Understanding Alcohol Use Disorder

On Cracking Addiction show this week

Alcohol use disorder can sometimes be difficult to define. The DSM defines alcohol use disorder is defined by the following criteria:

• Spending a lot of time getting, using, or recovering from use of the substance.

• Cravings and urges to use the substance.

• Not managing to do what you should at work, home, or school because of substance use.

• Continuing to use, even when it causes problems in relationships.

• Giving up important social, occupational, or recreational activities because of substance use.

• Using substances again and again, even when it puts you in danger.

• Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.

• Needing more of the substance to get the effect you want (tolerance).

• Development of withdrawal symptoms, which can be relieved by taking more of the substance.

It is important to know how to define alcohol use disorder to determine the severity of the disease with mild disease defined as the presence of 2-3 symptoms, moderate disease the presence of 4-5 symptoms and severe disease the presence of 6 symptoms.

Alcohol use disorder is a chronic relapsing disease that can have a high mortality (both through the effects of being intoxicated but also the secondary health effects with associated cancers, heart disease etc.) but also significant morbidity.

There are simple screening tests that can be done to identify patients at risk of alcohol use disorder including the CAGE questions and the AUDIT-C screening questionnaires that can identify people at risk of alcohol use disorder and with early interventions and appropriate support it is possible to significantly improve and impact the course of a patient's alcohol use disorder and their life.

This does not necessarily need to be time consuming and indeed brief interventions lasting no more than 10-15 minutes discussing someone's alcohol use disorder has good evidence to show that it can be effective.

A good framework for a brief intervention is the FRAMES model based on Feedback of personal risks or impairment, Responsibility (the patient's personal responsibility to implement change), Advice, Menu (of strategies to change the problematic habit or behaviour), Empathy and self-efficacy.

In this episode of Cracking Addiction we define what alcohol use disorder is, the difference between dependence and addiction and the progression of alcohol use disorder.