Alcohol Use Disorder (AUD)

The Centers for Disease Control and Prevention (CDC) estimates 178,000 deaths in the U.S. occur each year because of excessive alcohol use. Drinking alcohol has been defined as moderate drinking, binge drinking, heaving drinking, underage drinking and drinking while pregnant. It is estimated that 10% to 15% of nurses will abuse alcohol during their professional careers (Servodidio, 2011).

Moderate drinking is characterized as drinking one alcoholic drink a day for women and two for men. Some research shows moderate alcohol consumption, particularly red wine, may decrease the risk for heart disease.

Binge drinking is defined as drinking more than four drinks on a single occasion for women and five drinks for men once in 30 days. Heavy drinking is defined as consuming more than eight drinks a week for women and 15 or more drinks per week for men, as well as five or more episodes of binge drinking in 30 days. https://www.cdc.gov/alcohol/about-alcohol-use/index.html

DSM-5 alcohol use disorder (AUD) diagnostic criteria

AUD is classified by severity based on the number of symptoms.

Mild: The presence of 2 to 3 symptoms.

Moderate: The presence of 4 to 5 symptoms.

Severe: The presence of 6 or more symptoms.

The 11 symptoms of AUD

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. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm

A diagnosis of (AUD) includes:

https://auditscreen.org/check-your-drinking

Signs Of Alcoholism In Medical Professionals

Doctors and nurses who abuse alcohol are typically considered high-functioning alcoholics.  This refers to someone who drinks an unhealthy amount of alcohol but still balances a successful career or personal life. It is often more challenging for friends and family of high-functioning alcoholics to identify a problem because the alcoholic is so good at masking their condition. For the same reasons, high-functioning alcoholics are also more likely to deny that they have a problem. However, there are identifiable signs, including:

https://www.alcoholrehabguide.org/resources/alcoholism-and-medical-professionals/

Mercer et al (2023) found in an analysis of 78 articles the following were found to contribute to workplace stress and trauma that contributed to alcohol use by nurses.

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Frequent absences or breaks during a shift
Alcohol on breath
 Frequent hangovers
 Mood swings/ irritability
All of the above

References

Mercer, M., Stimpfel, A.W. & Dickson, V.V. (2023). Psychosocial Factors Associated With Alcohol Use Among Nurses: An Integrative Review. J Nurs Regul. 13(4), 10.1016/s2155-8256(23)00032-7.

Servodidia, C. A. (2011). Alcohol Abuse in the Workplace and Patient Safety. Clinical Journal of Oncology Nursing. 15(2), 143-5.

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