Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Any pattern of alcohol use causing significant physical, mental, or social dysfunction; key features are tolerance, withdrawal, and persistent use despite problems.
  • Alcohol abuse: maladaptive pattern of alcohol use manifested by ≥1 of:
    • Failure to fulfill obligations at work, school, or home
    • Recurrent use in hazardous situations
    • Recurrent alcohol-related legal problems
    • Continued use despite related social or interpersonal problems
  • Alcohol dependence: maladaptive pattern of use manifested by ≥3 of the following:
    • Tolerance
    • Withdrawal
    • Using more than intended
    • Persistent desire or attempts to cut down/stop
    • Significant amount of time obtaining, using, or recovering from alcohol
    • Social, occupational, or recreational activities sacrificed for alcohol use
    • Continued use despite physical or psychological problems
  • National Institute on Alcohol Abuse and Alcoholism criteria for “at-risk” drinking: men: >14 drinks a week or >4 per occasion; women: >7 drinks a week or >3 per occasion
  • Women experience harmful effects at lower levels of alcohol consumption and are less likely to report problems related to drinking.
  • System(s) affected: nervous, gastrointestinal (GI)
  • Synonym(s): alcoholism, alcohol abuse, alcohol dependence
Geriatric Considerations
  • Common and underdiagnosed in elderly; less likely to report problem; may exacerbate normal age-related cognitive deficits and disabilities
  • Multiple drug interactions
  • Signs and symptoms may be different or attributed to chronic medical problem or dementia.
  • Common assessment tools may be inappropriate.
Pediatric Considerations
  • Children of alcoholics are at increased risk for problem drinking.
  • 2.5% of adolescents ages 12 to 17 years has alcohol use disorder (AUD); 13.4% of youth age 12 to 20 years report binge drinking in the past month (2015: National Survey on Drug Use and Health [NSDUH]); negative effect on maturation and normal brain development
  • Early onset drinkers (those who start drinking before age 21 years) are 4 times more likely to develop a problem than those who begin after age 21 years.
  • Depression, suicidal or disorderly behavior, family disruption, violence or destruction of property, poor school or work performance, sexual promiscuity, social immaturity, lack of interests, isolation, moodiness
Pregnancy Considerations
  • Women should abstain during conception and throughout pregnancy.
  • 10–50% of children born to women who are heavy drinkers will have fetal alcohol syndrome.

Epidemiology

  • Predominant age: 18 to 25 years, but all ages affected
  • Predominant sex: male > female (3:1)

Prevalence
  • 27% of Americans age 18 years or older reported they engaged in binge drinking in the past month; 7% reported they engaged in heavy alcohol use in the past month.
  • 15 million adults (6%) age >18 years has AUD.

Etiology and Pathophysiology

  • Multifactorial: genetic, environment, psychosocial
  • Alcohol is a CNS depressant, facilitating γ-aminobutyric acid (GABA) inhibition and blocking N-methyl-D-aspartate receptors.

Genetics
50–60% of risk is genetic.

Risk Factors

  • Family history
  • Depression (40% with comorbid alcohol abuse)
  • Anxiety
  • Tobacco use; other substance abuse
  • Male gender; lower socioeconomic status
  • Unemployment
  • Poor self-esteem—seeking peer/social approval
  • Family dysfunction or childhood trauma
  • Posttraumatic stress disorder
  • Antisocial personality disorder
  • Bipolar disorder
  • Eating disorders
  • Criminal behavior

General Prevention

Counsel with family history and risk factors.

Commonly Associated Conditions

  • Cardiomyopathy, atrial fibrillation
  • Hypertension
  • Peptic ulcer disease/gastritis
  • Cirrhosis, fatty liver, cholelithiasis
  • Hepatitis
  • Diabetes mellitus
  • Pancreatitis
  • Malnutrition
  • Upper GI malignancies
  • Peripheral neuropathy, seizures
  • Abuse and violence
  • Trauma (falls, motor vehicle accidents [MVAs])
  • Behavioral disorders (depression, bipolar, schizophrenia): >50% of patients with these disorders have a comorbid substance abuse problem.

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Citation

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TY - ELEC T1 - Alcohol Use Disorder (AUD) ID - 1688004 Y1 - 2019 PB - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688004/all/Alcohol_Use_Disorder__AUD_ ER -