Alcohol Misuse vs. Dependence: What's the Difference?

When it comes to having a problem with alcohol, there are all sorts of terms out there — from alcohol abuse and alcohol dependence to alcohol addiction and the more colloquial term, “alcoholism.” While similar, these terms don’t all mean the same thing. For instance, alcohol misuse and alcohol dependence are two different conditions. How so? Let’s dive in.

Understanding Alcohol Dependence

Alcohol dependence is a chronic medical condition that causes us to experience symptoms of withdrawal when we stop consuming alcohol. In other words, our body develops a physical dependence on alcohol, and we have to keep consuming alcohol to avoid experiencing withdrawal.

We might have alcohol dependence if we exhibit some or all of the following characteristics:

• Increased tolerance. We need to drink increasing amounts over time to achieve the desired effects of alcohol. For instance, we used to drink two glasses of wine each night, but now it takes four to attain that “feel good” feeling.
• Withdrawal symptoms. We experience physical symptoms (such as insomnia, tremors, shaking, or mood swings) after going for a short period without drinking.
• Drinking to relieve or avoid withdrawal symptoms. We have to drink to stop the shakes or to “cure” hangovers.
• Awareness of the need to drink. We’re aware of how strongly we’re craving alcohol, even if we don’t admit it to others.
• Drinking larger amounts. We consume larger amounts of alcohol over a longer period than intended and are unsuccessful at any attempts to cut back.

Alcohol dependence is similar to drug addictions, such as cocaine or heroin, as they all can cause incredibly strong withdrawal symptoms. In fact, delirium tremens, otherwise known as DTs, is a severe, life-threatening form of alcohol withdrawal characterized by agitation, fear, shaking, hallucinations, seizures, and severe confusion. On rare occasions, it can even lead to death.

Understanding Alcohol Misuse

Alcohol misuse, on the other hand, refers to excessive alcohol consumption, and it’s characterized by continuing to drink even though it creates problems in our social, interpersonal, health, and work life.

While someone who misuses alcohol may be dependent on alcohol, they may also be able to stop drinking without experiencing withdrawal. Some experts describe alcohol dependence as the inability to quit, and alcohol misuse as drinking too much, too often.

One study noted that 90% of people who misuse alcohol are not alcohol dependent. This includes people who engage in excessive drinking and binge drinking. However, the study also noted that people who binge drink more often were more likely to be alcohol dependent.

We might misuse alcohol if we exhibit some or all of the following symptoms:

• Drinking more alcohol over a longer period of time than intended
• Wanting to cut back on drinking but being unable to do so
• Spending a lot of time obtaining alcohol, consuming it, and then recovering
• Inability to function normally in important areas of our life due to alcohol
• Strong cravings for alcohol
• Giving up important activities because of alcohol use
• Using alcohol in situations that may be dangerous or risky
• Continuing alcohol consumption despite negative consequences
• Increased tolerance, (i.e., needing to drink more to experience the same effects)
• Experiencing symptoms of withdrawal when alcohol use is reduced or stopped

It’s worth noting that alcohol misuse can eventually lead to alcohol dependency; and, as we’ve learned, once we become dependent, it’s much more difficult to quit drinking.

However, even though alcohol dependence is more severe, alcohol misuse can still be incredibly harmful and dangerous. For instance, many people who misuse alcohol binge drink regularly, which is defined as having five or more drinks in two hours for men, and four or more drinks in two hours for women. Binge drinking can be extremely dangerous, increasing our chance of alcohol poisoning, accidents, and injuries.

Treatment for Alcohol Misuse vs. Alcohol Dependence

People with alcohol dependence typically require comprehensive treatment by a medical professional. Doctors might prescribe medications to help manage withdrawal symptoms and support us in our effort to stop drinking. Benzodiazepines in particular can help alleviate withdrawal symptoms, and naltrexone can help us manage alcohol cravings. Healthcare providers might also recommend recovery centers to help prevent relapse.

In severe instances, alcohol use might also require professional medical help. In other cases, people can learn to alter their drinking patterns through a variety of tools and resources. In fact, meditation has proven to be particularly effective in helping people curb cravings and reduce their alcohol intake.

The Bottom Line

The main difference between alcohol misuse and alcohol dependence is that alcohol misuse doesn’t always include a physical dependence on alcohol. With alcohol dependence, we have a physical compulsion to drink and will experience withdrawal symptoms if we stop consuming alcohol. With alcohol misuse, we don’t necessarily have a physical dependence on alcohol, but engage in excessive drinking even if it’s causing us problems. If we don’t feel the need to drink, but turn to alcohol to escape difficult emotions, that is a sign of alcohol misuse.

If you suspect you’re misusing alcohol or have developed alcohol dependence, it’s important to contact your healthcare provider, who can help determine the best treatment option for you. You can also try Reframe, a research-backed app that has helped millions of people cut back on their alcohol consumption.