496 Substance-Related and Addictive Disorders
ing can accompany gastritis, and hepatomegaly, esophageal varices, and hemorrhoids may
reflect alcohol-induced changes in the liver. Other physical signs of heavy drinking include
tremor, unsteady gait, insomnia, and erectile dy sfunction. Males with chronic alcohol use dis-
order may exhibit decreased testicular size and feminizing effects associated with reduced
testosterone levels. Repeated he avy drinking in females is associated with menstrual irregu-
larities and, during pregnancy, spontaneous abortion and fetal alcohol syndrome. Individu-
als with preexisting histories of epilepsy or se vere head trauma are more likely to develop
alcohol-related seizures. Alcohol withdrawal ma y be associated with nausea, vomiting, gas-
tritis, hematemesis, dry mouth, puffy blot chy complexion, and mild peripheral edema.
Functional Consequences of Alcohol Use Disorder
The diagnostic features of alcohol use disord er highlight major area s of life functioning
likely to be impaired. These include driving and operating machinery, school and work,
interpersonal relationships and communication, and health. Alcoho l-related disorders
contribute to absenteeism from work, job-re lated accidents, and low employee productiv-
ity. Rates are elevated in homeless individual s, perhaps reflecting a downward spiral in
social and occupational functioning, although most individuals with alcohol use disorder
continue to live with their families and function within their jobs.
Alcohol use disorder is associated with a significant increase in the risk of accidents, vi-
olence, and suicide. It is estimated that one in  five intensive care un it admissions in some
urban hospitals is related to al cohol and that 40% of individu als in the United States ex-
perience an alcohol-related adverse event at so me time in their lives, with alcohol account-