More than half of Americans ages 18 or older (55.3%) admitted to drinking at least once in the past month, according to the 2018 National Survey on Drug Use and Health (NSDUH). The number was higher when extended to the past year (70%) and their lifetimes (86.3%).

However, less than 6% of these adults were considered to have an alcohol use disorder (AUD), which used to be called alcoholism, alcohol dependence, or alcohol addiction.

Since it is believed that addiction cannot be cured, only controlled, some of the 31% people who haven’t had a drink in the last month but have in their lifetimes may be part of that AUD group who are abstinent (not drinking alcohol) in recovery.

What Is Alcohol Use Disorder?

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) eliminated the terms alcoholic, alcohol dependence, and alcohol abuse in favor of alcohol use disorder (AUD). Whether or not someone’s drinking qualifies as AUD is determined by how one ranks on an 11-point scale.

Two of the 11 symptoms qualify as mild AUD, four rates a moderate AUD diagnosis, and six or more is severe AUD. Occasional heavy drinking doesn’t necessarily mean an AUD, but it can be a warning sign.

Alcohol Dependence vs. Alcohol Addiction

The differences between alcohol dependence vs. alcohol addiction depend upon whom you ask.

Some, like the DSM-5, say they are just different degrees of the same thing. Others say alcohol addiction is slightly more severe than alcohol dependence.

According to the Neuroscience Department Laboratories at Icahn School of Medicine at Mount Sinai, dependence is marked by physical symptoms while addiction is behavioral.

Dependence is a “physiological state” that includes tolerance and results in withdrawal symptoms if people stop consuming alcohol, according to the department. It notes that addiction is the “compulsive seeking and taking” of alcohol or drugs “despite adverse consequences.”

How Does Alcohol Dependence Develop?

So, something like half of all adults drink but don’t have an AUD. What determines who will develop alcohol dependence or addiction? Researchers don’t know why exactly, but there seem to be a few indicators, including:

  • Age. Those who start drinking in their teens or even early 20s seem more susceptible to addiction because their brains are still developing.
  • Frequency. How often they drink. Drinking changes chemicals in the brain. Abstaining for a few days after drinking usually restores them to normal, though the time it takes to restore them may increase the more and longer you drink.
  • Quantity. How much alcohol people consume at one sitting. Binge drinking (four or five drinks or more at one sitting) doesn’t necessarily lead to AUD but may be another contributing factor.
  • Depression, anxiety, or other emotional or mental health issues. Some people develop AUD or other substance use disorders (SUDs) by attempting to self-medicate for mental health issues.
  • Weight. The less you weigh, the more alcohol affects you.
  • Tolerance. Some people don’t feel or exhibit the symptoms of alcohol use as much as others. That doesn’t mean it doesn’t affect them or that they aren’t as susceptible to alcohol addiction. It can make them drink more, though.
  • Family history. There is a genetic component to AUD.
  • Significant life-altering or tragic events in their lives. Emotional or physical trauma, such as post-traumatic stress disorder (PTSD), can lead to increased drinking and risk of AUD.

How Long Does It Take to Get Addicted to Alcohol?

Some people think they can avoid AUD if they only drink a certain amount or only drink for so long before taking a break. That might help, but there is no standard safe quantity or frequency. It varies for each individual and also by the form of addiction: physical or emotional.

Generally, one standard drink per day is considered low-risk for women and two for men. One standard drink is:

  • 12 ounces of regular beer
  • 8 to 9 ounces of malt liquor
  • 5 ounces of table wine
  • 3 to 4 ounces of fortified wine, such as port or sherry
  • 1.5 ounces of distilled spirits, such as vodka or whiskey

More per day might still be considered moderate—although drinking every day might be a warning sign—provided the weekly total doesn’t increase.

Drinking slowly (sipping) and waiting to drink at least an hour after eating may prevent your body from absorbing alcohol too quickly. The faster alcohol is absorbed, the more likely you are to develop an AUD. It also takes about an hour to metabolize a standard drink, so pace yourself and alternate soft drinks—better yet, water—with alcohol.

Women metabolize more slowly than men because women have:

  • More body fat (it hangs on to alcohol)
  • Less body water
  • Less of the enzyme in the liver that breaks down alcohol. Females metabolize alcohol at a different rate than males, even if they weigh the same.

In addition, alcohol absorption also speeds up during ovulation and just before menstruation.

That’s the physical aspect of dependence or addiction. The emotional or psychological aspect of addiction is another matter. One drink may be enough to trigger this aspect.

How Do You Know When You Are Addicted to Alcohol?

Even though no one knows precisely what causes a given AUD, there are many signs to identify when you have one, such as when you need to:

  • Drink more to feel the same effects
  • Drink throughout the day, and progressively earlier
  • Drink to wind down, de-stress, or cope with the day’s events
  • Drink despite the problems it causes with your family, coworkers, and social life
  • Drink even though you can’t control how much you drink
  • Drink even though you avoid activities or events where you won’t be able to drink
  • Drink or you will eventually experience alcohol withdrawal symptoms

Signs of Withdrawal

Some of these signs might seem a little vague or subjective, but withdrawal is proof that you no longer choose to drink, you must drink to avoid negative consequences. Alcohol withdrawal symptoms include:

  • Difficulty sleeping
  • Feeling irritable, restless, or unsteady
  • Nausea
  • Sweating
  • Rapid heart rate
  • Seizures
  • Visual hallucinations

What to Do If You Believe You Are Becoming Addicted

If you believe you are addicted or on the road to it, you need to stop drinking but don’t go it alone. Depending on how severe your AUD is, stopping abruptly can be life-threatening. Locking yourself in a room for a weekend to go cold turkey like in the movies is not safe.

Attending Alcoholics Anonymous (AA) meetings isn’t enough either, though it can be a good start. It can provide fellowship, sympathy, and support from people who have been or are going through the same thing you are.

To stop drinking in a safer, more comfortable manner, you need professional medical and behavioral help, including: