Alcohol Intoxication DSM-5 303.00(F10.129), (F10.229), (F10.9292)
DSM-5 Category Substance Related and Addictive Disorders
Introduction
Alcohol intoxication is the direct result of alcohol consumption. The DSM-5 explains that alcohol intoxication is characterized by clinically significant behavioral or psychological changes that occur after drinking alcohol. Common symptoms include slurred speech, poor balance, dizziness, headache and nausea. Alcohol intoxication is extremely prevalent in the United States, particularly among young adults. Alcohol intoxication is extremely dangerous, and is the third leading cause of lifestyle related death in the United States. Illness and injury related to alcohol intoxication account for nearly a quarter of all emergency room visits. Alcohol poisoning, alcohol-related automobile accidents and suicide attempts while under the influence can all be fatal. In severe cases, alcohol intoxication requires emergency medical care. Assessing alcohol dependence is an important component of treating alcohol intoxication.
Symptoms of Alcohol Intoxication
The most common symptoms of alcohol intoxication are slurred speech, impaired coordination, trouble with balance and walking, involuntary eye movement, impaired attention or memory and loss of consciousness (American Psychiatric Association, 2013). Intoxicated individuals may also experience nausea, vomiting, vertigo, headache and present with bloodshot eyes (Vonghia, et al., 2008).The DSM-5 also explains that alcohol intoxication can produce problematic psychological or behavioral changes such as impaired judgment, unusual mood changes, inappropriate sexual behavior, and aggression. In some cases, the intoxicated individual may have little or no memory of events that occurred during intoxication. In severe cases, alcohol intoxication can lead to coma or death. All symptoms of alcohol intoxication begin shortly after alcohol ingestion and can last for several hours. Symptoms are not attributed to other medical condition or medication. Symptoms and severity of symptoms vary widely depending on the individual tolerance of the individual, the quantity of alcohol consumed and the period of time during which the alcohol was consumed (American Psychiatric Association, 2013).
Prevalence
Because alcohol is widely accessible, alcohol intoxication is extremely common; particularly among adults ages 18-25. According to the DSM-5, 44% of high school seniors and 70% of college students in 2010 reported having been intoxicated within the past year (American Psychiatric Association, 2013) .
Social Aspects of Alcohol Intoxication
Alcohol is most common during and around holidays and major social events. A recent Australian study found that alcohol intoxication requiring medical care happens most often on New Year’s Day, Christmas, Christmas Eve, and days during which a major sporting event occurred. Additionally, people enjoy drinking at wedding, parties, and while on vacation (Lloyd, et al., 2013).
Morbidity and Mortality Associated with Alcohol Intoxication
Alcohol intoxication can lead to a variety of injuries and dangerous medical conditions. Because alcohol impairs judgment, intoxicated individuals may make unwise or unsafe decisions. Gambling, unsafe sex, and physical confrontation can lead to injury or chronic health problems. Additionally, the poor physical coordination related to alcohol intoxication can make intoxicated individuals more likely to sustain injuries during every-day activities such as cooking, swimming or driving. One recent study found that individuals are 7 times more likely to require medical care when intoxicated than when not intoxicated. Nearly a quarter of all emergency room injuries are related to alcohol intoxication. Common injuries include suicide attempts, burns, near-drowning, falls, spinal cord injury and motor vehicle accident injuries. 36% of assaults requiring emergency treatment are also related to alcohol intoxication (Millier & Spicer, 2012). 35% of victims of intimate partner violence and child abuse report that their perpetrator was under the influence of alcohol at the time of the attack (Centers for Disease Control and Prevention, 2013).
Excessive alcohol is the third leading cause of lifestyle related death in the United States. In addition to injuries that more than one million emergency room visits each year, 88,000 deaths in the United States each year are related to alcohol intoxication (Centers for Disease Control and Prevention, 2013). Alcohol poisoning occurs when the blood stream contains so much alcohol that the brain is no longer able to control basic life functions such as breathing, heart rate and body temperature regulation. Symptoms of alcohol poison include vomiting, seizure, slowed breathing, low body temperature, mental confusion and loss of consciousness. Without emergency medical attention, alcohol poisoning can be fatal (National Institute on Alcohol Abuse and Alcoholism, 2013).
Driving while intoxicated is a significant health and safety issue in the United States. In 2013, 13,365 deaths were directly related to alcohol-related highway accidents. Although legislation has worked to reduce driving under the influence, it remains a frightening reality. Although less common, boating while the under the influence of alcohol is also very dangerous. In 2010, 22% of boating fatalities involved alcohol intoxication (Chambers, Liu & Moore, 2010).
The DSM-5 warns that alcohol intoxication increase the risk of attempted and completed suicide (American Psychiatric Association, 2013). Legal alcohol intoxication prior to completing a suicide is particularly common in the United States among ethnic minority males. In the United States, the rates vary greatly depending on ethnic background. 47% of Native American suicide descendants test positively for alcohol intoxication at time of death. 23% of Asian American suicide descendants are intoxicated. Among all ethnic groups, intoxicated suicide victims tend to be male, under 30 years old and use a gun as their method of suicide (Caetano, 2013).
Treatment of Alcohol Intoxication
Although the majority of alcohol intoxication is naturally resolved with time, acute alcohol intoxication may require emergency medical care. The clinical goal in treating alcohol intoxication is to stabilize the patient’s clinical condition. Patients are usually treated with intravenous fluid to hydrate the patient and to correct hypoglycemia or electrolyte imbalance. In some cases, medication is used to relieve nausea or vomiting. Special attention is paid to the patient’s respiratory, cardiac, pulmonary, metabolic and gastrointestinal health, as these can be damaged by severe alcohol intoxication (Vonghia, et al., 2008).
Perhaps the most important component of treating acute alcohol intoxication is to determine whether the alcohol intoxication is the result of a single incident or chronic alcohol abuse. This can be done through blood tests, to determine biological markers for alcohol dependence and patient interview. If the alcohol intoxication is the result of a single incident, brief counseling and education is usually sufficient to prevent continued harmful drinking practices. If the intoxication is the result of chronic alcohol abuse or dependence, the patient should be referred to alcohol treatment (Vonghia, et al., 2008).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Caetano, R., Kaplan. M.S., Hugeuet, N., McFarland, B.H., Conner, K., Giesbretcht, N. & Nolte, K.B. (2013).Acute Alcohol Intoxication and Suicide Among United States Ethnic/Racial Groups: Findings from the National Violent Death Reporting System. Alcoholism: Clinical and Experimental Research. 37 (5): 839-846
Centers for Disease Control and Prevention (2013). Fact Sheets: Alcohol Use and Health.
National Institute on Alcohol Abuse and Alcoholism (2013). Alcohol Overdose: The Dangers of Drinking Too Much.
Chambers, C., Liu, M. & Moore. (2010). Drunk driving by the numbers. United States Department of Education.
Lloyd, B., Matthews, S., Livingstons, M., Jayasekara, H. & Smith, K. (2013).http://pepperdine.worldcat.org/title/alcohol-intoxication-in-the-context-of-major-public-holidays-sporting-and-social-events-a-time-series-analysis-in-melbourne-australia-2000-2009/oclc/5153525716 Alcohol intoxication in the context of major public holidays, sporting and social events: a time-series analysis in Melbourne, Australia, 2000-2009. Addiction 108(4): 701-709
Vonghia, L., Leggio, L., Ferrulli, A., Bertini, M., Gasbarrini, G. & Addolorato, G. (2008). Acute alcohol intoxication. European Journal of Internal Medicine. 19(8): 561-567
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