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Alcohol use disorder
Background
Overview
Definition
AUD, according to DSM-5-TR, is characterized by a pattern of alcohol consumption that results in problems associated with ≥ 2 potential symptoms of tolerance, withdrawal, increased amount of alcohol consumed over time, difficulty in controlling drinking, neglect of activities, ineffective efforts to reduce use, craving, failure to fulfill major role obligations, recurrent alcohol use in hazardous situations, time spent drinking or recovering from alcohol, and drinking despite physical/psychological problems in the past year.
1
Pathophysiology
AUD is caused due to genetic, psychological, and environmental factors.
2
Disease course
The neurobiological disturbances due to habitual drinking cause AUD, which increases the risk of damage to the gastrointestinal, cardiovascular, immune, nervous, and other systems. AUD causes increased morbidity and mortality.
3
Prognosis and risk of recurrence
AUD is associated with increased mortality from all causes of death (mortality rate ratio, 3.0-5.2).
4
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of alcohol use disorder are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the American College of Gastroenterology (ACG 2024,2018), the American Society of Addiction Medicine (ASAM/AAAP 2024), the Society for Academic Emergency Medicine (SAEM 2024), the Canadian Research Initiative in Substance ...
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Screening and diagnosis
Definition: as per EASL 2018 guidelines, use the term AUD (defined by DSM-V criteria) in preference to alcoholic, alcohol abuse, alcohol dependence or risky drinker.
A
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Indications for screening
Choice of screening tool
Diagnostic investigations
Psychiatric evaluation
As per CRISM 2023 guidelines:
Conduct a diagnostic interview for AUD using the DSM-5-TR criteria and further assessment to inform a treatment plan, if indicated, in all adult and young patients screening positive for high-risk alcohol use.
B
Use clinical parameters, such as past seizures or delirium tremens, and the PAWSS to assess the risk of severe alcohol withdrawal complications and determine an appropriate withdrawal management pathway.
B
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Alcohol biomarkers
Evaluation for liver disease
Medical management
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Goals of treatment
Management in the emergency department
Naltrexone
Acamprosate
Disulfiram
Anticonvulsants
Benzodiazepines
Antipsychotics and antidepressants
Baclofen
Clonidine
Inpatient care
Prevention of alcohol withdrawal syndrome in the hospital: as per AAFP 2024 guidelines, assess for alcohol withdrawal symptoms in all patients with AUD at hospital admission and manage with benzodiazepines or phenobarbital.
B
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Prevention of alcohol withdrawal syndrome in the ICU
Nonpharmacologic interventions
General principles: as per WHO 2023 guidelines, consider offering structured and standardized psychosocial interventions in patients with AUD.
C
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Brief behavioral intervention
Mindfulness-based therapies
Technology-based interventions
Specific circumstances
Pregnant patients, screening
As per SOGC 2020 guidelines:
Ask all pregnant patients about their alcohol consumption using a single, nonjudgmental question to determine use. Use the AUDIT-C, the T-ACE, or another evidence-based screening tool if patients consume alcohol. Establish the pattern of alcohol use to screen for binge drinking.
A
Ensure a nonjudgmental, supportive approach to encourage disclosure of alcohol use and accessing of services.
A
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Pregnant patients (counseling)
Pregnant patients (brief intervention)
Pregnant patients (pharmacotherapy)
Patients with stimulant use disorder