Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Alcohol-related disorders

Last updated: April 9, 2021

Summarytoggle arrow icon

Alcohol-related disorders, including alcohol intoxication, alcohol use disorder (AUD), and alcohol withdrawal, are a group of conditions associated with disruptive patterns of alcohol use. Alcohol intoxication is the acute onset of behavioral and psychomotor impairment shortly after an episode of drinking. Alcohol use disorder (AUD) is characterized by clinically significant psychosocial and behavioral problems associated with alcohol use. Alcohol withdrawal develops after a sudden cessation or reduction of alcohol use in patients with a history of excessive drinking. The diagnosis of an alcohol-related disorder can be established using the DSM-5 criteria. The most important aspect of management for all alcohol-related disorders is the cessation of alcohol use. Therapeutic management is guided by the severity of the disorder.

See breakdown of ethanol for a review of alcohol metabolism pathways. See also “Alcohol withdrawal.”

  • Definition: : a temporary condition in which excessive consumption of alcohol alters a person's consciousness, cognition, perception, judgment, affect, and/or behavior [1]
  • Related terms
  • Pathophysiology
    • The majority of alcohol consumed is absorbed by the proximal small intestine. Only a small amount of alcohol gets absorbed by the oral, esophageal, and/or gastric mucosa. [2][3]
  • Clinical features [4][5]
Mild intoxication (BAC 0.01–0.1%, < 100 mg/dL) Moderate intoxication (BAC 0.1–0.3%, 100–300 mg/dL Severe intoxication (BAC > 0.3%; > 300 mg/dL)

In the US, the maximum legal limit for driving under the influence of alcohol is a BAC of 0.08%.

Because alcohol has a long absorption time (approx. 40 min), patients with alcohol intoxication may deteriorate over time.

Haloperidol may worsen respiratory depression secondary to alcohol intoxication!

References:[6][7]

AUD is a chronic condition in which an uncontrolled pattern of alcohol use leads to significant physical, psychological, and social impairment or distress. Symptoms of withdrawal emerge when drinking is discontinued. Not all individuals who drink heavily develop AUD, and not all individuals with AUD have a history of heavy alcohol use.

References: [8][12][13][14]

  • Genetic factors
  • Neurobiological factors
  • Psychosocial factors
    • Family history of AUD [15]
    • Environmental influence: e.g., social pressure to consume alcohol, economic disadvantage (e.g., unemployment), stressful life events

References:[16][17]

Diagnosis of AUD begins with a screening test, which is followed by a confirmatory test based on patient history. Commonly used screening tests include AUDIT-C and CAGE tests. Diagnosis is confirmed if the patient history meets the DSM-V criteria for AUD.

Screening

  • AUDIT-C test
    • Three questions based on the Alcohol Use Disorders Identification Test (AUDIT)
    • Evaluation
      • Every response is given a score from 0 to 4 points.
      • The total score can range from 0 to 12.
      • A positive test suggests the presence of an alcohol use disorder.
        • ≥ 4 in men
        • ≥ 3 in women
Question Response Score
How often did you have a drink containing alcohol in the past year? Never 0
≤ Monthly 1
2–4 times a month 2
2–3 times a week 3
≥ 4 times a week 4
How many drinks did you have on a typical day when you were drinking in the past year? 1–2 0
3–4 1
5–6 2
7–9 3
≥ 10 4
How often did you have ≥ 6 drinks on one occasion in the past year? Never 0
< Once per month 1
Monthly 2
Weekly 3
Daily or almost daily 4
  • CAGE test [18]
    • A series of four questions (CAGE) is used to screen for AUD
      1. Cut down drinking: Have you ever felt you should cut down on your drinking?
      2. Annoyed: Have people annoyed you by criticizing your drinking?
      3. Guilty: Have you ever felt guilty about drinking?
      4. Eye-opener: Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to overcome a hangover?
    • Every “yes” response counts as one point.
    • The CAGE test is considered positive for AUD if ≥ 2 questions are answered in the affirmative.

Diagnostic criteria (according to DSM-5)

  • 11 criteria based on the patient's history within the past 12 months
  • A diagnosis of AUD is established once ≥ 2 criteria are met.
    1. Drinking more or over a longer period than intended
    2. Tried to cut down or stop more than once, but couldn't
    3. Spends a lot of time drinking or recovering from aftereffects
    4. Strong desire to drink alcohol
    5. Drinking has a negative impact on everyday function (social, work etc)
    6. Continued drinking despite social or interpersonal problems
    7. Given up interests and activities that were important because of drinking
    8. Drinking in physically hazardous situations more than once
    9. Continued drinking despite physical or psychological problems
    10. Increasing amount of drinks to maintain same effects as before
    11. Features of withdrawal when the effects of alcohol wear off (see alcohol withdrawal below)
  • Severity
    • Mild: presence of 2–3 criteria
    • Moderate: presence of 4–5 criteria
    • Severe: presence of ≥ 6 criteria

Laboratory tests

AUD is a clinical diagnosis, and laboratory tests are not usually required, although they may provide evidence of problematic alcohol use in patients who cannot provide a conclusive history.

Don't be the lAST 2 hALT! (AST levels are at least 2 times higher than those of ALT in case of alcoholic hepatitis).

References:[21]

In contrast to diabetic ketoacidosis, blood glucose levels are normal or low in alcoholic ketoacidosis.

References:[1][3][6][24]

  1. Acute Intoxication. http://www.who.int/substance_abuse/terminology/acute_intox/en/. Updated: January 1, 2017. Accessed: May 5, 2017.
  2. Kasicka-Jonderko A, Jonderko K, Bożek M, Kamińska M, Mgłosiek P. Potent inhibitory effect of alcoholic beverages upon gastrointestinal passage of food and gallbladder emptying. J Gastroenterol. 2013; 48 (12): p.1311-1323. doi: 10.1007/s00535-013-0752-y . | Open in Read by QxMD
  3. Vij K. Textbook of Forensic Medicine & Toxicology: Principles & Practice. Elsevier Health Sciences ; 2014
  4. Olson KN, Smith SW, Kloss JS, Ho JD, Apple FS. Relationship Between Blood Alcohol Concentration and Observable Symptoms of Intoxication in Patients Presenting to an Emergency Department. Alcohol and Alcoholism. 2013; 48 (4): p.386-389. doi: 10.1093/alcalc/agt042 . | Open in Read by QxMD
  5. Okruhlica L, Slezakova S. Clinical signs of alcohol intoxication and importance of blood alcohol concentration testing in alcohol dependence. Bratislava Medical Journal. 2013; 114 (03): p.136-139. doi: 10.4149/bll_2013_030 . | Open in Read by QxMD
  6. Semmens-Wheeler R, Dienes Z, Duka T. Alcohol increases hypnotic susceptibility. Conscious Cogn. 2013; 22 (3): p.1082-1091. doi: 10.1016/j.concog.2013.07.001 . | Open in Read by QxMD
  7. Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clinic Proceedings. 2010; 85 (9): p.838-54. doi: 10.4065/mcp.2010.0099 . | Open in Read by QxMD
  8. Noor NM, Basavaraju K, Sharpstone D. Alcoholic ketoacidosis: a case report and review of the literature. Oxford Medical Case Reports. 2016; 2016 (3): p.31-33. doi: 10.1093/omcr/omw006 . | Open in Read by QxMD
  9. Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF. Massachusetts General Hospital Handbook of General Hospital Psychiatry E-Book. Elsevier Health Sciences ; 2017
  10. Bradley KA, Bush KR, McDonell MB, Malone T, Fihn SD. Screening for problem drinking. J Gen Intern Med. 1998; 13 (6): p.379-388. doi: 10.1046/j.1525-1497.1998.00118.x . | Open in Read by QxMD
  11. Torruellas C. Diagnosis of alcoholic liver disease. World J Gastroenterol. 2014; 20 (33): p.11684-11699. doi: 10.3748/wjg.v20.i33.11684 . | Open in Read by QxMD
  12. Sher KJ. The Oxford Handbook of Substance Use and Substance Use Disorders, Band 2. Oxford University Press ; 2016
  13. Association AP. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. American Psychiatric Pub ; 2018
  14. Osna NA, Donohue TM Jr, Kharbanda KK. Alcoholic Liver Disease: Pathogenesis and Current Management.. Alcohol research : current reviews. 2017; 38 (2): p.147-161.
  15. Dosumu OO, Osinubi AAA, Duru FIO. Alcohol induced testicular damage: Can abstinence equal recovery?. Middle East Fertility Society Journal. 2014; 19 (3): p.221-228. doi: 10.1016/j.mefs.2014.01.003 . | Open in Read by QxMD
  16. Nam T. Tran, Alexandra Clavarino, Gail M. Williams, Jake M. Najman. Gender Difference in Offspring's Alcohol Use Disorder by 21 Years: A Longitudinal Study of Maternal Influences. Subst Use Misuse. 2017; 53 (5): p.705-715. doi: 10.1080/10826084.2017.1363233 . | Open in Read by QxMD
  17. Holgate J, Bartlett S. Early Life Stress, Nicotinic Acetylcholine Receptors and Alcohol Use Disorders. Brain Sciences. 2015 .
  18. Yang P et al.. The Risk Factors of the Alcohol Use Disorders—Through Review of Its Comorbidities. Frontiers in Neuroscience. 2018 .
  19. Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015; 72 (8): p.757-766. doi: 10.1001/jamapsychiatry.2015.0584 . | Open in Read by QxMD
  20. Ferri FF. Ferri's Clinical Advisor 2017. Elsevier Health Sciences ; 2016
  21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). undefined. 2013 . doi: 10.1176/appi.books.9780890425596 . | Open in Read by QxMD
  22. Brown TE. ADHD Comorbidities. American Psychiatric Pub ; 2009
  23. Global Status Report on Alcohol and Health 2014. http://www.who.int/substance_abuse/publications/global_alcohol_report/en/. Updated: January 1, 2014. Accessed: May 5, 2017.
  24. Sinha R. Chronic Stress, Drug Use, and Vulnerability to Addiction. Ann NY Acad Sc. 2008 .
  25. Risks of Alcoholism Among Native Americans. https://americanaddictioncenters.org/alcoholism-treatment/native-americans. Updated: January 2, 2020. Accessed: July 7, 2020.
  26. Herold G. Internal Medicine. Herold G ; 2014
  27. Teeple RC, Caplan JP, Stern TA. Visual hallucinations: differential diagnosis and treatment.. Prim Care Companion J Clin Psychiatry. 2009; 11 (1): p.26-32. doi: 10.4088/pcc.08r00673 . | Open in Read by QxMD