Alcohol abuse and dependence - the difference

Drinking plays an important role in many people's lives. In moderation, alcohol is relaxing and can also be beneficial to one's health. Unfortunately, not enough is said about excessive drinking which can cause havoc in a person's personal, social and work life.

Alcohol abuse is linked to a staggering proportion of criminal activities and fatal car accidents. It also often plays a role in suicides. Despite these facts, people continue to ignore the potentially damaging and lethal effects of excessive alcohol use.

What are the physical and psychological effects of alcohol?
Alcohol is often incorrectly classified as a stimulant or "upper". Alcohol is in fact a tranquilliser which depresses the central nervous system. The short-term physical effects depend on the blood-alcohol level. It ranges from mild mood changes to complete loss of coordination, vision, balance and speech.

These effects usually wear off in a matter of hours after a person stops drinking. Larger amounts of blood alcohol can impair brain functioning and eventually cause unconsciousness. A severe overdose - when the blood-alcohol level is higher than 0,50 - can be fatal.

Long-term alcohol abuse can be very damaging to one's physical health. Health risks include cirrhosis (hardening) of the liver, gastrointestinal problems, damage to the heart muscle and impaired muscle functioning. Heavy drinkers often tend to miss meals or lack adequate diets and therefore suffer nutritional imbalance and have an impaired immune system. Brain damage can occur as a result of a vitamin B2 deficiency.

A well-known condition, Karsokov's syndrome, is an amnesic disorder which means that people find it difficult to remember past events and to learn new things. Alcoholism can also lead to impotence in men, damage to the foetus in pregnant women and an elevated risk of cancer of the larynx, oesophagus, stomach, pancreas and upper gastrointestinal tract. Women cannot tolerate alcohol as well as men and are more vulnerable to alcohol-related health risks.

The psychological effects of alcohol intoxication include lack of inhibitions, increase in aggression and violence, uninhibited sexual behaviour/lack of interest in sex, mood swings, depression, impaired memory and sensory-motor co-ordination.

When is alcohol a problem?
The Diagnostic and Statistical Manual of Mental Disorders classifies alcohol disorders into two categories: alcohol abuse and alcohol dependence.

Alcohol abuse
Alcohol abuse is defined as a maladaptive pattern of alcohol use leading to significant impairment or distress, as manifested by one or more of the following:



  • Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school or home (e.g. poor work performance or absenteeism, neglect of children or the household)
  • Recurrent drinking in situations in which it is physically hazardous (e.g. driving a car or operating a machine)
  • Recurrent alcohol-related legal problems (e.g. arrests for disorderly conduct)
  • Continued drinking despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g. arguments with spouse about consequences of intoxication)

Alcohol dependence:

The symptoms include:

  • Tolerance (diminished effect with continued use of the same amount of alcohol or the need for increased amounts of alcohol to achieve the desired effect)
  • Withdrawal (when you stop drinking, you experience a series of withdrawal symptoms. Alternatively, you use substances to relieve or avoid withdrawal symptoms)
  • Substance is taken in larger amounts or over a longer period than was intended
  • Persistent desire or unsuccessful efforts to cut down or control drinking
  • A great deal of time is spent on activities necessary to obtain alcohol, use the substance or recover from its effects
  • Important social, occupational or recreational activities are given up or reduced because of drinking
  • Alcohol use is continued even though the person knows that it worsens some physical or psychological problem.

When several of these symptoms are present then the person is said to be dependent on alcohol.

Where to get help
Historically, alcoholic behaviour was blamed on a character flaw or weakness of will. Nowadays, chronic alcoholism is considered as a disease that can afflict anyone. It is common for an alcoholic to deny the problem and to use all sorts of excuses to blame problems on something other than alcohol. This makes it difficult to convince someone to seek help.

Even if the person recognises the problem, the continual craving for alcohol makes it difficult for him/her to stop drinking. It is therefore important to seek help as soon as possible. - (Ilse Pauw, Health24)

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