Background: Alcohol use disorder is a chronic, relapsing condition that may simultaneously produce psychiatric, medical, traumatic and social harm.

Objective: We describe a patient whose escalating alcohol consumption culminated in alcohol-associated chronic liver disease, severe electrolyte abnormalities, recurrent falls, neglected distal humeral fracture and family disruption, followed by multidisciplinary rehabilitation.

Case Report: A 55-year-old man, trained chartered accountant and self-employed in a laundry business, had consumed alcohol for more than 30 years, with marked escalation during the preceding 3 years. He reported binge drinking, intake of approximately 5-8 units of gin on drinking days, craving, morning drinking, unsuccessful efforts to reduce intake, withdrawal symptoms, and continued use despite harm. Patient was earlier employed in a well-paid private establishment but lost job repeatedly thrice due to alcohol. He had severe episodes of quarrel with his wife, self-employed trader and children over the years before eventual separation from his wife and children 2 years before presentation. He however, denied cigarette use or other psychoactive substances. Physiological and behavioral dependence on alcohol were prominent. When he reduced or stopped drinking, he experienced poor sleep, restlessness, uneasiness and tremors. He described a desire to cut down, irritation when criticized, and guilt about his drinking and occasional eye-opener use. Alcohol use continued despite recognized recurrent falls, family separation and a serious upper-limb injury. His wife and children had distanced themselves because of his drinking, moved out of their matrimonial home and he had been living apart from them.

Approximately 2 years before the index admission, the patient was intoxicated while walking home in the rain. He began running, fell onto the right side of his body and immediately developed severe pain with inability to use the right upper limb. He was taken to hospital, stabilized and counselled for operative management, but he deferred admission and surgery. A persistent deformity around the right arm and elbow subsequently developed. X-ray done revealed malunion of a neglected distal humeral fracture. He is not known to have hypertension, diabetes mellitus, asthma or peptic ulcer disease but has positive family history of hypertension in his mother.

At admission, examination revealed a chronically ill man, icteric, wasted with mild bilateral pitting pedal edema. Cardiovascular examination revealed pulse rate of 98 beats/min, regular and of normal volume. Blood pressure of 130/90 mmHg, JVP was not elevated; S1 and S2 were heard, with a loud A2 and S4, but no murmur. The abdomen was full and moved with respiration and no area of tenderness. The liver was palpable approximately 2 cm below the right costal margin and liver span was 18 cm. There was no splenomegaly and the kidneys were not ballotable. Respiratory examination revealed vesicular breath sounds, no added sounds and SpO2 was 97%.

There was no area of tenderness. Musculoskeletal examination showed a neurovascularly intact, deformed right upper limb and neurological examination was grossly intact. Mental-state examination showed a well-kempt, calm and largely cooperative man with neutral mood and congruent affect. Speech was spontaneous and coherent, and thought form was organized. He expressed ambivalence and conflicting thoughts about alcohol use but had no delusions, hallucinations or other psychotic phenomena. Concentration and Japanese J Med Res, 2026 Volume 4 | Issue 4 | 2 of 7 Keywords Alcohol use disorder, Alcohol-associated liver disease, Hypokalaemia, Distal humeral fracture, Rehabilitation, Multidisciplinary care. Introduction Alcohol use disorder (AUD) is characterised by impaired control over alcohol consumption and persistent use despite adverse physical, psychological or social consequences. Its effects may extend far beyond intoxication, producing withdrawal, nutritional and electrolyte disturbances, liver injury, accidental trauma, family disruption and occupational decline. Contemporary diagnostic and treatment frameworks therefore require a broad biopsychosocial assessment rather than a narrow focus on the amount of alcohol consumed [1,2]. Cloninger's neurogenetic typology distinguishes a later-onset 25years, milieu-limited Type 1 pattern, commonly associated with anxiety, higher harm avoidance and lower novelty seeking, high reward dependence, from an earlier-onset, male-limited Type 2 pattern characterised by greater novelty seeking and antisocial traits [3,4] and intolerance of uncertainty and may contribute to anxiety-driven drinking in some patients [5]. These constructs do not replace the diagnosis of AUD [6]. Alcohol-associated liver disease spans steatosis, steatohepatitis, fibrosis and cirrhosis. Because continued alcohol exposure drives progression, effective management requires treatment of both the liver disease and the underlying AUD. Major hepatology guidance supports abstinence and coordinated care that integrates liver or medical treatment with addiction, psychological and social interventions [7-12]. The present case is notable for the convergence of severe AUD, alcohol-associated chronic liver disease, profound hypokalemia, an intoxication-related neglected distal humeral fracture, social implications, loss of job and major family consequences. It also demonstrates the practical value of a multidisciplinary rehabilitation programme in a resource-constrained setting. The report is structured in accordance with the CARE case-report framework [12]. Chest X-ray, 12-lead resting ECG and echocardiography were essentially normal Full blood count Gastroenterology assessment Table 1: Clinical timeline. Time Event More than 30 years before presentation Alcohol use began; initially described as modest. Approximately 3 years before presentation Marked escalation in quantity and loss of control, with binge drinking, craving, withdrawal symptoms, morning drinking and progressive family disruption. Approximately 2 years before presentation Intoxication-related fall with right distal humeral fracture. Operative care was recommended but deferred; chronic deformity developed. 17 February 2026 Later follow-up records identified this as the last reported alcohol use. 19 February 2026 Psychiatric and medical admission/review. Diagnoses included alcohol dependence/AUD, chronic liver disease, hypokalemia and neglected distal humeral fracture. Diazepam taper and vitamin supplementation were prescribed; urgent medical assessment and multidisciplinary referrals were arranged. February-April 2026 Inpatient and subsequent outpatient rehabilitation involving psychiatry, clinical psychology, occupational therapy, nursing and social work. Family meetings, relapse-prevention work, time and money management, 12-step activities and relaxation training were undertaken. 17 April 2026 Clinical psychology and occupational-therapy reviews documented good motivation, review of assignments, psychobehavioural time-management work, therapeutic sharing and progressive muscle relaxation. 6 May 2026 Patient reported approximately 11 weeks of abstinence. Sponsors and a relapse-response plan were identified; family reconciliation and medical follow-up were discussed. Later follow-up; exact date not visible Patient reported surgical treatment of the right upper limb at a private hospital, continued abstinence and improving communication with his children. Repeat liver tests and dietary review were advised. memory were intact, judgment was considered intact and insight was full.

Laboratory testing showed total bilirubin 45.1 µmol/L, conjugated bilirubin 14.8 µmol/L, aspartate aminotransferase 61 IU/L, alanine aminotransferase 42 IU/L, total protein 51 g/L, albumin 30 g/L, sodium 128 mmol/L and potassium 2.6 mmol/L. Ultrasonography demonstrated a coarse micronodular hepatic echotexture and hepatomegaly (17.2 cm). He received a benzodiazepine taper, vitamin supplementation, medical and gastroenterology review, orthopaedic assessment and an intensive multidisciplinary rehabilitation programme involving psychiatry, clinical psychology, occupational therapy, nursing, social work and family engagement. Interventions included relapse-prevention work, rational-emotive behavioural techniques, time and financial management, 12-step recovery activities, relaxation training and sponsor identification. He reported 11 weeks of abstinence, later underwent surgery on the affected upper limb, and described improving family communication and reunion with his wife and children. Conclusion: This case illustrates how severe alcohol use disorder can create a reinforcing cycle of medical illness, injury and psychosocial deterioration. Integrated addiction, medical, orthopaedic and psychosocial care can support meaningful early recovery, although long-term follow-up remains essential.