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Hiding in Plain Sight: Understanding Alcohol Abuse, Addiction and Dependency

According to Alcohol Change UK, of the 595,000 people in England who are currently alcohol dependent, only 20% are in treatment. This is shocking and needs to change. Alcohol-related illness creates a huge cost for the NHS and causes considerable harm not only to the those who are drinking, but also to their family and friends.

However, among many, perceptions around the ‘normal’ intake of alcohol are far from the recommended maximum units and there is little understanding of the phrases used to explain alcohol-related illnesses.

So, here is our guide to the differences between alcohol dependence, alcohol addiction and alcohol abuse:

Alcohol Dependence

1.6 million adults in England today may have some level of alcohol dependance, according to Public Health England. In other words, they have built up a tolerance to the extent that they suffer physical withdrawal symptoms when not drinking alcohol. According to their level of tolerance, the symptoms of Alcohol Dependence could involve shaky hands, a degree of anxiety, seizures and even delirium tremens (fever and confusion).

The 2017 figures on alcohol dependence are the most up-to-date released by Public Health England and they certainly make for sober reading. It costs the NHS around £3.5bn a year to treat alcohol-related illness. Alcohol-related crime is even higher, at a cost of £11bn, while productivity lost through alcohol-related sickness is equivalent to around £7bn a year.

Alcohol Addiction

So, if the above describes alcohol dependence, what is alcohol addiction? Both conditions sound similar and it can be difficult to initially differentiate between them. But, there is an important distinction:

In the case of alcohol addiction, drinkers psychologically crave alcohol. With alcohol dependence the craving is very much physical.

Like other addictions, the amount of the substance (in this case alcohol) required to ‘satisfy’ the addicted individual usually increases with time. This is despite harmful social, physical or psychological consequences caused by drinking.

Many high-functioning alcoholics tend to fall into this category i.e. ‘successful’ people who appear not to have a problem with alcohol and don’t display any withdrawal symptoms. This is an important point since, according to the government’s latest Opinions and Lifestyle Survey, individuals in managerial and professional occupations (the highest earners) were the group most likely to say they had taken alcohol within the study’s time remit.

Looking at the two distinctions – alcohol dependence and alcohol addiction – it’s clear the latter is a precursor to the former. There is another category which could be listed before alcohol addiction: the individual who abuses alcohol.

Alcohol Abuse

Someone who displays the symptoms of alcohol abuse doesn’t necessary become addicted – just as someone who is addicted doesn’t necessarily become dependent (especially when given intervention and other forms of treatment). However, there is the potential for the person to become addicted if he or she continues their behaviour.

An individual could be said to be abusing alcohol if they are binge drinking, driving while under the influence or generally behaving in a reckless manner. In other words, when drinking alcohol causes them to indulge in risky behaviour – actions that are detrimental to both themselves and others. This is particularly the case when it begins to interfere with their social, work or family life – and yet they continue to drink. If it continues unabated, the next stage is alcohol addiction.

Alcohol abuse, alcohol addiction and alcohol dependence are three categories on an alcohol disorder spectrum where one category can progressively lead to the next.

Correctly identifying the category which an individual is in should result in them getting the best form of treatment and help available.


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