Synopsis
Per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), alcohol use disorder is defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by multiple psychosocial, behavioral, or physiologic features. Formerly viewed as two distinct disorders, alcohol abuse and alcohol dependence, alcohol use disorder is now viewed as a single disorder, categorized as mild, moderate, or severe. In the United States, up to 29% of people meet criteria for an alcohol use disorder in their lifetime. Risk factors include younger age, male sex, Native American race, and adults with a disability, mood disorder, or substance abuse disorder. Genetic factors are also implicated in alcohol use disorder.
Patients present with a range of clinical findings that include dysarthria, gastrointestinal symptoms, tachycardia, hypertension, sleep disturbance, hypoglycemia, nystagmus, tremor, memory impairment, and headache. Behavioral and psychosocial findings include cravings, difficulty quitting, interference with relationships, job, school, and home responsibilities, and incidence of risky behavior that harms self or others. Associated diagnoses include liver cirrhosis, depressive disorder, gastritis, gastrointestinal tract bleeding, difficult-to-control diabetes, erectile dysfunction, Wernicke-Korsakoff syndrome, Wernicke encephalopathy, cardiomyopathy, and acute pancreatitis. Pregnant individuals face a greater risk of miscarriage and birth disorders due to fetal alcohol syndrome. Severe intoxication with high levels of blood alcohol, or alcohol toxicity, is life threatening and requires immediate medical attention.
Management is multifaceted and includes residential treatment, cessation and withdrawal support, lifestyle changes, medications (eg, disulfiram, naltrexone, acamprosate), cognitive behavioral therapy, individual and group therapy, family therapy, and support programs.
Patients with this disorder may have an increased risk of various general medical conditions.
Look For
Patients can be asymptomatic in early stages of the disease. In later stages, physical manifestations vary and include dehydration, jaundice, spider angiomata, hematemesis, coffee-ground emesis, abdominal pain associated with pancreatitis or peptic ulcers, tachycardia, hypotension, hypoxia in cases of aspiration, bruises and broken bones due to trauma, and loss of consciousness.
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