appropriate alternative for those with highly demanding personal or professional schedules.
If you or someone you love is suffering from alcoholism, contact a substance abuse professional today and begin the process of seeking help. Research proves that delaying treatment often leads to suboptimal outcomes and an increased risk of complications. Alcoholism is a chronic, relapsing disease that requires total personal commitment and a strong network of familial, social, and spiritual support in order to battle, and eventually, overcome. It also requires additional steps beyond the successful completion of a medically managed treatment program in order for the long-term benefits to be sustained.
For more about alcoholism and recovery, check out these related articles:
- “10 Signs to Identify a High Functioning Alcoholic and How to Help”
- “What Are the Long-Term Effects of Alcohol on the Heart”
- “How Untreated Drug or Alcohol Addiction Effects Other Health Issues”
- “Motivating Someone to Seek Help for a Drug or Alcohol Problem”
- Centers for Disease Control and Prevention (CDC). Contribution of Excessive Alcohol Consumption to Deaths and Years of Life Lost in the United States. June, 2014.
- Journal of the American College of Cardiology (JACC). Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults. August, 2017.
- The Journal of Pain. Analgesic Effects of Alcohol: A Systematic Review and Meta-Analysis of Controlled Experimental Studies in Healthy Participants. May, 2017.
- The Lancet. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. September, 2018.