Especially in the field of psychiatry hesitation exist sometimes in the use of laboratory biomarkers like GGT, CDT or PEth for diagnosis of chronic abuse.
The use of questionnaires like CAGE or AUDIT is very usefull in my opinion, but its use demands full and honest cooperation of the patient / client. Questionnaires or a structured interview like MATE are needed to describe the situation and they could give a rough estimate of the degree of abuse.
Biomarkers alone are not enough, since the response to alcohol depends (partly for some markers) on individual factors like gender, age, previous use etc. But biomarkers cannot hide alcohol (ab)use, although they do not tell always the truth: sensitivity and specificity are never perfect.
What is your opinion and experience in this field? What is your choice ? Do you know any professional Guideline that might be helpfull?
Both, structured questionnaires a n d accurate laboratory markers should be used. Chronic alcohol abuse should be assessed (diagnosed) by a holistic approach including the (social) history and clinical background of the patient, questionnaires (if possible) and laboratory medicine.
The latter should use only well-characterized markers with knowledge about causes for false positives (and false negatives). Valid decision limits are essential.
Most important, clinical and analytical validation of any potential marker of (chronic) alcohol abuse should be done and completed to an utmost possible value before introducing the marker into routine diagnoses but not post hoc after having made many diagnoses with the help of an insufficiently validated criterion.
Torsten Arndt agree for a fullest understanding of the extent of the problem but depends on the context of assessment. In the UK, AUDIT, AUDIT-C or CAGE may be used for screening by generalist practitioners, and the Paddington Alcohol Test (PAT) is shown to be a more effective early assessment in emergency departments. For specialist clinicians, SADQ provides a fairly useful tool for monitoring change, though subject to patient bias which may be confirmed with biomarkers such as GGT. However, early screening results help overcome hesitance and denial in the client if accompanied by brief intervention and advice and motivational interviewing. This, in my clinical experience, can be supported by biomarkers such as GGT, ultrasound or LFT to highlight the 'reality' to the client. Both sets of identification combine to give a convincing picture but there is still the challenge of accurate change monitoring.
Reply to Lucy Webb
The SADQ seems to me an extended form of the CAGE, very usefull for a rough indication of the severity of alcohol abuse or dependence, provided that the patient or client is fully cooperative.
It reminds me of the MATE structured interview, very usefull in clinical settings. But in forensic use such questionaires are unsufficient and also GGT is not to be used based on its low specificity. What is your or your institutes experience with modern biomarkers like CDT, or PEth?
Hallo to Everybody,
Biomarkers, used and interpreted correctly, give objective results which are independent from the subjective information given by the patient and from the subjective interpretation of this information by the treating physician. Also, biomarkers can give objective quantitative information in follow-up investigations.
Nevertheless, the history and clinical picture of the patient and the experience of the treating physician in recognizing and interpreting the symptoms and clinical background is of utmost importance.
As I mentioned already, a holistic approach is required, may be esp. in the field of diagnosis and treatment of alcohol abuse.
Sincerely,
Torsten
Lucy Webb
Thank you Lucy for pointing at this fine study. However it only compares questionaires using AUDIT as standard.
Not a single lab test is used for comparison, that is a pity.
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