Stages of Alcoholism: Abuse, Addiction, Dependence
Alcohol abuse, addiction, and dependence are not synonymous, although alcohol abuse can lead to addiction, dependence, or both.
Abuse is the act of drinking alcohol in a way that causes health, relationship, legal, or financial problems. Binge drinking is the most common form of alcohol abuse and is characterized by drinking enough alcohol within the space of two hours to raise your blood alcohol level to .08 percent. For men, this is roughly five drinks, and roughly four for women, according to the Centers for Disease Control and Prevention, which reports that the prevalence of binge drinking among men is twice that of women1.
Chronic alcohol abuse can transition to addiction, which is characterized as the inability to stop drinking despite wanting or trying to and in spite of negative consequences it may cause in terms of relationships, finances, legal status or physical or mental health. From the first drink, the brain associates alcohol with feelings of pleasure, so every time alcohol is consumed, this connection between drinking and pleasure becomes stronger. Changes in brain function and structure can cause intense cravings for alcohol, leading an individual to seek out and drink alcohol even if doing so causes negative consequences.
While choice is a factor in the initial decision to drink, once an addiction sets in, it’s no longer about choice. It is a compulsion caused by the changing function of brain chemicals. The National Institute on Drug Abuse stresses that willpower and good intentions are rarely sufficient for overcoming an addiction to alcohol2. In most cases, professional help is required to break the cycle of remission and relapse for long-term recovery, because addiction nearly always has underlying factors like unresolved trauma, high levels of stress, mental illness or a dysfunctional family system that must be addressed.
Over time, chronic abuse can lead to a shift in brain function wherein the brain operates more “normally” when alcohol is present than when it’s not. At this point, if alcohol is withheld from the body, brain chemical function rebounds and causes withdrawal symptoms. This is the major indication that dependence has developed.