Drinking Problems and Problem Drinkers
What differentiates heavy drinkers from alcoholics? The answer is not necessarily based on the frequency or the amounts drunk. The essential features of alcoholism include an inability to abstain and, once drinking starts, an inability to stop.
One of the most reliable ways of finding out if someone is an alcoholic ( Alcohol Dependence , in previous psychiatric nomenclature) is verifying their inability to stay sober despite numerous efforts to do so. Alcoholics are often remorseful and apologetic after getting drunk and in trouble, and will make promises never to start again. Yet, they will invariably find a rationalization or justification for drinking, no matter how severe or devastating the consequences. A heavy drinker (or Alcohol Abuser ) on the other hand, is able to abstain in the presence of powerful reasons to do so. Alcoholics see their lives spin out of control in front of their eyes, yet they invariably hit the bottle again and again. Some heavy drinkers could conceivably end up drinking larger amounts and/or more often than certain alcoholics. What sets them apart is not the amount or frequency of their alcohol use, but the seemingly hopeless inability of the real alcoholic to stay sober.
A second telling sign of alcoholism is the inability to stop once drinking has started. The powerful effects of the first drinks trigger strong cravings to continue. Stopping becomes impossible: " one drink is too many and ten are not enough ". Alcoholics will constantly try to drink in moderation ("normal drinking") only to find out, over and over again, that once the first few drinks are consumed they have no control over how much they will drink, or over when will they stop. The delusion of every alcoholic is that, some day, somehow, they will be able to drink in moderation.
An alcohol abuser drinks despite negative consequences (such as DWIs, problems at work or home, etc) but, unlike real alcoholics, is able to sober up if compelling reasons appear (severe medical problems, impending divorce, etc). Binge, sporadic drinkers may or may not progress to full-blown alcoholism, although most alcoholics were first alcohol abusers or binge drinkers. The current psychiatric classification ( DSM-V ) no longer separates Alcohol Abuse from Alcohol Dependence. It simply diagnoses "Alcohol Use Disorders" as mild, moderate or severe. In practice, two simple questions: "Have you tried repeatedly and unsuccessfully to stay sober?" and "Do you lose control of your drinking once you start?" often suffice to establish a strong suspicion of alcoholism.
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