Alcohol use disorder is a pattern of drinking that causes harm or distress, with loss of control, craving and continued use despite problems. It damages the liver, brain, heart and relationships, and medications plus counseling clearly improve the chance of recovery.
Key symptoms
- Drinking more or longer than intended, failed attempts to cut down
- Craving and much time spent drinking or recovering
- Missing work or family duties, conflict with others
- Tolerance and withdrawal: shakes, sweating, anxiety in the morning
- Falls, injuries, blackouts
What you find on exam
- Smell of alcohol, tremor, fast heart rate, high blood pressure
- Liver signs: enlarged liver, jaundice, spider angiomas, ascites
- Neuro signs: confusion, unsteady gait, abnormal eye movements
- Signs of injury and poor nutrition
Tests
- Screening with AUDIT-C or a single question about heavy drinking days
- Liver tests (AST higher than ALT), GGT, blood count with high MCV
- Electrolytes, magnesium, phosphate, glucose
- CIWA-Ar score to rate withdrawal severity
Treatment basics
- Brief intervention and motivational interviewing
- Withdrawal: benzodiazepines guided by CIWA-Ar, thiamine before glucose
- Relapse prevention with naltrexone, acamprosate or disulfiram
- Counseling, mutual help groups such as AA, and treatment of other mental health problems
- Vaccines and liver follow up
Red flags
- Seizures, hallucinations or confusion in withdrawal (delirium tremens)
- Confusion, gait problems or eye movement palsy (Wernicke encephalopathy)
- Vomiting blood, jaundice or a swollen abdomen
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.