Alcohol Use Disorder Vs. Alcoholism

Alcohol use disorders (AUD) and alcoholism affect millions of Americans across the United States. While AUD and alcoholism are often used interchangeably, these terms do not hold equal value, and it’s important to understand why.

Scroll on to learn more about AUD and alcoholism including key differences, signs and symptoms, diagnosis, and treatment options.

AUD is a medical diagnosis used by medical professionals to describe an inability to control your alcohol intake or stop drinking alcohol. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines the condition as “a problematic pattern of alcohol use leading to clinically significant impairment or distress.”

AUDs are classified as mild, moderate, or severe, depending on the number of criteria an individual meets. There are 11 symptoms defined by the DSM-5 that indicate AUD.

Symptoms include:

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 (See the “How is alcohol withdrawal managed?” section for some DSM-5 symptoms of withdrawal).
    b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

On the other hand, alcoholism is a colloquial term used to describe severe alcohol dependence. People with alcoholism will often have several of the above symptoms as well.

In a historical context, much of the use of the word “alcoholism” comes from Alcoholics Anonymous (AA). In AA, it is up to each participant to determine whether or not they are an alcoholic.

There is also a large stigma surrounding alcoholism. The way alcoholism is perceived in society is often not representative of the reality of alcohol dependence.

When many people think of someone with an alcohol problem, they think of very exaggerated examples of alcohol dependence. In other words, many people think of someone who is visibly drunk or always drinking. In reality, alcoholism can present in many different ways. Some people are able to function as usual with their condition, so much so that those around them don’t even realize they are struggling with alcoholism.

The main differences between AUD and alcoholism are the ways the terms are used and diagnostic criteria.

As mentioned above, AUD is a medical diagnosis and alcoholism is a colloquial term. In other words, alcoholism is often used in casual conversation to describe someone with an alcohol dependence whereas AUD is used in medical settings to define someone’s condition.

As far as diagnostic criteria go, individuals must meet at least two symptoms as defined by the DSM-5 to be diagnosed with AUD whereas alcoholism is not a diagnosis, and therefore, does not have diagnostic criteria. That being said, those with alcoholism typically have many symptoms of AUD.

We’ve covered the symptoms of AUD as defined by the DSM-5 above, but let’s take a look at the signs and symptoms of AUD and alcoholism in a more general sense.

Most signs and symptoms of both AUD and alcoholism overlap.

Common symptoms include:

• Trouble controlling alcohol intake
• Excessive drinking/heavy drinking
• Cravings for alcohol
• Drinking in inappropriate environments
• Withdrawal symptoms
• Drinking more than you used to for the same effect
• Planning your day around drinking
• Isolating yourself
• Neglecting responsibilities
• Hiding your drinking from others

While anyone can develop an AUD or alcoholism, there are specific populations that may be at an increased risk.

Risk factors and causes include:

• History of trauma
• Family history of AUD
• History of mental illness
• Early exposure to alcohol

Habits and behaviors surrounding alcohol consumption also play a large role in an individual’s risk of developing AUD. This can include binge drinking, heavy alcohol use, and prolonged alcohol misuse.

AUD and alcoholism can have extremely hazardous and even life-threatening effects on both your physical and mental health.

Physical health consequences include:

• Liver cancer
• Stroke
• Fatty liver disease
• Breast cancer
• Heart disease
• Fatigue
• Pancreatitis
• Digestive cancers
• Liver damage
• Weight loss
• Heartburn
• Colorectal cancer
• Weakened immune system
• Esophagus cancer
• Alcoholic hepatitis
• Gastritis
• Cirrhosis
• Ulcers
• Arrhythmias
• Cardiomyopathy

Mental health effects can include:

• Anxiety
• Depression
• Paranoia
• Irritability
• Psychosis
• Schizophrenia
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• Dementia
• Exacerbated pre-existing mental health conditions

In order to diagnose an AUD, you must receive a medical evaluation from a healthcare provider. They’ll ask questions about your alcohol use including frequency and amount. They may also ask questions about your behaviors surrounding alcohol.

As mentioned above, you must have at least two of the 11 symptoms of AUD as classified by the DSM-5. In order to diagnose your AUD as mild, moderate, or severe, your doctor will use the following guide:

• Mild: two to three symptoms
• Moderate: four to five symptoms
• Severe: six or more symptoms

Because alcoholism is not a diagnosis, there is no specific evaluation used to identify it. That being said, there are several self-assessments you can find online that can help you identify alcoholism in yourself or loved ones.

From there, you may choose to get a medical evaluation to determine if you have an AUD.

There are many evidence-based treatment and recovery options for AUD and alcoholism. You and a healthcare professional may determine which treatment services will be most effective for your condition, comparing treatment options and how they might meet your needs.

Detoxification Services

Many people with AUD start with a detox service before beginning their treatment program. Detoxification services help you through the withdrawal process while your body processes any remaining alcohol. Your care team will monitor your vitals, help you manage withdrawal symptoms, and administer any necessary treatments.

Rehab Programs

Alcohol dependence treatment programs are a very common treatment method for AUD and alcoholism. There are two main categories: inpatient and outpatient. Inpatient treatment offers 24/7 care in a facility where participants live for the duration of their program. On the other hand, outpatient treatment requires participants to travel to a rehab center several days a week for treatment.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a treatment method that uses specific medications to treat AUD. These medications are designed to manage withdrawal symptoms and cravings as well as block the pleasant effects of alcohol on the brain and body.

Counseling and Therapy

Another common treatment method is counseling or therapy. Many rehab programs offer individual and group counseling as part of a comprehensive treatment plan. Behavioral therapies such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are also commonly used in alcohol treatment to encourage healthier behaviors and thought patterns. Some people also pursue alternative therapies such as art therapy or yoga as part of their treatment.

In most cases, your care team will offer a combination of treatment methods to take a comprehensive approach and increase the effectiveness of your rehab services.

Living with AUD or alcoholism can be incredibly challenging and affect many areas of your life. Many people with AUD face daily challenges such as:

• Inability to focus
• Lack of interest in normal activities or hobbies
• Isolation from friends and family members
• Withdrawal symptoms
• Cravings for alcohol
• Engaging in risky behaviors

In addition to traditional treatment methods, there are several coping mechanisms and management strategies you can use to help manage your AUD or alcoholism.

This can include joining a local support group, finding new healthy hobbies, making new friends who support your recovery, trying alternative therapies, living in a sober environment, or reframing mindsets that exacerbate your condition.

As mentioned previously, there are many stigmas associated with both AUD and alcoholism. The social perception of these conditions can have detrimental effects on the lives of people struggling with them.

Common stigmas include:

• People with AUDs are responsible for their disorder
• People with AUDs should be ashamed
• People with AUDs just need to work harder to recover
• People with AUDs are troubled

All of these stigmas and more contribute to the shame, isolation, and feelings of worthlessness many people with AUD experience. These stigmas can also discourage people from seeking treatment, leading to exacerbated dependence and a greater risk of negative consequences.

It is vital to spread awareness about AUD and alcoholism to reduce these stigmas and encourage people to get the help they need. There are several efforts to reduce stigma including campaigns and public service announcements.

Here are a few stigma reduction resources:

• Words Matter – Terms to Use and Avoid When Talking About Addiction
• Reducing the Stigma of Addiction – Johns Hopkins Medicine
• Resource Guide: Overcoming Stigma, Ending Discrimination – Substance Abuse and Mental Health Services Administration (SAMHSA)

AUD and alcoholism are serious conditions that can have life-threatening effects if not treated properly. With professional help, it’s possible to manage your dependence on alcohol and achieve long-lasting recovery.

Ready to take the first step in your recovery journey? Give our helpline a call today.