It’s not always easy to tell when occasional or moderate alcohol use becomes alcohol abuse or addiction. If you’re wondering, “Do I have a drinking problem?” then you might want to know the difference between a drinking problem and alcoholism, also known as alcohol addiction or alcohol use disorder (AUD).
Continue reading to learn the differences between problem drinking vs. alcoholism, how problem drinking can lead to addiction, the definition of alcoholism, how to cut back or seek treatment if necessary.
What is Problem Drinking?
People who are problem drinkers and those struggling with alcohol use disorder (AUD) both have unhealthy relationships with alcohol, but problem drinkers aren’t necessarily addicted to alcohol nor have an AUD.
Problem drinking refers to a pattern of alcohol use that results in negative consequences such as relationship issues or arrests for DUIs; problem drinking is also known as “alcohol abuse” or “alcohol misuse.”1 A person who is addicted to alcohol or who has an AUD consistently and uncontrollably engages in problem drinking.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines two potentially problematic drinking patterns around the excessive use of alcohol:
- Heavy drinking means drinking 4 or more drinks per day for men or 3 or more drinks per day for women.3
- Binge drinking means consuming 5 or more drinks for men or 4 or more drinks for women within a span of around 2 hours.3
- In the U.S., a standard drink is defined as 12 oz. of (5%) beer, 5 oz. of (12%) wine, or 1.5 oz. of (40%) 80-proof distilled spirits.3
Heavy drinking or binge drinking can increase your risk of developing an AUD.3 Drinking excessively on a regular basis is a warning sign that you may have a problem with alcohol, regardless of the exact number of days you drink each week.4
Alcohol Abuse Self-Assessments
To better understand your own drinking habits, there are two self-assessments that you can do: AUDIT (Alcohol Use Disorders Identification Test) and CAGE (named after the first letters of the four questions in the test).
AUDIT is a series of 10 questions about your patterns of alcohol use, the number of drinks you have when you drink, and the consequences of your drinking habits.5 You can view the questionnaire and scoring guide here.
The CAGE self-assessment test is a simplified questionnaire that involves asking yourself the following 4 questions:6
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?
When used by a physician to screen patients for possible AUDs, two positive responses to the four CAGE questions indicate that further assessment is needed. Keep in mind that, while helpful in determining whether your current drinking habits could be problematic, these tests should not be considered a medical diagnosis.
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Signs of Alcohol Abuse
If you’re wondering about your own drinking habits or those of a loved one, there are some warning signs to be aware of that may point to alcohol abuse. These signs include: 3,7,8
- Feeling like you should minimize your alcohol intake.
- Being criticized by others for your drinking or having friends and family express concern about your alcohol use.
- Your drinking causes you to feel bad or guilty.
- Feeling like you need to drink first thing in the morning or that you need to drink to get through the day.
- Regularly drinking more than the recommended amounts in the Dietary Guidelines.
- Binge drinking or heavy alcohol use.
- Feeling like alcohol is starting to affect your work and/or home life.
Can Problem Drinking Lead to Addiction?
Over time, problem drinking may lead to addiction. Binge drinking and heavy alcohol use can increase a person’s risk of AUD.3,9 Through chronic excessive alcohol use, you can become physiologically dependent on alcohol, which means your body has adapted to the presence of alcohol and you need it to feel normal and to function.10
A person who is physiologically dependent on alcohol will experience alcohol withdrawal symptoms if they stop drinking. Drinking to avoid or minimize withdrawal symptoms satisfies one of the two criteria needed for a doctor to diagnose a person with an AUD.1,10,12 Alcohol withdrawal symptoms can range from mild to severe to life-threatening and requiring medical attention in certain cases.10,11
What Defines Alcoholism?
Alcoholism, or alcohol addiction, is a chronic, relapsing brain disease where a person has lost control of their alcohol use, and they continue to drink despite significant negative consequences it has on their lives.1,12 The American Psychiatric Association has outlined the criteria used by doctors to diagnose substance use disorders such as alcoholism. To receive an AUD diagnosis, a person must meet at least 2 of the following criteria within a 12-month period; however, only a qualified mental health professional or a physician can diagnose AUD:11
- Drinking more than you originally intended.
- Being unable to cut down alcohol use even if you want to.
- Spending a lot of time obtaining, using, and recovering from the effects of alcohol.
- Strong desires or cravings to drink alcohol.
- Failing to fulfill obligations at work, home, or school due to alcohol use.
- Continuing to drink despite developing interpersonal/social problems that are the consequence of your alcohol use.
- Giving up activities you once enjoyed because of alcohol use.
- Drinking in situations where it is physically dangerous to do so (like driving or operating machinery).
- Continuing to drink despite a persistent or recurring physical or mental health condition that is likely worsened or caused by your alcohol use.
- Tolerance, meaning you need to drink more to achieve previous effects.
- Withdrawal symptoms (like tremors, sweating, insomnia, or anxiety) when you stop drinking or significantly reduce your drinking (i.e., alcohol dependence).
How Much Alcohol is Safe to Consume?
Drinking alcohol inherently carries a certain level of risk to one’s own health as well as the health of others. These risks are minimized to a certain extent by things such as laws, like those designed to curb people from drinking under the influence, as well as health guidelines developed by doctors and researchers.
The Dietary Guidelines for Americans, for example, states that moderate alcohol use means men should not have more than 2 standard drinks per day, and women should not have more than 1 standard drink per day.2 Drinking beyond the level of daily alcohol intake defined in the Dietary Guidelines can increase the risk of serious health consequences, however, any level of drinking at all can cause health problems.2 In other words, drinking less is always better than drinking more.
Tips on Cutting Back
If you are concerned that you may have an alcohol problem or you simply want to cut back on your alcohol intake, it can be helpful to practice a few self-help techniques, such as:8,13,14
- Create a plan: Before you drink, it’s helpful to decide how much you want to drink in advance, so that you know when it’s time to stop.
- Have a budget: Decide that you’re only going to spend a certain amount of money on alcohol. This can be a specific, set amount per week or per drinking occasion.
- Share your goals: Let your family and friends know that you plan to cut down or stop drinking. This can make it easier to avoid temptation in social situations and can give them the opportunity to offer you support.
- Take things one step at a time: You don’t have to cut back all at once, just cut back a little at a time.
- Mix it up: Swap out higher percentage alcohol drinks for lower ones or try alternating an alcoholic drink with a nonalcoholic beverage.
- Dry days: Plan in a few alcohol-free days each week and try not to drink on consecutive days.
- Be aware of things that might trigger you to drink: This can be different for everyone but might include stress, difficult emotions, financial issues, being around people with whom you normally drink, or places where you typically drink. Plan an alternative activity to drinking or do something distracting until the urge to drink subsides.
- Practice HALT: This stands for Hungry, Angry, Lonely, and Tired. These are often triggering emotions that can make you feel like drinking. When you feel these emotions, stop (HALT), realize that drinking isn’t going to solve your problems, and do something positive for yourself instead (like exercising, talking to a friend, or going to a 12-step meeting).
- Know how to say no: You don’t have to get into a discussion with someone who offers you alcohol, just say “no thanks” and move on to another topic. You may even find there’s power in doing so.
When is Alcoholism Treatment Necessary?
If you’ve tried cutting down or eliminating alcohol from your life and you feel that your efforts haven’t been successful, or you feel like you’ve developed a problem, it could be time to seek treatment. Many factors can influence the decision to start treatment, but you might know it’s time if you notice some of the following signs:4,15,16
- You’re unable to drink within the limits you’ve established for yourself.
- You have a family history of alcoholism or addiction and you’re concerned about your risk.
- You have a physical or mental health condition that can worsen due to alcohol use.
- You take medication that interacts with alcohol.
- You are or want to become pregnant.
- You’ve experienced injuries related to alcohol use (or injured others as a result of your alcohol use).
- You have or think you have AUD.
- You’ve started neglecting your hygiene or physical health because of alcohol use.
- You’re frequently calling in sick to work or school.
- You use multiple substances.
- You’re a heavy smoker (animal studies have shown that combining cigarettes and alcohol may increase the risk of brain damage).
- You have suicidal thoughts.
- You’re experiencing increased stress and you don’t know how to cope.
If you suspect that you need treatment, consider talking to your physician or another doctor who can assess your situation, evaluate your overall level of health, advise you about making a treatment plan, and help determine the appropriate course of action (such as referring you to an addiction treatment center).17
How to Get Help for Addiction
Some of the ways you can get help for alcohol addiction include:17,18
- Calling an alcohol hotline to discuss your questions or concerns, or if you’d like more information about treatment.
- Asking for support from a friend or loved one.
- Asking friends and family to avoid offering you alcohol.
- Getting rid of the alcohol in your home.
- Going to mutual support groups, such as 12-step meetings like Alcoholics Anonymous, or non-12-step meetings like SMART Recovery.
- Talking to a counselor.
- Checking your insurance coverage to see if treatment is covered.
- Asking your doctor for referrals to rehabs.
- Researching treatment centers online.
- Calling treatment centers.
- Entering treatment.
Treatment isn’t based on a one-size-fits-all approach; it should take into account your specific and unique treatment needs. When considering a treatment facility, you may wish to ask specific questions, such as:17
- What kind of programs do they offer?
- What is their treatment approach/philosophy?
- Do they offer individualized treatment plans?
- How do they measure treatment success?
- What do they expect of you during treatment?
- How does the program handle/address relapse?
In general, the recovery process typically begins with detox, where alcohol is cleared from your body. This may involve medication or other interventions as needed so that you are medically stable so you can enter treatment.10,17 Depending on your specific needs, you’ll then enter either an inpatient or residential treatment facility or an outpatient rehab program so you can learn the skills you’ll need to avoid relapse and live a healthier, alcohol-free life.17
. American Psychological Association. (2012). Understandi2ng alcohol use disorders and their treatment.
. U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025. 9th Edition.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Drinking Levels Defined.
. Enoch, M. A., & Goldman, D. (2002). Problem drinking and alcoholism: diagnosis and treatment. American Family Physician, 65(3), 441–448.
. National Institute on Drug Abuse. (n.d.).AUDIT.
. Williams, N. (2014). The CAGE questionnaire. Occupational Medicine, 64(6), 473–474.
. NHS. (2018). Overview: Alcohol Misuse.
. Substance Abuse and Mental Health Services Administration. (2015). Faces of Change: Do I Have a Problem with Alcohol or Drugs?
. Centers for Disease Control and Prevention. (2021). Alcohol Use and Your Health.
. Becker, Howard C. Ph.D. (2008). Alcohol Dependence, Withdrawal & Relapse. Alcohol Research, Vol. 31 (4).
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Is there a difference between physical dependence and addiction?
. NHS. (2018). Tips on cutting down.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Rethinking Drinking: Tips to try.
. National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking: To cut down or to quit.
. Quinteros, D., Witt Hansen, A., Bellaver, B., Bobermin, L. D…& Gomez, R. (2019). Combined Exposure to Alcohol and Tobacco Smoke Changes Oxidative, Inflammatory, and Neurotrophic Parameters in Different Areas of the Brains of Rats. ACS Chemical Neuroscience, 10(3), 1336–1346.
. National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for Alcohol Problems: Finding and Getting Help.
. National Institute on Alcohol Abuse and Alcoholism. Rethinking Drin16king: Social support to stop drinking.