Disorders due to Substance Use: Alcohol Abuse and Addiction

Alcohol consumption behaviors occur along a wide continuum, with patterns of quantity, frequency, and duration varying significantly across individuals. Within this continuum, there are no distinct boundaries around categories such as “moderate” drinking and “harmful” drinking. However, there is consistency with recognizing that increased amounts of daily alcohol consumed and greater frequency of intoxication coincides with the presence of medical and psychosocial problems. The focus of this chapter is the alcohol-related disorders. Diagnostic features of alcohol use disorder (alcohol dependence), prevalence of patterns of drinking, and harms are discussed. Best practices for the clinical assessment of alcohol dependence and alcohol-induced disorders (alcohol-induced intoxication, withdrawal, and mental disorders) are presented along with differential diagnosisDifferential diagnosis considerations and common psychiatric comorbidities. Next, etiological and pathophysiological factors (genetic, neurobiological, psychological, and social/environmental factors) are reviewed. The final section of the chapter examines treatment issues including evidence-informed psychosocial/behavioral, pharmacological, and combined psychosocial and pharmacological options. Examples of technological innovations that have potential to advance alcohol treatment and research are described. Throughout, the preponderance of scientific evidence as identified by meta-analytic studies and systematic reviews is prioritized when possible, and aspects relevant to specific populations (e.g., adolescents, women, older adults, culture) are considered.