Alcohol Use Disorders

Scope

This page will cover:

• Alcohol Dependence

• Alcohol Intoxication

• Alcohol Withdrawal

Other pages related to alcohol disorders:

• Alcoholic Liver Disease

• Wernicke-Korsakoff Disorders

Alcohol Intoxication

Background

• Commonest cause of addiction in the UK

• A drug or alcohol related hospital admission on average takes 10 years off your life expectancy (in the UK)

• Associated diseases: GORD, anxiety & depression, insomnia 

Assessment

History

• Anxiety/ mood instability

• Diarrhoea/ abdominal pains

• Excessive alcohol consumption (> 40 units / week)

Examination

• Weight gain/ loss + malnourishment

• Hepatomegaly

• Tremor

Investigations

• Macrocytic anaemia

• Raised GGT

• Thrombocytopenia

Diagnosis

Screening: CAGE- inability to cut down, annoyed at another criticising your drinking, felt guilty about drinking or wanted an 'eye-opener' (morning drink)

Diagnosis: ICD-11

• Episodic continual alcohol consumption > 3 months

• Psychological: desire to drink alcohol, difficulty controlling behaviour, 

• Physiological tolerance: requiring higher volumes of alcohol & psychological withdrawal symptoms

• Negative consequences: neglect of alternative pleasures/ interests

Management

Options

• Psychology: CBT, counselling, group vs individual therapy

• Addiction services: detoxification

• Lifestyle: change in community

• Medication adjuncts

Alcohol Withdrawal

Background

• Serious condition which can result in seizures and death

Assessment

History

• Trembling, anxiety, nausea, agitated

• Hallucination- typically crawling insects

• Recent admission 24-48hrs

Examination

• Tachycardia

• Hypertensive

• Seizures

Investigations

• CIWA scale of alcohol withdrawal

Diagnosis

• Diagnostic criteria: positive CIWA score / clinical

• Differentials: sepsis, overdose, 

• Classification: severity based upon CIWA score

Management

Acute: trusts usually have good protocols for this:

1. Benzodiazepines: diazepam 10mg PO PRN

   1. If CIWA score raised, can be 20mg and require large doses > 100mg in 24hrs

   2. Lorazepam if Liver Cirrhosis 

2. Thiamine

   1. IV Pabrinex, IV or PO thiamine

3. Fluids PO vs IV

4. Antiemetics: e.g. ondansetron PO vs IV

Discharge planning:

• Addictions review prior to discharge for community FU

• Discharge & continue to drink alcohol in community

• Elective detoxification: higher success rates than emergency

Alcohol Intoxication

Assessment

History

• Alcohol overdose +- polysubstance

• Social stressors

• Background: alcohol dependence

Examination

• Drowsy, reduced GCS

• Bradypnoea if severe

Investigations

• Urine toxicology screen

• Ethanol level

Diagnosis

Diagnostic criteria: ethanol level > legal driving limit (taken within reasonable timescale)

Management

Acute

• Supportive: time

• Can require IVF and very rarely NG tube or intubation if losing airway

On Discharge

• Consider psych/ addictions referral for alcoholism

Resources and References

Links

• Body system: Nervous, GI systems

• Specialty: Psychiatry, Gastroenterology

Written in 2025