Know the Deadly Differences: Alcoholism Vs. Alcohol Abuse

Alcohol abuse and alcoholism affect millions of families with many of the same problems arising, but these two conditions are not the same.  Different diagnoses apply to each, with alcohol abuse being the less severe version of alcoholism. It’s essential to be aware of these differences in order to understand how these conditions affect such people’s family and friends, as well as the impact of their behavior on bystanders.

Problem Drinkers

Someone who abuses alcohol – or a ‘problem drinker’ – can still appear to be in control, but the effects of excessive alcohol consumption do start to interfere with their ability to live functional, well-adjusted lives. While problem drinkers usually recognize these negative consequences at some level, they may or may not change their behavior or seek help.

Problem drinkers usually exhibit symptoms more suddenly, in excessive binges, as opposed to alcoholics who may be so used to binge drinking – or drinking continuously throughout the day – that they are better able to hide their symptoms. Some alcoholics become “functional” because they are so used to abusing alcohol, whereas problem drinkers are more likely to repeatedly show clear symptoms, such as relationship trouble, accidents, mood swings and missing important dates.

Problem drinking is dangerous not just because of its immediate effects but because it can often be a precursor to alcoholism. When problem drinkers start compulsive drinking – drinking without giving it thought or thinking that they ‘must’ drink – they have most likely started down a path to alcoholism, even though they often feel that they can quit because their physical and psychological dependency is not yet so severe.

Genetic predispositions to alcoholism can affect how quickly one becomes dependant. Quitting cold turkey can be an option early on, but alcoholics almost always require professional help, i.e. alcohol rehab and counseling. The quantity of alcohol consumption does not, in itself, differentiate alcohol abuse from alcoholism. Binge drinking, around 5 or more drinks in one sitting, can be engaged in by either group; it is the regularity of their heavy drinking – as well as the state of their cognition – that defines an alcoholic.


The important thing to understand about alcoholism is that it is a compulsive behavior. Alcoholics don’t drink because they enjoy it, they drink because their physical and psychological cravings drive them to.

Unlike a problem drinker, an alcoholic (i.e. someone who has developed alcoholism) will likely either discount the dangers of their drinking or not care about the consequences. Alcoholism impairs the thinking of those with it, which means that their ability to be responsible decision-makers is impaired. This impairment can further worsen the addiction and make quitting harder.

Alcoholics do not necessarily drink all day every day, but a typical trait for an alcoholic is that they cannot stop themselves drinking excessively after they’ve had their first drink of the day. Whereas alcohol abusers may be able to bring themselves back to moderate levels, alcoholics find that much harder, and regularly relapse after re-introducing alcohol to their lives.

Treatment Alternatives

Treatment makes a difference in helping people gain control over their lives – as well as the lives of those they live with – and is often a life-saver.

Alcohol abuse is itself largely a symptom of emotional problems such as dealing with traumatic memories or as a coping mechanism to deal with difficult situations. Psychological counseling is, therefore, commonly needed when addressing problems underlying alcohol abuse. Although the same chemical dependency underlies the problem, treating alcohol abuse and alcoholism requires different approaches. Whereas alcoholism is a semi-permanent condition, alcohol abuse may not be a long-term issue. Abstinence is helpful in both cases, but harder for alcoholics given their greater chemical dependence on the drug. Professional help is advisable for both groups, especially for alcoholics, in order to evaluate their situation, give an accurate diagnosis and offer treatment services to meet their needs.

Conventional treatments include individual or group therapy, inpatient or intensive outpatient therapy and, for alcoholics, short or long spouts of detox. Alternative treatments – such as hypnosis and meditation – may be helpful for some people but should be pursued in combination with conventional treatments. Treatment may persist for months or years depending on the severity of addiction and the frequency of relapse.

It’s very rare to hear of people intervening on behalf of alcoholic or problem drinker friends/family too soon, but it’s all-too-common for people to think of intervening too late. If you know someone close to you who is exhibiting symptoms of problem drinking or alcoholism, consider whether it might be appropriate to raise the matter with them directly, or consider calling the free Substance Abuse and Mental Health Services Administration National Helpline.

Scott Hewitt works as a therapist with those suffering from addiction. He shares his insights and support with other sufferers through his articles.