Alcohol Use Disorder 495
Polymorphisms of genes for the alcohol- metabolizing enzymes alcohol dehydroge-
nase and aldehyde dehydrogenase are most ofte n seen in Asians and affect the response to
alcohol. When consuming alcoho l, individuals with these gene variations can experience a
flushed face and palpitations, reactions that ca n be so severe as to lim it or preclude future
alcohol consumption and diminish the risk fo r alcohol use disorder. These gene variations
are seen in as many as 40% of Japanese, Chinese, Korean, and related groups worldwide
and are related to lower risks for the disorder.
Despite small variations regarding individual criterion items, the diagnostic criteria
perform equally well across mo st race/ethnicity groups.
Gender-Related Diagnostic Issues
Males have higher rates of drinking and rela ted disorders than fema les. However, because
females generally weigh less than males, have more fat and less water in their bodies, and
metabolize less alcohol in their esophagus and stomach, they are likely to develop higher
blood alcohol levels per drink than males. Females who drink heavily may also be more
vulnerable than males to some of the physical consequences associated with alcohol, in-
cluding liver disease.
Diagnostic Markers
Individuals whose heavier drinking places them  at elevated risk for alcohol use disorder
can be identified both through standardized qu estionnaires and by elevations in blood test
results likely to be seen with regular heavie r drinking. These measures do not establish a
diagnosis of an alcohol-related disorder but can be useful in highlighting individuals for
whom more information should be gathered. Th e most direct test available to measure al-
cohol consumption cross-sectionally is blood alcohol concentration,  which can also be used to