Alcohol-related disorders

Alcohol Intoxication

Alcohol intoxication is defined by the presence of slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma, and clinically significant maladaptive behavioral or psychological changes (inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develop during or shortly after alcohol ingestion.

The diagnosis of alcohol intoxication must be differentiated from other medical or neurologic states that may mimic intoxication, for example, diabetic hypoglycemia; toxicity with various agents, including but not limited to ethylene glycol, lithium, and phenytoin; and intoxication with benzodiazepines or barbiturates.

The diagnosis of alcohol intoxication can be confirmed by serum toxicologic screening, including a blood alcohol level (BAL).

Alcohol Dependence

Alcohol abuse becomes alcohol dependence when effects on one's life become more global and tolerance and withdrawal symptoms develop. The alcoholically dependent patient drinks larger amounts over longer periods of time than intended, spends a great deal of time attempting to obtain alcohol, and reduces participation in or eliminates important social, occupational, or recreational activities because of alcohol. In alcohol dependence, there also is a persistent desire or unsuccessful efforts to cut down or control alcohol intake.

Epidemiology

The percentage of Americans who abuse alcohol is thought to be high. Two thirds of Americans drink occasionally; 12% are heavy drinkers, drinking almost every day and becoming intoxicated several times a month. The Epidemiological Catchment Area study found a lifetime prevalence of alcohol dependence of 14%. The male-female prevalence ratio for alcohol dependence is 4 : 1.

Etiology

The etiology of alcohol dependence is unknown.
Adoption studies and monozygotic twin studies demonstrate a partial genetic basis, particularly for men with alcoholism. Male alcoholics are more likely than female alcoholics to have a family history of alcoholism. Compared with control subjects, the relatives of alcoholics are more likely to have higher rates of depression and antisocial personality disorder (ASP). Adoption studies also reveal that alcoholism is multidetermined: genetics and environment (family rearing) both play a role.

Clinical Manifestations

History, Physical and Mental Status Examinations, and Laboratory Tests The alcohol-dependent patient may deny and/or minimize the extent of drinking, making the early diagnosis of alcoholism difficult. The patient may present with accidents or falls, blackouts, motor vehicle accidents, or after an arrest for driving under the influence. Because denial is so prominent in the disorder, collateral information from family members is essential to the diagnosis. Early physical findings that suggest alcoholism include acne rosacea, palmar erythema, and painless hepatomegaly (from fatty infiltration).