Whether it's a few beers at a gathering, wine at dinner, or cocktails at a club, most folks drink responsibly — regardless of what the PSAs proclaim.
"Lots of people drink alcohol on a regular basis," says Barbara Melton, a licensed professional counselor with a private practice downtown. "It doesn't automatically mean that they are abusing or addicted to the substance. So long as they don't have recurrent problems as a result of their use, they would be considered social drinkers."
There are some basic differences between alcohol use, alcohol abuse, and alcohol dependence. "For some people it provides a much needed escape from reality, which is also addicting in a different sense," Melton says. "And some people have a genetic predisposition to addiction. One person can drink socially and stop before they get drunk, while another person can drink the same amount and then not be able to stop. It's not fair, but it does happen."
Most scientists believe dopamine and endorphins are the main reasons why alcohol is so addictive. Others have speculated that people may already be wired to become addicted to alcohol.
Unfortunately, abuse is often a precursor to dependence. When a pattern develops, the symptoms become more severe.
"Lots of people drink heavily in college and then go on to be social drinkers and not have a problem with it later," Melton says. "But you never know which ones will end up crossing the line into addiction and real trouble, physiologically and psychologically. If you have a history of alcoholism in your family, you really should give it a wide berth. It is just not worth it."
The amount of alcohol one consumes — and the frequency with which one consumes it — can raise red flags, but they don't necessarily determine one's diagnosis. Heavy drinkers can abuse alcohol while not actually becoming alcoholics. On the other hand, light-to-moderate drinkers can also be alcoholics. It depends on how alcohol affects each person.
Austin O'Malley, a licensed professional counselor on faculty at MUSC's Institute of Psychiatry and a clinical instructor at the Center for Drug and Alcohol Programs, regularly deals with patients caught within the gray area between alcohol use and alcohol abuse.
The National Institute of Alcohol Abuse and Alcoholism defines binge drinking as consuming four or more alcoholic drinks — one shot of liquor, a 12-ounce beer, or a five-ounce glass of wine — on a single occasion for women and five or more alcoholic drinks in one sitting for men.
The NIAAA defines heavy drinking for men as having more than four standard measured drinks in any one day and more than 14 drinks in a week; for women, it's more than three drinks in any one day and having more than seven in a week.
"The notion of social drinker is not a scientific term," O'Malley says. "In science, there are low-risk drinkers and high-risk drinkers. One could argue that low-risk drinkers are 'the social drinkers.' The high-risk drinker is the heavy drinker, in that they exceed the NIAAA guidelines."
Alcohol affects a part of the brain known by doctors as the "reward center" — the part that is designed specifically to make people want to do things again. Alcohol use is pleasure-reinforced based on its effects on the brain. Recent scientific evidence indicates that alcohol can alter the prefrontal and orbital frontal cortex.
"These changes in the cortex due to heavy drinking impairs one's ability to make healthy decisions," O'Malley says. "Ultimately, alcohol takes over circuits in the brain that allow one to regulate behavior, weigh consequences of your actions, make good decisions, and stop yourself from poor choices."
Determining one's dependence on alcohol can be tricky. Wood Marchant is a licensed independent social worker and a clinical counselor. He works at Charleston County's Department of Alcohol and Other Drug Abuse Services (commonly known as the Charleston Center).
"To give a dependence diagnosis for addictions to any substance, you have to find that there's tolerance," he says. "The patient needs more of the substance to reach the same effect. They have to take larger amounts of a substance over a longer period of time than was intended. There's withdrawal as well. That's when a patient is getting off of a substance and they have problems. Their temper is shorter, and they're moody and irritable."
Marchant and others assess and treat patients with a traditional 28-day rehab program. "Losing control is when someone has a persistent desire and unsuccessful efforts to cut down or control the substance," he says. "You recognize that you need to do something about it, but you can't do anything about it because you're physically addicted. Your life starts to revolve around obtaining it and drinking. You can't keep promises to yourself. You give up social and recreational activities because of the substance abuse. You're unable to continue to live the same life that you had because you're unable to quit."
While moderation, self awareness, and willpower come easily for some drinkers, it's not so easy for others. "It's the only disease that tells you that you don't have a disease," Marchant adds. "If you're allergic to shellfish, you head doesn't tell you to go out and eat some more shrimp."