Alcohol Use Disorder (Alcoholism)

Key Features

Essentials of Diagnosis

• Major criteria

  • Physiologic dependence as evidenced by withdrawal when intake is interrupted

  • Tolerance to the effects of alcohol

  • Evidence of alcohol-associated illnesses, such as alcoholic liver disease, cerebellar degeneration

  • Continued drinking despite strong medical and social contraindications and life disruption

  • Impairment in social and occupational functioning

  • Depression

  • Blackouts

• Other signs

  • Alcohol odor on breath

  • Alcoholic facies

  • Flushed face

  • Scleral injection

  • Tremor

  • Ecchymoses

  • Peripheral neuropathy

  • Surreptitious drinking

  • Unexplained work absences

  • Frequent accidents, falls, or injuries

  • In smokers, cigarette burns on hands or chest

  • Laboratory tests: elevated values of mean corpuscular volume, serum liver biochemical tests, uric acid, and triglycerides

General Considerations

• The two-phase syndrome includes at-risk drinking and moderate to severe alcohol misuse

• At-risk drinking is the repetitive use of alcohol, often to alleviate anxiety or solve other emotional problems

  • For men, at-risk drinking is defined as > 4 drinks per day or 14 drinks per week

  • For women, at-risk drinking is defined as > 3 drinks per day or 7 drinks per week

• Moderate to severe alcoholism is similar to that which occurs following the repeated use of other sedative-hypnotics; characterized by

  • Recurrent use of alcohol despite disruption in social roles (family and work)

  • Alcohol-related legal problems

  • Taking safety risks by oneself and with others

• Alcoholism is associated with a high prevalence of lifetime psychiatric disorders, especially depression

Demographics

• Most suicides and intrafamily homicides involve alcohol

• Major factor in rapes and other assaults

• Male-to-female ratios of 4:1 are converging

• Adoption and twin studies indicate some genetic influence

• Forty percent of Japanese have aldehyde dehydrogenase deficiency, which increases susceptibility to the effects of alcohol

Clinical Findings

Symptoms and Signs

Acute intoxication

• Drowsiness, errors of commission, disinhibition, dysarthria, ataxia, and nystagmus

• Ataxia, dysarthria, and vomiting indicate a blood level > 150 mg/dL

• Lethal blood levels: 350–900 mg/dL

• Severe intoxication: respiratory depression, stupor, seizures, shock syndrome, coma, and death

• Serious overdoses often include other sedatives combined with alcohol

Withdrawal

• Categorized as mild, moderate, or severe withdrawal, withdrawal seizures, and delirium tremens (DTs)

• Symptoms of mild withdrawal

  • Tremor, anxiety, tachycardia, nausea and vomiting, insomnia

  • Begin about 6 hours after the last drink and end by day 2

• Symptoms of moderate withdrawal signs and symptoms fall between those of mild and severe

• Symptoms of severe withdrawal

  • Disorientation, agitation, diaphoresis, whole body tremor, vomiting, hypertension, and hallucinations (visual>tactile>auditory)

  • Occurs 48–96 hours after the last drink

  • Usually preceded by prolonged heavy alcohol use

• Withdrawal seizures

  • Occur as early as 8 hours after last drink

  • Do not manifest more than 48 hours after alcohol cessation

  • More prevalent in persons who have a history of withdrawal syndromes

  • These ...