title: How accurate are blood (or breath) tests for identifying self-reported heavy drinking among people with alcohol dependence?
abstract: OBJECTIVE
  Managing patients with alcohol dependence includes assessment for heavy drinking, typically by asking patients. Some recommend biomarkers to detect heavy drinking but evidence of accuracy is limited.
  
  
  METHODS
  Among people with dependence, we assessed the performance of disialo-carbohydrate-deficient transferrin (%dCDT, ≥1.7%), gamma-glutamyltransferase (GGT, ≥66 U/l), either %dCDT or GGT positive, and breath alcohol (> 0) for identifying 3 self-reported heavy drinking levels: any heavy drinking (≥4 drinks/day or >7 drinks/week for women, ≥5 drinks/day or >14 drinks/week for men), recurrent (≥5 drinks/day on ≥5 days) and persistent heavy drinking (≥5 drinks/day on ≥7 consecutive days). Subjects (n = 402) with dependence and current heavy drinking were referred to primary care and assessed 6 months later with biomarkers and validated self-reported calendar method assessment of past 30-day alcohol use.
  
  
  RESULTS
  The self-reported prevalence of any, recurrent and persistent heavy drinking was 54, 34 and 17%. Sensitivity of %dCDT for detecting any, recurrent and persistent self-reported heavy drinking was 41, 53 and 66%. Specificity was 96, 90 and 84%, respectively. %dCDT had higher sensitivity than GGT and breath test for each alcohol use level but was not adequately sensitive to detect heavy drinking (missing 34-59% of the cases). Either %dCDT or GGT positive improved sensitivity but not to satisfactory levels, and specificity decreased. Neither a breath test nor GGT was sufficiently sensitive (both tests missed 70-80% of cases).
  
  
  CONCLUSIONS
  Although biomarkers may provide some useful information, their sensitivity is low the incremental value over self-report in clinical settings is questionable.
authors.affiliation: Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland Nicolas.Bertholet@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bertholet
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University and Boston Medical Center, Boston, MA, USA Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University and Boston Medical Center, Boston, MA, USA Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000097:blood*; D000437:Alcoholism / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D001900:Boston; D001944:Breath Tests; D003430:Cross-Sectional Studies; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D057566:Self Report; D012680:Sensitivity and Specificity; D012795:Sialoglycoproteins / Q000097:blood*; D014168:Transferrin / Q000031:analogs & derivatives*; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D012795:Sialoglycoproteins; D014168:Transferrin; C519691:disialotransferrin; D005723:gamma-Glutamyltransferase
references.citation: Drug Alcohol Depend. 2006 May 20;82(3):231-7
references.pmid: 16256278
references.citation: Clin Chim Acta. 2006 Oct;372(1-2):184-7
references.pmid: 16790238
references.citation: Enzyme. 1987;37(1-2):87-107
references.pmid: 2436906
references.citation: Int J Legal Med. 2012 Mar;126(2):243-50
references.pmid: 21910015
references.citation: J Stud Alcohol. 2004 Nov;65(6):774-81
references.pmid: 15700516
references.citation: J Addict Med. 2008 Jun;2(2):55-65
references.pmid: 19809579
references.citation: Drug Alcohol Depend. 2004 Jun 11;74(3):273-9
references.pmid: 15194205
references.citation: Clin Chem. 2001 Apr;47(4):681-5
references.pmid: 11274018
references.citation: Br J Obstet Gynaecol. 1992 Feb;99(2):90-1
references.pmid: 1554681
references.citation: Subst Use Misuse. 2001 Feb;36(3):313-31
references.pmid: 11325169
references.citation: Clin Chim Acta. 2003 Dec;338(1-2):45-51
references.pmid: 14637264
references.citation: Am J Epidemiol. 2000 Oct 15;152(8):747-51
references.pmid: 11052552
references.citation: Addiction. 2002 Mar;97(3):249-52
references.pmid: 11964098
references.citation: Alcohol. 1999 Nov;19(3):261-71
references.pmid: 10580517
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: Alcohol Alcohol. 2004 Mar-Apr;39(2):75-85
references.pmid: 14998820
references.citation: JAMA. 1994 Mar 2;271(9):703-7
references.pmid: 8309035
references.citation: Med Care. 1996 Jan;34(1):73-84
references.pmid: 8551813
references.citation: Alcohol. 2001 Nov;25(3):185-8
references.pmid: 11839464
references.citation: J Consult Clin Psychol. 2000 Feb;68(1):134-44
references.pmid: 10710848
references.citation: J Stud Alcohol. 2006 Sep;67(5):778-84
references.pmid: 16847548
references.citation: Alcohol Clin Exp Res. 1998 Dec;22(9):1973-80
references.pmid: 9884140
references.citation: Alcohol Alcohol. 2005 Nov-Dec;40(6):531-4
references.pmid: 16103033
references.citation: JAMA. 2013 Sep 18;310(11):1156-67
references.pmid: 24045740
references.citation: J Toxicol Environ Health B Crit Rev. 2004 Jul-Aug;7(4):319-37
references.pmid: 15205047
references.citation: Addiction. 2003 Dec;98 Suppl 2:81-91
references.pmid: 14984245
references.citation: Alcohol Clin Exp Res. 2002 Aug;26(8):1215-22
references.pmid: 12198396
references.citation: Alcohol Clin Exp Res. 2002 Mar;26(3):332-9
references.pmid: 11923585
references.citation: J Chromatogr B Analyt Technol Biomed Life Sci. 2006 Sep 1;841(1-2):96-109
references.pmid: 16725384
references.citation: Alcohol Alcohol. 2012 Sep-Oct;47(5):552-7
references.pmid: 22691387
references.citation: J Subst Abuse Treat. 1992;9(3):199-213
references.pmid: 1334156
references.citation: Addict Behav. 1986;11(2):149-61
references.pmid: 3739800
references.citation: J Stud Alcohol. 1995 Mar;56(2):168-72
references.pmid: 7760562
references.citation: Clin Chem Lab Med. 2007;45(8):953-61
references.pmid: 17579567
references.citation: Alcohol Alcohol. 2004 Jul-Aug;39(4):336-9
references.pmid: 15208167
references.citation: Drug Alcohol Depend. 1997 Nov 25;48(2):97-103
references.pmid: 9363408
references.citation: Am J Addict. 2001;10(s1):s24-s28
references.pmid: 11268818
references.citation: JAMA. 2000 Oct 4;284(13):1689-95
references.pmid: 11015800
references.citation: Alcohol Clin Exp Res. 2004 Sep;28(9):1347-55
references.pmid: 15365305
references.citation: Clin Chem. 2001 Jan;47(1):13-27
references.pmid: 11148172
references.citation: Alcohol Clin Exp Res. 2009 Sep;33(9):1555-61
references.pmid: 19485968