Alcohol Use Disorder (AUD)
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- Any pattern of alcohol use causing significant physical, mental, or social dysfunction; key features are tolerance, withdrawal, and persistent use despite problems.
- Alcohol abuse: maladaptive pattern of alcohol use manifested by ≥1 of:
- Failure to fulfill obligations at work, school, or home
- Recurrent use in hazardous situations
- Recurrent alcohol-related legal problems
- Continued use despite related social or interpersonal problems
- Alcohol dependence: maladaptive pattern of use manifested by ≥3 of the following:
- Using more than intended
- Persistent desire or attempts to cut down/stop
- Significant amount of time obtaining, using, or recovering from alcohol
- Social, occupational, or recreational activities sacrificed for alcohol use
- Continued use despite physical or psychological problems
- National Institute on Alcohol Abuse and Alcoholism criteria for “at-risk” drinking: men: >14 drinks a week or >4 per occasion; women: >7 drinks a week or >3 per occasion
- Women experience harmful effects at lower levels of alcohol consumption and are less likely to report problems related to drinking.
- System(s) affected: nervous, gastrointestinal (GI)
- Synonym(s): alcoholism; alcohol abuse; alcohol dependence
- Common and underdiagnosed in elderly; less likely to report problem; may exacerbate normal age-related cognitive deficits and disabilities
- Multiple drug interactions
- Signs and symptoms may be different or attributed to chronic medical problem or dementia.
- Common assessment tools may be inappropriate.
- Children of alcoholics are at increased risk for problem drinking.
- 2.5% of adolescents have alcohol use disorder (AUD); 13.4% of youth age 12 to 20 years report binge drinking in the past month; negative effect on maturation and normal brain development
- Early onset drinkers (those who start drinking before age 21 years) are 4 times more likely to develop a problem than those who begin after age 21 years.
- Depression, suicidal or disorderly behavior, family disruption, violence or destruction of property, poor school or work performance, sexual promiscuity, social immaturity, lack of interests, isolation, moodiness
- Women should abstain during conception and throughout pregnancy.
- 10–50% of children born to women who are heavy drinkers will have fetal alcohol syndrome.
- Predominant age: 18 to 25 years, but all ages affected
- Predominant sex: male > female (3:1)
- 27% of Americans age 18 years or older reported they engaged in binge drinking in the past month; 7% reported they engaged in heavy alcohol use in the past month.
- 15 million adults (6%) age >18 years has AUD.
Etiology and Pathophysiology
- Multifactorial: genetic, environment, psychosocial
- Alcohol is a CNS depressant, facilitating γ-aminobutyric acid (GABA) inhibition and blocking N-methyl-D-aspartate receptors.
50–60% of risk is genetic.
- Family history
- Depression (40% with comorbid alcohol abuse)
- Tobacco use; other substance abuse
- Male gender; lower socioeconomic status
- Poor self-esteem—seeking peer/social approval
- Family dysfunction or childhood trauma
- Posttraumatic stress disorder
- Antisocial personality disorder
- Bipolar disorder
- Eating disorders
- Criminal behavior
Counsel with family history and risk factors.
Commonly Associated Conditions
- Cardiomyopathy, atrial fibrillation
- Peptic ulcer disease/gastritis
- Cirrhosis, fatty liver, cholelithiasis
- Diabetes mellitus
- Upper GI malignancies
- Peripheral neuropathy, seizures
- Abuse and violence
- Trauma (falls, motor vehicle accidents [MVAs])
- Behavioral disorders (depression, bipolar, schizophrenia): >50% of patients with these disorders have a comorbid substance abuse problem.