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Problems associated with alcohol use range from occasional drinking to alcohol abuse and alcoholism (a serious illness). Alcoholism, also known as alcohol dependence, is a primary chronic disease whose development and manifestations are influenced by genetic, psychosocial and environmental factors. Often it progresses and leads to death.
Experts define risky drinking by the volume of “standard drinks”, with one standard drink equaling approximately 350 ml of beer, 150 ml of wine, or 45 ml of spirits. These figures are based on “typical” (mass) forms of beer and wine. Many specialty beers can contain up to twice as much alcohol as mass-produced beers. For men, 4 or more drinks per day or 14 or more drinks per week for the last year is dangerous, while for women it is 3 or more drinks per day or 7 or more drinks per week.
While alcohol use is by definition necessary for the development of alcoholism, alcohol use in and of itself is not a disease. The amount, frequency, and regularity of drinking required to develop alcoholism varies greatly from person to person. People’s reactions to alcohol may depend on their weight, age, general health, and the medications they take. In some cases, drinking fewer drinks can cause health problems.
The diagnosis of alcohol dependence is usually based on the history. Laboratory tests have a sensitivity of no more than 50%, and a physical examination is useful only after the effects of alcoholism become apparent. Early diagnosis based on a thorough history can prevent such consequences. Physicians should use terms such as “person with a drinking problem” rather than “alcoholic,” which are common but derogatory terms.
While the dangers of alcoholism are well known, evidence suggests that doctors often fail to make a diagnosis. Less than 50% of people who see a doctor for an alcohol problem do not have a diagnosis of addiction. Numerous studies of inpatients and surgical patients in hospitals, as well as outpatients in internal medicine and family health care settings, show low rates of recognition and even lower rates of treatment.
Reasons alcohol-related problems are overlooked during diagnosis:
- patients often deny that they have a problem – they may not associate alcohol with its effects;
- patients may be unaware that a positive family history increases the risk of disease;
- they may fear being reported to employers;
- patients may be too ashamed to report their problem.
Patients identified as alcoholics tend to have antisocial personality disorder (type 2 alcoholism, characterized by association with criminal behavior (sociopathic), with onset in adolescence and drinking to achieve intoxication). While those whose diagnosis is not established are prone to depression or anxiety.
Also, sometimes doctors may be hesitant to brand a patient as an alcoholic because of the negative consequences. If an examination is prescribed, then there are no tests confirming alcoholism as such. Tests are carried out to evaluate the general state of health and the consequences that chronic intoxication has.
What tests are given for alcoholism
Alcohol biomarkers (metabolites) are physiological indicators of alcohol exposure or intake and may reflect the presence of an alcohol use disorder. These biomarkers are not intended to be diagnostic instead of taking a detailed history and physical examination by an appropriate healthcare professional. Any laboratory tests are non-specific, 50% reliable, and alcohol biomarkers should complement the assessment of indicators of alcohol use.
Alcohol biomarkers are usually divided into indirect and direct.
Indirect biomarkers of alcohol suggests heavy and long-term alcohol use, revealing the toxic effects alcohol may have on organ systems or body chemistry.
Indirect biomarkers of alcohol include aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), mean corpuscular volume (MCV), and carbohydrate transferrin deficiency (UTT).
GGT, AST and MCV are the most commonly used indirect biomarkers. As a screening for alcohol dependence, the sensitivity and specificity of WBT is usually higher than others. But the analysis is less sensitive and specific in women than in men.
This test is a set of different variants of transferrin molecules, an iron transport protein. Alcohol consumption above 50 to 80 g/day for 2 to 3 weeks appears to increase serum concentrations of this substance. It helps distinguish chronic alcoholics from those who drink little. There are several different ways to measure, and some measurements may be better than others, depending on factors such as type of alcohol consumption and gender.
The combination of HGT and UDT compared to doing them alone shows higher diagnostic sensitivity, higher diagnostic specificity, and a stronger correlation with actual amount of alcohol consumption. The combined values of GGT and UBT increase after the daily alcohol intake exceeds the threshold value of 40 g.
Other indirect alcohol biomarkers of emerging interest include total serum sialic acid, 5-hydroxytryptophol (5-HTOL), N-acetyl-beta-hexosaminidase, plasma apolipoprotein J sialic acid index, and salssolinol.
Direct biomarkers of alcohol are products of alcohol metabolism. Direct biomarkers of alcohol include alcohol itself and ethyl glucuronide (EGU). The blood alcohol level may be useful at the initial examination if the patient is intoxicated but denies alcohol abuse.
A blood alcohol level of more than 300 mg/dl, a blood alcohol level of more than 150 mg/dl without clear evidence of intoxication, or a blood alcohol level of more than 100 mg/dl on a routine examination indicates alcoholism with a high degree of certainty. The short half-life of alcohol limits its use as a biomarker. Because blood alcohol levels determine alcohol consumption in the previous few hours, it is not necessarily an accurate indicator of chronic excessive drinking.
EHU is a minor, non-oxidative, water-soluble, stable and direct metabolite of alcohol, which is formed by the conjugation of ethanol with activated glucuronic acid. Shortly after drinking, even in small amounts, EHU becomes positive. After a complete cessation of alcohol use, it can be detected in the urine for up to 5 days after heavy drinking, making EHU an important biomarker for recent alcohol use. Other direct alcohol biomarkers of growing interest to scientists and clinicians include acetaldehyde, fatty acid ethyl esters, ethyl sulfate, and phosphatidylethanol.
Where is alcoholism tested?
For the most part, tests for certain markers are used in scientific research, in practice they are rarely applicable.
How much do alcohol tests cost?
Some tests can be carried out in private laboratories, they cost within a few thousand rubles. But no test gives a 100% guarantee that the patient is an alcoholic.
Popular questions and answers
Answered questions about tests for alcoholism psychotherapist, evidence-based narcologist, cognitive behavioral therapist, head of the online clinic of Dr. Kisler Ilya Kisler.