What Is Alcohol Abuse?

Many people drink a small or moderate amount of alcohol to relax and enhance their social activities. Using alcohol in this way is not harmful for most adults.

However, people whose use of alcohol has negative effects on any aspect of their lives, including health, relationships, work or school and money, are considered to have an alcohol problem. These problems can range from mild to severe. The severity of an alcohol problem depends on factors including the type of alcohol you drink, how much you drink, and how long you have been drinking.

Experts divide levels of alcohol use and abuse into the following categories in terms of risk for developing problems:

• moderate drinking;

• at-risk drinking;

• alcohol abuse; and

• alcohol dependence (alcoholism).

Alcohol affects different individuals in different ways. The level of alcohol in the blood may be affected by gender, age, physical health, amount of food eaten, and any other drugs or medication taken.

What Is Moderate Drinking?

Moderate drinking is drinking that does not usually cause problems for the drinker or society and is considered low risk. In the United States, moderate drinking is usually defined as:

• men: no more than two drinks per day.

• women: no more than one drink per day.

• over age 65: no more than one drink per day.

A standard drink is considered to be:

• 12 ounces of beer or wine cooler;

• 5 ounces of wine; or

• 1.5 ounces of 80-proof distilled spirits.

The limit for women and all people over age 65 is lower because they have smaller amounts of water in their bodies than men age 65 and under. As a result, they reach the same concentration of alcohol in their blood after drinking a smaller amount of alcohol. In addition, more older people have medical conditions that can be worsened by alcohol and take medicines that can have harmful effects when mixed with alcohol.

These guidelines for moderate drinking do not apply to the following people, who should not drink alcohol at all:

• women who are pregnant or trying to get pregnant;

• people who are driving or operating machines;

• people who are taking medicine that interacts with alcohol;

• people who are recovering from alcohol dependence (alcoholism);

• people with certain medical conditions where alcohol use would be harmful, such as ulcer and liver disease; and

• children and adolescents (under age 21).

Although moderate drinking is generally considered low risk in terms of causing problems, some level of impairment can begin with the first drink. One example is decreased ability to concentrate and slower reflexes, which can lead to problems when driving or operating machines. Other health problems normally associated with heavier drinking can sometimes occur with low levels of alcohol use.

In recent years, there have been many media reports about possible benefits to the heart from moderate drinking. Evidence from research does show that moderate drinking (as opposed to not drinking or drinking larger amounts) is associated with decreased risk of death from heart disease. However, because drinking involves possible risks, people who drink little or no alcohol are not advised to drink more just to reduce their chance of developing heart disease. In addition, similar protective effects can be gained from a healthy diet and regular exercise.

What Is At-Risk Drinking?

In the United States, at-risk drinking is drinking that poses a risk of developing problems. It is considered to be:

• men: more than 14 drinks per week or more than 4 drinks per sitting.

• women: more than 7 drinks per week or more than 3 drinks per sitting.

What Is Alcohol Abuse?

Alcohol abuse is a pattern of drinking that involves one or more of the following problems within a one-year period:

• Failure to carry out major responsibilities at work, school, or home;

• Drinking in physically dangerous situations, such as while driving;

• Legal problems related to using alcohol; and

• Continued drinking despite ongoing problems in relationships with other people that are related to alcohol use.

Alcohol abuse does not involve physical dependence on alcohol. But if it is not treated, alcohol abuse can lead to alcohol dependence.

What Is Alcohol Dependence?

Alcohol dependence, also called "alcoholism," is a chronic and potentially fatal disease in which a person is addicted to alcohol. It cannot be cured, but it can be successfully controlled. Alcohol dependence is characterized by three or more of the following occurring in a one-year period:

• Tolerance: increasing amounts of alcohol needed to get the same effect.

• Withdrawal symptoms, such as shakiness, sweating, nausea, anxiety, and depression, when alcohol use is stopped after heavy drinking. Also, use of alcohol to relieve or avoid withdrawal symptoms.

• Drinking larger amounts and for longer than you intended.

• Inability to cut down or quit drinking.

• Spending a lot of time getting and drinking alcohol or recovering from its effects.

• Reducing or giving up important work or leisure activities.

• Continued use despite the physical or emotional problems it causes to the drinker or other people.

Alcohol abuse is different from alcoholism because alcoholics are physically dependent on alcohol and do not have control over their drinking. However, sometimes it is hard to draw a clear line between them because alcohol abusers experience many of the same effects that alcoholics do.