Alcohol use disorder: Recognition, testing, and initial management strategies

Abstract

Alcohol use is common around the world, and its use is growing, especially in the United States, where an epidemiological study found that rates of alcohol use, high-risk drinking (defined as 4 or more drinks on any day for women and 5 or more for men), and alcohol use disorder (AUD) had increased by 11.2%, 29.9%, and 49.4%, respectively, between 2001 and 2012 to 72.7% of respondents using alcohol, 12.6% partaking in highrisk drinking, and 12.7% meeting criteria for AUD. [1] Notably, these increases were greatest among women, older adults, and racial and ethnic minorities. [1] The harmful use of alcohol has resulted in ~3 million deaths and over 130 million disability-adjusted life years annually from various causes, including injury, cardiovascular disease, malignancy, and digestive diseases. [2] Excessive alcohol use is a significant cause of liver disease and a common indication for liver transplant in the United States. Studies have shown that AUD treatment with psychotherapy or medication decreases incidence of alcohol-associated liver disease (ALD) and lowers rates of decompensation in those with underlying cirrhosis. [3,4] Given this, hepatologists are uniquely positioned to help patients with harmful alcohol use; however, few feel adequately trained to do so. [5] ALCOHOL USE DISORDER AUD can be defined as a condition characterized by the inability to stop or control alcohol use despite adverse consequences. It is defined by behavioral and physical symptoms, including withdrawal, tolerance, and cravings. [6] It is a spectrum that varies from mild to severe based on the number of criteria experienced, with a diagnosis of AUD being made if the patient has had 2 or more of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria shown in Table 1 in the last 12 months.