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Assessing
Alcohol Intoxication
The potential for alcohol withdrawal syndrome (AWS) can be gauged only
imprecisely by asking the patient the pattern, type, and quantity of recent
and past alcohol use.
Recent
intake of alcohol can be assessed from the history, physical examination
(e.g., alcohol on the breath), or toxicological analysis of urine or blood.
The specific clinical picture of alcohol intoxication depends on quantity
and frequency of consumption, the duration of drinking at that level,
tolerance, time since last drink, expectations of effects, and the environment
or setting of drinking.
According
to the DSM-IV (APA, 1994) substance intoxication is:
- The development
of a reversible, substance-specific syndrome due to recent ingestion
of (or exposure to) a substance. Note: Different substances may produce
similar or identical syndromes.
- Clinically
significant maladaptive behavioral or psychological changes that are
due to the effect of the substance on the central nervous system (e.g.,
belligerence, mood lability, cognitive impairment, impaired judgment,
and impaired social or occupational functioning) and develop during
or shortly after use of the substance.
- Note:
The symptoms are not due to a general medical condition and are not
better accounted for by another mental disorder.
Other
substance intoxication considerations:
- The most
common signs and symptoms involve disturbances of perception, wakefulness,
attention, thinking, judgment, psychomotor behavior, and interpersonal
behavior.
- Patients
should be medically observed at least until the blood alcohol level
(BAL) is decreasing and clinical presentation is improving.
- Highly
tolerant individuals may not show signs of intoxication. For example,
patients may appear "sober" (or even exhibit significant withdrawal
symptoms) at BALs well above the legal limit (e.g., 80 or 100 mg percent),
but will still need detoxification.
Table
1. Signs and Symptoms of Intoxication (APA, 1994)
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Types
of Intoxication
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Signs
and Symptoms
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Alcohol
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•
Slurred speech
• Incoordination
• Unsteady gait
• Nystagmus
• Impairment in attention or memory
• Stupor or coma
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