______________________________________________________________ Alcohol and Alcohol Use Disorder
LABORATORY TESTS The FDA has approved a test to detect alcohol use disorder and alcohol-related diseases. The test detects the level of carbohydrate-deficient transferrin (CDT) in the body, which is elevated in persons with alcohol use disorder and remains elevated even several weeks after drinking is stopped [280]. The advantages of the CDT test are reliability and the availability of automated test results within four hours [281; 282]. The CDT is often used in combination with other screening tests, such as the gamma-glutamyl transferase (GGT) test. While both CDT and GGT are independently associated with alcohol abuse, combining tests may dramatically increase sensitivity [267; 283]. CDT is less sensitive/specific in women than in men [267]. Tests for Recent Alcohol Use (Hours) The relationship between alcohol and the liver serves as the basis for many of the tests that identify possible alcohol abusers. Alcohol markers for recent alcohol ingestion include urine/breath/blood, AlcoPatch, methanol, urinary ethyl glucuronide (EtG) and ethyl sulfate(ES), whole blood phosphatidylethanol, and the ratio of 5-hydroxytryptophol (5-HTOL) to 5-hydroxyindole-3-acetic acid (5-HIAA) [267; 284]. Tests for Less Recent Alcohol Use (Weeks) The CDT test is often used to assess prolonged ingestion of high amounts of alcohol (more than 50–80 g/day for two to three weeks) [267]. Another test examines hemoglobin or whole blood acetaldehyde adducts. In a study of almost 3,000 women and 4,000 men, the combination of CDT and GGT compared with either alone shows a higher diagnostic sensitivity and specificity and is correlated more strongly with alcohol consumption than either test alone (Table 1) [285; 286; 287]. Tests for Chronic Alcohol Use (Years) Tests in this category look at the classic toxic markers that use of alcohol leaves on the body. They include [267]:
• Liver function tests • GGT
• Aspartate aminotransferase (AST) • Alanine aminotransferase (ALT) • Red blood cell index • Mean corpuscular volume (MCV)
BRIEF INTERVENTION Despite the fact that alcohol abuse complications have caused grave illness and many deaths, physicians are not always good at detecting alcohol and other drug abuse in their patients. Even when physicians and other health professionals identify an individual with alcohol use disorder, they are sometimes unsure of how to proceed. At times, the physician will offer help but the patient refuses. Nevertheless, the addiction specialist or the primary care physician with a continuous, comprehensive, patient-centered approach to the medical, psychosocial, and family issues is the ideal person to offer intervention, treatment, and recovery support. Almost 20% of patients treated in a primary care setting drink at levels that may place them at risk for developing alcohol-related problems [267; 288]. Brief intervention, as part of primary healthcare, can help reduce this risk. Brief intervention is generally conducted over one to a few visits with each session lasting from just a few minutes up to one hour. The type of brief intervention varies depending on how severe the problem. Brief intervention is often used with patients who have not yet developed alcohol use disorder and the goal may be to reduce drinking rather than abstinence. For persons with alcohol use disorder, the goal of brief intervention is abstinence, and for these individuals, referral to a more comprehensive treatment may be necessary. The USPSTF recommends that clinicians provide patients who are engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse [263].
LABORATORY MARKERS FOR ALCOHOL USE
Markers
Sensitivity
Specificity
Men CDT GGT
73% 65% 90%
96% 89% 84%
CDT with GGT
Women CDT
52% 54%
94% 97% 91%
GGT
CDT with GGT
76%
Source: [285]
Table 1
69
MDMI1826
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