Symptoms

Noticeable changes in mood and behavior characterize alcohol use disorder symptoms. 

• Behavioral symptoms of AUD: increased alcohol consumption, unsuccessful attempts to limit the amount of alcohol use, continued usage despite evidence of adverse effects, and failure to meet daily responsibilities. 
• Physical Symptoms: developing a tolerance to alcohol, experiencing withdrawal symptoms such as tremors, blackouts, sweating, and nausea when not used, also common are liver disease and gastrointestinal problems. 
• Psychological Symptoms include: having a strong craving for alcohol, and mood disturbances like aggression, euphoria, loneliness, self-destructive behaviour, and anxiety. As much as half of the problematic users get depressed, with some becoming suicidal.

Clinical Findings

During psychiatric examination, signs of intoxication, cognitive impairments, mood swings, and withdrawal may be observed. Physical examination can present signs of chronic alcohol use, such as increased/decreased liver size, jaundice, ascites, and peripheral neuropathy. The examination is crucial as many clients may not report some features until when examined.

Differential Diagnosis

Several conditions that may present with unhealthy alcohol use include; 

• Posttraumatic stress disorder
• Bipolar disorder 
• Generalized anxiety disorder and panic disorder
• Dysthymic disorder
• Medical conditions like Hepatic encephalopathy and delirium
• Other Substance Use Disorders (Cannabis, opioids, and Polysubstance use).

Investigations

Investigations to consider during the diagnosis of AUD include:

• Evaluation of the patient's history 
• Use of screening questionnaires, e.g, Alcohol Use Disorders Identification Test (AUDIT), to assess the level of alcohol use, tolerance, and potential issues. 
• The severity of AUD can be determined using DSM-5 diagnostic criteria. 
• Drug Test: Alcohol is only seen in routine urine drug testing within 3 hours of last use, thus it may be negative on urine testing. This discordance between clinical self-report, psychometric tool assessment, and laboratory analysis underscores the need for further scrutiny and caution while using any approach as a stand-alone, especially when planning for interventions.
• Blood alcohol levels to confirm recent use.
• Some laboratory tests, such as liver function tests, are used to identify alcohol related organ damage. 

Treatment

Treatment involves the use of medications like disulfiram, naltrexone, or acamprosate to support abstinence and reduce cravings, a detoxification programme to manage acute symptoms, as well as engaging in cognitive behavioral therapy and support groups to manage the psychological aspect of the disorder. 

Follow-Up

Initially, patients may require evaluation within 1-2 weeks of starting treatment. Subsequent visits may increase or decrease in frequency as necessary based on adherence to treatment and changes in symptom severity.

Prevention and Control

Preventive measures of AUD include the following:

• Enlightening people about the adverse health effects of alcohol use 
• Regulation of sales and use of alcohol. 
• Primary care settings to offer AUD routine screening programs.
• Alcohol Abuse Treatment, Education and Rehabilitation
• Harm reduction
• Formation of support groups such as Alcohol Anonymous (AA)
• Encouraging alternative leisure activities and promoting healthy lifestyles. ​

Conclusion and Recommendations.

Alcohol use disorder is a medical condition caused by the unhealthy use of alcohol. It's a common disorder in Nigeria due to some socioeconomic factors like poverty, unemployment, and peer pressure. The increasing prevalence of depression and problematic drinking among university students is worrisome as this will not only adversely impact their academic performance but future productivity and the risk of other psychosocial and health problems. This is due to the heavy drinking impairing judgment, memory unhealthy behaviors which could affect both immediate academic and future performance. If neglected, AUD can affect normal daily life and cause chronic health issues such as liver disease and gastrointestinal problems. Effective actions to mitigate the effects of AUD include early diagnosis, therapy, and the right medications. Finally, there is a need for prompt interventions at family, community and government levels to curb this rising menace among university students in order to secure their futures.