Alcohol Use

Disorder
Dilpreet Kaur (28) Sanika Sharma (32) Tanya Khatri (69)
 Substance-Related
Disorders
In DSM-5, substance-related and addictive disorders
include problems with the use of depressants, stimulants,
opiates, and hallucinogens as well as gambling.

The substance-related disorders are divided into two

groups: substance use disorders (dependence & abuse)
and substance induced disorders (intoxication &
withdrawal, other substance/medication-induced mental
disorders).
 Depressants : result in behavioral sedation and can induce relaxation
- Alcohol (ethyl alcohol), barbiturates, benzodiazepines (for example, Valium, Xanax).

Stimulants: Increase alertness and can elevate mood.

- Amphetamines, cocaine, nicotine, and caffeine.

Opiates: produce analgesia temporarily (reduce pain) and euphoria.

- Heroin, opium, codeine, and morphine.

Hallucinogens: alter sensory perception and can produce delusions, paranoia, and hallucinations.
- Cannabis and LSD

Other drugs of Abuse : Inhalants, anabolic steroids, and other over-the-counter and prescription
medications

Gambling Disorder: are unable to resist the urge to gamble which, in turn, results in negative
personal consequences (e.g., divorce, loss of employment).
 Depressants primarily decrease central
Depressents nervous system activity. Their principal
effect is to reduce our levels of
physiological arousal and help us relax.
The most common depressant is alcohol
whereas less common ones are the
sedative, hypnotic, and anxiolytic drugs.

These are produce symptoms of physical

dependence, tolerance, and withdrawal.
Recipe of Alcohol is produced when certain yeasts
react with sugar and water and
Alcohol fermentation takes place.
Alcohol Use Substance use is the ingestion of psychoactive
substances in moderate amounts that does not

Disorder significantly interfere with social, educational,

or occupational functioning.

The DSM-5 defines substance abuse in terms of

how significantly it interferes with the user’s
life.

Alcohol use disorder (AUD) is a medical

condition characterized by an impaired ability
to stop or control alcohol use despite adverse
social, occupational, or health consequences.
 This includes tolerance to alcohol which
means higher amount is needed
progressively to have the same effect and
a characteristic cluster of mental and

Alcohol Use behavioural symptoms appearing when

one does not take alcohol i.e.,

Disorder
withdrawal.

Alcohol use disorder results in harm and

damage to one’s physical and mental
health, affects one’s functioning at work
and results in relational conflicts and
social and legal problems.
Alcohol The World Health Organisation now
prefers the term alcohol dependence
Dependence syndrome—“a state, psychic and usually
also physical, resulting from taking
Syndrome alcohol, characterised by behavioural and
other responses that always include a
compulsion to take alcohol on a
continuous or periodic basis in order to
experience its psychic effects, and
sometimes to avoid the discomfort of its
absence; tolerance may or may not be
present”
Let’s discuss a Case Study
Vishal is a 34-year old construction worker. He reports having to work in extreme heat during interstate
road repair and notes that his use of alcohol is comparable to others at the work-site. During a typical 10-
hour workday, he may drink up to 8 cold whisky to deal with the heat. He does not believe that it affects
his work productivity in any way but admits that he has experienced a couple of minor injuries while
under the influence. When he began this work a few years back, he recalls not drinking as much. Over
time, he has increased his alcohol use and even requires it when returning home. He reports being a
family man and had never had alcohol around his family until that time. He explains that his job is tiring
and he has no energy left to engage with his children or wife when at home. He also admits to not being
able to remember much of his off days because of his drinking. He says that when he tries to cut back
drinking during special events , he finds that he is irritable and craves alcohol. He eventually returns to
drinking a similar amount or more. His wife and he argue about how much of his paycheck is going to
buying alcohol instead of the bills and how he is too drunk to spend time with her or the kids. He believes
that if he wanted to he could probably cut back.
Prevalence
of AUD

AUD affects individuals

of all demographic groups
(Grant et al. 2015)
• Onset: 18-29 years
• Ethnicity
– American Indian &
• Worldwide (Slade et al., 2016) 20% , 8.5 % (12-month
Alaska Native 19.2%
• U.S. (Grant et al. 2015, 2017) 29%, 13.5% (12-month)
– Men 17.6% & Women 10.4%.
 Rural and urban Prevalent at the Indian
Statstics
areas with rate 24% to 48 %
prevalence rates in females in

of
varying from 23% certain sections
to 74% in males and communities.

The estimated numbers of The National Mental

AUD
people using alcohol in 1/3 of male population
Health Survey of India
India was 62.5 million drinks alcohol in India
2015–16 found the
with 17.4 % of them (10.6 and the use amongst
prevalence of AUDs to
million) having alcohol women in increasing.
be 9% in adult men.
use disorder (2005)
(WHO)
The
evolution Alcoholism and drug addiction were
grouped with

of AUD in "sociopathic personality disturbances"

DSM
Signs and symptoms were not described,
but they believed that the idea of
First edition : 1950 addiction
came from "Underlying brain or
personality disorder."
 DSM II
1968
The term Drug Dependence was
Added subtypes of alcoholism expanded

Episodic excessive drinking Specific drug classes and physiological

Habitual excessive drinking signs- Tolerance and Withdrawal were
Alcohol Addiction included
DSM III The idea of use and dependence emerged

changes
The term alcoholism was eliminated

Substance use disorders got their own section

and were removed from personality disorders
 DSM IV
1994
Over 100 different substance related Dependence was now seen as a
disorders for 12 different "Syndrome" involving compulsive
classes of drugs use, tolerance and withdrawal
Changes in The term Addiction was eliminated and a more
neutral term, Substance use disorder was
introduced

DSM 5
No longer separates the diagnoses for
abuse and dependence

Severity can be judged on the basis

of the number of criteria met
DSM 5
criteria
CRITERIA A

A problematic pattern of alcohol use

leading to clinically significant impairment
or distress, as manifested by at least two of
the following eleven symptoms, occuring
within a 12 month period
 Impaired Social
Control Impairment

Symptoms
of
Risky use
of substance
Pharmacological
Criteria
AUD
Impaired
Control Alcohol is often taken in larger amounts or
over a longer period than was intended

There is a persistant desire or unsuccessful

efforts to cut down or control alcohol use.
Impaired
Control A great deal of time is spent in activities
necessary to obtain alcohol, use alcohol or
recover from it's effects

Craving or a strong desire or

urge to use alcohol
Social
Impairment
Recurrent alcohol use resulting in a
failure to
fulfill major role obligations at
work, school or home.

Continued alcohol use despite

having persistent or recurrent
social or interpersonal problems
caused or exacerbated by the
effects of alcohol
Social
Impairment
Important social, occupational or
recreational activities are given up or
reduced because of alcohol use.
Risky Use Recurrent alcohol use in situations in

of the which it is physically hazardous

substance
Alcohol use is continued despite
knowledge of having a persistent or
recurrent physical or psychological
problem that is likely to have been
caused or exacerbated by alcohol
Pharmacological

Criteria Tolerance, as defined by either of the

following

a. A need for markedly increased amounts of

alcohol to achieve intoxication or desired effect

b. A markedly diminished effect with continued

use of the same amount of alcohol.
Pharmacological
Criteria Withdrawal, as manifested by either of the
following:

a. The characteristic withdrawal syndrome for

alcohol

b. Alcohol is taken to relieve or avoid

withdrawal symptoms
Severity MILD
2-3 symptoms

MODERATE
4-5 symptoms

SEVERE
6 or more symptoms
 In-patient
Case History
57 y/o male patient was admitted to the hospital due to a car
accident and had a slurred speech, after testing, his
tox screen came back positive and he constantly demanded
benzo for sleep during his hospital recovery. The patient also
has alcoholic steatohepatitis. This case was later sent to
psychiatry department.
 Physical H:
Alcoholic steatohepatitis,

Relevant Arrythmia

History Social H:
Lives alone, divorced b/c of alcohol habit,
no children, receiving disability help,
previously worked at food services

Family H:
Father- Alcohol use disorder
Substance Current alcohol use: 1.5 pints of Vodka

Use
(13 std drinks / day)

History Age of onset: 17 y/o

Highest use: 2.5 pints/day
Longest period of abstinence: 5 months

Medications: None
Psychosocial treatment: None

Drug use: None

Tobacco use: None
Does this patient have AUD?
 Using larger amounts for a longer time than

Let's Discuss intended

Persistent desire or unsuccessful attempts to cut

down or control use

Great deal of time spent in obtaining, using,

or recovering

Craving or strong desire or urge to use

Fail to fulfill major roles (work, school, home)

 Persistent social or interpersonal

Let's Discuss problems caused by substance use

Important social, occupational,

recreational activities given up or reduced

Use in physically hazardous

situations
Withdrawal

Tolerance

Use despite physical or psychological

problems caused by use
 Using larger amounts for a longer time than

Answers intended

Persistent desire or unsuccessful attempts to cut

down or control use

Great deal of time obtaining, using,

or recovering

Craving or strong desire or urge to use

Fail to fulfill major roles (work, school, home)

 Persistent social or interpersonal

Answers
problems caused by substance use

Important social, occupational,

recreational activities given up or reduced

Use in physically hazardous

situations
Withdrawal

Tolerance

Use despite physical or psychological

problems caused by use
Alcohol & the Brain
 At
Lower Levels
When you haven't started seeing your friends' clones (yet)

Alcohol activates pleasure areas

Alcohol releases endogenous opioids in the body

At
Higher Levels
When you start seeing your friends' clones

Alcohol depresses brain functioning

- glutamate (excitatory neurotransmitters) are inhibited

Alcohol impairs the ability to learn,

judge and perform other rational processes

Alcohol lowers self control and inhibitions

-unpleasant realities are screened out
At
Higher Levels
Sometimes, there are even multiple clones

The drinker looses motor coordination

The drinker's discrimination and perception of

cold, pain and discomforts are dulled

The drinker's self esteem and adequacy rises - a sense

of warmth, expansiveness and well being is experienced
The morning after this otherworldly pleasure comes

The Hangover
This is where you promise NEVER to see your friends for drinks again

Hangovers include
headache
nausea
fatigue
cognitive impairment
for 8-24 hours after alcohol consumption
The morning after this otherworldly pleasure comes

The Hangover
This is where you promise NEVER to see your friends for drinks again

Leading theories on why do hangovers happen say that it's because

of dehydration along with the buildup of alcohol metabolites such
as acetaldehyde and the triggering of the body's immune response

(hangover or not you might wanna take this as a reminder to

drink some water)
How much alcohol is

too much alcohol?

A. 500 ml/day

B. 1000 ml/day

C. 1500 ml/day
How much alcohol is

too much alcohol?

A. 500 ml/day

B. 1000 ml/day

C. 1500 ml/day

D. There is no fixed answer to that*

*Visible to the naked eye**
**Unless you carry a breathalyzer with you
 Its all
Subjective
Different researchers and professionals provide conflicting evidence and
suggestions on the appropriate amount of alcohol to consume daily
 Its all
Subjective
The one thing they all agree on is that it is NOT the amount of alcohol
consumed that determines intoxication BUT the alcohol actually
concentrated in the bodily fluids.
This depends on various things like: Age, Weight, Concurrent use of other
drugs, including both certain prescribed or over-the-counter
medications, General mental and physical health status, Genetic
influences, Sex, The amount of food in your stomach and The duration
of your drinking (basically don't glug glug chug it).
 Legal & Bodily In U.S. states when the alcohol content reaches
0.08 percent, the individual is considered

Limits intoxicated and hence unfit to drive

At 0.5 percent blood alcohol level, the entire

People tryna drink after reaching the 0.5 BAC limit
Their bodies : neural balance is upset and the individual
passes out

Unconsciousness acts as a safety device

because concentrations above 0.55
percent are usually lethal
 Developing
Alcohol Dependence

While many investigators

Others believe that in
maintain that alcohol is a
moderate amounts it is not
dangerous poison even in
harmful to most people
moderate amounts

For pregnant women though, they all agree that even moderate
amounts are dangerous and there is no safe level that the researchers
have been able to establish
Physical effects 5-10 percent of whatever you consume gets
eliminated through breath, urine and perspiration

of chronic alcohol use (so 5-10 percent of your drink is always going down
the toilet, literally)

The work of metabolizing the alcohol is done by

the poor little liver that when overworked, develops
cirrhosis of the liver: a disorder that involves
extensive stiffening of the blood vessels.

Alcohol is high calorie drug so it's consumption

reduces a drinker's appetite for other food leading
to malnutrition.
Physical effects Alcohol abuse has also been known to
of chronic alcohol use cause increased gastrointestinal symptoms

General health of the drinker deteriorates

leading to brain and liver damage

Research has found that even mild to

moderate drinking can adversely affect
memory and problem solving
Psycho-social effects
of Chronic Alcohol Use
Heavy drinkers suffer from chronic fatigue,
oversensitivity and depression

Excessive use can result in impaired

reasoning, poor judgement and gradual
personality deterioration

Behaviour becomes coarse and

inappropriate
Psychoses associated with
severe alcohol abuse
 Alcohol Withdrawal
Delirium
Slight noises of suddenly moving objects may cause considerable excitement and
agitation. Major symptoms include:
Disorientation for time and place
Vivid hallucinations particularly of small, fast moving animals
Acute fear in which these animals might change size, shape or form in terrifying ways
Extreme suggestibility
Marked tremors of the hands, tongue and lips
Other symptoms include perspiration, fever, a rapid and weak heartbeat, a coated tongue
and foul breath.
 Alcohol Withdrawal
Delirium
The delirium typically lasts from 3 to 6 days and is generally followed by a deep
sleep.

About 5-25% of patients with alcohol withdrawal delirium die as a result of

convulsions, heart failure and other complications.

Chlordiazepoxide helps reduce withdrawal symptoms and the risk of death that
comes with those symptoms.
 Alcohol Amnestic
Disorder
Memory defect (particularly with regard to recent events)

Sometimes accompanied by falsification of events or confabulation.

Individuals may appear delirious, delusional and disoriented from time and place

Other cognitive impairments like planning deficits, intellectual decline, emotional deficits,
judgement deficits and cortical lesions have also been seen

The symptoms of alcohol amnestic disorder result from malnutrition, specifically the lack of
vitamin B (thiamine).
Resources & Resources for Help
https://www.nhp.gov.in/

Helplines quit-alcoholism_pg

Rehab Centers:
https://indianhelpline.com/De-Addiction-
Helpline/

Alcoholics Anonymous National helpline

on 9022771011 / 022-65055134
 Let’s
Recapitulate
• Alcohol Use Disorder
• Prevalence : Worldwide & India
• Myths
• DSM-5 Criteria with Case Study
• Alcohol & Brain : Effects
• Psychoses associated