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Alcoholism Versus Risky, Problematic Drinking

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Alcoholism is a specific type of addiction.  In the previous section we discussed the diagnosis of alcohol use disorders.  About 7% of the people in the United States meet these diagnostic criteria (NIAAA, 2004; Miller, Forcehimes and Zweben, 2011).  In addition, about 20% of men and 10% of women drink more than the recommended moderation guidelines.  In this respect, they might not meet the diagnostic criteria for an alcohol use disorder but their alcohol use is still considered problematic.  The interested reader may find it helpful to review these guidelines published by NIAAA:

The identification of problematic or "risky" drinking is a complex one.  This is because individual drinking patterns change over time.  Moreover, many of the people in the "high risk" category do not consider themselves "alcoholic."  Therefore, they incorrectly conclude they do not need to pay attention to their drinking (Doyle & Nowinski, 2012).  Note that the DSM-5 (APA, 2013) does not use the word alcoholic.  As such, it has no diagnostic meaning. Nonetheless, most people are familiar with the term "alcoholic."  It is often used to describe severe cases of alcohol dependence.   Risky or problematic drinking occurs long before this level of severity and most certainly does require attention. 

The NIAAA moderation guidelines (referred to above) are typical.  Guidelines are based on the number of drinks per day, and the total number of drinks per week.  A drink equals a 12 oz. beer, or a 5 oz. glass of wine, or a 1.5 oz. shot of liquor.  For men, the maximum limits are: a) no more than 4 drinks in a day, and b) no more than 14 drinks per week.  For women, the maximum limits are:  a) no more than 3 drinks in a day, and b) no more than 7 drinks per week. For some people moderation is extremely difficult to maintain.  They end up over-drinking.  These people may go on to develop an alcohol use disorder.