What are the Differences Between Drug Addiction and Alcoholism?

The sooner you seek help, the greater your chances for a long-term recovery. Talk with your health care provider or see a mental health provider, such as a doctor who specializes in addiction medicine or addiction psychiatry, or a licensed alcohol and drug counselor. Cultural and societal factors determine what are acceptable or allowable forms of drug or alcohol use. Public laws determine what kind of drug use is legal or illegal. The question of what type of substance use can be considered normal or acceptable remains controversial.

In 2019, nearly half of drug overdose deaths involved more than one drug. Many people struggling with alcoholism will meet the criteria for a drug use disorder at some point in their lifetime. Patients with co-occurring alcohol and other drug use disorders also are likely to have more severe dependence-related problems than those without combined disorders—that is, they meet a higher number of diagnostic criteria for each disorder . People with co-occurring alcohol and other drug use disorders are more likely to have psychiatric disorders such as personality, mood, and anxiety disorders; they are more likely to attempt suicide and to suffer health problems . People who use both alcohol and drugs also are at risk for dangerous interactions between these substances. For example, a person who uses alcohol with benzodiazepines, whether these drugs are prescribed or taken illegally, is at increased risk of fatal poisoning .

Illicit drug use

The rate-limiting steps for the elimination of ethanol are in common with certain other substances. As a result, the blood alcohol concentration can be used to modify the rate of metabolism of methanol and ethylene glycol.

We see much higher rates in the USA and across several countries in Eastern Europe. In the USA, this was dominated by illicit drug dependence, whereas alcoholism was much more common in Russia and Eastern Europe.

Substance use disorders

CYP2E1 is inducible by ethanol, so while alcohol dehydrogenase handles acute or low concentrations of ethanol, MEOS is predominant with higher concentrations or with repeated/chronic use. A small amount of ethanol undergoes conjugation to form ethyl glucuronide and ethyl sulfate. There may also be another metabolic pathway that metabolizes as much as 25 to 35% of ethanol at typical concentrations. With acute alcohol consumption, dopamine is released in the synapses of the mesolimbic pathway, in turn alcohol vs drugs heightening activation of postsynaptic D1 receptors. The activation of these receptors triggers postsynaptic internal signaling events through protein kinase A, which ultimately phosphorylate cAMP response element binding protein , inducing CREB-mediated changes in gene expression. Ethanol’s rewarding and reinforcing (i.e., addictive) properties are mediated through its effects on dopamine neurons in the mesolimbic reward pathway, which connects the ventral tegmental area to the nucleus accumbens .

Still, in our culture we have isolated alcohol from other drugs, usually referring to “alcohol and drugs,” giving “alcohol” a special status, and, lest we forget, alcohol is legal, while most other drugs are not. Some majority-Muslim countries, such as Saudi Arabia, Kuwait, Pakistan, Iran and Libya prohibit the production, sale, and consumption of alcoholic beverages because they are forbidden by Islam.