Episode Details

Episode 175: Alcohol Use Disorder Basics   

Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD.    

Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.

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What is Alcohol Use Disorder?

AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. 

According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: 

1. Alcohol is frequently used in higher quantities or for longer periods than planned.
2. There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.
3. Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.
4. A strong need or desire to consume alcohol—a craving.
5. A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.
6. Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.
7. Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.
8. Frequent consumption of alcohol under risky physical circumstances.
9. Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcohol
10. Tolerance: requiring significantly higher alcohol intake to produce the same intended effect. 
11. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.

How can we determine the severity of AUD? 

• Mild: 2–3 symptoms
• Moderate: 4–5 symptoms
• Severe: >/= 6 symptoms

Who is at risk for AUD?

Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. 

The risk factors for AUD are: 

• Male gender
• Ages 18-29
• Native American and White ethnicities
• Having Significant disability
• Having other substance use disorder
• Mood disorder (MDD, Bipolar)
• Personality disorder (borderline, antisocial personality)

What is heavy drinking?

According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: 

• Males who drink > 4 drinks daily or > 14 drinks per week 
• Females who drink > 3 drinks on any given day or > 7 drinks per week

Pathophysiology of AUD.

The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase