How to Understand Alcohol Abuse vs. Dependence Questions on the SW Exam

Some of the easiest questions to miss on the Social Work Exam are those that make you apply a simple definition to a case example. Below are definitions and case examples to help you remember:

Alcohol Abuse is not as extreme as Alcohol Dependence, although they both are harmful. For the full DSM-IV-TR criteria, click here

Example 1:
For the past year, a 23 year old woman parties every weekend and will often wake up in unknown places. She is always late to work and fears that she will lose her job due to being too hung over all of the time. She recently was pulled over for a DUI but still continues to drive drunk.

This would be an example of Alcohol Abuse because this woman has continued substance use that resulted in failure to perform work, legal implications, and continued drinking even after she was aware of the consequences. The DSM states that only one of the impairments described above need to be in place in the last 12 months to be considered a Substance Abuser. 

Example 2:
A 40 year old man recently left his wife and children after a 3 day binge and losing his job. For the past year, this man has been drinking daily and has needed more and more to feel normal. He has attempted to stop many times but is unable to deal with the withdrawal symptoms. He hangs around his buddies more than his family because they understand him and don't mind his drinking.

This man is suffering from Alcohol Dependence. The DSM states that within a 12 month period someone needs to show 3 of the following: signs of tolerance, withdrawal, the need for more to achieve the desired effects, failed attempts to stop, wasted time on drinking activities, missing other life events in order to drink, continued use even after known harmful effects are present. 

Please be aware that the DSM V (published May 2013) no longer distinguishes between alcohol abuse and dependence and instead places both terms together as part of the overall diagnosis of a Substance Use Disorder. A Substance Use Disorder is now evaluated on a continuum of abuse. According to the ASWB website, the new DSM V will not be reflected on any exam until July 2015. Click Here for the official announcement from the ASWB site.