ALCOHOL USE DISORDERS

Conditions resulting from different patterns of alcohol consumption, including acute alcohol intoxication, harmful
alcohol use, alcohol dependence syndrome and alcohol withdrawal state.

Causes

  • Genetic
  • Social and environmental factors including availability
  • Stress, peer pressure
  • Personality disorders

Clinical features

Acute intoxication

  • Transient condition following intake of alcohol resulting in disturbances of consciousness, cognition, perception, affect or behaviour

Harmful alcohol use

  • Pattern of alcohol consumption that is causing damage to the health, physical (e.g. liver disease) or mental (e.g.
    depressive disorder). Criteria:

    • More than 5 drinks in any given occasion in the last 12 months
    • More than 2 drinks a day
    • Drinking every day
  • These patients consume more alcohol than recommended but they do not fulfil (yet) the criteria for alcohol
    dependence

Alcohol consumption during pregnancy is extremely harmful for the baby: it can cause foetal alcohol syndrome.
Counsel against any consumption

Alcohol dependence

  • A disorder characterised by the need to take large daily amounts of alcohol for adequate functioning. The use of
    alcohol takes on a much higher priority for the individual than other behaviours that once had greater value
  • Complications: malnutrition, thiamine deficiency (causing Wernicke encephalopathy), liver disease, chronic
    pancreatitis, peptic ulcer, cardiomyopathy, neuropathy, head trauma etc

Alcohol withdrawal

  • Symptoms occurring upon cessation of alcohol after its prolonged daily use (6 hours to 6 days after)
  • Tremor in hands, sweating, vomiting, tachycardia, hypertension, agitation, anxiety, headache, seizure and
    confusion in severe cases

Diagnostic criteria for alcohol dependence:

If 3 or more of the features below are present:

  • A strong desire to take alcohol
  • Difficulties controlling alcohol use in terms of onset, termination or levels of use
  • A physiological withdrawal state when alcohol use has ceased or been reduced (alcohol withdrawal syndrome)
  • Evidence of tolerance: increased doses of alcohol are required to achieve effects originally produced by lower
    doses
  • Progressive neglect of alternative pleasures or interests because of alcohol use
  • Alcohol use persists despite clear evidence of harmful consequences e.g. liver damage, depression, cognitive
    impairment, loss of a job, friends, relationships

Differential diagnosis

  • Abuse of other psychoactive substances
  • Depression, chronic psychosis (often co-existing!)

Investigations

  • Blood: complete blood count, liver enzymes
    • Shows elevated MCV and GGT levels
  • Social investigations

Management

Acute intoxication, withdrawal and Wernicke’s encephalopathy
See section
Harmful alcohol consumption

  • Counselling and advice
  • Investigate and treat concurrent medical or psychiatric illness (dementia, depression anxiety,
    psychosis etc.)
  • Follow up and refer if not better

Alcohol dependence

  • Counselling and education of the patient
  • Assess and manage concurrent medical and mental conditions
  • Advise thiamine 100 mg daily

If patient willing to stop, facilitate alcohol cessation

  • Determine appropriate setting, refer for detoxification, treat withdrawal symptoms with
    diazepam
  • Consider referral to self help groups
  • Counsel the family, provide psychosocial interventions if available

Prevention

  • Health education on dangers of alcohol abuse
  • Reduce accessibility to alcohol