Alcohol use disorder
Alcohol use disorder is a chronic pattern of drinking meeting 2 or more of 11 DSM-5 criteria within a 1-year period, screened with the CAGE or AUDIT-C and confirmed by history. First-line management combines a brief behavioral intervention and cognitive behavioral therapy with naltrexone or acamprosate, reserving disulfiram for highly motivated patients who can maintain abstinence.
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What this article covers
- Overview
Definition: alcohol use disorder (AUD) is a chronic, relapsing pattern of alcohol use meeting 2 or more of 11 Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria…
- Epidemiology
Sex and age distribution: AUD occurs roughly 4 times more often in men than women, most often between 21 and 34 years of age, though incidence in women is rising.
- Risk factors
Positive family history: the most consistently cited risk factor, reflecting combined genetic and environmental influence.
- Pathophysiology
GABA-A receptor adaptation: alcohol increases activation at the gamma-aminobutyric acid type A (GABA-A) receptor; chronic use downregulates GABA-A receptors, the neuroadaptation behind tolerance and…
- Clinical features
Diagnostic criteria, the core of the diagnosis: AUD requires 2 or more of 11 criteria within a 1-year period: larger amounts or longer use than intended; a persistent desire or failed efforts to cut…
- Differential diagnosis
Non-pathological (lower-risk) alcohol use: intake stays within 4 drinks/occasion or 14 drinks/week for men, or 3 drinks/occasion or 7 drinks/week for women and men over 65, without meeting the 2-criteria threshold, unlike AUD.
- Diagnosis
Diagnostic basis: the diagnosis is clinical, based on a detailed alcohol use history establishing 2 or more of the 11 DSM-5 criteria within a 1-year period; no laboratory test or imaging study substitutes for this history.
- Management
Start with a brief behavioral intervention at the point of screening: any patient positive for hazardous or at-risk drinking gets brief behavioral counseling at that same visit, aimed at cutting alcohol misuse.
- Complications
Hepatic disease: steatosis progressing to alcoholic hepatitis and cirrhosis in about 25% of heavy drinkers, with hepatocellular carcinoma risk once cirrhosis is established.
- Prognosis
Combined care outperforms either alone: naltrexone and acamprosate lower relapse most reliably when paired with psychotherapy, not used alone.
- Prevention
Universal screening: screen all adults with CAGE, AUDIT, AUDIT-C, or the single-question screen; a positive result (2 or more CAGE "yes" answers, or any nonzero answer to the single-question screen) prompts formal DSM-5 assessment.
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