THE COMPLEXITY OF ALCOHOL
period – can diagnose the
disorder. Clinicians often
divide the problematic
behaviors into four main
categories as illustrated in
Table 2. Meeting any two
of the 11 criteria results
in a diagnosis of AUD.
Psychiatrists classify the
disorder as mild, moder-
ate and severe depending
on the number of criteria
that are met.
Alcohol use disorder
Table 1: Transition of Alcohol use disorder over time (adapted from Robinson, et al.) 1 .
accounts for significant
morbidity and mortality:
85,000 deaths a year in the
country and 10,500 traf-
fic related fatalities were
related to alcohol use in
2015. AUD is also linked
to an increased prevalence
of cardiovascular disease,
hepatic disease and lower
life expectancy. The sys-
temic effects of end-stage
chronic alcohol use are
well understood by phy-
sicians and range from
liver dysfunction and
nutritional deficiencies,
to encephalopathy and
psychosis. The psychiat-
Table 2
ric effects of pathological
to accept alcoholism as anything but a moral failure is still palpable
drinking can be subtle.
today. Cultural and societal barriers limit many patients from ac-
Depressive disorders, anxiety disorders and posttraumatic stress
knowledging the disorder. Though many still believe that AUD is
disorder may lead to the development of an AUD, or may be caused
the result of a “weak will” or a “lack of character,” we must continue
by excessive drinking. Clinicians are often unable to differentiate
to vocalize and affirm what is really is - a medical condition that
what came first, the psychiatric disorder or the alcohol use disorder.
requires treatment from a trained medical professional.
The psychiatric implications of AUD are glaringly obvious when
looking at suicide rates of individuals with problematic drinking:
the lifetime rate of suicide attempts among frequent alcohol users
has been reported to be as high as 7%, a marked increase compared
to the 1% risk in the general population.
Our understanding of the psychology behind alcohol use is
ever-evolving, and ever-expanding. Mental health issues have long
been ignored and stigmatized in Western society, and the reluctance
Dr. Farooqui is a PGY-2 Resident at the University of Louisville Hospital Department
of Psychiatry.
References:
1. Robinson SM, Adinoff B. The Classification of Substance
Use Disorders: Historical, Contextual, and Conceptual
Considerations. Behav Sci (Basel). 2016;6(3)
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