In the 25-plus years that I was in private practice, clients would change, as would personalities, needs and countless dynamics that set each individual apart. What often did not change were the issues.
Today, I will attempt a response to “What is the difference between alcoholism and alcohol abuse?”
From a clinical perspective, the Diagnostic and Statistical Manual of Mental Disorders, both are illnesses. An alcoholic may experience withdrawal symptoms after alcohol cessation such as delirium, sweating, hand tremors, insomnia, nausea or vomiting, anxiety and grand mal seizures, this last symptom sometimes bringing on heart failure. An alcoholic (who is alcohol dependent) typically devotes substantial periods of time attempting to obtain and consume alcohol. Despite depression, liver disease and blackouts, an alcoholic is not generally able to recover without intervention.
Alcohol abuse is defined as the use of alcohol despite symptoms of maladaptive behavior or psychological changes (such as inappropriate sexual or aggressive behavior, impaired judgment, impaired social or occupational functioning) slurred speech, incoordination and unsteady gait. Although the abuse may create absences from work or school, and general negligence from overall responsibilities and although withdrawal has similar unpleasant symptoms, (like alcoholism) the consequences are not always medical in nature and the presentation not always apparent.
Having shed a bit of light on the definitions of these problems, I want to share a snapshot of clients who suffered from one or the other. It is important to understand the sheer enormity of possible symptoms and the unique nature of each individual’s specific plight with their illness.
“Tony” is an alcoholic. (there is a common belief that despite sobriety, an alcoholic will always be regarded as an alcoholic, albeit a recovering one) He engaged in therapy as best he could, but mostly he missed our sessions. He had been drinking for most of his life (30-plus years) had no driver’s license (continued to drive) and had lost a job that he’d loved (police officer). Tony’s wife and child would not speak to him and he lived with his mother. No matter what he lost or who he alienated, Tony could not stop drinking. He wanted to stop drinking. He could not. His impairment was striking.
“Lucy” abused alcohol. She was not usually prompt but did keep her appointments with me. Lucy managed to keep her job, and her license, and was a really great mom (self-report). Sometimes she got into trouble after work, when she enjoyed going to bars or restaurants, by herself, and drinking and beers. (too many for her to drive herself home). Her husband always agreed to stay at home with their kids, Lucy would take a cab home, and her husband would drop her off in the morning wherever she had parked the night before. She did not focus solely on seeking alcohol, but when she drank she became impaired, it impacted her judgment and required careful planning on her part. She also depended heavily on her husband’s willingness to enable her. When asked if she could stop drinking her reply was “Sure, but why would I?”
When I present issues I’ve encountered professionally, they are small portions of people’s stories and are not meant to reflect their individual recovery process.
In either case, be it someone you care about, someone you love, who you suspect may have a drinking problem, (and that someone may be you) it is important that you not judge others or yourself. It is easy to formulate long-standing stereotypes that historically have been associated with this disease. It may seem unrealistic and impossible to offer compassion if you are being lied to or stolen from. We cannot change or control how others behave.
My suggestion is that you seek professional help, and perhaps a 12 Step group called Al-Anon. You can seek support from others who share your fears and concerns. Sometimes it is helpful to meet others who have been where you are. This website provides access to local the meeting information: al-anon.org/al-anon-meetings/find-an-al-anon-meeting
If you think that you have an unhealthy relationship with alcohol, there is a 12 Step group called Alcoholics Anonymous. Their meetings can be found by Googling Alamance County Meeting List AA North Carolina District 33.
Cindy Davis is a retired, licensed professional counselor. All inquiries are confidential. Questions can be emailed to email@example.com.