Relationship Between Alcohol Use and Alcohol Problems

Alcohol problems can range in severity from mild, negative consequences in a single life situation to severe alcohol dependence with significant health, employment, and interpersonal consequences. To emphasize this point, the figure depicts a triangle whose widest side is on the left and its narrowest point faces right. It also emphasizes that-while the majority of people consume alcohol safely-there is a minority of people who consume heavy amounts of alcohol. The triangle is divided into 4 parts and depicts that alcohol use and its associated problems can be viewed on a continuum, ranging from-on left-no alcohol problems following modest consumption to-far right-severe problems often associated with heavy consumption. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has established criteria of these categories corresponding to the severity of alcohol problems as follows:

At Risk for Alcohol Problems: Risky Drinking:
A. Current drinking patterns (amount or situation of drinking) place drinker at risk for adverse consequences.
B. Is not already experiencing consequences due to drinking behavior.
C. Does not meet criteria for Alcohol Dependence.

Mild to Moderate Alcohol Problems: Problem Drinking
A. Experiencing adverse consequences due to drinking behavior.
B. Does not meet criteria for Alcohol Dependence.

Moderate to Severe Alcohol Problems: Alcohol Abuse
One or more of A-D in the past 12 months and E.
A. Role impairment.
B. Hazardous use.
C. Recurrent legal problems related to alcohol.
D. Social or interpersonal problems due to alcohol.
E. Does not meet criteria for Alcohol Dependence.

Severe Alcohol Problems: Alcohol Dependence
DSM-IV Criteria: Three or more of A-G during the same 12-month period.
A. Tolerance B. Alcohol withdrawal signs or symptoms.
C. Drinking more or longer than intended.
D. Persistent desire or unsuccessful attempts to control use.
E. Excessive time related to alcohol.
F. Reduction in social, recreational, or work activities due to alcohol.
G. Use despite knowledge of physical or psychological consequences.

[Source: based on The Diagnostic Indicators for Alcohol Dependence and Alcohol Abuse from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text Revision. Copyright 1994, American Psychiatric Association.]