NCLIP

Alcohol Use Disorder

3 min read

Alcohol Use Disorder

Key Points

  • AUD is a chronic brain disorder marked by impaired control of alcohol use despite social, medical, and occupational harm.
  • Heavy drinking thresholds are at least 8 drinks/week for women and 15 drinks/week for men; binge drinking is at least 4 drinks for women or 5 drinks for men per occasion.
  • A standard drink contains 14 g (0.6 oz) of pure alcohol.
  • Withdrawal can progress to seizures or delirium-tremens, requiring rapid protocol-based management.

Pathophysiology

Alcohol dysregulates inhibitory and excitatory neurotransmission and reinforces reward circuitry. Repeated exposure produces tolerance and dependence, then withdrawal hyperexcitability when intake abruptly decreases. This physiologic instability underlies tremor, autonomic overactivity, anxiety, and severe complications.

AUD severity is classified as mild, moderate, or severe based on diagnostic burden and functional impact. Co-occurring depression, trauma, and anxiety frequently complicate treatment and increase relapse risk.

Classification

  • Mild: Early harmful pattern with lower symptom burden.
  • Moderate: Clear role dysfunction and persistent use despite consequences.
  • Severe: High dependence burden with recurrent withdrawal and major impairment.

Nursing Assessment

NCLEX Focus

Track withdrawal trajectory over time; worsening autonomic signs and altered sensorium signal escalation risk.

  • Assess pattern of use, last drink, prior detox history, and withdrawal complications.
  • Screen with audit-c and CAGE; assess withdrawal severity with ciwa-ar.
  • Assess vital signs, tremor, diaphoresis, agitation, orientation, and hallucination risk.
  • Assess nutrition status and deficiency risk (especially thiamine depletion).
  • Assess fall risk, seizure risk, aspiration risk, and suicidality.

Nursing Interventions

  • Implement CIWA-Ar protocol and provide symptom-triggered medication administration.
  • Maintain seizure precautions, close observation, and frequent reassessment intervals.
  • Support hydration, electrolyte correction, and nutritional replacement per orders.
  • Provide brief motivational counseling and referral planning for continuing care.
  • Engage family/support systems when clinically appropriate.

Alcohol Withdrawal Emergency

Untreated withdrawal may progress to seizures and delirium tremens; escalate care immediately for severe autonomic instability or fluctuating cognition.

Pharmacology

FDA-approved medications for AUD treatment include naltrexone, acamprosate, and disulfiram. Withdrawal treatment commonly relies on benzodiazepines such as diazepam, lorazepam, or chlordiazepoxide, with anticonvulsants in selected cases.

Nurses commonly administer thiamine and monitor electrolytes to reduce neurologic complications, including wernickes-encephalopathy progression risk. Ongoing medication adherence and relapse-prevention teaching remain central after stabilization.

Clinical Judgment Application

Clinical Scenario

A hospitalized client with escalating wine intake develops anxiety, tremor, sweating, headache, and increasing CIWA-Ar score.

Recognize Cues: Rising autonomic signs, visible tremor, and worsening anxiety. Analyze Cues: Findings are consistent with active alcohol withdrawal. Prioritize Hypotheses: Prevent seizure, delirium, and cardiopulmonary deterioration. Generate Solutions: Continue symptom-triggered protocol, safety precautions, and hydration support. Take Action: Administer prescribed withdrawal medication and re-evaluate CIWA-Ar response. Evaluate Outcomes: Confirm symptom reduction, stable vitals, and readiness for step-down treatment.

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