Assessment and Management of Medical Complications of Alcohol Use

Patients with an AUD may present with medical complications of alcohol misuse as the trigger for change rather than to seek direct help for alcohol problems. For many individuals, concerns about medical complications may be the only motivator to seek help for alcohol dependence, and these factors can be important in keeping patients engaged and committed to abstinence-oriented treatment programs.  

Patients with AUD frequently have significant physical comorbidities and require assessment for these comorbidities irrespective of the reason for presentation. Therefore, management of AUD should include screening for major physical health problems, particularly of liver and pancreas, cardiovascular diseases, and cancers. Clinicians involved in the assessment and treatment of AUD should be aware of and familiar with the assessment of important medical comorbidities. Generally, younger people with alcohol problems are more likely to present with an acute injury related to alcohol, while older patients are more likely to present with chronic complications from alcohol.  

Pharmacologic interventions for AUD (see Chapter 10) such as naltrexone and disulfiram can be hazardous in advanced liver disease, and clinicians prescribing such agents should be able to assess for an underlying diagnosis of decompensated alcohol-related liver cirrhosis. 

Chapter Recommendation Grade of recommendation
22.2 Comprehensive medical evaluation for physical comorbidities is recommended for patients with AUD, even when the reason for a consultation does not include a medical comorbidity. B