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Alcohol use disorder

Última revisão: 21 Sep 2025
Última atualização: 25 Sep 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • withdrawal
  • tolerance
  • increased/decreased liver size, jaundice, ascites
Detalhes completos

Outros fatores diagnósticos

  • insomnia
  • erectile dysfunction
  • nicotine use disorder
  • gastrointestinal distress
  • muscle cramps, pain, tenderness, altered sensory perception
  • hypertension and tachycardia
  • impaired nutritional status
  • broad-based gait
Detalhes completos

Fatores de risco

  • family history of alcohol use disorder
  • depression, anxiety, and other mental health disorders
  • socioeconomic deprivation
  • lack of facial flushing on exposure to alcohol
  • low responsivity to the effects of alcohol
  • history of gastric bypass
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • diagnostic interview
  • alcohol level (breath and blood)
  • Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)
Detalhes completos

Investigações a serem consideradas

  • carbohydrate-deficient transferrin (CDT)
  • gamma glutamyl transpeptidase (gamma-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST)
  • CBC
  • urinary ethyl glucuronide
  • phosphatidylethanol (PEth)
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

at-risk drinking

alcohol use disorder: nonpregnant adult with no concurrent opioid use or mental health diagnosis

alcohol use disorder: nonpregnant adult with concurrent opioid use

alcohol use disorder: nonpregnant adult with concurrent mental health diagnosis

alcohol use disorder: nonpregnant adolescent

alcohol use disorder: pregnant

Colaboradores

Autores

Elisabeth Poorman, MD, MPH

Assistant Professor of Medicine

Department of Medicine

University of Illinois Chicago

Chicago

IL

Declarações

EP declares that she has no conflicting interests.

Marlene Martin, MD

Associate Professor of Clinical Medicine

Director, Addiction Care Team

San Francisco General Hospital

University of California, San Francisco

San Francisco

CA

Declarações

MM is a board member for the National Harm Reduction Coalition and has done consultancy work for the Society of Hospital Medicine.

Sarah Messmer, MD

Assistant Professor of Clinical Medicine and Pediatrics

University of Illinois Chicago

Chicago

IL

Declarações

SM declares that she has no conflicting interests.

Agradecimentos

Dr Elisabeth Poorman, Dr Marlene Martin, and Dr Sarah Messmer would like to gratefully acknowledge Dr Colin Drummond, Dr Julie R. Pittman, Dr Philip H. Chung, Dr Robert M. Swift, and Dr Lorenzo Leggio, previous contributors to this topic.

Declarações

CD, JRP, PHC, and RMS declare that they have no competing interests. LL is an author of a reference cited in this topic.

Revisores por pares

Stephen Holt, MD, MS

Associate Professor of Medicine

Yale School of Medicine

New Haven

CT

Divulgaciones

SH declares that they have no competing interests.

Bhanu Prakash Kolla, MD, FRCPsych

Professor of Psychiatry

Department of Psychiatry and Psychology

Addiction Psychiatrist and Sleep Physician

Center for Sleep Medicine, Mayo Clinic

Rochester

MN

Divulgaciones

BPK declares that they have no competing interests.

Paul S. Haber, MD

Royal Prince Alfred Hospital and Discipline of Medicine

University of Sydney

Sydney

Australia

Divulgaciones

PSH is an author of a reference cited in this topic.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

American Society of Addiction Medicine. Engagement and retention of nonabstinent patients in substance use treatment: clinical consideration for addiction treatment providers. Oct 2024 [internet publication].Texto completo

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

World Health Organization. International classification of diseases,​ 11th revision (ICD-11). Feb 2025 [internet publication].Texto completo

US Department of Veterans Affairs. VA/DOD clinical practice guidelines: management of substance use disorders. 2021​ [internet publication].Texto completo

Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry. 2018 Jan 1;175(1):86-90.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Diferenciales

    • Other psychiatric disorders
    • Other substance use disorders (especially sedatives)
    Más Diferenciales
  • Guías de práctica clínica

    • Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR)
    • Management of substance use disorders: guidelines from the VA/DoD
    Más Guías de práctica clínica
  • Patient information

    Alcohol-use disorder

    More Patient information
  • Calculators

    Alcohol Consumption Screening AUDIT Questionnaire

    More Calculators
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