II. Epidemiology: General

  1. Prevalence
    1. Alcohol Dependence: 8-14% lifetime
    2. Alcohol Use Disorder: 29% lifetime (14% one year), 14.5 Million in U.S. as of 2022
  2. Age of symptom onset: 15 to to 19 years
  3. Familial predisposition in Autosomal Dominant pattern

III. Epidemiology: Alcohol Impaired Driving

  1. Alcohol Impaired Driving Survey (n=102,263)
    1. Overall alcohol Impaired Driving in last month: 2.5%
    2. Lowest rate: Women over age 55 years old (0.1%)
  2. Predictors of alcohol Impaired Driving
    1. Men aged 21 to 34 years: 7%
    2. Over 4 Alcoholic drinks on 1 occasion in last month
    3. Greater than two Alcoholic drinks per day
  3. States of highest alcohol Impaired Driving
    1. Alaska
    2. Nevada
    3. Wisconsin
    4. Michigan
    5. North Dakota
  4. References
    1. Liu (1997) JAMA 277:122-5 [PubMed]

IV. History: Famous Alcoholics

  1. Sinclair Lewis
  2. Edgar Allen Poe
  3. Dylan Thomas
  4. F. Scott Fitzgerald
  5. Jim Thorpe

V. Pathophysiology

  1. See Addiction Pathophysiology
  2. Substance Abuse or Alcoholism Definition Criteria
    1. Compulsion-Preoccupation
    2. Use despite adverse consequences
    3. Loss of Control
    4. Denial
  3. Mechanism
    1. Alcohol increases activity at GABA Receptors with secondary CNS depression
      1. Chronic Alcohol use down regulates GABA Receptors and up regulation of NMDA receptors
      2. Alcohol Withdrawal results in excessive excitation
    2. Limbic System drive state
    3. Alcoholics have lower level of endogenous endorphins
      1. Need TIQs externally from Alcohol to feel normal
  4. Other preparation misued for their Alcohol content
    1. Mouthwash
    2. Vanilla extract
    3. Ethanol-based hand sanitizer (especially in health care centers)
      1. Small ingestions of hand sanitizer can cause significant Alcohol Intoxication (>60% Alcohol)
      2. Some users extract the Alcohol content with salt

VI. Physiology: Alcohol Digestion Pathway

  1. One ounce Alcohol takes 1 hour, mouth to excretion
  2. No Digestion required before absorption
  3. Small amount absorbed in Stomach
  4. Most Alcohol absorbed in Small Intestine (duodenum)
  5. Metabolism
    1. Alcohol converted to acetaldehyde
    2. Acetaldehyde converted in liver to acetic acid
  6. Excretion
    1. Renal excretion: 10%
    2. Hepatic excretion: 90%

VII. History

  1. See Alcoholism Screening
    1. AUDIT-C (or full AUDIT tool, or single question screening)
    2. CAGE Questions
    3. NIAAA Quantity and Frequency Questionnaire
  2. See Alcohol Use Disorder Diagnosis
    1. Alcohol Use Disorder integrates Alcohol Abuse and dependence into a single diagnosis
  3. See Substance Abuse Evaluation
  4. See medical complications and comorbid conditions below
  5. Alcohol use history (See Grading Alcohol Use)
    1. Drinks per day
      1. Men: >2 per day (>14/week) suggests Alcohol Dependence
      2. Women: >1 per day (>7/week) suggests Alcohol Dependence
    2. Last drink
    3. Binge drinking
      1. Men: >5 drinks on single occasion in last year suggests Alcohol Dependence
      2. Women: >4 drinks on single occasion in last year suggests Alcohol Dependence
  6. Other Illicit Drug use
    1. Marijuana
    2. Cocaine
    3. Heroin
    4. Amphetamines
    5. Benzodiazepine Abuse
    6. Barbiturate Abuse
    7. Quaalude
    8. Hallucinogen
  7. Prior attempts at cessation
    1. Greatest duration of sobriety
    2. Trials of cold turkey
    3. Rehabilitation Programs
    4. Detox Center Admissions
  8. Overuse Complications
    1. Blackouts
    2. Seizures
    3. Hangovers
  9. Accidents
    1. Motor Vehicle Accidents
    2. Driving while intoxicated (DUI or DWI)
  10. Injuries
    1. Frequent falls or minor Trauma
    2. Burns
    3. Violence
  11. Withdrawal complications
    1. See Alcohol Withdrawal
    2. Hallucinations
    3. Delirium Tremens (DT's)
    4. Grand Mal Seizures (GTCS)

XI. Comorbid Conditions: Infectious disease

XIII. Complications: Vitamin Deficiency

  1. Vitamin A Deficiency (Retinol Deficiency)
    1. Presents with night blindness
  2. Vitamin C Deficiency (Scurvy)
    1. Presents with Bleeding Gums, Fatigue
  3. Vitamin B1 Deficiency (Thiamine deficiency, Wernicke's Encephalopathy)
    1. Presents with Ataxia, Confusion, Ophthalmoplegia (lateral Gaze Palsy)
  4. Vitamin B3 Deficiency (Niacin Deficiency, Pellegra)
    1. Presents with Diarrhea, dermatitis and Dementia (3 D's)
  5. Vitamin B6 Deficiency (Pyridoxine deficiency)
    1. Presents with Glossitis, Peripheral Neuropathy
  6. Vitamin B9 Deficiency (Folic Acid Deficiency)
    1. Presents with Macrocytic Anemia (also caused by B12 Deficiency)
  7. Vitamin B12 Deficiency (Cobalamin Deficiency, Pernicious Anemia)
    1. Presents with weakness, Peripheral Neuropathy, Ataxia, Dementia, macroyctic Anemia
  8. References
    1. Jhun et al. in Herbert (2016) EM:Rap 16(9): 8-10

XV. Prognosis: Relapse after CD treatment

  1. Relapse after Treatment in first 3 months: 50%
  2. Relapse after treatment in first 6 months: 80%
  3. Remain sober with Alcoholics Anonymous > 1 year: 76%

XVI. Resources

  1. See Chemical Dependency Resources
  2. Alcoholics Anonymous
    1. http://www.aa.org/
  3. Al-Anon/Ala-Teen (Family and Friends of Alcoholics)
    1. http://www.al-anon.org/
  4. Information from your Family Doctor: Alcohol Abuse
    1. http://www.familydoctor.org/healthfacts/006
  5. Rethinking Drinking (NIH)
    1. https://www.rethinkingdrinking.niaaa.nih.gov/

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Alcoholic Intoxication, Chronic (C0001973)

Definition (MEDLINEPLUS)

For most adults, moderate alcohol use is probably not harmful. However, about 18 million adult Americans are alcoholics or have alcohol problems. Alcoholism is a disease with four main features:

  • Craving - a strong need to drink
  • Loss of control - not being able to stop drinking once you've started
  • Physical dependence - withdrawal symptoms, such as nausea, sweating, or shakiness when you don't drink
  • Tolerance - the need to drink greater amounts of alcohol to feel the same effect

Alcoholism carries many serious dangers. Heavy drinking can increase the risk of certain cancers. It can cause damage to the liver, brain, and other organs. Drinking during pregnancy can harm your baby. Alcoholism also increases the risk of death from car crashes, injuries, homicide, and suicide.

If you want to stop drinking, there is help. Start by talking to your health care provider. Medicines, counseling, and support groups may help you to stop drinking.

NIH: National Institute on Alcohol Abuse and Alcoholism

Definition (NCI_NCI-GLOSS) A chronic disease in which a person craves drinks that contain alcohol and is unable to control his or her drinking. A person with this disease also needs to drink greater amounts to get the same effect and has withdrawal symptoms after stopping alcohol use. Alcoholism affects physical and mental health, and can cause problems with family, friends, and work.
Definition (MSH) A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (Morse & Flavin for the Joint Commission of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism: in JAMA 1992;268:1012-4)
Definition (CSP) a disorder characterized by a pathological pattern of alcohol use that causes a serious impairment in social or occupational functioning.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D000437
ICD9 303
ICD10 F10.2
SnomedCT 191809008, 191801006, 192209003, 268639004, 154908007, 191808000, 268683008, 268764008, 191815008, 191814007, 87012002, 66590003, 7200002, 284591009
DSM4 303.90
LNC LA6152-8
English Alcoholism, Alcohol dependence syndr. NOS, Alcohol dependence syndrome NOS, Chronic alcoholism NOS, Mental and behav dis due to use alcohol: dependence syndr, Mental and behavioral disorders due to use of alcohol: dependence syndrome, Mental and behavioural disorders due to use of alcohol: dependence syndrome, Unspecified chronic alcoholism, [X]Alcohol dependence syndrome, [X]Mental and behav dis due to use alcohol: dependence syndr, [X]Mental and behavioral disorders due to use of alcohol: dependence syndrome, [X]Mental and behavioural disorders due to use of alcohol: dependence syndrome, Intoxication, Chronic Alcoholic, Mental and behavioral disorders due to use of alcohol, dependence syndrome, Mental and behavioural disorders due to use of alcohol, dependence syndrome, ALCOHOL DEPENDENCE, ALCOHOLISM, ALCOHOLIC INTOX CHRONIC, Alcohol abuse chronic, Alcohol abuse, continuous drinking behaviour, Alcohol abuse, continuous drinking behavior, alcoholism, ETOHism, ETOH dependence, addicted to alcohol, alcohol dependence, alcohol dependence (diagnosis), Alcohol addiction, Alcoholism [Disease/Finding], alcoholism chronic disorders, Abuse;alcohol;chronic, Addiction;alcohol, Intoxication;alcohol;chronic, Dependence;alcohol, Alcoholism;chronic, alcoholism/alcohol abuse, addiction alcohol, dependence alcoholism alcohol, chronic alcohol abuse, alcoholism chronic, abuse alcohol alcoholism, alcohol dependence syndrome, alcoholism disorders, alcoholisms, alcohol dependences, disorder alcoholism, alcohol abuse alcoholism, alcohol dependency, Alcohol Dependence, Alcohol Addiction, Addiction, Alcohol, Dependence, Alcohol, Unspecified chronic alcoholism (disorder), Chronic alcoholism (disorder), Alcohol dependence syndrome (& [dipsomania]) (disorder), Chronic alcoholism (& [dipsomania]), Alcohol dependence syndrome (& [dipsomania]), Chronic alcoholism NOS (disorder), [X]Alcohol addiction, [X]Dipsomania, (Alcohol dependence syndrome [including alcoholism]) or (alcohol problem drinking) (disorder), Alcohol dependence syndrome NOS (disorder), Chronic alcoholism (& [dipsomania]) (disorder), (Alcohol dependence syndrome [including alcoholism]) or (alcohol problem drinking), Dipsomania (finding), [X]Mental and behavioral disorders due to use of alcohol: dependence syndrome (disorder), [X]Chronic alcoholism, alcohol abuse - persistent, alcohol abuse - persistent (diagnosis), Alcohol dependency, Alcohol dependence, Alcohol dependence syndrome, Dipsomania, Chronic alcoholism, Chronic alcohol abuse, Persistent alcohol abuse, Alcohol problem drinking, Alcohol dependence (disorder), Alcoholism (disorder), Persistent alcohol abuse (disorder), dipsomania, chronic; drunkenness, dependence; alcohol, drunkenness; chronic, addiction; alcohol, alcohol; addiction, alcohol; dependence, Alcoholism, NOS, Chronic alcoholism [Ambiguous], Alcoholic Intoxication, Chronic, Chronic Alcoholic Intoxication, dependence; ethyl alcohol, ethyl alcohol; dependence, alcohol addiction, chronic alcoholism, chronic alcohol intoxication
Italian Alcoolismo, Sindrome di dipendenza da alcool, Alcolismo cronico, Dipsomania, Abuso cronico di alcool, Abuso di alcool, assunzione continua, Abuso di alcool, abitudine al bere continua, Intossicazione alcolica cronica, Alcolismo
Dutch alcoholverslaving, alcoholafhankelijkheidssyndroom, dipsomanie, chronisch alcoholisme, alcoholmisbruik, continu drinkgedrag, chronisch alcoholmisbruik, Chronisch alcoholmisbruik, afhankelijkheid; alcohol, alcohol; afhankelijkheidssyndroom, alcohol; verslaving, chronisch; dronkenschap, dronkenschap; chronisch, verslaving; alcohol, Psychische stoornissen en gedragsstoornissen door gebruik van alcohol; Afhankelijkheidssyndroom, alcoholisme, afhankelijkheid; ethylalcohol, ethylalcohol; afhankelijkheidssyndroom, Alcoholintoxicatie, chronische, Alcoholisme
French Addiction à l'alcool, Dipsomanie, Syndrome de dépendance à l'alcool, Alcoolisme chronique, Abus d'alcool, comportement vis-à-vis de la boisson continu, Abus chronique d'alcool, Abus d'alcool, comportement de consommation continue, Alcoolodépendance, Dépendance à l'alcool, Intoxication chronique à l'alcool, Toxicomanie alcoolique, Dépendance alcoolique, Alcoolisme, Éthylisme, Intoxication alcoolique chronique
German Alkoholismussyndrom, Alkoholabhaengigkeit, Dipsomanie, chronischer Alkoholismus, Alkoholkrankheit, kontinuierliches Trinkverhalten, Alkoholmissbrauch, kontinuierliches Trinkverhalten, Alkoholmissbrauch chronisch, Psychische und Verhaltensstoerungen durch Alkohol: Abhaengigkeitssyndrom, Alkoholismus, Intoxikation, Alkohol-, chronische
Portuguese Alcoolismo crónico, Alcooldependência, Síndrome de alcooldependência, Dipsomania, Abuso de álcool, comportamento continuado de bebedor, Abuso crónico de álcool, Abuso do álcool com comportamento de bebedor crónico, Intoxicação por Álcool Crônica, Alcoolismo, Intoxicação Alcoólica Crônica
Spanish Adicción al alcohol, Síndrome de dependencia del alcohol, Alcoholismo crónico, Dipsomania, Abuso del alcohol con comportamiento de bebedor crónico, Abuso continuo del alcohol, Abuso crónico del alcohol, [X]trastornos mentales y del comportamiento debidos al uso de alcohol: síndrome de dependencia, alcoholismo crónico, SAI (trastorno), [X]trastornos mentales y del comportamiento debidos al uso de alcohol: síndrome de dependencia (trastorno), síndrome de dependencia alcohólica, SAI (trastorno), alcoholismo crónico no especificado (trastorno), alcoholismo crónico no especificado, dipsomanía (hallazgo), dipsomanía, alcoholismo crónico, SAI, síndrome de dependencia alcohólica, SAI, Envenenamiento por Alcohol Crónico, Envenenamiento Alcohólico Crónico, Intoxicación por Alcohol Crónica, abuso crónico de alcohol (trastorno), abuso crónico de alcohol, alcoholismo (trastorno), alcoholismo crónico, alcoholismo, dependencia de alcohol (trastorno), dependencia de alcohol, Alcoholismo, Intoxicación Alcohólica Crónica
Japanese 渇酒症, アルコール嗜癖, アルコール依存症候群, アルコールイゾンショウコウグン, アルコールシヘキ, アルコールショウ, カツシュショウ, マンセイアルコールショウ, アルコール乱用、持続的飲酒行動, アルコールランヨウジゾクテキインシュコウドウ, マンセイアルコールランヨウ, 慢性アルコール乱用, 慢性アルコール中毒, アルコール中毒症, アルコール乱用, 飲酒症, アルコール依存症, 慢性アルコール症, アルコール中毒-慢性, アルコール中毒, 中毒-アルコール-慢性, アルコール症, アルコール依存
Swedish Alkoholism
Czech alkoholismus, Alkoholismus, Abúzus alkoholu, souvislé užívání, Závislost na alkoholu, Chronický alkoholismus, Dipsománie, Abúzus alkoholu chronický, Syndrom závislosti na alkoholu, chronická intoxikace alkoholem, závislost na alkoholu
Finnish Alkoholismi
Polish Przewlekłe zatrucie alkoholem, Nadużywanie alkoholu, Uzależnienie od alkoholu, Alkoholizm
Hungarian Dipsomania, Alkohol abusus, folyamatos ivó viselkedés, Chronicus alkoholismus, Alkoholismus, Idült alkohol abusus, Alkohol addictio, Alkohol függőségi syndroma
Norwegian Alkoholisme, Alkoholavhengighet, Alkoholforgiftning, kronisk, Avhengighet av alkohol, Psykisk forstyrrelse og atferdsforstyrrelse som skyldes bruk av alkohol

Ontology: Alcohol abuse (C0085762)

Definition (CCC) Excessive use of distilled liquors
Definition (NCI) The use of alcoholic beverages to excess, either on individual occasions ("binge drinking") or as a regular practice.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D000437
ICD9 305.00, 305.0
ICD10 F10.1
SnomedCT 304606004, 15167005
DSM4 305.00
LNC LP36309-0, MTHU019366
English Abuse, Alcohol, Alcohol abuse, abuses alcohol, Alcohol abuse, unspecified drinking behavior, Alcohol abuse, unspecified drinking behaviour, dysfunctional alcohol use, alcohol abuse, alcohol abuse (diagnosis), ethanol abuse, ETOH abuse, Alcohol abuse-unspec, rndx alcohol abuse, rndx alcohol abuse (diagnosis), alcohol abuse disorder, problem drinking, alcohol abuses, drinking problems, drinking problem, Alcohol abuse, unspecified, Ethanol abuse (finding), AA - Alcohol abuse, Ethanol abuse, Alcohol abuse (disorder), abuse; alcohol, alcohol; abuse, problem; alcohol use, alcohol; use, problem, Problem Drinking, Alcohol Abuse
Portuguese Abuso de Álcool, Abuso de álcool, Abuso de álcool, comportamento de bebedor NE, Abuso do álcool com comportamento de bebedor não especificado
Spanish Abuso del alcohol, Abuso del alcohol con comportamiento ante la bebida indeterminado, Abuso no especificado del alcohol, Abuso de Alcohol, abuso de alcohol (trastorno), abuso de alcohol
French Abus d'alcool, comportement vis-à-vis de la boisson non précisé, Abus d'alcool, comportement de consommation non précisé, Abus d'alcool, Abus alcoolique, Consommation excessive d'alcool
Dutch alcoholmisbruik, alcoholmisbruik, niet-gespecificeerd drinkgedrag, alcohol; gebruik, probleem, alcohol; misbruik, misbruik; alcohol, probleem; alcoholgebruik, Alcoholmisbruik
German Alkoholmissbrauch, unspezifisches Trinkverhalten, Alkoholkrankheit, unspezifisches Trinkverhalten, Alkoholabusus, Alkoholmissbrauch, Alkoholmißbrauch
Italian Abuso di alcool, abitudine al bere non specificata, Abuso di alcool, Abuso di alcool, assunzione non specificata, Abuso di alcol
Japanese アルコールランヨウショウサイフメイノインシュコウドウ, アルコール乱用, アルコールランヨウ, アルコール乱用、詳細不明の飲酒行動
Czech Abúzus alkoholu, blíže neurčené užívání, Abúzus alkoholu, nadužívání alkoholu, abúzus alkoholu, nadměrná konzumace alkoholu, nadměrné užívání alkoholu
Hungarian Alkohol abusus, nem meghatározott ivó viselkedés, Alkohol abusus, ivó viselkedés nem meghatározott, Alkohol abusus
Norwegian Alkoholmisbruk