Alcohol use disorder

Background
  • Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.
  • Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.
  • It is estimated that about 6% of adults in the US suffer from alcohol use disorder.

Clinical Features
  • Drinking more or for a longer period of time than intended.
  • Feeling incapable of cutting back on the amount of alcohol consumed.
  • Becoming sick for an extended period of time as a result of drinking too much.
  • Inability to concentrate due to alcohol cravings.
  • Inability to care for a family, hold down a job, or perform in school.
  • Continuing to drink despite problems caused with friends or family.
  • Decreased participation in activities which were once important.
  • Finding oneself in dangerous or harmful situations as a direct result of drinking.
  • Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out.
  • Drinking more as a result of a tolerance to alcohol.
  • Experiencing withdrawal symptoms.
Mild = 2-3 features
Moderate = 4-5 features
Severe = 6 or more features

Differential Diagnosis

Evaluation
  • A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, alcohol withdrawal, and co-ingestion with other drugs or toxic alcohols.

Management
  • If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.
  • Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction.

Vitamin Prophylaxis for Chronic alcoholics
  • At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
  • Give multivitamin PO; patient at risk for other vitamin deficiencies

Banana bag

The majority of chronic alcoholics do NOT require a banana bag[1][2]

Disposition
  • Outpatient

See Also



References
  1. Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
  2. Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.
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