Alcoholism Differential Diagnoses

Updated: Sep 12, 2017
  • Author: Warren Thompson, MD, FACP; Chief Editor: Randon S Welton, MD  more...
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Diagnostic Considerations

The relationship between alcohol and bipolar disorder is an important dual diagnosis. In fact, a substance abuse disorder is seen in nearly 60% of individuals with bipolar disorder. [33] Any individual who presents with significant mood fluctuations must be screened for an alcohol use disorder.

Panic disorder, generalized anxiety disorder, social phobia, dysthymic disorder, major depression, bipolar mania, or primary (idiopathic) insomnia: Alcohol abuse or dependence might reflect self-treatment for these conditions.

Other drug abuse (both prescription drugs and street drugs): Consider the possibility of other drug abuse, both prescription drugs and street drugs.

Comorbid disorders: Also consider comorbid psychiatric conditions such as anxiety and depression. Depression, anxiety, and antisocial personality all are more common in persons with alcoholism than in the general population (20.5% vs 7.2%, 23.5% vs 11.1%, and 18.3% vs 3.6%, respectively).

Of particular importance is the common concurrence of posttraumatic stress disorder (PTSD) and alcohol abuse. The activating symptoms of alcohol withdrawal aggravate the PTSD, which inevitably increases the risk of relapse. [34] A number of studies examined alcohol use in the aftermath of the attacks on the World Trade Center. A survey conducted 9 months after the terrorist attack found a 17.5% increase in alcohol use when compared with consumption patterns in the month preceding the attack. The same study noted that PTSD declined during those 9 months, but alcohol use remained elevated. [35] Individuals glued to the television experienced higher rates of PTSD. Nationwide estimates of PTSD in the 2 months following 9/11 varied according to the television viewing time, ranging between 2.7-4.3%. [36]

Another study examined combat veterans of the first Gulf War. Six years after that brief war, a significant correlation still existed between alcohol use disorders and PTSD. [37] The co-occurring disorders of PTSD and alcohol abuse are expressed differently between the genders. Men are much more likely to experience irritability as they drink excessively. [38] Women with PTSD also abuse alcohol, but are more likely to suffer from vague physical complaints and depression. [39]

Differential Diagnoses