Alcohol Use Disorders

Introduction and Terms

Alcohol use in adolescents

According to large epidemiological study 35% of adolescents (12-17) had used alcohol in the last year; 16% of those who had used alcohol met criteria for an alcohol use disorder (abuse or dependence). Thus the prevalence of alcohol use disorders in adolescents is around 5%. By comparison, of the 13% of adolescents smoked marijuana, a quarter went to develop a drug use disorder. The prevalence of marijuana use disorder and analgesic opioids use disorders were (3.4%) and (1.2%) respectively. (1)

Diagnostic pearls

Etiological subtypes (based on Cloninger’s Alcoholism Typology)

• Type 1 (also type A) alcoholism (75%) is characterized by adult onset and drinking to relieve depression and anxiety; alcoholics often feel guilty about drinking. Patients quickly develop behavioral tolerance

• Type 2 (also type B) alcoholism (25%) is characteized by early onset and antisocial and risk-taking behavior while intoxicated; it has been termed male-limited alcoholism due to perceived transmission from fathers to sons

Laboratory tests

• Markers of heay use: GGT (same as GGTP) gamma-glutamyl transferase (or transpeptidase) and CDT (carbohydrate-deficient transferrin). GGT is also elevated in DM, HTN, chronic liver disease (low specificty)

• Elevated AST and ALT with classic ratio of 2:1
• Elevated MCV, a finding also seen in macrocytic and Folate/Vitamin B12 anemias
• Blood alcohol level (BAL)

Clinical pearls

Distingwsuish between a "hangover" and withdrawal