perience an alcohol-related adverse event at so me time in their lives, with alcohol account-
ing for up to 55% of fatal driving events. Severe alcohol use disorder, especially in
individuals with antisocial personality disorder, is associated with the commission of
criminal acts, including homicide. Severe problematic alcohol use also contributes to dis-
inhibition and feelings of sadness and irritab ility, which contribute to suicide attempts and
completed suicides.
Unanticipated alcohol withdrawal in hospitalized individuals for whom a diagnosis of
alcohol use disorder has been overlooked can a dd to the risks and costs of hospitalization
and to time spent in the hospital.
Differential Diagnosis
Nonpathological use of alcohol. The key element of alcohol use disorder is the use of
heavy doses of alcohol with resulting repeated and significant distress or impaired func-
tioning. While most drinkers sometimes consume enough alcohol to feel intoxicated, only
a minority (less than 20%) ever develop al cohol use disorder. Therefore, drinking, even
daily, in low doses and occasional intoxication do not by themselves make this diagnosis.
Sedative, hypnotic, or anxiolytic use disorder. The signs and symptoms of alcohol use
disorder are similar to those seen in sedative, hypnotic, or anxiolytic use disorder. The two
must be distinguished, however, because the c ourse may be different, especially in rela-
tion to medical problems.
Conduct disorder in childhood and adult antisocial personality disorder. Alcohol use
disorder, along with other substa nce use disorders, is seen in the majority of individuals
with antisocial personality and preexisting conduct disorder. Because these diagnoses are
associated with an early onset of alcohol use disorder as well as a worse prognosis, it is im-
portant to establish both conditions.
Comorbidity