Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Alcohol Use Disorder

—

In one line

·Alcohol Use Disorder (AUD) is diagnosed when someone shows 2 or more of 11 behaviors within 12 months—like needing more alcohol to get the same effect (tolerance), feeling sick when stopping (withdrawal), or continuing to drink despite harm to health, work, or relationships.

—

Normal physiology

·A healthy brain balances excitatory signals (glutamate, which activates neurons and sharpens focus) and inhibitory signals (GABA, which calms neurons and reduces anxiety), plus reward circuits (dopamine, which motivates behavior and marks experiences as 'do that again') and executive control (the prefrontal cortex, which applies the brakes to impulses and helps you plan ahead).

—

What goes wrong

·Chronic alcohol exposure weakens (down-regulates) GABA receptors (the calming docking sites on neurons where GABA lands to slow things down) and strengthens (up-regulates) NMDA glutamate receptors (the activating docking sites where glutamate lands to speed things up). This means the brain becomes hyper-excitable—too easily activated and revved up—when alcohol is absent. At the same time, the prefrontal cortex (the brain region that stops impulses and manages stress) shrinks and loses gray matter (the neuron cell bodies that do the thinking) with repeated heavy drinking. This creates a vicious cycle: the person drinks to calm stress and anxiety that the drinking itself has amplified, and the damaged prefrontal cortex can no longer pump the brakes to stop the cycle.

—

Hallmark signs

·Tolerance
·Withdrawal symptoms
·Drinking more or longer than intended
·Persistent desire or unsuccessful efforts to cut down
·Spending a lot of time obtaining, using, or recovering from alcohol
·Cravings or strong urges to drink
·Failure to fulfill major responsibilities at work, school, or home
·Continued use despite recurrent social or interpersonal problems

—

Red flags · escalate now

·Delirium tremens (DTs): severe confusion, seeing or feeling things that are not there (hallucinations), unstable vital signs (fever, fast heart over 120, high or swinging blood pressure), usually 2 to 4 days after the last drink—life-threatening and requires intensive care with IV benzodiazepines to calm the brain
·Seizures during withdrawal: full-body convulsions (generalized tonic-clonic or grand mal seizures), typically 6 to 48 hours after stopping alcohol—require emergency benzodiazepines and hospital admission to prevent status epilepticus (a seizure that will not stop) (seizures that do not stop)
·Wernicke encephalopathy: sudden confusion, paralyzed or wobbly eye movements (ophthalmoplegia), and unsteady walking (ataxia) from severe thiamine (vitamin B1) deficiency—give IV thiamine immediately before any glucose to prevent permanent memory damage (Korsakoff syndrome)
·Suicidal thoughts or suicide attempt: alcohol use disorder increases suicide risk tenfold—screen every visit, ask directly about plans to harm oneself, and arrange immediate safety (remove means, involve family, consider hospitalization)
·Mixing alcohol with opioids or benzodiazepines: both types of drugs slow breathing and brain activity; together they can stop breathing entirely (respiratory arrest) and cause death—always ask about all drugs and pills

—

Workup

·Liver enzymes: AST (aspartate aminotransferase), ALT (alanine aminotransferase), and GGT (gamma-glutamyl transferase)
·Mean corpuscular volume (MCV), which measures the average size of your red blood cells
·Complete blood count (CBC) with platelets
·Hepatitis B surface antigen (HBsAg) and hepatitis C antibody with reflex to HCV RNA if antibody is positive
·Lipid panel (total cholesterol, LDL, HDL, and triglycerides)
·Thiamine (vitamin B1) level, though empiric IV or IM thiamine is given before the lab result returns
·Carbohydrate-deficient transferrin (CDT) if diagnosis is uncertain or monitoring abstinence is needed
·Blood alcohol concentration (BAC) if intoxication or withdrawal severity assessment is needed

—

Treatment

·Screen all adults age 18 and older annually with AUDIT-C (men score 4 or higher, women 3 or higher equals positive) or single-question screen ('How many times in the past year have you had 5 or more drinks in a day for men, or 4 or more drinks in a day for women?'—one or more times equals positive). Then confirm diagnosis using DSM-5-TR criteria: 2 or more of 11 symptoms in a 12-month period equals alcohol use disorder.
·Naltrexone 50 mg by mouth once daily or 380 mg intramuscular injection once monthly (blocks mu-opioid receptors in the mesolimbic reward pathway, reducing the euphoria and reinforcement from drinking) OR acamprosate 666 mg by mouth three times daily (modulates GABA and glutamate activity in the brain, reducing craving and the discomfort of early abstinence)
·Benzodiazepine-based alcohol withdrawal protocol using CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised—a 10-item scale that scores tremor, sweating, agitation, headache, nausea, and hallucinations) with symptom-triggered dosing of lorazepam 1 to 2 mg or chlordiazepoxide 25 to 100 mg every 1 to 2 hours as needed until CIWA-Ar is below 8, plus thiamine 500 mg IV or IM three times daily for at least 3 days
·Screen for and treat co-occurring major depressive disorder, generalized anxiety disorder, PTSD (post-traumatic stress disorder), or bipolar disorder with evidence-based psychotherapy (cognitive-behavioral therapy, trauma-focused therapy such as prolonged exposure or EMDR—eye movement desensitization and reprocessing) and/or antidepressants (SSRIs like sertraline or escitalopram, SNRIs like venlafaxine)
·Address social determinants of health: connect to stable housing (transitional housing, sober living, Housing First programs), food assistance (SNAP—Supplemental Nutrition Assistance Program), income support (SSI/SSDI—Supplemental Security Income or Social Security Disability Insurance for people unable to work, TANF—Temporary Assistance for Needy Families), and job training or supported employment programs
·Mutual-support groups (Alcoholics Anonymous, SMART Recovery—Self-Management and Recovery Training, Refuge Recovery, LifeRing) or individual cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), or contingency management (rewarding abstinence with vouchers or prizes)
·Disulfiram 250 mg by mouth daily (blocks aldehyde dehydrogenase, the enzyme that breaks down acetaldehyde—a toxic byproduct of alcohol—so drinking causes immediate flushing, nausea, vomiting, headache, and chest pain)

—

NCLEX trap

·Alcohol Use Disorder is a chronic brain disease, just like diabetes is a disease of insulin control. Repeated alcohol use rewires the nucleus accumbens (the brain's reward center that controls pleasure and motivation) and the amygdala (the brain's alarm center that handles fear and stress). The brain adapts to constant alcohol by making changes that persist even after drinking stops. These changes make cravings powerful and withdrawal dangerous. Your genes (biology), past trauma (abuse, violence, loss), and your environment (peer pressure, stress, access to alcohol) all drive Alcohol Use Disorder. Willpower alone cannot undo brain rewiring. Treatment requires medicine, counseling, and social support together, per SAMHSA and NIAAA guidelines.
·Withdrawal symptoms (shakes, sweats, fast heart rate when alcohol is removed) are just one sign of Alcohol Use Disorder. The DSM-5 (the official manual doctors use to diagnose mental and substance use disorders) lists 11 signs; you need any 2 or more over 12 months to diagnose Alcohol Use Disorder. Other signs include drinking more than you planned, spending lots of time drinking or recovering, giving up hobbies or work because of alcohol, drinking even when it causes fights or health problems, and strong cravings. Many people meet these criteria without ever shaking or sweating. Severity (mild 2 to 3 signs, moderate 4 to 5 signs, severe 6 or more signs) depends on how many signs you have, not whether you withdraw.
·Medicine alone does not fix Alcohol Use Disorder. You must treat the whole person: the body (stop dangerous withdrawal, replace vitamins the body is missing, prevent seizures), the mind (treat depression, anxiety, trauma, and teach coping skills to handle cravings), and the social world (stable housing, job support, mending family relationships, connecting to peer groups like AA or SMART Recovery). Studies from SAMHSA (the U.S. agency that oversees mental health and addiction services) and Cochrane (a trusted global research network) show that combining medicine, counseling, and community support works far better than medicine alone. Without this full approach, relapse (return to drinking) is very common.
·The type of drink does not matter; what matters is how much pure alcohol (ethanol) your body gets each day. A standard beer (12 oz), a glass of wine (5 oz), and a shot of liquor (1.5 oz) all contain roughly the same amount of ethanol (about 14 grams, which is called one standard drink). Drinking six beers a day delivers the same ethanol as six shots of vodka, rewires the nucleus accumbens (your brain's reward center) the same way, causes the same liver damage, and creates the same withdrawal danger. The DSM-5 diagnosis is based on behavior and harm, not the label on the bottle. Total daily ethanol intake determines your risk for dependence and organ damage, per NIAAA guidelines.
·Stopping alcohol suddenly after heavy, long-term use is medically dangerous and can kill you. When alcohol (a brain-slowing substance) is removed abruptly, the brain's excitatory signals (the circuits that speed things up, using glutamate as the main chemical messenger) go wild because they are no longer balanced. This can cause seizures (uncontrolled electrical storms in the brain), delirium tremens (severe confusion, seeing things that are not there, dangerously high blood pressure and heart rate), and death. Current ASAM (American Society of Addiction Medicine) guidelines say heavy drinkers must stop under medical supervision with sedative medicine (usually a benzodiazepine like lorazepam or diazepam that boosts GABA, the brain's main calming chemical) and thiamine (vitamin B1 that protects brain cells). Stopping without a doctor can be fatal.
·Relapse (drinking again after a period of not drinking) is a normal, expected part of Alcohol Use Disorder recovery, not a sign of failure. The nucleus accumbens (reward center) and prefrontal cortex (front of the brain that controls planning and impulse control) have been changed by years of alcohol; healing those circuits takes time, often many attempts, and strong support. SAMHSA calls Alcohol Use Disorder a chronic relapsing disease, just like asthma or high blood pressure can flare despite treatment. When relapse happens, the care team adjusts the treatment plan (maybe increase counseling frequency, switch medicines like adding acamprosate or disulfiram, add group therapy, address new stressors), strengthens support, and continues. Each attempt teaches the person more about their triggers and builds recovery skills. NIAAA research shows that most people who achieve long-term recovery have had at least one relapse along the way.

—

Install Maldek by Hill as an app — studies work even offline