Alcohol use disorder — CCFP MCQ

Instant feedback + full explanation. One question, done properly.

HardMental healthAlcohol use disorderCCFP

A 42-year-old man drinks 8 to 10 beers nightly and has morning tremor relieved by alcohol. GGT is elevated and he has missed work twice this month. He wants to cut down but fears withdrawal. He has no seizures and no delirium history. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Alcohol use disorder with physiological dependence

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

The correct answer is A: Alcohol use disorder with physiological dependence. The morning tremor relieved by alcohol is pathognomonic for alcohol dependence—tremor reflects CNS hyperexcitability during early withdrawal and is suppressed by acute alcohol intake. The patient exhibits clinically significant impairment (work absence), loss of control (wants to cut down but cannot), and fear of withdrawal, all diagnostic of AUD. Canadian guidelines (CMAJ 2023) use DSM-5-TR criteria with severity classification; this case meets ≥6 criteria (heavy use, loss of control, harm, tolerance, withdrawal symptoms, continued use) indicating severe AUD. Option B is ruled out by the quantity, frequency, and consequences. Options C, D, and E are distractors exploiting the tremor finding: panic disorder may present with anxiety but not alcohol-specific tremor; hyperthyroidism causes persistent tremor unrelated to alcohol relief; cognitive disorder is not evident. The clinical key is recognizing that tremor relieved by alcohol is the hallmark of withdrawal-related physiological dependence, not a thyroid or primary psychiatric condition.

Reference: Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023;195(40):E1364. https://www.cmaj.ca/content/195/40/E1364