Alcohol addiction and alcohol dependence are not the same thing. But what exactly is the difference?
Often the terms alcohol addiction and alcohol dependence are used interchangeably, which can lead to confusion. While closely related, alcohol addiction and alcohol dependence are not exactly the same thing, however the difference can be difficult to discern and understand.
What is the Difference Between Alcohol Addiction and Alcohol Dependence?
Abuse of alcohol, alcohol addiction and alcohol dependence can be seen as different sets of symptoms and behaviours that occur progressively along a spectrum of the same disorder which we will examine further below.
Abusing alcohol encompasses many harmful behaviours including binge drinking, driving while intoxicated, and drinking alcohol at the expense of participating in other activities. Alcohol use has entered the realm of abuse when a person experiences negative consequences due to their drinking behaviour. While abuse of alcohol does not always lead to addiction, it is often a sign of the beginning stages of the disorder. Especially when alcohol use begins to interfere with work, school, or social obligations, leads to reckless behaviour while under the influence such as drinking and driving, and ultimately continuing to drink despite consequences, then abuse is progressing quickly towards addiction.
There is a fine line between the abuse of alcohol and alcohol addiction. Alcohol addiction is a primary condition characterised by the inability to stop using alcohol despite growing negative consequences. Uncontrollable cravings for alcohol, exceeding self-imposed limits, continued use despite physical, psychological, and social consequences, and an inability to stop drinking once one has started are all behaviours that signal addiction has developed. In addition, when someone is addicted to alcohol, tolerance and withdrawal may occur. This means that the user needs more and more alcohol to achieve the same effects, and the user may experience symptoms of withdrawal when not drinking. These attributes signal the development of a physical dependence on alcohol.
Alcohol dependence refers to a physical dependence on alcohol and is characterised by tolerance to alcohol and alcohol withdrawal syndrome. Alcohol withdrawal syndrome can be life-threatening and occurs when heavy drinkers stop drinking or drastically cut down their alcohol intake. Symptoms can range from mild anxiety and shakiness, to serious seizures and delirium tremens and can persist for up to a few weeks. The death rate of those who experience delirium tremens, which is a condition characterised by confusion, rapid heartbeat, and fever, is approximately between 1% and 5%. For chronic heavy drinkers who are alcohol dependent, the withdrawal syndrome can be medically serious so care should be taken when these individuals decide to get help and stop drinking.
Taking a Broader Look at Addiction vs. Dependence
When it comes to alcohol, addiction can occur without developing dependence, however alcohol dependence is generally known as the most severe form of alcohol addiction. This is not the case for all drugs, and here we will take another look at how dependence and addiction are related.
Addiction can occur without dependence.
One does not necessarily have to be physically dependent on alcohol or any other drug in order to have an addiction. In these cases the addiction is psychological wherein even though the body does not actually need the substance, and would actually be better off without it — the brain is truly convinced otherwise and will often stop at nothing to get its next fix. Process addictions, for example, such as sex and gambling addiction are very real — however no physical dependence on a substance occurs.
Dependence can occur without addiction.
Alcohol dependence is always related to addiction, however with some drugs, especially some prescription medications, physical dependence is defined by developing tolerance, and experiencing withdrawal can occur without the uncontrollable cravings and other maladaptive behaviours associated with addiction.
How does the Delineation Between Dependence and Addiction Impact Treatment?
Most people associate alcoholism with alcohol dependence, which fuels denial and makes getting treatment more difficult for many. In fact, it is the incorrect stereotype that to be an alcoholic one must wake each morning and begin drinking alcohol and continue all day, that stops many alcoholics from getting treatment. As mentioned above, it is not necessary to be physically dependent on alcohol to have an addiction to it. And even then there are several different levels of alcohol addiction including a group termed ‘high-functioning alcoholics‘ who outwardly appear to have their life in order, but struggle with drinking behind closed doors.
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