Alcohol Use, Abuse, Dependence, and Addiction

There are many types of alcohol consumption ranging from the healthy to the deadly. Some people of the prohibitionist persuasion will ague that any use is destructive, but neither medical research nor personal experience supports that conclusion. Unhappily, most "screening" protocols are heavily weighted towards a diagnosis of addiction justifying punitive treatment approaches and "abstinence only" outcomes. In reality, many different degrees of alcohol use exist, and the following thumbnail guide can be helpful in deciding what category is appropriate, and in predicating various – as well as usual - outcomes. Healthy alcohol consumption has been found to be approximately two drinks of distilled spirits, two bottles of beer, or one half bottle of wine per day for an adult man, and half that for an adult women. These amounts confer the most health benefits without any associated detrimental effects. Obviously, not everyone consumes these set amounts, nor do most people who drink necessarily always stop at one or two. Certain social settings may find one consuming more over the duration of an event, for example, but the average should remain within the recommended parameters. People who clearly fall into this category may, unfortunately, still find themselves in need of help. Particularly in child custody disputes, but in other legal matters as well, unfounded accusations are frequently hurled and difficult to refute. As John Donne noted, "Two things will be believed of any man whatsoever, and one is that he has taken to drink." Alcohol abuse is defined as consumption which consistently exceeds the recommended levels and/or is done in isolation rather than socially. Frequent contributing factors include loneliness, exhaustion, and a paucity of peers or activities. At this stage, remediation is common enough to be the norm, with a return to healthy use the usual outcome. Counseling may expedite the process and help with the underlying causes. Clients who find themselves at this level can usually benefit from a process of assessment, skill building through Cognitive-Behavioral Therapy (CBT), and the adoption of non-alcohol related activities. As in more serious conditions to follow, the key lies in the creation of a life with reduced alcohol use that is more satisfactory than the current one. An onerous life, or a continued focus on alcohol, will nearly guarantee a return to misuse. Alcohol dependence occurs after long periods of excessive use leading to social, physical, and emotional dependence. Drinking becomes a primary coping mechanism across multiple categories; for example, socially, recreationally, vocationally, and spiritually. Symptoms may include physical withdrawal following cessation, depression, increased isolation, significant weight gain, decreased liver function, and possible legal, financial, and/or employment problems. As multiple problems need attention, counseling can help with the reorganization, prioritization, and systematic accomplishment of necessary changes. While a return to moderate or healthy use is normal, a period of abstinence, possibly one to two years, is recommended. Many people who do this never return to drinking at all, having successfully modified their lives in satisfactory ways. Alcohol addiction, or alcoholism, results when a person's physical, emotional, and psychological being is permeated by alcohol and its consumption. Distinct withdrawal symptoms – physical (i.e. tremors, seizures) and psychological ones (i.e. blackouts) – are present and alcohol related disintegration in several areas of life (i.e. financial, legal, vocational, marital, recreational, social, medical) is present. While approximately a third of diagnosed alcoholics return to moderate drinking, this is not generally recommended. At this stage both medical and counseling help is usually necessary given the physical, social, emotional, and psychological aspects. Recovery prospects are uncertain at best and outcomes vary. As always, motivation, spousal support, and a belief in personal efficacy, as opposed to "powerlessness," are the primary factors in success. In general, alcohol problems of all magnitude are remarkable for both their persistence over time (being stabile rather than progressive) and their frequent spontaneous remission. While some individuals do follow a path from use to abuse to dependence to addiction, and death, they are the exception, not the rule.

- By: Mary Ellen Barnes, Ph.D.
Mary Ellen Barnes, Ph.D., is a therapist with offices in Rolling Hills Estates who approaches all clients as unique individuals capable of overcoming difficulties through the development and redirection. Mary Ellen can be contacted through her profile here: