Criteria for the Diagnosis of Alcohol Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol.
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Naltrexone blocks opioid receptors that are invloved in the rewarding effects of drinking alcohol and the craving for alcohol. Oral Nalterxone reduces relapse to heavy drinking and cuts the relapse risk during the first 3 months.
Acamprosate (Campral) acts on the GABA and glutamate neurotransmitter systems and is thought to reduce symptoms of protracted abstinence such as insomnia, anxiety, restlessness and dysphoria. Acamprsate increases the proportion of dependent drinkers who maintain abstinence for several weeks to months.
Topiramate (Topomax) is a GABA-receptor agonist (GABA is the predominant inhibitory neurotransmitter) and a glutamate antagonist (glutamate is a predominant excitatory neurotransmitter). In a chronic alcoholic state, GABA is decreased while glutamate and dopamine are increased. Topiramate blocks the glutamate receptors and increases the GABA effect; this combined effect produced a decrease in heavy drinking days and alcohol craving, with an increase in abstinent days and improved liver functions.
Gabapentin (Neurontin) normalizes the stress-induced GABA activation in the amygdala that is associated with alcohol dependence. Gabapentin may reduce alcohol-cued cravings and sleep disturbance in alcohol-dependent individuals. People suffering from alcohol addiction have low levels of GABA in their system, making them crave the substance, as alcohol's consumption increases GABA levels.