Some people worry about their alcohol use but are not convinced that they need help. Friends or relatives might express their concern--"You have a drinking problem." But often that well-intentioned statement fails to define the issue or suggest a clear solution. 

To cut through the confusion, it helps to understand the difference between alcohol abuse and alcohol dependence. Making this distinction can help you think clearly about a "drinking problem"--and allow you or a loved one to get the kind of help that makes a difference. 

Alcohol dependence--often called "alcoholism"--is only one potential complication of drinking. Alcohol abuse can disrupt lives as well. In its diagnostic manual, the American Psychiatric Association defines alcohol abuse as drinking that leads to "clinically significant impairment or distress." For example:

• Neglecting major responsibilities at work, school or home.
• Drinking in hazardous situations, such as driving while intoxicated.
• Drinking that leads to recurrent legal problems, such as arrests for disorderly conduct.
• Continued drinking even when it leads to recurrent social problems--for example, violent arguments.

Those consequences are serious enough. But alcohol dependence can involve any of them and goes on to include:

• Tolerance--drinking in greater quantities in order to achieve a desired level of intoxication.
• Withdrawal--feeling symptoms of illness when alcohol is not available. Examples of those symptoms are anxiety, nausea, vomiting, trembling, confusion, seizures and hallucinations.
• Compulsive use--drinking that continues even after a person makes repeated promises to quit or experiences significant problems that relate directly to alcohol use.

In short, dependence has two dimensions. One is psychological--the belief that alcohol is essential to functioning in daily life. The other one is physiological--feeling extreme discomfort when access to alcohol is delayed or denied. Alcoholics Anonymous defines alcoholism simply: "a physical compulsion, coupled with a mental obsession to drink."

Chuck Rice, a licensed alcohol and drug abuse counselor at Hazelden and an adjunct assistant professor in Hazelden's Graduate School of Addiction Studies in Center City, Minn., makes three points that can help you further understand the nature of alcohol abuse and dependence.

• First, these diagnoses are points on a single continuum. In fact, a common scenario is for drinkers to move from casual alcohol use to abuse and then to dependence. "In plain English, the difference is really a matter of degree," says Rice. "When drinkers start having tolerance and withdrawal, they are at a point where they move into dependence."
• Second, however, drinkers do not always follow a fixed path from abuse to dependence. Some remain abusers all their lives. And others cross the line to dependence soon after their first drink.
• Finally, it's not the amount of alcohol consumed that defines the difference between abuse and dependence. Instead, says Rice, "we measure the problem by the impact of drinking on somebody's life. The real question is: What's your level of impairment and distress?"

Alcohol abusers may be more episodic in their problems, but they pose the same grave danger to themselves as well as the general public. If they're involved in an alcohol-related accident, they may be court ordered to undergo a addiction assessment or attend substance abuse education classes. If they seek addiction treatment, notes Rice, they generally find their way into an outpatient program.

This may contrast with people who are dependent on alcohol, or those who cannot drink safely at all. The depth of their drinking problem may call for intensive inpatient treatment--a residential program that removes them from the people, places and things associated with their alcohol use.

The complexity of alcohol-related diagnoses makes a case for getting professional help when you have a concern about alcohol use. See your doctor and ask for a referral to someone trained in addiction treatment. Or call the National Drug and Alcohol Treatment Referral Routing Service at 800-662-HELP (4357). Getting an expert assessment up front can save time--and perhaps save your life.

--Published February 21, 2005