Definition of Alcoholism

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  At what point is one considered an alcoholic?

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I'm not very fond of the term "alcoholic."  It has accumulated much too much negative baggage.  I like to think of peoples' drinking behaviors on a spectrum that runs from abstinence to severe alcohol dependence (alcoholism).  What follows are brief descriptions of different points along that spectrum:
Occasional Low-Risk Drinking - This describes the drinking behavior of people who are able to drink (no history of alcohol problems, no medical problems exacerbated by drinking, and non-pregnant women) and who drink moderate amounts of alcohol (1 or 2 standard drinks at a sitting) on a very occasional basis (once a week or less).
Regular "Healthful" Drinking - People who are able to drink (no history of alcohol problems, no medical problems exacerbated by drinking, and non-pregnant women) and who want to maximize the positive cardiovascular benefits of moderate drinking should drink as follows: 3-6 standard drinks per week for men (never more than 3 at a sitting), 2-4 standard drinks per week for women (never more than 2 at a sitting).
Lower Risk Drinking - People who are able to drink (no history of alcohol problems, no medical problems exacerbated by drinking, and non-pregnant women) and who want to avoid developing a drinking problem should adhere to the following limits: Men under 65 should limit themselves to 14 standard drinks per week and 4 standard drinks per sitting; Women and older men should limit themselves to 7 standard drinks per week and 3 standard drinks per sitting.  People should drink alcohol at a rate of 1 standard drink per hour to avoid excessively high blood alcohol concentrations.
High Risk Drinking - One group of high risk drinkers includes those who drink despite being advised by a qualified medical professional not to drink.  A second group of high risk drinkers includes those who exceed the guidelines for Lower Risk Drinking described in the previous paragraph.
Problem Drinking (Alcohol Abuse) - People whose drinking has caused or is causing problems in their lives are problem drinkers.  Drinking can lead to the following: Medical problems; legal problems; family and other interpersonal problems; functional problems at work or at school; and, psychological or psychiatric problems (examples include insomnia, anxiety & depression).  Ongoing problem drinking is referred to as alcohol abuse.  Alcohol abusers are generally better off stopping altogether, although a select few may succeed in becoming lower risk drinkers. Any problem drinker who has attempted to become a lower risk drinker who subsequently experiences  further problems due to drinking needs to stop altogether.
Alcohol Dependence (Alcoholism) - People who lose control of their drinking, who are preoccupied with drinking, or who drink heavily on a daily basis and experience withdrawal symptoms when they attempt to cut down or stop are alcohol dependent (alcoholic).  Long-term abstinence and a genuine, ongoing and active commitment to sobriety are the only reasonable remedy for alcohol dependence (alcoholism).
For the precise definition of terms like "standard drink" and "withdrawal symptoms" and for much more information about the use and abuse of alcohol, check out the DRINKING section of my Ask DrSteve web site, conveniently hyperlinked below.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition,
Steve Adelman, M.D. (a.k.a. DrSteve)
Keyword: alcohol dependence, alcohol abuse, alcoholism, problem drinking


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