ALCOHOL USE DISORDER

• A chronic disease characterized by uncontrolled drinking and clinically significant psychosocial and behavioural problems associated with alcohol use
• Alcoholism is the inability to control drinking due to both physical and emotional dependence on alcohol. Alcohol dependence syndrome is a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substance takes on a much higher priority for a given individual than other behaviours that once had greater value
• AUD is a chronic condition in which an uncontrolled pattern of alcohol use leads to significant physical, psychological, and social impairment or distress. Symptoms of withdrawal emerge when drinking is discontinued
• It accounts for > 3 million deaths per year worldwide and the Peak incidence of onset is in the late 2nd or early 3rd decade

Biological factors :

• Genetic Vulnerability with family history
• Comorbid psychiatric disorder

Psychologicalfactors

• Curiosity; the need for novelty-seeking
• Poor impulse control
• Childhood trauma
• Poor stress management skills
• Psychological distress

Social Factors

• Peer pressure
• Imitating behaviour of others
• Easy availability

• Whole-body: blackout, dizziness, shakiness, craving, or sweating
• Behavioural: aggression, agitation, compulsive behaviour, self-destructive behaviour, or lack of restraint
• Mood: anxiety, euphoria, general discontent, guilt, or loneliness
• Gastrointestinal: nausea or vomiting
• Psychological: delirium or fear
• Also common: physical substance dependence, problems with coordination, slurred speech, or tremor

Complications:

• Delirium tremens(DT) – Most severe alcohol withdrawal syndrome. It occurs within 2-4 days of complete or significant abstinence from heavy alcohol drinking. It happens in about 5% of patients and requires emergency care
• Alcoholic seizures: Generalized tonic-clonic seizures occur in about 10% of alcohol dependence patients, usually 12-48 hours after a heavy bout of drinking. Sometimes status epilepticus may be precipitated

Differential diagnosis

• Alcohol Intoxication
• Alcohol withdrawal

• Clinical diagnosis is done based on DSM 5 or ICD 11 criteria.
• Laboratory investigations: GGT( gamma-glutamyl transferase), MCV, LFT are the markers used to detect dependence.
• MAST (Michigan Alcoholism Screening Test), AUDIT-C and CAGE questionnaire are used to screen and rate the severity of the condition.

Laboratory tests

• Acute alcohol intoxication: High BAC( Blood alcohol concentration )
• Chronic alcohol intoxication
• Liver damage
• ↑ GGT (a most sensitive marker of alcohol abuse)
• ↑ ALT, ↑ AST
• (AST levels are at least 2 times higher than those of ALT in case of alcoholic hepatitis).
• Carbohydrate-deficient transferrin (CDT) is the most specific marker for AUD. For CDT levels to become elevated, approximately 50–80 g of alcohol must be consumed daily for 1–2 weeks. 
• Malnutrition and bone marrow damage
• ↓ Folic acid, ↓ vitamin B12 (cobalamin), ↓ vitamin B1 (thiamine), ↓ vitamin B6 (pyridoxine), ↓ vitamin D, ↓ vitamin K
• Megaloblastic anaemia (↓ Hb, ↑ MCV), thrombocytopenia 

• Counselling
• Psychosocial support (e.g., Alcoholics Anonymous)
• Satwavajaya chikitsa

Internal medicines:

• Kharjuradi mantha –to control withdrawal symptoms
• Ajamodarka –improves appetite and reduces withdrawal symptoms
• Sankhupushpi + yashti churna
• Drakshadi kashaya –Associated agitation, irritation and anxiety.
• Samana snehapana - Dhatryadi ghrita, kalyanaka ghrita , tiktaka ghrita
• Somalatha choorna – In sleep disturbances

Procedures:

• Snehapana - Dhathryadi / Tiktaka Ghrita
• Vamana / Virechana depending on rogibala
• Yogavasti
• Nasya with ksheerabala taila
• Takra dhara or Usheera kashaya dhara
• Sirolepa - improve sleep and reduce irritability