Alcohol Use Disorder

Diagnostic Criteria for Alcohol Use Disorder
Alcohol use disorder is defined as “a problematic pattern of alcohol use leading to clinically
significant impairment or distress” as manifested by at least 2 of the following criteria over the
same 12-month period (Kim et al., 2018):
Alcohol used in larger amounts or over a longer period of time than intended
Persistent desire or unsuccessful attempts to cut down or control alcohol use
Significant time spent obtaining, using, and recovering from the effects of alcohol
Craving to use alcohol
Recurrent alcohol use leading to failure to fulfil major role obligations at work, school, or home
Recurrent use of alcohol, despite having persistent or recurring social or interpersonal problems
caused or worsened by alcohol
Recurrent alcohol use despite having persistent or recurring physical or psychological problems
caused or worsened by alcohol
Giving up or missing important social, occupational, or recreational activities due to alcohol use
Recurrent alcohol use in hazardous situations
Tolerance: markedly increased amounts of alcohol are needed to achieve intoxication or the
desired effect, or continued use of the same amount of alcohol achieves a markedly diminished
effect
Withdrawal: there is the characteristic alcohol withdrawal syndrome, or alcohol is taken to
relieve or avoid withdrawal symptoms.
Psychotherapy and Psychopharmacologic Treatment
Some of the most common therapies used to treat AUD are behavioral therapies. Through
behavioral therapies, an individual is able to change the way they act, often through the
modification of the way they think. Negative actions may often tem from maladaptive thoughts.
Cognitive Behavioral Therapy (CBT: This is designed as a method to prevent and minimize
problematic drinking. It is a popular form of therapy for alcoholism that helps individuals
recognize thoughts that are negative, and that may lead to self-destructive actions (Reus et al.,
2018). Through CBT, an individual is able to make connections between thoughts and actions,
and thereby change negative behaviors by modifying thought patterns (Reus et al., 2018). Thus,
individuals my lean how to recognize potential triggers and learn how to manage stress, and
develop healthy coping mechanisms. Furthermore, it can help an individual from relapsing.
Motivational Interviewing (MI): This is a patient-centered approach enables individuals who are
unable to see the need for change. MI can help improve an individuals’ willingness to change by
motivating them to embrace change (Kim et al., 2018). Therapists guide the individual through
MI sessions in a non-judgmental manner, and instead of insisting on change, they guide the
individual to change their behaviors and see the need to change. At times, individuals may not
see the need for change, and through MI, they can be guided to seek help, and adopt other
forms of therapy and medication.
Apart from other forms of therapy, healthy peer support is also an important step towards
recovery. 12-Step programs such as Alcoholics Anonymous (AA) can provide avenues for
individuals to get peer support and remain abstinent from alcohol (Kim et al., 2018).
When it comes to medication, pharmacotherapy can be started either in the outpatient setting or
during hospitalization for intoxication or withdrawal.
One of the first-line FDA approved, agents used to treat AUD is oral naltrexone. This blocks the
mu-opioid receptor that modulates the dopaminergic mesolimbic pathway, thereby dampening
alcohol’s pleasurable, reinforcing effects (Kim et al., 2018). Dosage can start from 50mg/day
over a period of 1 to 2 weeks, and it has been shown to reduce alcohol intake and relapse rate
by 83% (Kim et al., 2018).
Another medication, Acamprosate, used as an “artificial alcohol” is used to inhibit the glutamate
system and enhances the GABA system like the alcohol itself without the addictive properties of
alcohol (Swift & Aston, 2015). Typically, the dosage is two 333mg tablets, three times a day
(Swift & Aston, 2015).
Clinical Features That One Would Expect to Observe in The Client
Typically, I would expect a client with AUD to have a strong desire or sense of compulsion to
consume alcohol, have difficulties controlling alcohol-taking behaviors in terms of termination,
onset, or levels of use. More so, they would more likely use alcohol to relieve or avoid withdraw
symptoms. This align with DSM-V criteria for AUD.

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