Alcohol Use Disorder

Overview:

A. Excessive alcohol use can increase a persons risk of developing serious health
problems in addition to those issues associated with intoxication behaviors and alcohol
withdrawal symptoms. According to the Centers for Disease Control and Prevention
(CDC), excessive alcohol use causes 88,000 deaths a year.
B. Data from the National Survey on Drug Use and Health (NSDUH)show that in 2013,
slightly more than half (52.2%) of Americans ages 12 and up reported being current
drinkers of alcohol. Most people drink alcohol in moderation. However, of those 135.5
million alcohol users, an estimated 18 million have an AUD.
C. Many Americans begin drinking at an early age. In 2012, about 24% of eighth graders
and 64% of twelfth graders used alcohol in the past year.
D. To be diagnosed with an AUD, individuals must meet certain diagnostic criteria. Some of
these criteria include problems controlling intake of alcohol, continued use of alcohol
despite problems resulting from drinking, development of a tolerance, drinking that leads
to risky situations, or the development of withdrawal symptoms. The severity of an AUD
mild, moderate, or severeis based on the number of criteria met.
E. How AUD affects the United States
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1. Strains the health care system

2. Strains the economy
3. Harms family life
4. Threatens public safety
5. Accounts for of all ED admissions
6. Accounts for 1/3 of all suicides
7. Accounts for more than of all homicides and incidents of domestic violence
8. Contributes to illness in heart disease, stroke, and liver disease
9. Accounts for almost of all traffic fatalities
10. Contributes to fetal alcohol syndrome which is the leading known cause of
mental retardation
II.

Effects on the Body:

A. Alcohol induces a general, nonselective depression of the CNS

B. Results in behavioral and mood changes
C. At low doses, alcohol produces relaxation, loss of inhibitions, lack of concentration,
drowsiness, slurred speech, and sleep
D. Chronic abuse results in multisystem physiological impairments

III.

AUD and The Nervous System:

A. Peripheral Neuropathy
1. Characterized by peripheral nerve damage resulting in pain, burning, tingling, or
prickly sensation of the extremities
2. Direct result of deficiencies in the B vitamins, particularly thiamine (Vitamin B1)
3. Reversible with restoration of nutritional deficiencies and abstinence from alcohol
B. Wernickes Encephalopathy 1. The most serious form of thiamine (Vitamin B1) deficiency in alcoholics
2. Symptoms include
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Paralysis of the ocular muscles

Diplopia

Ataxia
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Somnolence

Stupor

If thiamine replacement is not done quickly, death will ensue

C. Korsakoffs Psychosis 1. Syndrome of confusion, loss of recent memory, and confabulation in alcoholics
2. Frequently seen in those patients recovering from Wernickes Encephalopathy
3. Treatment is po or IV thiamine (Vitamin B1) replacement
D. Blackouts
1. Transient global amnesia
2. Remote memory not affected
3. Will appear normal in nature during this period but cannot remember what they
did during this time period
4. Not the same as passing out
5. Etiology is not well understood
IV.

AUD and Nutritional Deficiencies:

A. Common in alcoholics because of insufficient intake of nutrients as well as the toxic

effects of alcohol that result in malabsorption of nutrients.
B. Replace thiamine (Vitamin B1) and add folic acid and a multivitamin daily
V.

AUD and the Cardiac System:

A. Alcoholic Cardiomyopathy
B. Accumulation of lipids in the myocardial cells
C. Similar to findings related to CHF and arrhythmia
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Decreased exercise tolerance

Tachycardia
Dyspnea
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o
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D.

Edema
Palpitations
Nonproductive cough
Elevation of CPK, AST, ALT, and LDH

E. Changes seen on EKG and chest x-rays

VI.

AUD and the Digestive System:

A. Esophagitis
1. Occurs because of the toxic effects of alcohol on the esophageal mucosa
2. Esophagitis also occurs because of frequent vomiting associated with alcohol
abuse
3. Effects of alcohol on the stomach include inflammation of the stomach lining
characterized by epigastric distress, nausea, vomiting, and distention
4. Alcohol breaks down the stomachs protective mucosal barrier, allowing
hydrochloric acid to erode the stomach wall.
5. Damage to the mucosa linings can include damage to blood vessels which may
result in hemorrhage.
B. Pancreatitis
1. Acute pancreatitis usually occurs 1-2 days after a binge of excessive alcohol
consumption.
2. Chronic pancreatitis can also result.
3. Pancreatitis contributes to malnutrition in the alcoholic.
C. Alcoholic hepatitis
1. Alcoholic hepatitis is inflammation of the liver caused by long-term heavy
alcohol use
2. Clinical manifestations of alcoholic hepatitis include
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Enlarged and tender liver

Nausea and vomiting
Anorexia
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o
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Elevated WBC
Elevated LFTs
Fever
Jaundice
Ascites
Weight loss
Can lead to hepatic encephalopathy
Can led to cirrhosis

D.Cirrhosis
1.) Cirrhosis is the end-stage of alcoholic liver disease
2.) Clinical manifestations of cirrhosis of the liver include
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VII.

Same manifestations as alcoholic hepatitis

Portal hypertension
Any blood in emesis or stool is an emergency varicosities
related to portal hypertension
Esophageal varices
Ascites
Hepatic encephalopathy

AUD and the Hematology / Immunology System:

A.The production, survival, and function of white blood cells, red blood cells, and platelets are
impaired in alcoholics.
B.Leukopenia (low WBCs) results in high risk for contracting infectious diseases as well as
complicates recovery.
C.Thrombocytopenia (low platelets) places the alcoholic at high risk for hemorrhage.

VIII.

Alcohol Withdrawal: Remember that in withdrawal, the patient experiences the

opposite effect of the substance being abused!

A.Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged (several days
or longer) alcohol use
B.Alcohol is a central nervous system depressant. When intoxicated, the central nervous
system is depressed. Therefore, during withdrawal, the central nervous system is excited
resulting in autonomic hyperactivity. This causes the following 1) Coarse tremors of the hands, tongue, or eyelids
2) Nausea or vomiting
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3) Malaise or weakness
4) Tachycardia
5.) Sweating
6.) Elevated blood pressure
7.) Anxiety
8.) Depressed mood
9.) Irritability
10.)

Hallucinations or illusions

11.)

Headaches

12.)

Insomnia

13.)

Increased pulse

14.)

Psychomotor agitation

15.)

Complicated withdrawal syndrome may progress to alcohol withdrawal delirium

16.)

Grand mal seizures

17.)

Possible stroke

18.)
The physical effects of withdrawal from alcohol and CNS depressants are
potentially life threatening and can lead to death
IX.

Treatment of Alcohol Withdrawal:

A. Withdrawal from alcohol and other CNS depressants results in CNS excitement resulting in
the signs and symptoms listed above
B. Substitution therapy may be required to reduce the life-threatening effects of withdrawal
from alcohol and other CNS depressants. Another medication that is a CNS depressant is
substituted for the alcohol and the patient is slowly titrated off CNS depressants. Do not
abruptly take a patient off a CNS depressant this can result in seizures and death.
C. Benzodiazepines are a CNS depressant and are the most widely used group of drugs for
substitution therapy in alcohol withdrawal
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Lorazepam
Chlordiazepoxide
Oxaxepam
Diazepam
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D. The approach to treatment of withdrawal with benzodiazepines is to start with a higher dose
and reduce the dosage every day until withdrawal is complete.
E. Additional doses may be given for breakthrough signs and symptoms.
F. Some HCPs may order anticonvulsant medication (e.g., carbamazepine, valproic acid, or
gabapentin) for management of withdrawal seizures.
G. The signs and symptoms of withdrawal are monitored using some type of objective tool
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Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA)

Various signs and symptoms are rewarded a numerical score
Based on the numerical score, the dose and type of medication (used
for substitution therapy for withdrawal) is ordered

H. Multivitamin therapy, in combination with thiamine, is common protocol. Remember,

thiamine replacement therapy is required to prevent neuropathy, confusion, and
encephalopathy.
X.

Treatment Modalities for Alcohol Abuse:

A. Alcoholics Anonymous
B. Counseling
C. Group Therapy
D. See interventions listed in Substance Abuse: Overview packet
E. Disulfiram (Antabuse)
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Administered as a deterrent to drinking

Ingestion of alcohol while Antabuse is in the body results in a

syndrome of symptoms that can produce a great deal of discomfort Flushed skin
Throbbing in the head and neck
Respiratory difficulty
Dizziness
Nausea and vomiting
Sweating
Hyperventilation
Tachycardia
Hypotension
Weakness
Blurred vision
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 Confusion