Summary
Definition
History and exam
Key diagnostic factors
- withdrawal
- tolerance
- increased/decreased liver size, jaundice, ascites
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
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
Diagnostic investigations
1st investigations to order
- diagnostic interview
- alcohol level (breath and blood)
- Clinical Institute Withdrawal Assessment for Alcohol--revised (CIWA-Ar)
Investigations to consider
- carbohydrate-deficient transferrin (CDT)
- gamma glutamyl transpeptidase (gamma-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST)
- CBC
- urinary ethyl glucuronide
Treatment algorithm
significant alcohol withdrawal (CIWA-Ar score ≥8-10)
problem alcohol use and mild alcohol dependence
moderate-to-severe alcohol dependence
Contributors
Authors
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
London
UK
Disclosures
CD declares that he has no conflicting interests.
Acknowledgements
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
Sydney
Australia
Disclosures
PSH is an author of a reference cited in this topic.
Roberta Agabio, MD
Bernard B. Brodie Department of Neuroscience
University of Cagliari
Cagliari
Italy
Disclosures
RA is an author of a number of references cited in this topic.
Differentials
- Other psychiatric disorders
- Other substance use disorders (especially sedatives)
More DifferentialsGuidelines
- 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 GuidelinesPatient leaflets
Alcohol-use disorder
More Patient leafletsCalculators
Alcohol Consumption Screening AUDIT Questionnaire
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