Alcohol-use disorders

Alcohol use disorder is a complex topic, complicated by the fact that there are several different terms to describe a range of scenarios and conditions. Generally, ‘alcohol use disorder’ can be defined as two problems/conditions (National Institute for Health and Care Excellence, NICE, 2011):

Harmful/high-risk drinking – this is where a patient consumes alcohol to the extent that it causes health problems directly relating to alcohol. They could be psychological problems; accidents or injuries; or physical symptoms and conditions. It can interfere with a patient’s everyday life to varying degrees.

Alcohol dependence – this is where a patient has developed a tolerance to the effects of alcohol, experiences cravings and a preoccupation with alcohol, and continues to drink despite harmful physical and psychological consequences. Alcohol dependence is recognised as being a psychological disorder by ICD-10 (the International Classification of Diseases) and DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders),

Alcohol use disorder may be evident in the patient’s behaviour and the effects it is having on their life, and manifest in consequences to their physical and mental health (Centers for Disease Control and Prevention, CDC, 2021). Often, it is the patient’s close family members or friends who notice that problems are worsening.

The signs and symptoms will often depend on the extent of the patient’s drinking and how long they have been misusing alcohol. A patient may not present with many of the symptoms but could be at risk of developing them if their alcohol use disorder progresses (CDC, 2021; Drinkaware, 2021b; 2021c; 2021d; NHS, 2018).

Physical effects:

• High blood pressure
• Liver disease (e.g. cirrhosis)
• Heart disease (e.g. coronary artery disease, atrial fibrillation, heart failure)
• Cardiovascular disease (e.g. stroke)
• Alcohol poisoning
• Pancreatitis
• Certain types of cancers (e.g. cancer of the mouth, liver, bowel or breast)

Psychological/mental health effects:

• Depression

Aetiology and risk factors

Alcohol use disorder can result from a complex interplay of genetic, psychological, social and environmental factors. This means some people are at higher risk than others of having problems with alcohol (Health and Safety Executive, 2019; Mayo Clinic, 2021).

Patterns of drinking – a person who drinks above the recommended levels regularly, and over a long period of time, is more likely to develop alcohol use disorder. This risk is increased if they start drinking at a young age, especially if they binge drink.

Genetics/parent history – people who have a parent with alcohol misuse problems are also at greater risk, perhaps because of a genetic predisposition.

Mental health problems/trauma – alcohol use disorder is more common among people with depression, anxiety, bipolar disorder and schizophrenia, as well as other mental health problems. The risk of developing alcohol use disorder is higher among people who have

Alcohol use disorder might be suspected on the basis of the presence of signs, symptoms and consequences, and if the patient or a loved-one intimates a pattern of regular heavy drinking. Identifying risk factors can support this suspicion. Tests and investigations, like blood tests to determine whether there is any sign of liver damage, might help to diagnose physical manifestations of harmful drinking, but they are not useful in diagnosing alcohol use disorder (NICE, 2011).

There are some methods of assessing the severity of alcohol use disorder. Commonly used ones are:

The CAGE screening tool – Cut down; Annoyed; Guilty; Eye-opener

A series of 4 closed yes/no questions, which should not follow questioning about alcohol intake because of contextual sensitivity. Answering ‘yes’ to any of the questions could indicate a problem with alcohol (Tidy, 2021).

1. Have you ever felt you should Cut down on your drinking?

Appropriate treatment for alcohol use disorder depends on the severity of the disorder and the patient’s individual needs. Severe alcohol dependency requires intervention, treatment and support from a specialist centre or clinic.

A general health check-up can identify if specific tests and investigations are needed, the results of which can guide whether treatment is necessary for physical complications of alcohol use disorder (Alcohol Change UK, 2021).

Sometimes, patients may need to take medication (NHS, 2018). These include:

• Chlordiazepoxide to manage and treat withdrawal symptoms, given in tapered doses over a short timeframe.
• Acamprosate or naltrexone to manage alcohol cravings, given at a fixed dose over a period of 6-12 months.
• Medication to treat low mood, depression, anxiety and sleep problems.

An important part of treating and managing alcohol use disorder is ongoing support. As well as support from family and friends, patients may benefit from specialist therapy or counselling, such

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