What's the Difference Between Alcoholism and Alcohol Use Disorder?

What’s the Difference Between Alcoholism and Alcohol Use Disorder?

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Alcoholism vs alcohol use disorderThis post was originally published on March 28, 2016.

There are many facets of the human condition whose explanation stands divided between science and intuition—addiction is unfortunately one of them. A new study, published in the Proceedings of the National Academy of Sciences, is another attempt to solve the “drinking problem” by looking into the brain chemistry of human alcoholics and rats (two species that even science acknowledges are similar).

What They Are Trying to Figure out

The question researchers are asking is: does alcohol dependency result in an excess or deficiency of dopamine in the body? While I am no scientist, as a recovering alcoholic, I feel like I can answer the question without much research beyond how desperately I crave Klondike bars on a daily basis. Dopamine, a neurochemical in the brain responsible for reward-seeking behavior (among many other things), has long been linked addiction. The fact that some people feel compelled to abuse drugs and alcohol and “act out” with other vices that raise dopamine levels seems obvious—we crave it because we don’t have enough. So as far as I am aware, the idea that addiction may be a result of too much dopamine is a new one.

While I understand that scientists do what they do—study science—it is frustrating that this kind of research is seemingly the only kind being done on alcoholism. I never read about studies involving clear-headed recovering alcoholics, who have gained a deeper understanding about why they drank (and possibly even why they kept relapsing). Other than the countless therapists with bursting files around the world, is anyone collecting data about the mental and emotional aspects of addiction?

Disease or Just Dis-Ease

Part of the problem is that, though much more accepted now, the idea that addiction is a “disease” is still much debated, even in the rooms of 12-step recovery. Why? Because of the whole science versus human experience thing. And since science can only quantify the physical compulsion to abuse substances, there is still doesn’t seem to be a scientific measurement for the psychological and emotional aspects of addiction. But any addict will tell you, that doesn’t mean they aren’t there.

What’s sad about the whole thing is that the two sides are so segregated. Science works with facts and theories while those actually suffering from alcoholism are left to be like, “Why can’t I manage to return phone calls, open my mail, leave my house?” And that’s often coming from people who are sober. As many of us will tell you, drinking may have become our problem (blackouts, arrests, promiscuity) but it started out as our solution—our medicine to treat the real problem—how we felt.

Let’s Just Throw More Pills at It!

Which brings me back to this study. I agree that there is value in looking at all angles of what makes, and therefore can help treat, an alcoholic. But when we spend too much time looking at how to fix a body that had been altered by alcohol abuse in hopes of keeping people sober, we are missing the point. It’s a mistake to focus on the chemical biology of an existing problem in order to create the best medication to treat it, rather than looking at the bigger issue of how to prevent it in the first place.

As of now, there is no definition of “Alcoholism” in the DSM-5, the medical manual used to classify and diagnose all recognized psychiatric disorders. Instead, there is something called “Alcohol Use Disorder (AUD),” which is defined by a list of criteria ranging from mild to severe. The list includes questions similar to those found on handouts many of us got as kids when we were forced to go through programs like DARE. Things like:

  • Have you had times when you ended up drinking more or longer than you intended?
  • Have you tried more than once to cut down or stop drinking but couldn’t?
  • Have you spent a lot of time drinking or being sick from the aftereffects?

These questions cover only the symptomatic traits of the alcohol abuse and dependency—basically asking if you are already physically dependent on alcohol. Other than verbally warning us of the dangers of abusing substances, how have we not come up with a way to help prevent people from becoming physically addicted to alcohol?

AUD Is Not Alcoholism

Because we need to first recognize that AUD is more than just that, it is a mental illness characterized by traits like extreme ego (both entitlement and low self-esteem), dishonesty (to protect that ego), self-centeredness (“I am the only one who matters” as well as “no one thinks I matter at all”), selfish behavior (as a result of the self-centeredness), unrealistic expectations of people and the world and the real kicker—a warped perception of reality.

These are only some of the lovely traits shared by alcoholics. Many of us also talk about feeling uncomfortable in our own skin, desperately wanting to fit in or be liked and having a negative inner voice telling us we both deserve more and are worthless pieces of shit. And we all agree; alcohol was the one thing that quieted that voice, until the day it stopped working on some level.

So until science and the medical field are willing to look beyond the chemical makeup of addicts and spend time and effort looking at the psychological elements, all we are going to see is more medication, more addiction and more broken hearts. Upside? We may also see more episodes of Intervention.

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3 Comments

  1. I came by to this site looking for a treatment center for male toeheads who are triggered by the color blue and read your post. Daniele Stewart . Always a good alcoholism read, thanks..

  2. Stephanie Burkhart on

    I appreciate this article on AUD. I was just diagnosed through an interview process as part of treatment required for a DUI conviction in Illinois. I was accepting of the diagnosis as it made me reflect on prior years. I’ve made many poor choices and I attribute the use of alcohol.
    I am now going through risk education and intervention courses. It has been an eye opening experience as far as expenses are concerned. I am thoroughly upset that some insurance does not cover mental health centers, vice versa, the centers don’t accept the insurance. It is a health issue for sure as it has a diagnosis.
    I wish I would have had the education sooner rather than now. And I believe awareness education should be more prevalent and available. Because to me, now it is only better known because of its fines. It forces people to pay thousands of dollars.
    I’ve noticed myself with higher anxiety levels, not getting adequate sleep. And they ask you these questions to do with the alcohol? No, this comes from being a depressed single mother trying to make ends meet.
    I think helping to make more preventative measures would be very beneficial. This should start Freshman year of highschool. Questionares should be a part of education of mental health. Active counselors should also be readily available and referrals as necessary. This should be mandatory in every school. I don’t think enough is being done at that level for our youth.

    Again, thank you for your article.

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About Author

Danielle Stewart is a Los Angeles-based writer and recovering comedian. She has written for Showtime, E!, and MTV, as well as print publications such as Us Weekly and Life & Style Magazine. She returned to school and is currently working her way towards a master’s degree in Marriage and Family Therapy. She loves coffee, Law & Order SVU, and her emotional support dog, Benson.