About the Terms Alcohol Abuse | Alcoholism | Alcohol Use Disorder
Confusion about the terms alcohol abuse | alcoholism | alcohol use disorder often gets in the way of a person seeking the help they need or causes family members, friends, co-workers, and society-at-large to excuse, rationalize, deny, blame and/or shame that person in their misguided attempts to avoid labeling them an alcoholic or alcohol abuser. [What I explain in the remainder of this post applies to other drug use disorders / substance use disorders, as well. The term substance use disorder is explained at the end of this post]
Origins of the Terms Alcohol Abuse | Alcoholism | Alcohol Use Disorder
Until May 2013, it was common to use the terms alcohol abuse and alcoholism to describe a drinking problem. These were the classifications used in the 4th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM is the manual used by clinicians to give them a common language with which to understand, diagnose, and talk about a wide range of mental health disorders. Yes, alcohol abuse and alcoholism are considered mental health disorders. [Mental health disorders are also known as mental illnesses, mental disorders, and mental health conditions.]
The American Psychiatric Association (APA)’s DSM-5 eliminates Alcohol Abuse and Alcoholism and identifies these within the Alcohol Use Disorders (AUD) Classification.
In May 2013, the DSM was updated and released as the DSM-5. The revised edition removed the references to alcohol abuse and alcoholism and rolled them into one disorder classification called “Alcohol Use Disorder (AUD).”
Why Alcohol Abuse | Alcoholism | Alcohol Use Disorder are Considered Mental Disorders
Alcohol abuse | alcoholism | alcohol use disorder — understanding the brain’s electro-chemical signaling process [the process by which brain cells (neurons) “talk” to one another] — helps us understand why alcohol abuse, alcoholism, and alcohol use disorders are considered mental disorders.
The following is a simplified description of what goes into making a neural network. If any one of these “things” is changed or different, it changes the way neural networks perform, which can then cause a person to think, feel, and behave differently.
- Cue or Trigger – a sound, sight, touch, smell, memory, emotion…something that triggers the electrical portion of the electro-chemical signaling to start.
- Brain cells (aka neurons) – the “brains” of the neural network; messages are passed from one to another.
- Axons and Dendrites – outgoing and incoming branchlike extensions – take messages to and from cells.
- Neurotransmitters – the chemical portion of the electro-chemical signaling process located at the end of outgoing branchlike extensions. These change the electrical signal into a chemical signal that can float across the synapse.
- Synapse – the gap between outgoing and incoming branchlike extensions.
- Receptors – located at the end of incoming branchlike extensions. They accept the neurotransmitter – like a “key in a door lock” – and change it back into an electrical signal to carry on the message to the receiving cell.
Through a series of connections, neural networks form systems between the brain and other organs to control our body’s major functions. These include the fight-or-flight stress response system, for example, as well as the circulatory and digestive systems.
Neural networks also work together to form “brain maps” for the things we do regularly. Brain maps take very little, if any, thought. They just happen. And thank goodness they do. If we did not have these brain maps, we would still be trying to get out of bed because the millions of neuron connections needed to do that simple function would take forever to consciously hook together. So, over the course of our lives, we create brain maps for riding a bike, typing, brushing our teeth, reading, climbing, swimming, driving a car, operating equipment, playing an instrument, texting—just think about it! Basically, then, brain maps are our habits, coping skills, life skills and typical behaviors.
When a person drinks more alcohol than their liver can metabolize (get rid of), the ethyl alcohol chemicals in alcoholic beverages interrupt the chemical portion of the electro-chemical signaling process. This interruption changes how neural networks function. When it is prolonged and/or excessive, it actually changes brain structure and function and can result in the mental health disorders of alcoholism and alcohol abuse or as the new DSM-5 classifies them, a mild, moderate or severe alcohol use disorder.
Alcoholism | Alcohol Abuse – Now Incorporated as Part of One Disorder – Alcohol Use Disorder (AUD)
To help us understand the change in terms to describe and identify drinking problems, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) wrote the PDF, “Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5,” accessed February 20, 2018. I have taken a screen shot of page 2 of this PDF and copied it below.
As you see in the above screen shot, the severity of an alcohol use disorder is identified by the number of symptoms (items 1-11 in the blue column) as either mild (2-3 symptoms), moderate (4-5 symptoms, or severe (6 or more symptoms).
I Still Use the Terms Alcohol Abuse and Alcoholism, as well as Alcohol Use Disorder
More often than not, I continue to use society’s more commonly used terms, alcohol abuse and alcoholism, for two reasons.
The first is because these are the terms most people know and use. The second is to make the distinction easier to explain and understand because the way a person stops their alcohol abuse is different than the way a person develops and treats their alcoholism.
For information on how a person develops and treats a drinking problem, check out the National Institute on Alcohol Abuse and Alcoholism (NIAAA)’s website, “Treatment for Alcohol Problems: Finding and Getting Help,” and the National Institute on Drug Abuse (NIDA)’s website, “Drugs, Brains, and Behaviors: The Science of Addiction.”
Regardless of Terms, All Alcohol Use Disorders Have Something in Common
Whether it’s called alcohol abuse or alcoholism or a mild, moderate, or severe alcohol use disorder – these conditions all have something hugely significant in common – drinking behaviors. Drinking behaviors, in turn, cause secondhand drinking impacts for family members, friends, co-workers, and society at large.
Drinking behaviors occur when a person has consumed more alcohol (ethyl alcohol chemicals) than their brain and body can process, causing the ethyl alcohol chemicals to interrupt the brain’s electro-chemical signaling processes. Drinking behaviors include:
- verbal, physical, emotional abuse
- neglect
- blackouts
- alcohol-related crime
- unplanned, unwanted sex, sexual assault
- breaking promises to stop or cut down
- shaming, blaming, denying
- unpredictable behaviors
- driving while impaired.
For a more complete understanding of alcohol use disorders AND their impacts on family and friends, check out my latest book, 10th Anniversary Edition If You Loved Me, You’d Stop!
Lastly… About the Terms Alcoholic | Alcohol Abuser
Another part of this new brain science is the use of new language to replace terms such as alcoholic or alcohol abuser. Just as we refer to persons with other mental disorders as “a person with _____________ [anxiety, depression, ADHD, bipolar],” so, too, are persons with alcohol use disorders now being referred to as “a person with an alcohol use disorder.” This helps to remove the stigma, misinformation and shame that surrounds drinking problems and typically keeps people from seeking the help they need. It’s the idea of the individual being seen as a person with a mental disorder not as their mental disorder.
As with the above, however, I continue (for now) to use the terms alcoholic and alcohol abuser (in addition to the new language) because that is how society commonly refers to these conditions.
And Similarly, What About the Terms for other Drug Use Disorders and Persons With those Disorders?
When talking about the combination of alcohol and other drug use disorders, the term is substance use disorders (SUD).
When talking about a specific drug other than alcohol, the term is that drug’s name, followed by use disorder. For example, mild marijuana use disorder or severe cocaine use disorder.
When talking about a person with a drug use disorder other than alcohol, the individual is referred to as “a person with a marijuana use disorder” (or cocaine or meth or heroin…, depending on the drug.)
The concepts described above apply to other substance use disorders, as well.
©2018 Lisa Frederiksen. Reviewed January 2020.
Lisa Frederiksen
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Thank you for this clarification. This does clear up the confusion.
Thanks Debbie – glad to hear it helps.