Diagnosing abuse of a substance such as alcohol is complicated by the fact that moderate use of this substance is common in American society. Part of the diagnostic decision thus turns on drawing the dividing line between 'alcohol use' and 'alcohol use disorder'. Richard's reports of the increasing amounts of alcohol he consumed on all recent drinking occasions, the discomfort he felt beginning several hours after he stopped drinking, and the relief that came with a resumption of drinking, are evidence of tolerance and withdrawal. The delirium tremens (DTs) Richard experienced in the ER offers the final bit of evidence that his drinking reached the point of inducing physiological dependence on alcohol, making the appropriate diagnosis one of Alcohol Use Disorder, Severe. The goals of Richard's treatment included restoring his overall social functioning as well as facilitating abstinence and avoiding relapse. Psychologically, there are reasons why Richard may be drinking too much.