Alcohol Use Disorder (Alcoholism)

KEY FEATURES

Essentials of Diagnosis

• Major criteria

  • Physiologic dependence: 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, peripheral neuropathy

  • Ecchymoses

  • Surreptitious drinking

  • Unexplained work absences

  • Frequent accidents, falls, or injuries of vague origin

  • In smokers, cigarette burns on hands or chest

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

General Considerations

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

• A drink is defined as 12 oz of beer, 8 oz of malt liquor, 5 oz of wine, or 1.3 oz or a “shot” of 80-proof distilled spirits or liquor

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

  • For men, defined as > 4 drinks per day or 14 drinks per week

  • For women, defined as > 3 drinks per day or 7 drinks per week

  • Individuals with at-risk drinking are at an increased risk for the development of an alcohol use disorder

• Moderate to severe alcohol misuse (similarly to what follows the repeated use of other sedative-hypnotics) is 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

• Alcohol use disorder 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 genetic factors in causation

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

CLINICAL FINDINGS

Symptoms and Signs

Acute alcohol intoxication

• Alcoholic intoxication and overdosage from any other central nervous system depressant share the same signs

  • Drowsiness, errors of commission, psychomotor dysfunction, disinhibition, dysarthria, ataxia, and nystagmus.

• Blood alcohol levels < 50 mg/dL rarely cause significant motor dysfunction; legal limit for driving under the influence is commonly 80 mg/dL

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

• Lethal alcohol blood levels: 350–900 mg/dL

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

• Serious overdoses often include combination of other sedatives with alcohol

Alcohol withdrawal

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

• Mild withdrawal

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

    ...