title: Optimizing heroin-assisted treatment (HAT): assessment of the contribution of direct ethanol metabolites in identifying hazardous and harmful alcohol use.
abstract: BACKGROUND
  Heavy alcohol consumption may accelerate the progression of hepatitis C-related liver disease and/or limit efforts at antiviral treatment in opioid-dependent patients receiving heroin-assisted treatment (HAT). Our study aims to assess alcohol intake among HAT patients by self-reports compared to direct ethanol metabolites.
  
  
  METHODS
  Fifty-four patients in HAT were recruited from the centre for HAT at the University of Basel, Switzerland. The patients completed the Alcohol Use Disorder Identification Test (AUDIT), a self-report questionnaire on past-week ethanol intake and provided samples for the determination of ethyl glucuronide (UEtG) and ethyl sulphate (UEtS) in urine and of ethyl glucuronide (HEtG) in hair.
  
  
  RESULTS
  Eighteen patients scored above the AUDIT cut-off levels. Twenty-six patients tested positive for UEtG and 29 for UEtS. HEtG identified ethanol intake of more than 20 g/d in 20 additional cases that did not appear in the AUDIT. Using the total score of the AUDIT, HEtG detected 14 additional cases of relevant alcohol intake.
  
  
  CONCLUSIONS
  The findings of this study, which is the first assessing alcohol intake in HAT patients using direct ethanol metabolites and self reports, suggest the complementary use of both. Improved detection of hazardous or harmful alcohol consumption in the context of HCV and heroin dependence will allow for earlier intervention in this population. This ultimately will contribute to an improvement in quality of life of patients in HAT. Furthermore, a significant reduction of costs can be achieved through a reduction of complications caused by alcohol intake.
authors.affiliation: Department of Psychiatry and Psychotherapy II, Christian-Doppler-Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, Salzburg A-5020, Austria. f.wurst@salk.at
authors.forename: Friedrich M
authors.initials: FM
authors.lastname: Wurst
authors.forename: Natasha
authors.initials: N
authors.lastname: Thon
authors.forename: Michel
authors.initials: M
authors.lastname: Yegles
authors.forename: Claudia
authors.initials: C
authors.lastname: Halter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weinmann
authors.forename: Barbara
authors.initials: B
authors.lastname: Laskowska
authors.forename: Johannes
authors.initials: J
authors.lastname: Strasser
authors.forename: Gregory
authors.initials: G
authors.lastname: Skipper
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Wiesbeck
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dürsteler-Macfarland
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000378:metabolism*; D000431:Ethanol / Q000378:metabolism; D005260:Female; D005965:Glucuronates / Q000378:metabolism*; D006556:Heroin Dependence / Q000378:metabolism* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000379:methods* / Q000592:standards; D013463:Sulfuric Acid Esters / Q000378:metabolism*; D055815:Young Adult
chemical_list: D005965:Glucuronates; D013463:Sulfuric Acid Esters; C093924:ethyl glucuronide; D000431:Ethanol; C011612:diethyl sulfate