Alcohol use disorder

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

• Ethanol toxicity
• Alcohol use disorder
• Alcohol withdrawal
  • Alcohol withdrawal seizures
  • Delerium tremens
• Electrolyte/acid-base disorder
  • Alcoholic ketoacidosis
  • Beer potomania syndrome
  • Beriberi
  • Thiamine deficiency
  • Wernicke-Korsakoff syndrome

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.

Disposition

• Outpatient