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Alcohol - Diagnosis

The ICD-10 lists six criteria, three of which must have occurred simultaneously in the last 12 months for a diagnosis of alcohol dependence to be made:

  • Strong desire or compulsion to consume the addictive substance
  • Limited control over the onset, cessation and quantity of consumption
  • Withdrawal symptoms upon reduction or cessation of use; use to alleviate withdrawal symptoms.
  • Development of tolerance: increasingly higher doses are required to achieve a consistent effect
  • Increasing neglect of other activities and interests in favor of use Continued use despite evidence of sequelae.

Questionnaire instruments are more sensitive and specific than biochemical markers. Biochemical markers are not sensitive enough to detect alcohol dependence, abuse or excessive and risky consumption. Thus, the use of questionnaires is recommended in the diagnosis of alcohol dependence Two questionnaires are particularly suitable for this purpose due to the small number of items for screenings in hospitals. They are shown below.

TestQuestionsYesNo

LAST
(Lübeck Alcoholism Screening Test)
(Rumph, H.-J. Hapke, U. John, U.)

Are you always able to stop drinking alcohol when you want to?
01
Have you ever felt that you should reduce your alcohol consumption?
10
Have you ever felt guilty or guilty about your drinking?
10
Have your (spouse) partners or your parents or other close relatives ever worried or complained about your drinking?
10
Have you ever had problems at work because of drinking?
10
Have you ever been told you have a liver disorder (e.g. fatty liver or cirrhosis)?
10
Have you ever been hospitalized for your alcohol use?10

Evaluation notes ( LAST )
The authors assume that a sum of 2 or more points indicates alcohol abuse or alcohol dependence.


TestQuestions (Yes/No)

CAGE
(Ewing, 1984)

Have you ever thought about drinking less?
Have you ever caused offence to others because, in their opinion, you drink too much?
Have you ever felt guilty about your drinking?
Have you ever drunk alcohol first thing in the morning to stabilize your nerves or get rid of a hangover?

Evaluation Instructions (CAGE)
Two or more yes answers indicate harmful use/alcohol abuse or alcohol dependence is likely.

Biological markers are not as sensitive as the screening tools mentioned above. Biochemical markers alone are therefore not sufficient to detect alcohol dependence or abuse. However, they can be used as a "hook" for addressing alcohol use if necessary. Suitable markers are listed in the table below with corresponding norm ranges.

DrinkAlcohol contentQuantityPure alcohol
Beer
approx. 5 vol.
0,2 l
approx. 8,0 g
Wine
approx. 10 Vol. %
0,1 l
approx. 8,0 g
Fruit liqueur
approx. 30 Vol. %
2 cl
approx. 4,8 g
Korn
approx. 32 Vol. %
2 cl
approx. 5,0 g
Obstlerapprox. 35 Vol. %
2 cl
approx. 5,6 g
Brandy
approx. 40 Vol. %
2 cl
approx. 6,4 g

Signs that may indicate alcohol-related disorders are primarily (Wetterling and Veltrup 1997):

  • Alcohol odor
  • Reddened conjunctivae of the eyes; bloated (oedematous) face, often reddened, with telangiectasias, but also sallow, rhinophyma.
  • Typical skin changes (e.g. vascular spider, palmar erythema, "bill skin", psoriasis, nail changes)
  • Trembling of the hands (tremor)
  • Vegetative lability, especially increased tendency to sweat (moist hands)
  • Acceleration of the pulse
  • Gait unsteadiness (somewhat wide-legged, clumsy)
  • Typical posture ("beer belly", contrast with atrophy of shoulder and/or leg muscles)
  • Reduced general condition
  • Gastrointestinal disturbances, especially morning sickness, lack of appetite
  • Increased irritability, reduced impulse control and stress tolerance
  • Sleep disturbances
  • Lack of concentration, forgetfulness
  • Impaired performance (subjective and objective)
  • Disorders of sexual interest and potency

Denial, trivialization, or falsification tendencies can make it difficult to adequately assess the disorder. Typically, denial consists of alcoholic patients readily realizing their problems but recognizing them as a cause rather than a consequence of excessive drinking. In order not to reinforce his defenses, special conversational techniques are recommended in dealing with the alcoholic patient, such as motivational (non-confrontational) interviewing.

According to ICD-10 (F10.3), it is a symptom complex of varying composition and varying severity following absolute or relative withdrawal from alcohol that has been consumed repeatedly and usually over a longer period of time, usually in larger quantities. Alcohol withdrawal syndrome usually begins 4-12 hours after cessation or reduction of drinking, reaches its strongest expression on the second day of abstinence, and usually disappears after 4-5 days. The following symptoms may occur:

  • Somatic-internal: General malaise and weakness, gastrointestinal disturbances (lack of appetite, stomach pain, diarrhea, nausea, vomiting, bleeding), cardiovascular disturbances (pulse acceleration and blood pressure elevation, peripheral edema), hypoglycemia, electrolyte changes;
  • Vegetative: dry mouth, increased sweating, pruritus, sleep disturbances;
  • Neurologic: tremor (hands, tongue, eyelids), articulation disorders, ataxia, paresthesias, nystagmus, double vision, muscle pain, headache; because seizure tendency is increased, withdrawal seizures may occur;
  • Psychological: anxiety, irritability, motor and inner restlessness, depressive moods, impaired concentration and memory, rarely impaired consciousness and fleeting hallucinations.

Withdrawal syndrome with delirium is a short-lasting but occasionally life-threatening toxic confusional state with physical disturbances that occurs in less than 5% of patients. It occurs in addicts, usually with a long history, and usually begins after discontinuation of alcohol or significantly reduced consumption, but may also occur during an episode of heavy drinking. About half of all delirium begins with a cerebral seizure.

The typical early signs are insomnia, tremors, and anxiety. The classic symptoms are (World Health Organization 2000):

  • Clouding of consciousness and confusion
  • vivid hallucinations or illusions of any perceptual quality (especially visual)
  • pronounced tremor
  • Delusions, restlessness, insomnia or reversal of the sleep-wake rhythm and vegetative hyperexcitability.

The withdrawal syndrome with delirium and/or cerebral seizure lasts longer than the simple withdrawal syndrome. In the case of protracted delirium, further differential diagnosis should be carried out in addition to consistent drug treatment and monitoring of vital functions, so that, for example, a chronic subdural haematoma is not overlooked even after a longstanding head injury.

Learn more

Detailed information on screening and diagnosis of alcohol dependence

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