Dr. Carmella Sebastian discusses the difference between alcohol dependence and abuse.
• Alcohol abuse is different from Alcohol dependence. Abuse is characterized by “any harmful” use of alcohol. People who abuse alcohol drink despite legal, social or interpersonal harm caused by the drinking. Dependence is distinguished by some or all the following: 1. Narrowing of the drinking repertoire (drinking only one brand or type of alcoholic beverage).
2. Drink-seeking behavior (only going to social events that will include drinking, or only hanging out with others who drink).
3. Alcohol tolerance (having to drink increasing amounts to achieve previous effects).
4. Withdrawal symptoms (getting physical symptoms after going a short period without drinking).
5. Drinking to relieve or avoid withdrawal symptoms (such as drinking to stop the shakes or to "cure" a hangover).
6. Subjective awareness of the compulsion to drink or craving for alcohol (whether they admit it to others or not).
7. A return to drinking after a period of abstinence (deciding to quit drinking and not being able to follow through).
• Figures from the Centers for Disease Control that showed binge drinking— consuming four or more drinks on an occasion—was common among women in the United States: One in eight women regularly binge-drinks. And as their alcohol consumption has increased, so have the negative effects. More women now are getting picked up for drunk driving, and more college-aged women wind up in ERs because they’re dangerously intoxicated. • The intoxicating effects of alcohol are higher for women because women’s bodies contain more fat (which can’t absorb alcohol, causing it to enter the bloodstream) and less water (which dilutes alcohol). Women also produce less of the enzyme dehydrogenase, which helps process alcohol, and that means women get drunk faster. • One size doesn’t fit all. Many people have been helped by AA. The 12 step program and “powerlessness over alcohol” have and do work for many people. • For some, it is not the answer. There are alternatives. • Moderation Management (MM), a secular group founded in 1993 that, like AA, offers a program that starts with an alcohol-free period. But unlike AA, MM limits the ban to a month and doesn’t require that its members submit to a Higher Power to reach sobriety. Instead, it focuses on self-monitoring so that people can live better lives (which can include moderate amounts of alcohol). Its steps consist of commonsense exercises such as “write down your life priorities” and “take a look at how much, how often, and under what circumstances you drink.” • HAMS (Harm Reduction, Abstinence, and Moderation Support), founded in 2007. The program’s orientation is more pragmatic and encouraging than MM’s. HAMS “recognizes recreational intoxication as a reality and seeks to reduce the harm associated with it,” according to its website, and it “does not force people to change in ways that they do not choose themselves.” Members name an objective —safer drinking, reduced drinking, or quitting—and craft a plan to get there. • SMART Recovery (Self-Management And Recovery Training), which was created in 1994 by mental-health professionals as a science-based recovery group that “teaches increasing self-reliance.” SMART has four strategies: building and maintaining motivation; coping with urges; managing thoughts, feelings, and behaviors; and living a balanced life. It urges people to use logic to examine their drinking. • The most important thing is to identify that you need help to reduce or quit drinking and seek out a program that can work for you