Are All Heavy Drinkers Alcoholics?

I’ve heard that there’s a difference between heavy drinking and alcoholism and that not all heavy drinkers are alcoholics. How can you tell the difference? Does it matter whether someone is a heavy drinker or an alcoholic?

– March 6, 2015

You may think that alcoholism and heavy drinking amount to a distinction without a difference, but a 2014 study from the U.S. Centers for Disease Control and Prevention (CDC) and another U.S. government agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), defined “excessive drinking” and distinguished it from alcoholism.

The study was based on data from 138,100 U.S. adults who participated in the National Survey on Drug Use and Health (NSDUH) in 2009, 2010, or 2011, which contained questions about current drinking, binge drinking, average alcohol consumption, and symptoms of alcohol dependence.

The researchers defined excessive drinking as binge drinking (four or more drinks on a single occasion for women, five or more drinks on a single occasion for men); consuming eight or more drinks a week for women or 15 or more drinks a week for men; any alcohol use by pregnant women or anyone under the minimum legal drinking age of 21.

Alcoholism was defined as a chronic medical condition that typically includes a current or past history of excessive drinking, a strong craving for alcohol, continued use of alcohol despite repeated problems with drinking, and an inability to control alcohol consumption.

The study determined that nearly one in three adults in the U.S. drinks excessively, and that most of them binge drink, usually on multiple occasions in a month. It also concluded that one in 30 adults is alcohol dependent. The researchers concluded that rates of alcohol dependence increase with the amount of alcohol consumed and that about 10 percent of binge drinkers are alcohol dependent, as are 30 percent of people who binge frequently (10 or more times a month).

Signs of alcoholism include continuing to drink even though it causes serious problems in your life, a physical dependence on alcohol, and an increasing tolerance, so that you need to consume more and more to feel its effects.
In its summary, the CDC found that excessive alcohol use and alcohol dependence contribute to 88,000 deaths annually in the U.S.  This includes deaths from diseases associated with excessive drinking over time, such as breast cancer, liver disease and heart disease as well as violence, alcohol poisoning and motor vehicle accidents as a result of drinking too much in a short period of time.

There are other serious risks. Alcohol is a factor in about 60 percent of fatal burn injuries, drownings, and homicides; 50 percent of severe trauma injuries and sexual assaults; and 40 percent of fatal motor vehicle accidents, suicides, and fatal falls. Heavy drinking also puts you at greater risk of liver and nervous system disease, heart disease, sleep disorder, stroke, depression, bleeding from the stomach, and sexually transmitted infections from practicing unsafe sex, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

It matters whether or not a drinker is alcoholic in that treatment for alcoholism is not considered appropriate for heavy drinkers. Instead, the study suggested that state and local programs that increase the cost and limit the availability of alcohol might deter some heavy drinkers and that counseling might be beneficial.

Andrew Weil, M.D.

Marissa Esser et al, “Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011.” Preventing Chronic Disease,

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