The Difference Between Alcohol Abuse and Alcohol Dependence

The Difference Between Alcohol Abuse and Alcohol Dependence

When discussing alcohol-linked disorders and conditions, a wide range of terms often get thrown around to the point that they’re being used interchangeably. In particular, people are confused when it comes to knowing the difference between alcohol dependence and alcohol abuse. One of the reasons for this is because both of them were once classified as separate disorders by the American Psychiatric Association (or APA) even though they’re more correlated or interrelated than previously believed. Since then, they’ve been renamed, reclassified, and integrated into one another, but not necessarily in that order.

Changes in The 5th Edition of the DSM

In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-V, the APA made some changes back in 2013. This is because the 4th edition of the DSM or DSM-IV considered alcohol dependence and alcohol abuse to be conditions that are separate or mutually exclusive from one another. However, in DSM-V, they were combined into a single disorder known as “alcohol use disorder”. It’s measured as mild to severe on a continuum.

This term eventually went on to refer to the pattern of alcohol use and abuse that result in alcohol problems such as addiction.

  • Alcohol Use and Alcohol Dependence: Despite the DSM-V officially referring to “alcohol abuse” and “alcohol dependence” as one disorder named “alcohol use disorder”, the two terms remain in wide use at present. Therefore, it’s important to understand what they mean and what they’re differences are to gain a better appreciation of the terms and to understand what people wish to convey when using such words. Keep on reading to find out what they’re supposed to represent.
  • What Is Alcohol Abuse? Alcohol abuse is an alcohol drinking pattern that doesn’t stop despite negative consequences. So it’s a mix between addiction and the behavior that an burgeoning addict engages in. Suffering from alcohol abuse is also considered the earliest stage of being alcohol dependent. According to the DSM-IV, you can get an alcohol abuse diagnosis if one or more criteria are met over a period of 1 year or 12 months. This criteria include risky behavior while or after drinking, such as:
    • Arrests
    • Driving
    • Unsafe sex
    • Swimming
    • Using machinery
    • Other legal problems
    • Held at the police station
    • Other dangerous activities
    • Experiencing repeated legal issues from drinking
    • Continued drinking despite resulting relationship difficulties with family or friends
    • Drinking or being sick from drinking, such that it interferes with your daily life or causes your trouble with family, work, or school
  • What is Alcohol Dependence? Alcohol dependence happens whenever someone has a psychological and physical dependence to alcohol. The DSM-IV describes it as anyone meeting the criteria outlined below over a year’s period or a 12-month period. If you suffer from the following in that time period, then the diagnosis for that is alcohol dependence.
    • Increased tolerance to alcohol
    • Drinking longer or more than you intend
    • Unsuccessful efforts to stop or cut back from drinking despite your persistent desire to do so
    • You need to drink more to get the desired effects because drinking the same amount is less effective than before
    • Drinking or being sick from drinking, which causes interference with your work, school, or family life on a daily basis

You can also end up experiencing withdrawal symptoms when effects wear off, which includes the following.

    • Nausea
    • Seizures
    • Sweating
    • Shakiness
    • Restlessness
    • Racing heart
    • Hallucination
    • Difficulty sleeping
    • Giving up recreational, occupational, or social activities in favor of drinking
    • Spending a lot of time thinking about drinking, drinking, or recovering from the effects of drinking
    • Continuing to drink despite psychological problems such as depression and anxiety or in spite of physical health problems
  • What Is Alcohol Use Disorder? According to the DSM-V, the concepts of alcohol abuse and alcohol dependence have been combined into a single disorder in order to simplify everything. Alcohol abuse disorder covers both alcohol abuse behavior that can lead to alcohol dependence and alcohol dependence itself. The criteria for both conditions have been combined into one list, with a couple of changes included. These changes involve some removals of criteria.
    • Cravings have been included as criterion
    • Legal problems have been removed as a criterion

The 11 items include the following.

    • Tolerance
    • Withdrawal symptoms
    • Cravings for alcohol use
    • Recurring alcohol use during hazardous situations like drunk driving
    • Recurring alcohol use, leading to failure to fulfill obligations at home, work, or school
    • You spend a significant amount of time recovering from, using, and obtaining alcohol
    • Missing or giving up on recreational, occupational, or social activities because of alcohol use
    • Alcohol is consumed in increasing amounts or over a longer period of time than one intends
    • Recurring alcohol use despite having recurring or persistent problems socially or interpersonally caused by alcohol use
    • Unsuccessful attempts to stop, control, or cut down your alcohol use despite your persistent desire to do so
    • Recurring alcohol use, despite suffering from psychological or physical problems caused by or worsened by alcohol use that persist or recur

Alcohol use disorder is considered as part of the diagnosis when 2 of the 11 criteria are met during a year’s period or a 12-month period.

    • Mild: If you’re suffering from 2-4 symptoms.
    • Moderate: If you’re suffering from 4-6 symptoms.
    • Severe: If you’re suffering from 6 or more symptoms or even all 11 symptoms.

More about Alcohol Abuse


A person suffering from alcohol abuse will tend to drink alcohol despite having issues with it stemming from or worsened by drinking. For example, if you were abusing alcohol, you could face problems with the law, like drunk driving or driving under the influence as well as drinking in public places or open container laws regulating or prohibiting drinking in certain areas such as in vehicles, parks, and sidewalks. You can also qualify for alcohol abuse if you were to repeatedly drink in situations where it’s dangerous to drink, like when driving a car or operating heavy machinery. Recurring alcohol consumption can also lead you to not fulfilling major responsibilities at home, school, or work.

Alcohol abuse criteria are loose and liberal on purpose for the sake of identifying the people whose alcohol use has led to negative consequences. There are four major categories of alcohol abuse. Nevertheless, there are a myriad of methods or ways for these categories to link or relate to actual life experience. More to the point, someone who gets drunk on weekends then drives home while intoxicated can be considered a sufferer or alcohol abuse, and the same goes with a person who’s always drunk then argues with his partner. This is also the case with anyone who comes to work or school always late as a result of drinking alcohol. The number of ways that one can become an alcohol abuser is unlimited in terms of potential.

More about Alcohol Addiction

Alcohol addiction, also known as alcohol dependence by the DSM and alcoholism, is likely to have an abuse issue. All the same, people who meet alcohol abuse diagnostic criteria won’t necessarily qualify for an alcohol dependence or addiction diagnosis. For most cases, it’s not out of the realm of possibility to state that the road to alcohol dependence is paved with alcohol abuse. An alcohol abuser might end up graduating to alcoholism given enough time or alcohol consumed, even if the alcohol abuse disorder itself hasn’t been properly put in as a diagnosis.

  • Tolerance of Alcohol: An alcohol dependent can display the following issues within a year in order to get the diagnosis of alcohol dependence. First off, he should be tolerant of alcohol, such that as time passes by he needs to drink more alcohol in order to get the desired effects or to become intoxicated in the first place because his limit from the past has decreased potency to him now.
  • Withdrawal and Consumption: He should also suffer from withdrawal syndrome or symptoms that can only be sated by drinking alcohol or drinking some other similar substance. He might also end up consuming alcohol in bigger amounts to the point of binge drinking for long time periods than what he might intend in order to chase the high or intoxication he used to experience with fewer amount of alcohol. In other words, he might not only have two drinks but a whole bottle of alcohol instead.
  • Giving Up on Life: His quality of life might suffer as his dependence or addiction to alcohol becomes worse and worse. He might abandon or reduce his time on activities that used to be important to him like work, social life, or leisure time. This is particularly ironic since many people end up becoming alcohol abusers or alcoholics exactly because they suffered peer pressure to drink with friends or to drink socially in order to better fit in with their peer group.
  • Alcohol Obsession: You might be an alcoholic or alcohol dependent if spend all your time using alcohol, obtaining alcohol, or recovering from alcohol. This is also the case if you continue to drink alcohol despite knowing or realizing that you’re facing huge consequences from doing so. It’s ruining your life already but you can’t help but drink all the same because you’re now addicted to it. You’re now on a downward spiral worsened by your own inability to control yourself and your alcohol consumption.

What about Heavy Drinking or Binge Drinking?


Heavy drinking is described by the National Institute on Alcohol Abuse and Alcoholism as having five (5) or more drinks in one sitting or on the same occasion for five (5) different days in a period of 30 days or a month. Although drinking that much increases your risk for alcohol abuse, unless the criteria above are also met then heavy drinking on its own won’t result in an alcohol abuse or alcohol dependence diagnosis. This is because there are some heavy drinkers who can hold their liquor well and can avoid the downsides of drinking so much that can lead to abuse, dependence, or alcohol use disorder.

Meanwhile, the National Institute of Alcohol Abuse and Alcoholism defines binge drinking as using an amount of alcohol in a 2-hour period that raises your blood alcohol levels to 0.08 percent. So you could drink about five or more drinks in two hours and get to that level if you’re a man or four or more drinks if you’re a woman. Again, someone who’s binge drinking won’t necessarily be considered an alcohol abuser unless he also becomes so intoxicated that he consequently faces problems with the law or fails in fulfilling major responsibilities in his work, school, or family within a given year.

These criteria exist in order to separate those who can handle their liquor despite how much they consume it from those who can’t. However, as a rule of thumb, those who binge drink or heavily drink tend to end up becoming alcohol abusers, dependents, or sufferers of alcohol use disorder.

Substance Dependence versus Substance Use Disorder

Even though terms like substance addiction, substance dependence, and substance abuse aren’t formally used in the DSM-V, they’re frequently still utilized by mental health professionals as shorthand for the official terms when they’re treating various forms of issues involving abuse or dependence. This is what makes disambiguating addiction and abuse such a sticky situation, with the DSM revising whether dependence or abuse over alcohol should be considered mutually exclusive terms or correlated terms referring to one disorder.

  • DSM Terminologies: Back in 1994, the term addiction was eliminated from diagnostic terminology with the release of the DSM-IV on the same year. In the year 2000, the DSM-IV-TR didn’t revise any diagnostic criteria at all, but the descriptive material in the text was updated all the same to be less ambiguous and more specific. This was the text adopted for DSM-related literature until the release of DSM-V in 2014. The entire scheme for alcoholism and alcohol addiction diagnosis was changed and reworked in DSM-V.
  • Interchangeable Terms: Terms such as substance use disorder or alcohol use disorder, dependence, and addiction are all used in an interchangeable manner for simplicity’s sake. Although a number of people still use the terms alcohol addiction and alcohol abuse interchangeably, they’re two different syndromes according to the DSM-IV and are covered by the umbrella term of alcohol use disorder in DSM-V, thus explaining everyone’s confusion.
  • The Main Difference: Originally and technically, what’s different between substance dependence and substance abuse relates to the number of potential diagnostic criteria a person meets. Abuse is mild and dependence is severe. Abuse can also lead to dependence or dependence is self-perpetuating abuse where the person really can’t help himself in consuming a given substance like alcohol and drugs. Their difference is on a scale of severity.
  • Why Combine Abuse with Addiction? Alcohol, drug, and other substance abuse problems had criteria formed that are viewed as less serious, dangerous, or severe than alcohol, drug, and other substance addiction problems. That was the perception since DSM-IV. However, people with substance abuse still experienced serious repercussions from their usage just like in substance addiction, thus necessitating changes in people’s way of interpreting the two conditions. There’s almost no point in separating them as far as their consequences are concerned.
  • Abuse Can Result in Serious Repercussions Too: Those who met the criteria of alcohol abuse but not alcohol dependence still faced the same serious repercussions and signs of a significant problem, so categorizing alcohol abuse as mild and separate from the more severe alcohol addiction seems misplaced. This is why even if that person didn’t meet the criteria for addiction he is now considered a sufferer of alcohol use disorder.
  • In Terms of Alcohol Usage: In terms of alcohol use, an alcohol user who’s diagnosed with alcohol abuse will tend to experience withdrawal symptoms and negative consequences as a result of his abuse. However, the issues he experienced and the length of time he’s been drinking aren’t as longstanding as a person who’s been diagnosed with alcoholism. Long story short, abuse and dependence have been combined into one disorder to address the fact that they both result in dangerous consequences.

The Lowdown on Alcoholism versus Alcohol Abuse


Alcohol abuse and alcoholism is a chicken versus the egg kind of thing in which they’re correlated but it’s confusing which one causes the other. This is because the more you consume alcohol, the more you tolerate it, leading you to consume more of it to get the same sort of buzz you’re used to getting before without binge drinking. You can end up abusing alcohol even if you’re not addicted yet, leading to alcohol dependence in the long run. On the other hand, as you get more and more addicted, one of the symptoms naturally involves binge drinking and alcohol abuse. At any rate, if you’re an alcohol abuser or addict, then you should go to Lanna Rehab for the right treatment.

These conditions also happen when you develop tolerance for alcohol. This occurs when you need to increase the amount of alcohol you consume in order to become intoxicated or get a buzz. It also refers to continued usage of the same amount of alcohol that results in a diminished effect, so you’re chasing the high or the drunken stupor with more alcohol. You can also suffer from withdrawal symptoms due to alcohol abuse and dependence, wherein if you stop drinking alcohol, you’ll suffer significant uncomfortable symptoms that can only be relieved or avoided by more alcohol intake.

Lanna Rehab Can Help You Deal with Alcoholism and Alcohol Abuse

The main difference between alcohol abuse and alcohol dependence is cause and effect. Usually, a person indulges in alcohol abuse if they’re already dependent or addicted to alcohol. In turn, abusing alcohol can also lead to alcohol addiction or alcoholism. The inpatient rehab center in Chiang Mai, Thailand doesn’t only offer holistic treatment offerings that incorporate evidence-based and CAM therapy to help you achieve sobriety. It also has outpatient treatment techniques like the 12-step program available in Alcoholics Anonymous to help you kick the habit.

If you want to know more about Lanna Drug and Alcohol Addiction Rehab in Chiang Mai, Thailand, then call their 24/7 hotline right now for booking information, travel packages, and price quotes.

Martin Peters

Martin Peters has a BA (Hons) Dip HE Dip RN CSAT III and is the Group Program Director Lanna Healthcare. He is a Registered Nurse and Certified Substance Abuse Therapist working in the mental health field since 1994; Martin has had a wide range of experience in management and supervisory roles within established healthcare systems, and has provided consultancy services to a number of private and public sector organizations in the UK and Asia in terms of management, policy writing, accreditation and recruitment. Martin’s addictions experience has been in developing inpatient services in Thailand since 2009, both clinical and operational. He has been instrumental in expanding and developing a non 12 step inpatient treatment centre and opening a further inpatient centre with a 12 step approach, implementing KIPU Electronic Records, strengthening hospital partnerships, introducing a Scholarship for students under the Masters in Addiction Studies Program at The ASEAN Institute for Health Development and working with an international accreditation body. Martin has also been a speaker at several international conferences on addiction, including ASEAN conferences and has also guest lectured at Mahidol University (Thailand), University of Sarghoda (Pakistan) Institute of Medical Sciences (Pakistan) and has been a representative on the CARF Standards Advisory Committee for 2016.In 2015. Martin became a Co-Founder of Lanna Healthcare, launching Lanna Rehab in March 2016 and opening Jintra in January 2018. In June of 2018, Martin was involved in the merger of Lanna and DARA, becoming Thailand's biggest private licensed operator. Martin is currently a Joint and Asia Health Co Ltd Owner Operator of Lanna Healthcare Co Ltd, which under its umbrella manages Lanna Rehab in Chiang Mai, Jintra Rehab in Chiang Mai and DARA Rehab in Koh Chang - all Thailand MoPH Licensed Addiction Facilities providing world-class treatment in Thailand.

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