Alcohol Use Disorder Diagnosis and Management

Etiology and Epidemiology

The prevalence of Alcohol Use Disorder (AUD) has increased by 50% between 2001 and 2013, with greater increases among women, minorities, and those of lower socioeconomic status 2
Alcohol-associated liver disease comprises a substantial portion of overall cirrhosis burden, with mortality rates increasing particularly among younger patients (25-34 years old) 3
Highest rates of per capita alcohol consumption occur in northern and eastern European countries and Russia 2
Binge drinking prevalence has increased significantly, with substantial increases in consumption of distilled spirits (+11.5%) and wine (+7.7%) between 2000-2013 2

Patients present with problematic patterns of alcohol use accompanied by clinically significant impairment or distress 2
Key presenting features include escalating alcohol consumption despite attempts to cut back, negative personal consequences, and alcohol craving 2
Physical manifestations may include signs of alcohol-associated liver disease, ranging from steatosis to alcoholic hepatitis and cirrhosis 3
Patients may exhibit withdrawal symptoms when alcohol use is discontinued, including tremors, anxiety, nausea, and in severe cases, seizures or delirium tremens 4

The AUDIT (Alcohol Use Disorders Identification Test) is recommended as a 10-question assessment with high sensitivity and specificity for detecting hazardous drinking and AUD 5, 6
The AUDIT-C, a shortened 3-question version focusing on consumption patterns, maintains good sensitivity while requiring less time to administer 5
The CAGE Questionnaire is a brief 4-question tool with 85% sensitivity and 89% specificity that asks about attempts to Cut down, Annoyance with criticism about drinking, Guilt about drinking, and using alcohol as an Eye-opener 5, 4
Biomarkers of alcohol use can aid diagnosis, support recovery, and serve as catalysts for discussion with patients 7
Laboratory tests including liver enzymes (GGT, AST, ALT), carbohydrate-deficient transferrin (CDT), and complete blood count can help identify alcohol-related organ damage 7

Psychiatric disorders with similar presentations include major depressive disorder, bipolar disorder, anxiety disorders, and post-traumatic stress disorder 5
Medical conditions that may mimic alcohol withdrawal include hypoglycemia, thyrotoxicosis, and certain neurological disorders 5
Medication side effects or interactions may present similarly to alcohol intoxication or withdrawal 5
Distinguish AUD from non-problematic alcohol use, which is defined as drinking that doesn't meet diagnostic criteria for AUD 2

Brief behavioral counseling interventions are recommended for persons engaged in risky or hazardous drinking 2
Treatment should address comorbid psychiatric conditions, which are common in patients with AUD 5

Complications include alcohol-associated liver diseases (steatosis, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma) 3

A patient with a high AUDIT score (22) and meeting 7 DSM-5 criteria for AUD (severe) should be managed with brief intervention, referral to an addiction specialist, and initiation of medication such as naltrexone, alongside regular counseling sessions and liver function monitoring 4, 5, 6