Presenting Complaints

• Patients seldom present because they are drinking but instead may present with:
  • Depressed mood
  • Nervousness
  • Insomnia
  • Physical complications of alcohol use( ulcer, gastritis, liver disease )
  • Accidents or injuries due to alcohol use
  • Poor memory or concentration
    
    
• May sometimes deny or minimize alcohol use.
• Legal and social problems due to alcohol use(marital problems, missed work).
• Signs of alcohol withdrawal (sweating, tremors, morning sickness, hallucinations).
• Family may request help before patient (e.g. irritable at home, missing work).

Diagnostic Features

• Harmful alcohol use:
  • Heavy alcohol use (quantity defined by local standards, e.g. over 28 drinks per week for men, over 14 drinks per week in woman)
  • and overuse of alcohol has caused physical harm (e.g. liver disease, gastrointestinal bleeding), psychological harm (e.g., depression or anxiety due to alcohol) or has led to harmful social consequences (e.g., loss of job).
    
    
• Standard questionnaires (e.g., AUDIT) may help identify harmful use.
  
  
• Alcohol dependence:
  • continued alcohol use despite harm
  • difficulty controlling alcohol use
  • strong desire to use alcohol
  • tolerance (drinks large amounts of alcohol without appearing intoxicated)
  • withdrawal (anxiety, tremors, sweating after stopping drinking).

Differential Diagnosis

• Reducing alcohol use may be desirable for some patients who do not fit the above guidelines.
  
  
• Symptoms of anxiety or depression may occur with heavy alcohol use. If these continue after a period of abstinence, see Depression,. and Generalized anxiety.