Alcohol use disorder

Revision as of 13:04, 31 October 2017 by Rossdonaldson1 (talk | contribs) (Disposition)

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

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

Disposition

  • Outpatient

See Also

External Links

References