Because of its widespread acceptance and availability, the lines between alcohol use, abuse, and dependence can get a little blurry. Sometimes drinkers aren’t sure if they have a problem or not. The tendency to deny substance-related problems makes it even harder to determine whether drinking behaviors are normal or constitute abuse or dependency.

You may go through cycles of more or less alcohol use. Some fluctuation is normal and most people who drink are light to moderate drinkers. It’s when drinking interferes with relationships, jobs, and other areas of life that it becomes a danger to you and those around you.

Do you have arguments while drinking? Are you annoyed when a friend or family member criticizes your drinking? Does alcohol interfere with family, work, or recreational time? Have you ever felt that you need to cut down on your drinking? “Yes” answers to any of these questions suggests that you might have a drinking problem.

Addiction, Dependence, and Abuse Definitions

“Addiction” is a broad term applied to a range of physical and psychological compulsions. It’s commonly used to describe physical dependence on a substance. For the purposes of clarity, this article will adhere to the clinical terms in the diagnostic manual for mental disorders, the DSM-IV-TR: (1) dependence and (2) abuse.

Doctors and counselors use the DSM-IV-R standards to evaluate alcohol dependence and abuse. Both conditions involve patterns of maladaptive behavior that produce unwanted consequences and “clinically significant impairment or distress.” Both dependence and abuse indicate a need for intervention or treatment to prevent further physical, social, or psychological damage.

Alcohol Dependence

Alcohol dependence is a pattern of impairment that often includes cravings or physical symptoms. Sometimes dependence takes the form of increased tolerance, like with “heavyweight” drinkers who can drink a lot without obvious effect. Other times, withdrawal symptoms such as hangovers or cravings occur when alcohol leaves a person’s system. Yet behavioral or psychological dependence can occur even without physical tolerance or withdrawal symptoms.

The DSM-IV-TR defines alcohol dependence as the presence of three or more of the following factors within a one-year period:

1. Tolerance (the same amount of alcohol produces less effect than in the past)
2. Withdrawal (physical and psychological symptoms that occur when alcohol leaves the system)
3. Drinking more or for longer periods of time than one intends
4. Unmet desire or intention to control or cut down on drinking
5. Significant time spent obtaining, using, or recovering from the substance (including special trips to get alcohol, hangovers)
6. Less frequent involvement in or elimination of job, family, and social activities because of drinking
7. Continued use despite physical or psychological problems that result

Alcohol Abuse

The term “abuse” applies when someone doesn’t meet the above criteria but when alcohol use repeatedly results in one or more of the following within a one year period:

1. Inability to meet obligations at school, work, or home (absences, impaired performance, reprimands, neglecting child care responsibilities)
2. Drinking when it is physically hazardous (such as while driving)
3. Alcohol-related legal / law enforcement problems
4. Continued use despite social or relationship problems (arguments, withdrawing from friends)

Evaluating Risk for Alcohol Abuse or Dependence

If you recognize these behaviors in yourself, you may be at risk for alcohol abuse or dependence. The World Health Organization developed a brief screening test called the AUDIT (Alcohol Use Disorders Identification Test, link below) to evaluate your risk for alcohol abuse or dependence. While the AUDIT is a suitable screening tool, the most reliable way to determine your risk is to request a clinical evaluation from your counselor or health care provider.

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Source: American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author