Alcohol Abuse & Addiction Treatment

Question:
What’s the difference between alcohol abuse and alcohol addiction?

Answer:
Essentially alcohol abuse is too much, too often and alcohol dependence is the inability to quit drinking despite the negative consequences.
Alcohol abuse leads to unfulfilled responsibilities at home, work or school and/or repeated dangerous situations as a result of drinking. Alcohol dependence has similar criteria to abuse but is more severe. These symptoms include; increased tolerance, drinking larger amounts or for longer periods than intended, an inability to reduce or stop drinking despite negative consequences and withdrawal symptoms.

Three key features of all addictions are compulsion (powerlessness over taking the first drink), obsession (persistent & dominating thoughts to drink) and loss of control (can’t stop drinking once started).

Once addicted, permanent changes happen to the brain’s reward, motivation and memory circuit’s resulting in intense craving. It’s important to recognise that once addicted, stopping drinking isn’t a matter of will power, strength of character or intellect. Alcohol dependence has been proved to be a brain disease. Once you drink enough to become alcoholic, the brain cannot return to its pre-alcoholic state, where ‘normal’ drinking was possible.

Alcoholism is:
– A primary illness and needs to be treated first. Many secondary ailments e.g. depression, simply disappear once the alcoholic is in stable recovery. Comprehensive treatment will address co-occurring mental health issues should they exist.
– Chronic (lasts longer than 3 months), results in physical, mental, social & spiritual problems. Alcoholics pathologically seek relief through drinking in spite of the dysfunction it causes in relationships and have a greatly diminished awareness of the negative effect their drinking is having. Most alcoholic’s need to be pressured into a rehab centre and this has no bearing on treatment success.

The CAGE test below was developed by Dr. John Ewing at University of North Carolina in 1984.
C –Have you ever felt you should cut down on your drinking?
A –Have people annoyed you by criticizing your drinking?
G –Have you ever felt bad or guilty about your drinking?
E – Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

The CAGE test is intended to identify alcohol problems over the lifetime. Any 2 positive answers indicate a need for further assessment.

The latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has integrated what used to be see two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.  DSM–5 removes ‘legal problems’ and adds ‘craving’.

Here’s a new comparison fact sheet, “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5

The Eleven Symptoms of Alcohol Use Disorder

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which it is physically hazardous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.
  11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

If You Meet 2 of the 11 Criteria for AUD, contact us for assessment and treatment help.

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