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Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis

Jeanette M Tetrault, MD, FACP
Patrick G O'Connor, MD, MPH
Section Editor
Richard Saitz, MD, MPH, FACP, DFASAM
Deputy Editor
Richard Hermann, MD


The degree to which individuals consume alcohol varies greatly, as does alcohol’s impact on health and the risk of associated behavioral and medical problems [1]. An estimated 4 to 40 percent of medical and surgical patients experience problems related to alcohol [2]. More than 85,000 deaths a year in the United States (US) are directly attributed to alcohol use [3]; the annual economic cost of alcohol use is estimated to be over $250 billion [4]. Roughly 1 in 10 deaths among working age adults results from excessive drinking [5].

Unhealthy alcohol use ranges from use that puts patients at risk of health consequences to use causing multiple medical and/or behavioral problems meeting DSM-5 diagnostic criteria for alcohol use disorder.

The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of patients with unhealthy alcohol use, including alcohol use disorder, are discussed here. Screening and brief intervention for unhealthy alcohol use are discussed separately. Pharmacotherapy and psychosocial treatment for alcohol use disorder are also discussed separately. (See "Screening for unhealthy use of alcohol and other drugs in primary care" and "Brief intervention for unhealthy alcohol and other drug use" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder".)


Many terms have been used to describe alcohol use and alcohol-related problems and disorders; this terminology is evolving rapidly. The most useful, consistently defined terms are discussed below:

Unhealthy alcohol use — Unhealthy alcohol use encompasses the spectrum of alcohol use that can result in health consequences [6], including:


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