What’s the difference between alcohol use, misuse, abuse, and dependence? And between moderate and heavy consumption, binge drinking, and Alcohol Use Disorder (AUD)? We hear these highly related terms a lot, often used casually and unspecifically. That makes it tough if you’re trying to understand the distinctions and find out if your relationship with alcohol is safe and healthy or problematic.
It helps to remember that alcohol-related behaviors and conditions don’t exist on their own. Each of us has unique developmental differences, life experiences, personalities, social and cultural influences, motivations, traumas, and mental health challenges that contribute to how we approach and interact with alcohol. It’s not always easy to pinpoint whether alcohol is a problem in your life, and whether adjusting your relationship with alcohol or something else will help you overcome whatever struggles you might be facing.
It can become even more confusing when you read up on these terms. Some of the information you find online is contradictory. You may exhibit some, but not all the behaviors linked to risky alcohol use, or feel like you sit somewhere in between two levels of consumption. The important thing to remember is that alcohol use lies on a spectrum. No definition or diagnosis is perfect. They are simply there to help you start to make sense of your relationship with alcohol, to get some idea of what constitutes healthy vs. unhealthy drinking behavior. You don’t have to identify with anything perfectly, or at all.
Ask yourself how you feel about your drinking. Does alcohol make you feel good about yourself and your connections to other people? Is that consistent, or is there turbulence in your life fueled by alcohol? Are there patterns of repercussions that are impacting you negatively (injuries, unintended behavior, embarrassment, work or legal challenges)? Does alcohol augment positive aspects of your personality or negative ones? Asking yourself questions like these can be more clarifying than reading behavioral and diagnostic terms.
However, language is important for helping us describe our world, to categorize and communicate, and at times, to heal. For that reason, here are some of the many terms often used in recovery settings to define alcohol consumption.
- Alcohol use: This simply refers to the behavior of consuming alcohol. People “use” alcohol at different levels – not at all, moderately, or heavily.
- Moderate alcohol use: The numbers can feel a little stringent, especially because they don’t take into account how varied our body composition can be. But this is defined as up to three drinks on any single day and up to seven drinks per week for women. For men, it’s up to four drinks on any single day and up to 14 drinks per week.
- Heavy alcohol use: This is defined in terms of the frequency of binge drinking. Doing so on five or more days within a month is classified by the Substance Abuse and Mental Health Services Administration (SAMHSA) as heavy alcohol use. This blog is mostly catered to people who have consumed alcohol at this level and are interested in navigating sobriety, because that was my experience – so naturally, that’s where I’m writing from.
- Alcohol misuse: This is an umbrella term referring to a range of behaviors that increase a person’s risk of adverse health and social consequences. These behaviors include risky, or excessive alcohol use (which encompasses binge drinking), as well as alcohol abuse and alcohol dependence – two terms that have been replaced in the medical literature and are now encompassed under the broader diagnosis of Alcohol Use Disorder (AUD).
- Risky (excessive) alcohol use: This refers to heavy alcohol use, binge drinking, and any drinking by pregnant women or people younger than the age of 21 (CDC). It is based on the amount of alcohol that increases the risk of poor health outcomes such as high blood pressure, heart disease, stroke, liver disease, and certain cancers – along with an increased risk of developing Alcohol Use Disorder (AUD).
- Binge drinking: If you come from a hard-partying college in the U.S. like I did, you probably need no introduction to what binge drinking is. But here’s how SAMHSA defines it: five or more alcoholic drinks for males, and four or more alcoholic drinks for females consumed within a couple of hours on at least one day within a month. That’s the level that typically (again, dependent on body composition) brings blood alcohol concentration (BAC) levels to 0.08 g/dL.
That’s a good start, but it doesn’t tell us what’s normal and at what level heavy alcohol use becomes a “disorder.” How do you know if you really have a problem? And how serious is it? While the below can only be diagnosed by a medical professional, looking at the criteria for Alcohol Use Disorder (AUD) can help you to start thinking clearly about your alcohol consumption and relationship with alcohol on a larger scale.
Again, don’t jump to any conclusions about yourself! Though frequent binge drinking is quite common (one in six adults binge drinks around four times per month), not everyone who does so develops AUD. The statistics show that among people who have one heavy drinking day per month, two in 10 have AUD, and among those who have one heavy drinking day per week, three in 10 have AUD. The risk is higher for those who have two or more heavy drinking days per week, among whom five in 10 have AUD.
- Alcohol Use Disorder (AUD): The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) distinguished between alcohol abuse and alcohol dependence based on the number of diagnostic criteria met under each of those categories. But the new edition of this diagnostic resource – the DSM-V – removes that distinction and instead has one diagnosis, called Alcohol Use Disorder, classified by severity (mild, moderate, severe) depending on how many of 11 criteria are met. Most of us are brought up to believe that you either are or are not an “alcoholic.” But the current definitions seem to imply that here is really a spectrum of alcohol-related problems, rather than this binary concept of alcoholism. Because of this, I won’t be referring to “alcoholism” in my blog.
In general, AUD involves continuing to drink despite recurrent social, interpersonal, and/or legal problems that result from alcohol use. Behaviorally, it usually involves frequent binge drinking, but may or may not reach the level of chemical dependence. A person may start to narrow in on social events and friendships that involve drinking, require increasing amounts of alcohol to achieve the same effect, and be subjectively aware of cravings and the compulsion to drink, continuing to do so even if it’s making them feel depressed or anxious.
At more severe levels, they’ll experience physical and emotional withdrawal symptoms like tremors, nausea, sweating, and insomnia shortly after they stop drinking, and drink to relieve or avoid those symptoms. If they decide to quit, the intensity of withdrawal symptoms may push them to lapse back into drinking behavior.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides several questions that can help when considering whether if you might be suffering from AUD. If you have severe AUD and might experience withdrawal symptoms upon quitting drinking, outside help is advised during the recovery process. You should work with your doctor to determine what’s best for you, but that additional help might include detoxification, medical treatment, or professional rehab – in addition to the counseling and group support that, in my opinion, are helpful to anyone moving from misuse to sobriety. The SAMHSA helpline is available 24/7 to help you locate a range of recovery resources.
To summarize things, the risks of alcohol use are typically gauged by the amount consumed, considering the number of drinks, frequency, and other behaviors surrounding drinking and its impacts. Alcohol misuse is an umbrella term that describes a broad spectrum of behaviors and conditions – including risky (excessive) alcohol use and AUD – that increase a person’s risk of adverse health and social consequences.
I hope these definitions will be of some value as you consider whether you feel in control of your drinking behavior. Remember that none of the above come with the label of “alcoholic,” but refer only to behaviors. And problem behavior always exists on a spectrum. It’s important that we try to shake off some of the stigma surrounding how we talk about alcohol use and sobriety so we can begin to think clearly about it!