What are alcohol abuse and alcohol dependence?

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While some people can enjoy a drink now and then without any problem, other people are not able to control how often or how much they drink. Nearly 3 in 10 adults in the United States drink too much or too often or have problems because of their drinking.

If you are not able to quit or cut back on your drinking, even though you know it is causing problems, you might have a problem with alcohol abuse or alcohol dependence.

Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking too often or drinking too much. Alcohol abuse can harm your relationships, cause you to miss work, and make it hard to meet your obligations. It can lead to legal problems, such as being arrested for disorderly conduct or driving while intoxicated. If alcohol abuse continues, it can lead to dependence.

Alcohol dependence (alcoholism) means that you are not able to quit drinking on your own, even when you want to. If you are dependent on alcohol, you are physically and emotionally addicted to it. You might feel compelled to drink, and alcohol might take over your life. You might drink secretly or hide the amount that you drink. Over time, it will take larger amounts of alcohol before you feel its effects. You might get irritable or shaky or have other withdrawal symptoms when you are not able to drink or when you try to quit on your own.

Over time, drinking too much alcohol can cause or make worse health problems such as heart disease, high blood pressure, stroke, liver disease, gallstones, pancreatitis, and cancer. It can also cause problems at school or work and with relationships. If you have trouble with alcohol, cutting back or quitting can help you live a happier, healthier life.

Am I drinking too much?

Drinking can become a habit. You might have friends or family members who drink often, so drinking a lot might seem normal. Or you might not realize how much, or how often, you drink. You might not be aware of the problems that alcohol causes in your life. But the more you drink, the greater is your risk for health problems or other problems as a result.

A standard drink is :

• 1 can or bottle of beer [12 fl oz(355 mL)].
• 1 glass of wine [5 fl oz(148 mL)].
• 1 mixed drink containing 1.5 fl oz(44 mL) of hard liquor.

You are drinking too much if you are:

A woman who has more than 7 standard drinks a week or more than 3 drinks in a day. A man who has more than 14 standard drinks a week or more than 4 drinks in a day.

Am I drinking too much? Drinking can become a habit. You might have friends or family members who drink often, so drinking a lot might seem normal. Or you might not realize how much, or how often, you drink. You might not be aware of the problems that alcohol causes in your life. But the more you drink, the greater is your risk for health problems or other problems as a result.

Is some alcohol actually good for my health?

Some studies have found that moderate drinking (no more than 1 standard drink a day for women or 2 standard drinks a day for men) might have some health benefits, such as decreasing the risk of getting heart disease or having a stroke.

But the idea that "if a little is good, a lot must be better" isn't true when it comes to alcohol. Having more than 1 to 2 standard drinks a day does more harm than good. It can increase your risk of heart failure, stroke, and high blood pressure and cause many other health problems, such as liver damage.

For some people, even moderate drinking has health risks, such as an increased risk of accidents related to drinking and a greater chance of getting certain types of cancer.

Alcohol in any amount can be dangerous for certain people. You should not drink at all if you:

• Are a child or teenager. Drinking alcohol can interfere with your learning, growth, and development, and it is illegal.
• Are pregnant. Heavy drinking while you are pregnant can cause your child to be born with serious lifelong mental and physical problems (such as fetal alcohol syndrome or fetal alcohol spectrum disorder). Since researchers are not sure about what amount (if any) of alcohol can be safely consumed during pregnancy, the only safe recommendation is not to drink at all.
• Are taking medicines that interact with alcohol. There are more than 130 medicines that can cause health problems if you take them when you drink.
• Have certain health conditions that are made worse by drinking, such as liver disease.
• Have had problems before with alcohol abuse or dependence.

Is alcohol causing problems in my life?

Many people who have alcohol problems are successful in other areas of their lives, and they might even be able to hide their problems with alcohol for years. Most people have trouble admitting to others or even to themselves that alcohol is causing problems. The good news is that when people realize they have a problem and make a commitment to change, most are able to cut their drinking back to a safe level or to quit altogether.

Are problems with alcohol a sign of weakness?

Addiction to alcohol is not a sign of weakness and does not mean that you lack willpower. Some people who have trouble with alcohol might be able to drink less or quit on their own, but many people who have problems with alcohol need treatment to get better. Addiction to alcohol is a long-term disease, just like diabetes or asthma. You might need professional counseling, medicines, or a combination of the two to get better. If you have been drinking for a long time, you might need medical help with the withdrawal symptoms caused by stopping drinking (detoxification).

What causes alcohol abuse and dependence?

It is not clear why some people develop alcohol use problems and others do not, although experts know that alcoholism can be passed down in families (genetic link). Experts believe that alcohol problems are also caused by cultural values (such as being part of a group of people who drink a lot) and mental health issues (such as drinking as a way of coping with stress or problems).

What are the signs of alcohol abuse and dependence?

You might have problems with alcohol abuse if you have:

• Had trouble at work, school, or home because of drinking or being hung over.
• Been in situations where you could have been hurt or could have hurt someone else because of your drinking, such as driving while intoxicated.
• Had legal problems caused by drinking.
• Kept drinking even though you knew it was causing problems with your family or friends.

You might be dependent on alcohol if you have had three or more of the following problems in the last year:

• You need to drink much more than you once did to get the same effect, or when you drink the usual amount the effect is less than before.
• When you don't drink, you notice withdrawal symptoms (such as shakiness, sweating, or trouble sleeping), or you drink just to prevent withdrawal symptoms.
• You drink more often than you want to or you drink larger amounts than you want to.
• You have tried unsuccessfully to quit drinking or to cut back the amount you drink.
• You spend a lot of time drinking and recovering from drinking.
• You have given up other activities that are important to you so that you can drink.
• You continue to drink even though you know your drinking might be causing problems.

If you crave alcohol, are not able to quit drinking even when you want to, or develop withdrawal symptoms when you stop drinking, you are physically dependent on alcohol.

Symptoms of alcohol abuse in children and teens are different from the symptoms seen in adults. For more information, see the topic Teen Alcohol and Drug Abuse.

How are alcohol abuse and dependence diagnosed?

Your doctor can diagnose alcohol abuse and dependence based on your medical history, a physical exam, and sometimes a mental health assessment. Your doctor may do other tests to rule out other conditions.

How are alcohol abuse and dependence treated?

If you are physically dependent on alcohol, the first step of treatment is to relieve symptoms of withdrawal. Once your withdrawal symptoms are treated, the second step of treatment is to work on staying sober. A combination of counseling, support groups, and sometimes medicine can help you do this.

Treatment for withdrawal symptoms can be provided by your doctor. If your withdrawal symptoms are severe, you might need to stay in a hospital until they pass. Your doctor may give you medicines that can help you through withdrawal symptoms.

Treatment to help you stay sober can come from your doctor or another health professional or from a support group, such as Alcoholics Anonymous (AA).

When a person has an alcohol use problem, it can affect the lives of his or her family. Often family therapy and education are a part of the recovery process.

Admitting that you have a drinking problem can be hard, but it is the first step to recovery. Although relapse (starting to drink again) is common, alcohol problems can be overcome.

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Reviewed: 11/2005