Alcohol: Clinical Aspects



Alcohol is the most widely used psychoactive drug in the world, and alcohol dependence is a significant cause of morbidity and mortality. One of the most widely recognized alcohol-related disorders is liver disease. While there are many risk factors for becoming dependent on alcohol, such as the age of onset of drinking behavior, ethnicity, gender, place of residence, and religion, it is the clinical picture of the individual that most decidedly points to the progression of excessive drinking to alcohol dependence. The pathophysiology of alcohol presents as particular signs and symptoms. Systems affected by alcohol use include the cardiovascular, gastrointestinal, hepatic, endocrine, immune, hematologic, integumentary, central nervous, and peripheral nervous systems. The clinical picture of alcohol dependence also takes into account nutritional status, the risk of cancer, and the impact of alcohol use on fetal development. The psychological and psychiatric complications of alcohol dependence can be divided into acute and chronic effects, with the acute effects depending on the blood alcohol concentration of the individual and the chronic effects potentially being decreased by changes in drinking behavior.


Alcohol Dependence Cirrhosis Fetal alcohol syndrome Blood alcohol concentration 



We thank Catharine Helms and Robert H. Cormier, Jr. for their assistance with manuscript preparation.


  1. 1.
    Bailey WJ: Indiana Prevention Resource Center FactLine on high potency alcoholic beverages [Online]. Available at: (1998). Accessed 16 Jan 2009
  2. 2.
    Bailey BA, Sokol RJ (2008) Pregnancy and alcohol use: evidence and recommendations for prenatal care. Clin Obstet Gynecol 51:436–444CrossRefGoogle Scholar
  3. 3.
    Baumberg B (2006) The global economic burden of alcohol: a review and some suggestions. Drug Alcohol Rev 25:537–551PubMedCrossRefGoogle Scholar
  4. 4.
    Bishai DM, Bozzetti LP (1986) Current progress toward the prevention of the Wernicke-Korsakoff syndrome. Alcohol Alcohol 21:315–323PubMedGoogle Scholar
  5. 5.
    Bohman M, Sigvardsson S et al (1981) Maternal inheritance of alcohol abuse. Cross-fostering analysis of adopted women. Arch Gen Psychiatry 38:965–969PubMedCrossRefGoogle Scholar
  6. 6.
    Bucholz KK, Heath AC et al (1996) Can we subtype alcoholism? A latent class analysis of data from relatives of alcoholics in a multicenter family study of alcoholism. Alcohol Clin Exp Res 20:1462–1471PubMedCrossRefGoogle Scholar
  7. 7.
    Burch GE, Phillips JH Jr, Ferrans VJ (1966) Alcoholic cardiomyopathy. Am J Med Sci 252:123/89–138/104CrossRefGoogle Scholar
  8. 8.
    Burd L, Deal E, Rios R, Adickes E, Wynne J, Klug MG (2007) Congenital heart defects and fetal alcohol spectrum disorders. Congenit Heart Dis 2:250–255PubMedCrossRefGoogle Scholar
  9. 9.
    Caetano R, Ramisetty-Mikler S et al (2008) The Hispanic Americans baseline alcohol survey (HABLAS): DUI rates, birthplace, and acculturation across Hispanic national groups. J Stud Alcohol Drugs 69:259–265PubMedGoogle Scholar
  10. 10.
    Carigulo T (2007) Understanding the health impact of alcohol dependence. Am J Health Syst Pharm 64(5 Suppl 3):S5–S11CrossRefGoogle Scholar
  11. 11.
    Charness ME, Diamond I (1984) Alcohol and the nervous system. Curr Neurol 5:383–422Google Scholar
  12. 12.
    Cherpitel CJ, Robertson M et al (2007) Comorbidity for alcohol use disorders and drug use in Mexican-origin groups: comparison of data from national alcohol surveys in the U.S. and Mexico. Subst Use Misuse 42:1685–1703PubMedCrossRefGoogle Scholar
  13. 13.
    Cholet F, Nousbaum JB et al (2004) Factors associated with liver steatosis and fibrosis in chronic hepatitis C patients. Gastroenterol Clin Biol 28:272–278PubMedCrossRefGoogle Scholar
  14. 14.
    Chou SP, Dawson DA et al (2006) The prevalence of drinking and driving in the United States, 2001–2002: results from the National Epidemiological Survey on Alcohol and Related Conditions. Drug Alcohol Depend 83:137–146PubMedCrossRefGoogle Scholar
  15. 15.
    Claus D, Eggers R, Engelhardt A, Neundorfer B, Warecka K (1985) Ethanol and polyneuropathy. Acta Neurol Scand 72:312–316PubMedCrossRefGoogle Scholar
  16. 16.
    Cloninger CR, Bohman M, Sigvardsson S (1981) Inheritance of alcohol abuse. Cross-fostering analysis of adopted men. Arch Gen Psychiatry. 38:861–868PubMedCrossRefGoogle Scholar
  17. 17.
    Cohen EJ, Klatsky AL, Armstrong MA (1988) Alcohol use and supraventricular arrhythmia. Am J Cardiol 62:971–973PubMedCrossRefGoogle Scholar
  18. 18.
    Corrao G, Arico S et al (1997) Female sex and the risk of liver cirrhosis. Collaborative groups for the study of liver diseases in Italy. Scand J Gastroenterol 32:1174–1180PubMedCrossRefGoogle Scholar
  19. 19.
    Courville CB (ed) (1955) Effects of alcohol on the nervous system of man. San Lucas, Los Angeles, CAGoogle Scholar
  20. 20.
    Dawson DA, Grant BF et al (2005) Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction 100:281–292PubMedCrossRefGoogle Scholar
  21. 21.
    Day CP (2000) Who gets alcoholic liver disease: nature or nurture? J R Coll Physicians Lond 34:557–562PubMedGoogle Scholar
  22. 22.
    DeBakey SF, Stinson FS, Grant BF, Dufour MC (1996) Liver cirrhosis mortality in the United States, 1970–1993. Surveillance Report #41. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MDGoogle Scholar
  23. 23.
    DelBello MP, Strakowski SM et al (1999) Familial rates of affective and substance use disorders in patients with first-episode mania. J Affect Disord 56:55–60PubMedCrossRefGoogle Scholar
  24. 24.
    Demakis JG, Proskey A, Rahimtoola SH, Jamil M, Sutton GC, Rosen KM, Gunnar RM, Tobin JR (1974) The natural course of alcoholic cardiomyopathy. Ann Intern Med 80:293–297PubMedGoogle Scholar
  25. 25.
    DeWit DJ, Adlaf EM et al (2000) Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatry 157:745–750PubMedCrossRefGoogle Scholar
  26. 26.
    Diamond I, Messing RO (1994) Neurologic effects of alcoholism. West J Med 161:279–287PubMedGoogle Scholar
  27. 27.
    Dick DM, Bierut LJ (2006) The genetics of alcohol dependence. Curr Psychiatry Rep 8:151–157PubMedCrossRefGoogle Scholar
  28. 28.
    Donovan JE, Jessor R et al (1983) Problem drinking in adolescence and young adulthood. A follow-up study. J Stud Alcohol 44:109–137PubMedGoogle Scholar
  29. 29.
    Duranceaux NC, Schuckit MA et al (2008) Ethnic differences in level of response to alcohol between Chinese Americans and Korean Americans. J Stud Alcohol Drugs 69:227–234PubMedGoogle Scholar
  30. 30.
    Eriksson A, Tengstrom A et al (2007) Typologies of alcohol use disorders among men with schizophrenic disorders. Addict Behav 32:1146–1163PubMedCrossRefGoogle Scholar
  31. 31.
    Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ (1978) Arrhythmias and the holiday heart: alcohol-associated cardiac rhythm disorders. Am Heart J 95:555–562PubMedCrossRefGoogle Scholar
  32. 32.
    Fillmore KM, Midanik L (1984) Chronicity of drinking problems among men: a longitudinal study. J Stud Alcohol 45:228–236PubMedGoogle Scholar
  33. 33.
    Floyd RL, Sidhu JS (2004) Monitoring prenatal alcohol exposure. Am J Med Genet C 127C:3–9CrossRefGoogle Scholar
  34. 34.
    Gerding LB, Labbate LA et al (1999) Alcohol dependence and hospitalization in schizophrenia. Schizophr Res 38:71–75PubMedCrossRefGoogle Scholar
  35. 35.
    Gilder DA, Lau P et al (2007) A co-morbidity of alcohol dependence with other psychiatric disorders in young adult Mexican Americans. J Addict Dis 26:31–40PubMedCrossRefGoogle Scholar
  36. 36.
    Gilman SE, Breslau J et al (2008) Education and race-ethnicity differences in the lifetime risk of alcohol dependence. J Epidemiol Community Health 62:224–230PubMedCrossRefGoogle Scholar
  37. 37.
    Grant BF (1992) Prevalence of the proposed DSM-IV alcohol use disorders: United States, 1988. Br J Addict 87:309–316PubMedCrossRefGoogle Scholar
  38. 38.
    Grant BF (1997) Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol 58:464–473PubMedGoogle Scholar
  39. 39.
    Grant BF, Dawson DA (1998) Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse 10:163–173PubMedCrossRefGoogle Scholar
  40. 40.
    Grant T, Huggins J, Connor P, Pederson JY, Whitney N, Streissguth A (2004) A pilot community intervention for young women with fetal alcohol spectrum disorders. Community Mental Health J 49:85–91Google Scholar
  41. 41.
    Haile CN, Kosten TA et al (2008) Pharmacogenetic treatments for drug addiction: alcohol and opiates. Am J Drug Alcohol Abuse 34:355–381PubMedCrossRefGoogle Scholar
  42. 42.
    Haller RG, Knochel JP (1984) Skeletal muscle disease in alcoholism. Med Clin North Am 68:91–103PubMedGoogle Scholar
  43. 43.
    Harlem Brundtland G (2001) WHO European Ministerial Conference on Young People and Alcohol. World Health Organization, SwedenGoogle Scholar
  44. 44.
    Haynes JC, Farrell M et al (2008) Alcohol consumption as a risk factor for non-recovery from common mental disorder: results from the longitudinal follow-up of the National Psychiatric Morbidity Survey. Psychol Med 38:451–455PubMedCrossRefGoogle Scholar
  45. 45.
    Her M, Rehm J (1998) Alcohol and all-cause mortality in Europe 1982–1990: a pooled cross-section time-series analysis. Addiction 93:1335–1340PubMedCrossRefGoogle Scholar
  46. 46.
    Hingson RW, Heeren T et al (2006) Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med 160:739–746PubMedCrossRefGoogle Scholar
  47. 47.
    Hulse GK, Lautenschlager NT, Tait RJ, Almeida OP (2005) Dementia associated with alcohol and other drug use. Int Psychogeriatrics 17:S109–S127CrossRefGoogle Scholar
  48. 48.
    Inaba DS, Cohen WE (2004) Uppers, downers, all arounders: physical and mental effects of psychoactive drugs, 5th edn. CNS Publications, Ashland, ORGoogle Scholar
  49. 49.
    Itthagarun A, Nair RG, Epstein JB, King NM (2007) Fetal alcohol syndrome: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103: e20–e25PubMedGoogle Scholar
  50. 50.
    Jacobson JL, Jacobson SW (2002) Effects of prenatal alcohol exposure on child development. Alcohol Res Health 26:282–286PubMedGoogle Scholar
  51. 51.
    Jessor R (1987) Problem-behavior theory, psychosocial development, and adolescent problem drinking. Br J Addict 82:331–342PubMedCrossRefGoogle Scholar
  52. 52.
    Johnson BA, Cloninger CR, Roache JD, et al (2000) Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population. Am J Addict 9:17–27PubMedCrossRefGoogle Scholar
  53. 53.
    Kasper EK, Willem WRP, Hutchins GM, Deckers JW, Hare JM, Buaghman KL (1994) The causes of dilated cardiomyopathy. Clinicopathologic review of 673 consecutive patients. J Am Coll Cardiol 23:586–590PubMedCrossRefGoogle Scholar
  54. 54.
    Keil U, Swales JD, Grobbee DE (1993) Alcohol intake and its relation to hypertension. In: Verschuren PM (ed) Health issues related to alcohol consumption. ILSI, Washington, DCGoogle Scholar
  55. 55.
    Kendler KS, Schmitt E et al (2008) Genetic and environmental influences on alcohol, caffeine, cannabis, and nicotine use from early adolescence to middle adulthood. Arch Gen Psychiatry 65:674–682PubMedCrossRefGoogle Scholar
  56. 56.
    Kessler RC, Crum RM et al (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 54:313–321PubMedCrossRefGoogle Scholar
  57. 57.
    Klatsky AL (1994) Epidemiology of coronary heart disease – influence of alcohol. Alcohol Clin Exp Res 18:88–96PubMedCrossRefGoogle Scholar
  58. 58.
    Klatsky AL (1995) Blood pressure and alcohol intake. In: Laragh JH, Brenner BM (eds) Hypertension: pathophysiology, diagnosis, and management, 2nd edn. Raven, New YorkGoogle Scholar
  59. 59.
    Konarzewska B, Poplawska R et al (2007) Impact of alcohol dependence on the course and psychopathology of schizophrenia. Psychiatr Pol 41:715–726PubMedGoogle Scholar
  60. 60.
    Kosten TR, O’Connor PG (2003) Management of drug and alcohol withdrawal. N Engl J Med 348:1786–1795PubMedCrossRefGoogle Scholar
  61. 61.
    Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse. Ann NY Acad Sci 252:85–105PubMedCrossRefGoogle Scholar
  62. 62.
    Lieber CS (1994) Alcohol and the liver: 1994 update. Gastroenterology 106:1085PubMedGoogle Scholar
  63. 63.
    Lupton C, Burd L, Harwood R (2004) The cost of fetal alcohol spectrum disorders. Am J Med Genet C Sem Med Genet 127C:42–50CrossRefGoogle Scholar
  64. 64.
    Maclure M (1993) Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. Epidemiology Rev 15:328–351Google Scholar
  65. 65.
    MacMahon S (1987) Alcohol consumption and hypertension. Hypertension 9:111–121PubMedCrossRefGoogle Scholar
  66. 66.
    McLane JA (1987) Decreased axonal transport in rat nerve following acute and chronic ethanol exposure. Alcohol 4:385–389PubMedCrossRefGoogle Scholar
  67. 67.
    Merikangas KR, Stolar M et al (1998) Familial transmission of substance use disorders. Arch Gen Psychiatry 55:973–979PubMedCrossRefGoogle Scholar
  68. 68.
    Michalak L, Trocki K et al (2007) Religion and alcohol in the U.S. National Alcohol Survey: how important is religion for abstention and drinking? Drug Alcohol Depend 87:268–280PubMedCrossRefGoogle Scholar
  69. 69.
    Moddrey WC (1988) Alcoholic hepatitis: clinicopathologic features and therapy. Sem Liver Dis 8:91–102CrossRefGoogle Scholar
  70. 70.
    Mukherjee RAS, Hollins S, Turk J (2006) Fetal alcohol spectrum disorder: an overview. J R Soc Med 99:298–302PubMedCrossRefGoogle Scholar
  71. 71.
    National Institute on Alcohol Abuse and Alcoholism (1997) Alcohol metabolism. Alcohol Alert No. 35Google Scholar
  72. 72.
    National Institute on Alcohol Abuse and Alcoholism (2000) Medical consequences of alcohol abuse. Alcohol Res Health 24:27–31Google Scholar
  73. 73.
    National Institute on Alcohol Abuse and Alcoholism (2003) Understanding alcohol: investigations into biology and behaviorGoogle Scholar
  74. 74.
    National Institutes of Health: Understanding alcohol [Online]. Available at (2006). Accessed 22 June 2009
  75. 75.
    National Institute on Alcohol Abuse and Alcoholism (2007) Helping patients who drink too much: a clinician’s guideGoogle Scholar
  76. 76.
    National Institute on Alcohol Abuse and Alcoholism (2008) Surveillance Report #85: apparent per capita alcohol consumption: national, state, and regional trends, 1977–2006Google Scholar
  77. 77.
    Noble EP (1977) A health caution: fetal alcohol syndrome. National Institute on Alcohol Abuse and Alcoholism. U.S. Department of Health, Education and Welfare, Washington, DCGoogle Scholar
  78. 78.
    O’Connell J, Novins DK et al (2006) The relationship between patterns of alcohol use and mental and physical health disorders in two American Indian populations. Addiction 101:69–83PubMedCrossRefGoogle Scholar
  79. 79.
    Orrego H, Israel Y, Blake JE et al (1983) Assessment of prognostic factors in alcoholic liver disease: towards a global quantitative expression of severity. Hepatology 3:896PubMedCrossRefGoogle Scholar
  80. 80.
    Parrish KM, Dufour MC et al (1993) Average daily alcohol consumption during adult life among decedents with and without cirrhosis: the 1986 National Mortality Followback Survey. J Stud Alcohol 54:450–456PubMedGoogle Scholar
  81. 81.
    Pratt OE (1984) Introduction: what do we know of the mechanisms of alcohol damage in utero? Ciba Found Symp 105:1–7PubMedGoogle Scholar
  82. 82.
    Regan TJ (1984) Alcoholic cardiomyopathy. Prog Cardiovasc Dis 27:141–152PubMedCrossRefGoogle Scholar
  83. 83.
    Rehm JT, Bondy SJ, Sempos CT, Vuong CV (1997) Alcohol consumption and coronary heart disease morbidity and mortality. Am J Epidemiol 146:495–501PubMedCrossRefGoogle Scholar
  84. 84.
    Rehm J, Sulkowska U et al (2007) Alcohol accounts for a high proportion of premature mortality in central and eastern Europe. Int J Epidemiol 36:458–467PubMedCrossRefGoogle Scholar
  85. 85.
    Renaud S, Criqui MH, Farchi G, Veenstra J (1993) Alcohol drinking and coronary heart disease. In: Verschuren PM (ed) Health issues related to alcohol consumption. ILSI, Washington, DCGoogle Scholar
  86. 86.
    Reuler JB, Girard GE, Conney TG (1985) Wernicke’s encephalopathy. N Engl J Med 312:1035–1038PubMedCrossRefGoogle Scholar
  87. 87.
    Rohde P, Lewinsohn PM et al (1996) Psychiatric comorbidity with problematic alcohol use in high school students. J Am Acad Chil Adolesc Psychiatry 35:101–109CrossRefGoogle Scholar
  88. 88.
    Safdar K, Schiff ER (2004) Alcohol and hepatitis C. Semin Liv Dis 24:305–315CrossRefGoogle Scholar
  89. 89.
    Sampson PD, Streissguth AP, Bookstein FL (1997) Incidence of developmental alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology 56:317–326PubMedCrossRefGoogle Scholar
  90. 90.
    Saxton J, Munro CA et al (2000) Alcohol, dementia, and Alzheimer’s disease: comparison of neuropsychological profiles. J Geriatr Psychiatry Neurol 13:141–149PubMedGoogle Scholar
  91. 91.
    Schiff ER, Ozden N (2003) Hepatitis C and alcohol. Alcohol Res Health 27:232–239PubMedGoogle Scholar
  92. 92.
    Schuckit MA, Tipp JE et al (1995) An evaluation of type A and B alcoholics. Addiction 90:1189–1203PubMedCrossRefGoogle Scholar
  93. 93.
    Seitz HK, Sutter PM (1994) Ethanol toxicity and nutritional status. In: Kotsonis FN, Mackey M, Hjelle J (eds) Ethanol toxicity and nutritional status. Raven, New YorkGoogle Scholar
  94. 94.
    Shimamura AP, Jernigan TL, Squire LR (1988) Korsakoff’s syndrome: radiological (CT) findings and neuropsychological correlates. J Neurosci 10:561–565Google Scholar
  95. 95.
    Song SK, Rubin E (1972) Ethanol produces muscle damage in human volunteers. Science 175:327–328PubMedCrossRefGoogle Scholar
  96. 96.
    Stasiewicz PR, Vincent PC et al (2008) Factors affecting agreement between severely mentally ill alcohol abusers’ and collaterals’ reports of alcohol and other substance abuse. Psychol Addict Behav 22:78–87PubMedCrossRefGoogle Scholar
  97. 97.
    Strakowski SM, DelBello MP et al (2005) Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry 62:851–858PubMedCrossRefGoogle Scholar
  98. 98.
    Streithguth AP, O’Malley K (2000) Neuropsychiatric implications and long term consequences of fetal alcohol spectrum disorders. Sem Clin Neuropsychiatry 5:177–190CrossRefGoogle Scholar
  99. 99.
    Szlemko WJ, Wood JW et al (2006) Native Americans and alcohol: past, present, and future. J Gen Psychol 133:435–451PubMedCrossRefGoogle Scholar
  100. 100.
    Temple MT, Fillmore KM (1985) The variability of drinking patterns and problems among young men, age 16–31: a longitudinal study. Int J Addict 20:1595–1620PubMedGoogle Scholar
  101. 101.
    Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E (1989) The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med 320:409–415PubMedCrossRefGoogle Scholar
  102. 102.
    Vaillant GE (1980) Natural history of male psychological health: VIII. Antecedents of alcoholism and “orality”. Am J Psychiatry 137:181–186PubMedCrossRefGoogle Scholar
  103. 103.
    Vaillant GE, Gale L et al (1982) Natural history of male alcoholism. II. The relationship between different diagnostic dimensions. J Stud Alcohol 43:216–232PubMedGoogle Scholar
  104. 104.
    Victor M, Adams RD, Collins GH (1989) The Wernicke’s-Korsakoff syndrome and related neurologic disorders due to alcoholism and malnutrition. FA Davis, Philadelphia, PAGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Departments of Psychiatry and Neurobehavioral Sciences, Medicine, and NeuroscienceUniversity of VirginiaCharlottesvilleUSA
  2. 2.Departments of Psychiatry and Neurobehavioral Sciences, Medicine, and NeuroscienceUniversity of VirginiaCharlottesvilleUSA

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