Alcohol use disorder (AUD) is a problematic pattern of alcohol use leading to significant impairment or distress. Unhealthy alcohol use includes the spectrum of at-risk drinking and alcohol use disorders.
Unhealthy alcohol use is defined by more than 3 drinks per day or 7 per week for women and more than 4 drinks per day or 14 per week for men. To differentiate between at-risk drinking and alcohol use disorder, the DSM-5-TR criteria should be used.
Unhealthy alcohol use is underdiagnosed and undertreated.
Treatments should be driven by a patient’s alcohol-related goals and the evidence behind them. Treatments include psychosocial therapies, medication, or both. Medications used include naltrexone, acamprosate, disulfiram, gabapentin, and topiramate.
Unhealthy alcohol use includes hazardous use, harmful use, and alcohol use disorder. Hazardous use is defined as alcohol use that puts a patient at risk for harm (commonly, at least two heavy drinking episodes in the previous year), whereas harmful alcohol use is alcohol use that has caused adverse health or psychosocial consequences. Alcohol use disorder is defined as clinically significant impairment or psychosocial stress in the previous 12 months. People with hazardous or harmful alcohol use are at higher risk of developing an alcohol use disorder, but do not have to develop a diagnosable disorder to suffer harm.
Heavy drinking has been defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as >3 drinks per day or >7 drinks in a week for women, and >4 drinks per day or >14 drinks in a week for men.
“Dependence” and “abuse” are old terms that are no longer used since the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) in 2013. The authors encourage clinicians treating people with alcohol use disorder to use updated terms, because “dependence” can imply that alcohol use disorder cannot exist without withdrawal, and the word “abuse” has been linked to stigma and less patient-centered decisions. Terms such as “alcoholic,” “alcoholism,” and “addict” are not clinical terms and are associated with stigma and so should not be used. Terms such as "person with alcohol use disorder and addiction" should be used instead.
History and exam
Key diagnostic factors
- increased/decreased liver size, jaundice, ascites
Other diagnostic factors
- erectile dysfunction
- nicotine use disorder
- gastrointestinal distress
- muscle cramps, pain, tenderness, altered sensory perception
- hypertension and tachycardia
- impaired nutritional status
- broad-based gait
- family history of alcohol use disorder
- 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
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)
- urinary ethyl glucuronide
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
- Other psychiatric disorders
- Other substance use disorders (especially sedatives)
- Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR)
- International statistical classification of diseases and related health problems, 11th ed. (ICD-11)
Alcohol-use disorderMore Patient leaflets
Alcohol Consumption Screening AUDIT QuestionnaireMore Calculators
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