Definition and Diagnosis
Alcohol use disorder is a maladaptive pattern of alcohol consumption leading to clinically significant impairment or distress, marked by impaired control over drinking, continued use despite harmful consequences, tolerance, and a characteristic withdrawal syndrome.
Epidemiology
Alcohol use disorder is among the most common substance use disorders worldwide, with lifetime prevalence estimates ranging from 10-30% depending on the population studied. It is more common in men, though the gap has narrowed in recent decades, and onset is typically in late adolescence to the mid-twenties.
Risk Factors
Genetic factors account for an estimated 50-60% of risk, with family history, early age at first use, co-occurring psychiatric conditions such as depression or anxiety, chronic stress, and permissive social or cultural norms around drinking all contributing.
Symptoms and Subtypes
Features include strong craving, loss of control over the amount or duration of drinking, tolerance, and withdrawal symptoms such as tremor, sweating, anxiety, and, in severe cases, seizures or delirium tremens. Continued drinking despite social, occupational, or health consequences is characteristic.
Diagnosis
DSM-5-TR requires at least two of eleven specified criteria occurring within a twelve-month period, with severity classified as mild, moderate, or severe based on the number met. Screening tools such as the AUDIT and CAGE questionnaire are commonly used in clinical practice.
Treatment
Management often begins with medically supervised withdrawal, frequently using benzodiazepines to prevent seizures and delirium tremens. Ongoing treatment combines psychosocial approaches such as CBT and motivational interviewing with pharmacotherapy (naltrexone, acamprosate, or disulfiram) and mutual-help groups such as Alcoholics Anonymous.
Prognosis
Course is often relapsing and remitting, but sustained recovery is achievable with ongoing treatment and support. Untreated withdrawal can be medically dangerous, and long-term heavy use carries substantial risk of liver, cardiovascular, and neurocognitive complications.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.); New Oxford Textbook of Psychiatry (2nd ed.).