Alcohol use disorder: Difference between revisions

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==Clinical Features==
==Clinical Features==
* In order to make the diagnosis, patients must have several of the following 11 symptoms:
*Drinking more or for a longer period of time than intended.
# Drinking more or for a longer period of time than intended.
*Feeling incapable of cutting back on the amount of alcohol consumed.
# Feeling incapable of cutting back on the amount of alcohol consumed.
*Becoming sick for an extended period of time as a result of drinking too much.
# Becoming sick for an extended period of time as a result of drinking too much.
*Inability to concentrate due to alcohol cravings.
# Inability to concentrate due to alcohol cravings.
*Inability to care for a family, hold down a job, or perform in school.
# Inability to care for a family, hold down a job, or perform in school.
*Continuing to drink despite problems caused with friends or family.
# Continuing to drink despite problems caused with friends or family.
*Decreased participation in activities which were once important.
# Decreased participation in activities which were once important.
*Finding oneself in dangerous or harmful situations as a direct result of drinking.
# Finding oneself in dangerous or harmful situations as a direct result of drinking.
*Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out.
# Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out.
*Drinking more as a result of a tolerance to alcohol.
# Drinking more as a result of a tolerance to alcohol.
*Experiencing withdrawal symptoms.
# Experiencing withdrawal symptoms.


* Mild = 2-3 features
;Mild = 2-3 features
* Moderate = 4-5 features
;Moderate = 4-5 features
* Severe = 6 or more features
;Severe = 6 or more features
 
==Differential Diagnosis==
{{Ethanol DDX}}


==Evaluation==
==Evaluation==
* A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, [https://wikem.org/wiki/Alcohol_withdrawal alcohol withdrawal], and co-ingestion with other drugs or [https://wikem.org/wiki/Toxic_alcohols toxic alcohols].
* A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, [[alcohol withdrawal]], and co-ingestion with other drugs or [[toxic alcohols]].


==Management==
==Management==
* If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.  
* If the patient is not acutely [[Ethanol toxicity|intoxicated]] or at risk for [[alcohol withdrawal]], they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.  
* Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction.
* Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction.
{{Vitamin prophylaxis for ETOH}}
==Disposition==
*Outpatient
==See Also==
==External Links==
==References==
<references/>
[[Category:Psychiatry]]

Revision as of 23:09, 7 November 2017

Background

  • Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.
  • Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.
  • It is estimated that about 6% of adults in the US suffer from alcohol use disorder.

Clinical Features

  • Drinking more or for a longer period of time than intended.
  • Feeling incapable of cutting back on the amount of alcohol consumed.
  • Becoming sick for an extended period of time as a result of drinking too much.
  • Inability to concentrate due to alcohol cravings.
  • Inability to care for a family, hold down a job, or perform in school.
  • Continuing to drink despite problems caused with friends or family.
  • Decreased participation in activities which were once important.
  • Finding oneself in dangerous or harmful situations as a direct result of drinking.
  • Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out.
  • Drinking more as a result of a tolerance to alcohol.
  • Experiencing withdrawal symptoms.
Mild = 2-3 features
Moderate = 4-5 features
Severe = 6 or more features

Differential Diagnosis

Ethanol related disease processes

Evaluation

  • A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, alcohol withdrawal, and co-ingestion with other drugs or toxic alcohols.

Management

  • If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.
  • Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction.

Vitamin Prophylaxis for Chronic alcoholics

  • At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
  • Give multivitamin PO; patient at risk for other vitamin deficiencies

Banana bag

The majority of chronic alcoholics do NOT require a banana bag[1][2]

Disposition

  • Outpatient

See Also

External Links

References

  1. Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
  2. Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.