CHAPTER 5
The Alcohol Use Disorders
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
5.2: Comprehend the complications of the chronic use of alcohol
•
5.4: Describe the alcohol withdrawal syndrome
•
5.5: Understand the DSM criteria for alcohol-related disorders
CHAPTER OUTLINE
A Working Definition of the Alcohol Use Disorders
Scope of the Problem
Who Is the Typical Person with an Alcohol Use Disorder?
Physical Dependence, Tolerance, and “Craving”
Complications of Chronic Alcohol Use
The Effects of Chronic Alcohol Use on the Digestive System
The Effects of Chronic Alcohol Use on the Liver
The Effects of Chronic Alcohol Use on the Circulatory System
The Effects of Chronic Alcohol Use on the Central Nervous System (CNS)
Wernicke-Korsakoff’s Disease
Alcohol’s Effects on the Sleep Cycle
The Effects of Habitual Alcohol Use on the Peripheral Nervous System
The Effects of the Alcohol Use Disorders on the Individual’s Emotions
The Effects of Habitual Alcohol Use on the Respiratory System
The Effects of Chronic Alcohol Use on Other Body Systems
Chronic Alcohol Use and Medication Abuse
The Alcohol Withdrawal Syndrome
Extended Alcohol Withdrawal
Alcohol Use Disorder and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition)
CHAPTER OVERVIEW
The purpose of this chapter is to review the subjective and objective problems induced by the
alcohol use disorders. This will include a review of the consequences of long-term habitual or
addictive alcohol use on the human body and contrast these consequences with those of the
individual who drinks only rarely or socially discussed in the last chapter.
Break-Out Discussion #1:
At which point? There are few who would argue that alcohol use disorders do not cause terrible
damage, both to peoples’ bodies and to their social world. The physical damage associated with
alcohol misuse and addiction is discussed in your text. However, at what point do we say that a
person definitely has an alcohol use disorder? The end-stage alcoholic can be easy to recognize.
However, the high-functioning alcoholic is not always as easily identified.
Imagine yourself as two different individuals. One is the vice president of a major corporation, in
his or her early 60s, earning a salary well into the six-figure range, and married with two children
In contrast to this scenario is a second hypothetical person who drinks beer. This person goes to
a favorite bar three to four nights a week and also has a sizable supply of beer bottles in the
refrigerator at home. This person earns about $20,000 a year, and his or her spouse has to work
to supplement the family income. They have two children, one of whom has been arrested for
Questions
1. Would you suggest that one or the other did not have a drinking problem? Why or why not?
2. What information do you feel is needed to diagnose an individual with an alcohol use
disorder? Does economic status alter the individual’s diagnosis? Should economic status
influence the diagnosis? Why or why not?
Break-Out Discussion #2:
Nonalcoholic liver disease: As stated in your text, excessive alcohol consumption is a major
cause of liver disease in this country. However, there are other conditions that can induce liver
disease, many of which appear very similar to alcohol-induced liver damage. Viral hepatitis is
one such disorder. Another is Nonalcoholic Steatohepatitis (NASH). NASH is usually “silent,”
which is to say that it does not induce obvious physical symptoms, although blood tests for liver
NASH is not automatically progressive, but can halt at an intermediate stage, go into remission,
or progress to the point where scar tissue forms on the liver and cirrhosis of the liver develops.
If the cirrhosis continues to progress, the individual will eventually suffer so much liver damage
that he or she enters end-stage liver disease. As is seen with alcohol-induced liver disease,
persons with nonalcoholic liver disease are at risk for premature death, although the death rate
Questions
1. Do you know anybody who has nonalcoholic liver disease? Is the fact that their liver disease is
2. If you were to be diagnosed with a nonalcoholic liver disorder, would you wonder whether
people that you knew accepted that it was not alcohol related, or would you constantly wonder
whether other people suspected that you were a “closet” drinker?
3. Are there other diseases you can think of that have similar stigmas? Is there a scientific basis
for these beliefs? If not, how do you think people develop them?
Break-Out Discussion #3:
Cravings and thoughts about drinking: These concepts are often confusing to the student, or the
health care professional who does not frequently work with persons who have alcohol use
disorders. To further confuse matters, “cravings” and “thoughts” about a drug of misuse are
A thought about having a drink is just that, a passing thought. A person who has been sitting on
a boat in the hot sun fishing or working outdoors all day might briefly entertain the thought “I
approaching examination in class, briefly entertains the thought of joining her friends at a party,
before returning to her studies.
The urge, often referred to as a “craving” to use the chemicals of misuse, is more difficult to
explain. It is a whole-body experience, in which people become totally preoccupied with the
thought of using of a compound. Their total awareness is focused on the use of that chemical, in
this case alcohol. They remember past drinking experiences: the surrounding sounds, the smells,
Substance use “urges” or “cravings” are not signs of a treatment failure (Washton & Zweben,
2006). Rather, they are the result of associational memory, which in turn reflects the process of
memory formation on a cellular level. Over time, the person will either consciously or
unconsciously associate certain sights, sounds, smells, mood states, and so on, with substance
use, and when these triggers are encountered, they will initiate the craving cascade. A person is
Questions
1. Urges and cravings are not limited to the world of substance misuse. Any person who has
been on a diet can attest to the intensity of craving for forbidden foods. A patient about to
2. What sort of outside influences, training, or guidance do you think is useful in helping to resist
cravings?
3. Is the intense desire to engage in sexual relations different than the urge to engage in drug
use? Why or why not?
References
Soderberg, C., Stal, P., Askling, J., Glaumann, H., et. al., (2010). Decreased survival of subjects
with elevated liver function tests during a 28 year follow-up. Hepatology, 51 (2), 596–602.
Washton, A. M., & Zweben, J. E. (2006). Treating Alcohol and Drug Problems in Psychotherapy
Practice. New York: Guilford.
KEY CONCEPTS AND TERMS
Reverse tolerance: When drinking alcohol on a chronic basis, an individual may not require as
much alcohol to achieve a given level of intoxication as previously needed
Alcohol hepatitis: Condition which is an extension of steatosis, with the additional symptoms of
liver inflammation, pain, the death of liver cells, and development of collagen deposits in the
liver
Cirrhosis: Condition during which individual liver cells die and are replaced by scar tissue
Free radicals: Molecules that, because of their ionic charge, are able to attach to and damage
other molecules, thus disrupting the normal function of cells and possibly contributing to
cellular death. Free radical molecules often contain an extra oxygen molecule, which will then
bind to molecules found in cell walls, causing damage to them
Alcohol-induced gastritis: A painful condition where the stomach becomes inflamed
Blackouts: Resulting from consuming sufficient quantities of alcohol which then interferes with
the formation of memories in the individual’s brain
Anterograde amnesia: Inability to remember events after a specific point in time. This condition
usually results from any of a wide range of forms of neurological trauma, or a wide range of
chemical compounds.
Alcohol-induced “blackouts” are a form of chemically induced state of anterograde amnesia.
Other medications, such as Versed, a benzodiazepine often used in “conscious sedation”
medical procedures, and ketamine also can induce this same effect.
Traumatic brain injury may also induce anterograde amnesia. It is not uncommon for a
patient who has been in a motor vehicle accident to assert that they cannot remember events
for the first few hours or days after the accident. It should be pointed out that anterograde and
retrograde amnesia are not mutually exclusive, and may coexist in the same patient
Prefrontal cortex: Region of the brain that, among other things, is involved in complex cognitive
and psychomotor processes including self-regulation of goal-directed behavior, working
memory, problem solving, and response inhibition
Confabulation: A neurological disorder in which the individual is (a) unable to remember part of
his or her past, and (b) will make up a history. Without collateral information, the individual’s
rendition of his or her past might actually seem plausible in many cases, making the need for
collateral information imperative to detect such cases. Causes of confabulation include (but are
not limited to) Korsakoff’s syndrome. Thus, it is imperative that the assessor rule out other
possible causes of confabulation before assuming that it is alcohol related
Tardive dyskinesia (TD): Condition resulting in abnormal movements of muscles. Technically,
the term “tardive” means “late,” and dyskinesia refers to abnormal muscle movements. This
condition was often seen as a late complication of Parkinson’s disease
Aspiration pneumonia: A form of pneumonia that results when the individual aspirates stomach
contents into the lungs during the process of vomiting. Bartlett (1999) identified two necessary
components: (a) the aspiration of stomach contents into the lungs as a result of a breakdown of
normal body defenses designed to prevent this and (b) damage to lung tissue from gastric juices
or bacterial infection
Alcohol withdrawal syndrome: A group of symptoms that occur after discontinuation of
alcohol, particularly in those who have a physical dependence on alcohol
confusion and symptoms such as sweating, shaking, and irregular heart rate rapidly appear; can
result in seizures and potentially death
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
A Working Definition of
the Alcohol Use Disorders
Scope of the Problem
Who Is the Typical Person
with an Alcohol Use
Disorder?
5.1:
Understand
what
constitutes
an AUD and
who might be
the typical
individual
with an AUD
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Complications of Chronic
Alcohol Use
5.2: Comprehend
the complications of
the chronic use of
alcohol
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
A Working Definition of
the Alcohol Use Disorders
Physical Dependence,
Tolerance, and “Craving”
5.3:
Understand
the
differences
between
chronic use
of alcohol
and social
drinking
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
The Alcohol Withdrawal
Syndrome
5.4: Describe
the alcohol
withdrawal
syndrome
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Alcohol Use Disorder and
the Diagnostic and
Statistical Manual of
Mental Disorders (5th
Understand
the DSM
criteria for
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
Edition)
alcohol-
related
disorders
development, functioning, and behavior