Alcohol use disorder

Last reviewed: 28 Dec 2022
Last updated: 06 Jan 2023



History and exam

Key diagnostic factors

  • withdrawal
  • tolerance
  • increased/decreased liver size, jaundice, ascites
More key diagnostic factors

Other diagnostic factors

  • nicotine dependence comorbidity
  • social, economic, legal, or psychological problems
  • nausea, vomiting, abdominal pain, hematemesis
  • muscle cramps, pain, tenderness, altered sensory perception
  • hypertension and tachycardia
  • impaired nutritional status
  • cutaneous manifestations
  • alterations in normal dental hygiene
  • broad-based gait
Other diagnostic factors

Risk factors

  • family history of alcoholism
  • antisocial behavior (premorbid)
  • high trait anxiety level
  • lack of facial flushing on exposure to alcohol
  • low responsivity to the effects of alcohol
  • history of gastric bypass
More risk factors

Diagnostic investigations

1st investigations to order

  • diagnostic interview
  • alcohol level (breath and blood)
  • Clinical Institute Withdrawal Assessment for Alcohol--revised (CIWA-Ar)
More 1st investigations to order

Investigations to consider

  • carbohydrate-deficient transferrin (CDT)
  • gamma glutamyl transpeptidase (gamma-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST)
  • CBC
  • urinary ethyl glucuronide
More investigations to consider

Treatment algorithm


significant alcohol withdrawal (CIWA-Ar score ≥8-10)


problem alcohol use and mild alcohol dependence

moderate-to-severe alcohol dependence



Colin Drummond, MB ChB, MD, FRCP, FRCPsych, FFPH, FRCGP (Hon.)

Professor of Addiction Psychiatry

Addictions Department

National Addiction Centre

Institute of Psychiatry, Psychology and Neuroscience

King's College




CD declares that he has no conflicting interests.


Dr Colin Drummond would like to gratefully acknowledge Dr Julie R. Pittman, Dr Philip H. Chung, Dr Robert M. Swift, and Dr Lorenzo Leggio, previous contributors to this topic. JRP, PHC, and RMS declare that they have no competing interests. LL is an author of a reference cited in this topic.

Peer reviewers

Paul S. Haber, MD

Royal Prince Alfred Hospital and Discipline of Medicine

University of Sydney




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

Roberta Agabio, MD

Bernard B. Brodie Department of Neuroscience

University of Cagliari




RA is an author of a number of references cited in this topic.

  • Differentials

    • Other psychiatric disorders
    • Other substance use disorders (especially sedatives)
    More Differentials
  • Guidelines

    • International statistical classification of diseases and related health problems, 10th ed. (ICD-10)
    • Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5)
    More Guidelines
  • Patient leaflets

    Alcohol-use disorder

    More Patient leaflets
  • Calculators

    Alcohol Consumption Screening AUDIT Questionnaire

    More Calculators
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