A second test with comparable or even higher levels of sensitivity and specificity is carbo- hydrate—deficient transferrin (CDT), with levels of 20 units or higher useful in identifying in- dividuals who regularly consume eight or more drinks daily. Since both GGT and CDT levels return toward normal within days to weeks of stopping drinking, both state markers may be useful in monitoring abstinence, especially when the clinician observes increases, rather than decreases, in these values over time—a finding indicating that the person is likely to have returned to heavy drinking. The combination of tests for CDT and GGT may have even higher levels of sensitivity and specificity than either test used alone. Additional useful tests include the mean corpuscular volume (MCV), which may be elevated to high- normal values in individuals who drink heavily—a change that is due to the direct toxic ef— fects of alcohol on erythropoiesis. Although the MCV can be used to help identify those who drink heavily, it is a poor method of monitoring abstinence because of the long half-life of red blood cells. Liver function tests (e.g., alanine aminotransferase [ALT] and alkaline phos- phatase) can reveal liver injury that is a consequence of heavy drinking. Other potential markers of heavy drinking that are more nonspecific for alcohol but can help the clinician think of the possible effects of alcohol include elevations in blood levels or lipids (e.g., tri- glycerides and high-density lipoprotein cholesterol) and high-normal levels of uric acid.
Additional diagnostic markers relate to signs and symptoms that reﬂect the consequences often associated with persistent heavy drinking. For example, dyspepsia, nausea, and bloat— ing can accompany gastritis, and hepatomegaly, esophageal varices, and hemorrhoids may reﬂect alcohol-induced changes in the liver. Other physical signs of heavy drinking include tremor, unsteady gait, insomnia, and erectile dysfunction. Males with chronic alcohol use dis- order may exhibit decreased testicular size and feminizing effects associated with reduced testosterone levels. Repeated heavy drinking in females is associated with menstrual irregu- larities and, during pregnancy, spontaneous abortion and fetal alcohol syndrome. Individu- als with preexisting histories of epilepsy or severe head trauma are more likely to develop alcohol-related seizures. Alcohol withdrawal may be associated with nausea, vomiting, gas- tritis, hematemesis, dry mouth, puffy blotchy complexion, and mild peripheral edema.
Functional Consequences of Alcohol Use Disorder
The diagnostic features of alcohol use disorder highlight major areas of life functioning likely to be impaired. These include driving and operating machinery, school and work, interpersonal relationships and communication, and health. Alcohol-related disorders contribute to absenteeism from work, job-related accidents, and low employee productiv- ity. Rates are elevated in homeless individuals, perhaps reﬂecting a downward spiral in social and occupational functioning, although most individuals with alcohol use disorder continue to live with their families and function within their jobs.
Alcohol use disorder is associated with a significant increase in the risk of accidents, vi— olence, and suicide. It is estimated that one in five intensive care unit admissions in some urban hospitals is related to alcohol and that 40% of individuals in the United States ex- perience an alcohol-related adverse event at some time in their lives, with alcohol account- ing for up to 55% of fatal driving events. Severe alcohol use disorder, especially in individuals with antisocial personality disorder, is associated with the commission of criminal acts, including homicide. Severe problematic alcohol use also contributes to dis- inhibition and feelings of sadness and irritability, which contribute to suicide attempts and completed suicides.
alcohol use disorder has been overlooked can add to the risks and costs of hospitalization and to time spent in the hospital.