Disorders due to use of alcohol

Disorders Due to Use of Alcohol are characterized by the pattern and consequences of alcohol use. Alcohol—more specifically termed ethyl alcohol or ethanol—is an intoxicating compound produced by fermentation of sugars usually in agricultural products such as fruits, cereals, and vegetables with or without subsequent distillation. There are a wide variety of alcoholic drinks, with alcohol concentrations typically ranging from 1.5% to 60%. Alcohol is predominantly a central nervous system depressant. Unlike most other substances, elimination of alcohol from the body occurs at a constant rate, such that its clearance follows a linear rather than a logarithmic course. In addition to ability to produce Alcohol Intoxication, alcohol has dependence-producing properties, resulting in Alcohol Dependence in some people and Alcohol Withdrawal when alcohol use is reduced or discontinued.

Alcohol is implicated in a wide range of harms affecting most organs and systems of the body (e.g., cirrhosis of the liver, gastrointestinal cancers, pancreatitis). Harm to others resulting from behaviour during Alcohol Intoxication is well recognized and is included in the definitions of harmful use of alcohol (i.e., Episode of Harmful Use of Alcohol and Harmful Pattern of Use of Alcohol). Several alcohol-induced mental disorders (e.g., Alcohol-Induced Psychotic Disorder) and alcohol-related forms of neurocognitive impairment (e.g., Dementia Due to Use of Alcohol) are recognized.

Alcohol use is one of the most common causes of premature death and illness among men and is still a substantial, though less common, cause of premature death and illness among women. The use of alcohol is implicated in millions of deaths per year (e.g., due to motor vehicle accidents).

Although alcohol is used worldwide and its use is legal among adults in most countries, there are substantial differences in cultural and religious acceptability of its use. Consequently, prevalence of alcohol use disorders shows substantial regional variation; the highest prevalence is observed in Eastern Europe and the lowest in Africa. Low prevalence of alcohol use in some countries is related to lower rates of Disorders Due to Use of Alcohol.

Polymorphisms of the genes for the alcohol-metabolizing enzymes alcohol dehydrogenase (ADH1B) and aldehyde dehydrogenase are seen more frequently in East Asians than other groups and affect the response to alcohol. Individuals with certain polymorphisms may develop facial flushing and palpitations when consuming alcohol, which may be so severe as to preclude alcohol consumption and thus lower the risk of alcohol use disorder.

Diagnostic Categories that Apply to Alcohol

Following is a list of specific diagnostic categories of that apply to alcohol:

• 6C40.0 Episode of Harmful Use of Alcohol
• 6C40.1 Harmful Pattern of Use of Alcohol
• 6C40.2 Alcohol Dependence
• 6C40.3 Alcohol Intoxication
• 6C40.4 Alcohol Withdrawal
• 6C40.5 Alcohol-Induced Delirium
• 6C40.6 Alcohol-Induced Psychotic Disorder
• 6C40.70 Alcohol-Induced Mood Disorder
• 6C40.71 Alcohol-Induced Anxiety Disorder
• 6C40.Y Other Specified Disorder Due to Use of Alcohol
• 6C40.Z Disorder Due to Use of Alcohol, Unspecified

Additional categories of disorders induced by psychoactive substances are included in other parts of the ICD-11 chapter on Mental, Behavioural, and Neurodevelopmental Disorders. They are cross-listed in the section below on Substance-induced Mental Disorders for reference. These categories include:

• 6D72.10 Amnestic Disorder Due to Use of Alcohol
• 6D84.0 Dementia Due to Use of Alcohol

The first three diagnoses listed above (Episode of Harmful Use of Alcohol, Harmful Pattern of Use of Alcohol, and Alcohol Dependence) describe the pattern of alcohol use. One of these three diagnoses, or Disorder Due to Use of Alcohol, Unspecified, for cases in which the use pattern in unknown at the time of evaluation, is considered to be the primary diagnosis. That is, one of these four diagnoses should be assigned when making a diagnosis of a Disorder Due to Alcohol Use.

The remaining diagnoses reflect the impact of the pattern of alcohol use and are thus considered to be associated with one of the primary use pattern diagnoses. These diagnoses should therefore be assigned together with the relevant primary diagnosis. For example, 6C40.1/ 6C40.5 is Harmful Pattern of Use of Alcohol associated with Alcohol-Induced Psychotic Disorder, 6C40.2/6C40.70 is Alcohol Dependence associated with Alcohol-Induced Mood Disorder, 6C4Z/6C40.3 is Disorders Due to Substance Use, Unspecified associated with Alcohol Intoxication (i.e., the pattern of use in this last case is unknown).

Alcohol-induced Mental Disorders are characterized by psychological, cognitive, or behavioural symptoms that develop during or soon after alcohol intoxication or withdrawal or use. The duration or severity of the symptoms is substantially in excess of the characteristic syndrome of Alcohol Intoxication or Alcohol Withdrawal.