Important Concepts in

Alcohol Use Disorder

Paul H. Earley, M.D., DFASAM

Earley Consultancy, LLC
President, American Society of Addiction Medicine
Immediate Past President, Federation of State Physician Health Programs
www.paulearley.net
Important Concepts in
Alcohol Use Disorder

Paul H. Earley, M.D., DFASAM

Earley Consultancy, LLC
President, American Society of Addiction Medicine
Immediate Past President, Federation of State Physician Health Programs
www.paulearley.net
 COI Disclosures
 Financial
 Georgia Professionals Health Program, Inc., a 501(c)3 foundation (Salary)
 Principal, Earley Consultancy, LLC (Salary)
 DynamiCare Health, Inc. (Stock)
 Two Books related to this talk:
 RecoveryMind Training
 Recovery Skills Manual for RecoveryMind Training

 Non-financial
 President, American Society of Addiction Medicine (ASAM)
 Immediate Past President, Federation of State Physician Health
Programs (FSPHP)
Alcohol Consumption per Capita

Reporting average (per capita) consumption in liters of pure alcohol per year
 Heavy Alcohol Use
 NIAAA defines heavy alcohol use as more than 4 standard drinks on
any day for men or more than 3 drinks for women.
 SAMHSA defines heavy alcohol use as binge drinking on 5 or more
days in the past month.
 Global Averages
 The worldwide average consumption in 2016 was 6.4 liters of grain
alcohol which is ~5,024 grams. This equates to an approximate
average of one standard drink per person, per day worldwide.
 The country with the highest per capita consumption is Moldova with
15.2 liters of alcohol per person over 15. This equates to an
approximate average of 2.4 standard drinks per person, per day in
Moldova. This means that NIAAA-defined “heavy daily alcohol use”
occurs in ~2/3 Moldovans over 15.
 However, 90% of excessive drinkers do not meet the criteria for
current alcohol use disorder moderate or severe.1
 However, individuals with AUD consume much more than social
drinkers.

6
1
Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS. Prevalence of alcohol
dependence among US adult drinkers, 2009-2011. Prev Chronic Dis. 2014;11:E206. 2014 - data from
the NSDUH study.
 Is there a safe amount of alcohol use?

• Alcohol use was the seventh leading cause of death and

disability worldwide in 2016; about 2% of female deaths and
7% of male deaths (2.8 million deaths in total) were
considered alcohol-related.
• For those ages 15 to 49, alcohol was the leading risk factor for
death and disability worldwide. Tuberculosis, road injuries,
and self-harm were the top causes (the risk of each of these
conditions is higher if you drink enough).
• For older adults, cancers related to alcohol use were the top
causes of death.
• In general, health risks rose with rising amounts of alcohol
use. 
• The authors concluded: “Our results show that the safest level
of drinking is none.”
 Broad Spectrum of Alcohol Use

Use crosses
over a “wall”

Casual Use Misuse Use creates Addiction

life
consequences
 Risk of Transitioning to SUD
(from first use)

80

70

60

50

40

30

20

10

0
Cannabis Cocaine Alcohol Nicotine

Lopez-Quintero C, et al. Probability and predictors in transition from first use to dependence on nicotine, alcohol,
cannabis, and cocaine: Results of the National Epidemiological Survey on Alcohol and Related Conditions
(NESARC). Drug Alcohol Depend. 2011; 115:120–130.
 ASAM Definition of Addiction
2019

 Addiction is a treatable, chronic medical disease

involving complex interactions among brain circuits,
genetics, the environment, and an individual’s life
experiences. People with addiction use substances or
engage in behaviors that become compulsive and often
continue despite harmful consequences. 
 Prevention efforts and treatment approaches for
addiction are generally as successful as those for other
chronic diseases.
Physiological Dependence versus Addiction

Physiological Addiction
Dependence
Occurs in all individuals Occurs in 10% of the
population
Is a characteristic of certain Is a characteristic of certain
drugs people with certain drugs
Craving occurs during drug Craving is tied to many
withdrawal. emotional and cognitive
triggers, occurring long past
the withdrawal time.
 The Etiology of Addiction

Genetic Earlier Life

Proclivity Trauma

Addiction
Personality Environment
and and Access
Psychiatric
Disease
The VTA Reprograms the Brain
 The Addictionectomy

Substance Abusing Patient

Treatment

Non-substance Abusing Patient

This diagram and concept is from A. Thomas McLellan, PhD, and is courtesy of Dr. McLellan
 Recovery is a
Recovery
marathon not a
sprint.
 ASAM
SUPPORTING ACCESS TO ALCOHOL USE DISORDER AND
ALCOHOL WITHDRAWAL TREATMENT DURING THE COVID-19 PANDEMIC

https://www.asam.org/Quality-
Science/covid-19-
coronavirus/access-to-alcohol-
use-disorder-and-alcohol-
withdrawal-treatment
 Education and Consultation

 For more information and training:

– World Wide Web:
– www.paulearley.net
– E-mail: paulearley@earleyconsultancy.com