Key Terms
Authors
Alyssa M. Peckham, PharmD, BCPP; Michael G.
Alcohol Use Disorder (AUD)
Primary, chronic disease characterized by cravings and continued drinking despite adverse outcomes; involves brain rewar
Diagnostic tool
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Number of criteria: 11 criteria total Sever
Mild AUD
May respond to non-medication treatment (psychosocial therapy) alone; medication offered if patient is interested. Moder
AUD
Medication should be part of treatment plan, with or without non- medication treatment.
USPSTF recommendation
Screen all adults 18+ for unhealthy alcohol use, including pregnant women; offer interventions for risky or hazardous dr
Cause
Poor diet and impaired nutrient absorption from excessive alcohol use. Key deficiencies: thiamine, folic acid, vitamin B
Scale
CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised version) Purpose: measures AWS severity. Monitori
No treatment (supportive care only)
Mild AWS; patient is medically stable. Outpatient treatment: moderate AWS; patient has social support, no significant co
Appropriate when
FDA-approved agents are contraindicated, not tolerated, not preferred by patient, or have failed. Off-label medications
Elderly and adolescents
Naltrexone is treatment of choice; other agents appropriate after considering comorbidities and concurrent medications.
NR
32-year-old female; AUD (severe); 10 years near-daily drinking; prior hospitalization and detox; prior naltrexone use (f
PMH
Bulimia nervosa (in remission), OCD personality disorder, social anxiety disorder, severe AUD. Current meds: Mirena IUD,
AUD severity tool
DSM-5; 11 criteria evaluation. NR already has documented severe AUD.
AWS monitoring
Last drink 12 hours ago; onset window is 6-24 hours; currently in the onset window. Monitor for several days given varia