Chronic alcohol abuse

Alcohol abuse, also known as alcohol use disorder (AUD), is a condition characterized by an unhealthy drinking pattern that leads to significant impairment or distress.

Causes:

  • Genetic Factors: A family history of alcoholism can increase the risk.
  • Psychological Factors: Stress, anxiety, depression, or other mental health issues.
  • Social Factors: Peer pressure, social environment, cultural norms.
  • Behavioral Factors: Patterns of binge drinking or using alcohol as a coping mechanism.
  • Biological Factors: Changes in brain chemistry and structure.

Diagnosis:

  • Clinical Criteria (DSM-5): Includes a pattern of alcohol use leading to significant impairment or distress, as manifested by at least two of several criteria over a 12-month period. These include:
    • drinking more or longer than intended,
    • unsuccessful efforts to cut down,
    • time spent drinking or recovering from effects,
    • cravings,
    • recurrent alcohol use resulting in failure to fulfill major role obligations, and
    • continued use despite having persistent or recurrent social or interpersonal problems.
  • Screening Tools: Such as
    • The CAGE questionnaire
      • Have you felt the need to Cut down on your drinking?
      • Do you feel Annoyed by people complaining about your drinking?
      • Do you ever feel Guilty about your drinking?
      • Do you ever drink an Eye-opener in the morning to relive the shakes?
    • Alcohol Use Disorders Identification Test (AUDIT).
  • Laboratory Tests: Liver function tests, blood alcohol levels, and carbohydrate deficient transferrin

Differential Diagnosis:

  • Substance Use Disorders: Abuse of other substances can have similar presentations.
  • Psychiatric Disorders: Conditions like depression or anxiety disorders.
  • Medical Conditions: Liver disease, pancreatitis, or neurological disorders due to or mimicking alcohol abuse.

Management:

  • Detoxification: Medical supervision to manage withdrawal symptoms. Valium and thiamine are the mainstays
  • Behavioral Treatments: Counseling, cognitive-behavioral therapy (CBT), motivational enhancement therapy.
  • Medications: Naltrexone, acamprosate, and disulfiram to reduce craving and prevent relapse.
  • Support Groups: Alcoholics Anonymous (AA) and other peer support groups.
  • Treatment of Co-Occurring Conditions: Addressing any psychiatric disorders concurrently.
  • Lifestyle Modifications: Building a supportive social environment, engaging in healthy activities.
  • Long-Term Follow-Up: To prevent relapse and support recovery.

Prevention:

  • Education and Awareness: Educating about the risks of excessive alcohol use.
  • Early Intervention: For those at risk of developing alcohol use disorder.
  • Stress Management: Healthy coping strategies for stress and emotional challenges.

Special Considerations:

  • Pregnancy: Alcohol abuse can lead to fetal alcohol syndrome and other developmental disorders.
  • Adolescents and Young Adults: Early intervention is crucial as they are at a higher risk for developing AUD.
  • Dual Diagnosis: Treatment should address both AUD and any co-occurring mental health disorders.

Managing alcohol abuse requires a comprehensive approach, including medical, psychological, and social support. The prognosis varies depending on the severity of the disorder, the presence of co-occurring conditions, and the individual’s commitment to treatment.