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During the past decade, advances have been made in the identification, development, and application of alcohol biomarkers. This is important because of the unique functions that alcohol biomarkers can serve in various applied settings. To carry out these functions, biomarkers must display several features including validity, reliability, adequacy o...
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Context 1
... there is, at present, no ideal biomarker, biomarkers, nevertheless, are in use in multiple applied settings. This section reviews some of these applications and reports current knowledge of and strategies for using alcohol biomarkers (Table 4). In all such applications, it is critical that biomarkers be validated by adequately controlled research studies. ...Similar publications
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Methods: descriptive, epidemiol...
The purpose of this study was to evaluate the associations between weight status and mental disorders, including depressive disorder, anxiety disorder and alcohol use disorder. A total of nationally representative 6,510 subjects aged 18-64 yr was interviewed in face-to-face household survey. Response rate was 81.7%. Mental disorders were diagnosed...
Objective:
There is little research examining alcohol use disorder (AUD) symptoms (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) in young adulthood. We assessed symptom structure at 24 years using latent class analysis (LCA), examining relationships between class membership and (a) concurr...
This study was conducted to evaluate the diagnostic accuracy and determine the optimum cut-off scores for clinical use of the Center for Epidemiological Studies Depression scale (CES-D) and Alcohol Use Disorders Identification Test (AUDIT) against a reference psychiatric diagnostic interview, in TB and anti-retroviral therapy (ART) patients in prim...
Citations
... breath, or its metabolites ethyl glucuronide and ethyl sulfate in urine, is simple, only relatively recent alcohol use will be identified, owing to the rapid rate of metabolism of ethanol (on average, 0.0179 ± 0.0030 g ethanol per decilitre per hour in women and 0.0159 ± 0.0028 g ethanol per decilitre per hour in men) 61,62 . Measuring phosphatidylethanol (PEth) concentration requires whole blood and is costly but has higher sensitivity and specificity for detecting past alcohol exposure up to 4 weeks 63,64 than other biomarkers such as carbohydrate-deficient transferrin, γ-glutamyl transpeptidase and mean corpuscular volume. ...
... Drinking outcomes can be ascertained from self-reported alcohol consumption using the timeline follow-back methodology (30), considered the gold standard tool for assessing drinking outcomes in alcohol clinical trials (28). These self-reported drinking measures can be supported by biomarkers, among which phosphatidylethanol in blood (PEth) and ethylglucuronide in urine both provide measures of recent drinking (past 4 weeks and past several days, respectively) that are highly specific and both more specific and more sensitive than other commonly used lab tests, such as liver function tests (31)(32)(33)(34). In the future, transdermal alcohol sensors may provide direct measures of alcohol consumption in near real time, but technological advances are needed before these sensors can produce reliable and valid data (35,36). ...
Alcohol-related harm, a major cause of disease burden globally, affects people along a spectrum of use. When a harmful pattern of drinking is present in the absence of significant behavioral pathology, low-intensity brief interventions that provide information about health consequences of continued use provide large health benefits. At the other end of the spectrum, profound behavioral pathology, including continued use despite knowledge of potentially fatal consequences, warrants a medical diagnosis, and treatment is strongly indicated. Available behavioral and pharmacological treatments are supported by scientific evidence but are vastly underutilized. Discovery of additional medications, with a favorable balance of efficacy versus safety and tolerability can improve clinical uptake of treatment, allow personalized treatment, and improve outcomes. Here, we delineate the clinical conditions when pharmacotherapy should be considered in relation to the main diagnostic systems in use and discuss clinical endpoints that represent meaningful clinical benefits. We then review specific developments in three categories of targets that show promise for expanding the treatment toolkit. GPCRs remain the largest category of successful drug targets across contemporary medicine, and several GPCR targets are currently pursued for alcohol-related indications. Endocrine systems are another established category, and several promising targets have emerged for alcohol indications. Finally, immune modulators have revolutionized treatment of multiple medical conditions, and they may also hold potential to produce benefits in patients with alcohol problems.
... These self-report measures can be supplemented with objective measures of alcohol use (alcohol biomarkers) such as phosphatidylethanol (PEth). [133][134][135][136][137][138] There is emerging evidence of the benefits of incorporating self-report alcohol use measures with alcohol biomarkers like PEth for valid assessment of problem drinking. [136][137][138][139][140][141][142][143][144][145][146][147][148][149] Problem drinking is affected by numerous factors at population and individual levels, and identifying these factors is important for informing the design of harm minimisation interventions. ...
Background
The term “problem drinking” includes a spectrum of alcohol problems ranging from excessive or heavy drinking to alcohol use disorder. Problem drinking is a leading risk factor for death and disability globally. It has been measured and conceptualised in different ways, which has made it difficult to identify common risk factors for problem alcohol use. This scoping review aims to synthesise what is known about the assessment of problem drinking, its magnitude and associated factors.
Methods
Four databases (PubMed, Embase, PsycINFO, Global Index Medicus) and Google Scholar were searched from inception to 25 November 2023. Studies were eligible if they focused on people aged 15 and above, were population-based studies reporting problem alcohol use and published in the English language. This review was reported based on guidelines from the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist’. Critical appraisal was done using the Newcastle-Ottawa Scale.
Results
From the 14 296 records identified, 10 749 underwent title/abstract screening, of which 352 full-text articles were assessed, and 81 articles were included for data extraction. Included studies assessed alcohol use with self-report quantity/frequency questionnaires, criteria to determine risky single occasion drinking, validated screening tools, or structured clinical and diagnostic interviews. The most widely used screening tool was the Alcohol Use Disorder Identification Test. Studies defined problem drinking in various ways, including excessive/heavy drinking, binge drinking, alcohol use disorder, alcohol abuse and alcohol dependence. Across studies, the prevalence of heavy drinking ranged from <1.0% to 53.0%, binge drinking from 2.7% to 48.2%, alcohol abuse from 4.0% to 19.0%, alcohol dependence from 0.1% to 39.0% and alcohol use disorder from 2.0% to 66.6%. Factors associated with problem drinking varied across studies. These included sociodemographic and economic factors (age, sex, relationship status, education, employment, income level, religion, race, location and alcohol outlet density) and clinical factors (like medical problems, mental disorders, other substance use and quality of life).
Conclusions
Due to differences in measurement, study designs and assessed risk factors, the prevalence of and factors associated with problem drinking varied widely across studies and settings. The alcohol field would benefit from harmonised measurements of alcohol use and problem drinking as this would allow for comparisons to be made across countries and for meta-analyses to be conducted.
Trial registration number
Open Science Framework ID: https://osf.io/2anj3.
... This study and previous studies 18, 19 have underscored the fluctuating nature of alcohol intake, which suggests that quantification should encompass a defined observation period. Although single measurements of phosphatidyl ethanol (also known as PEth) show promise as an operational tool to assess alcohol intake within the preceding 2-4 weeks, 20 we advocate for sequential measure ments of phosphatidyl ethanol in clinical practice, especially when correct classification has important clinical implications. Sequential measurements should also be used in the context of clinical trials as they are often used when evaluating patients with ALD for liver transplantation Another issue within the framework of the new nomenclature is the substantial heterogeneity encompassed in the ALD subclass, as it categorises individuals with both cardiometabolic risk factors and a daily alcohol intake exceeding 50 g or 60 g, alongside individuals without cardiometabolic risk factors but a daily alcohol intake exceeding 20 g or 30 g. ...
... They can also be costly and burdensome to use (Kuntsche et al. 2022). TASs could address some of these limitations, as they can be worn over extended periods while providing continuous measurement (Litten et al. 2010;Leffingwell et al. 2013). This means TAS could capture data when self-report is not possible (for example, when heavy drinking leads to lack of capacity and blackouts) or when it is not possible for multiple daily breathalysers, blood, or urine tests (Kuntsche et al. 2022). ...
The development of transdermal alcohol sensors (TASs) presents a new method to monitor alcohol consumption with the ability to objectively measure data 24/7. We aimed to evaluate the accuracy of two TASs (BACtrack Skyn and Smart Start BARE) in a laboratory setting. Thirty-two adults received a dose of ethanol 0.56 g/kg body weight as a 20% solution while wearing the two TASs and provided Breath Alcohol Concentration (BrAC) measurements for 3.5 h postalcohol consumption. Pearson's correlations and repeated measures analysis of variance tests were conducted on the peak, time-to-peak, and area under the curve data. Bland-Altman plots were derived. A time series analysis and cross-correlations were conducted to adjust for time lag. Both TASs were able to detect alcohol and increase within 20 min. BrAC peaked significantly quicker than Skyn and BARE. BrAC and Skyn peaks were negatively significantly correlated (r = -0.381, P = .035, n = 31), while Skyn and BARE peaks were positively significantly correlated (r = 0.380, P = .038, n = 30). Repeated measures analysis of variance found a significant difference between BrAC, Skyn, and BARE (F(1.946, 852.301) = 459.873, P < .001)). A time series analysis found when BrAC-Skyn and BrAC-BARE were adjusted for the delay to peak, and there was still a significant difference. Failure rates: 1.7% (Skyn) and 4.8% (BARE). Some evidence was obtained for TAS validity as both consistently detected alcohol. Failure rates and time lag show improvements in older device generations. However, neither TAS presented strong equivalence to the breathalyser even when the lag time was adjusted. With further testing and technology advancements, TAS could be a potential alcohol monitoring tool. Two of the newest TAS devices were worn in laboratory conditions for one afternoon to compare their accuracy of alcohol monitoring to a breathalyser. Findings suggest that the two TASs (BACtrack Skyn and SmartStart BARE) recorded significantly similar data postalcohol consumption, but not with the breathalyser.
... Transdermal alcohol detection devices, such as the SCRAM, have shown a strong correlation (r = 0.84) between area under the curve (AUC) values and breath alcohol content (BrAC) (51). The SCRAM-CAM (Secure Continuous Remote Alcohol Monitor Continuous Alcohol Monitoring; Alcohol Monitoring Systems, Inc., Littleton, CO) anklet is the most commonly used and well-validated alcohol biosensor available (52)(53)(54). The SCRAM device can reflect blood alcohol concentration (BAC) within a drinking event continuously and in near real-time (55) by plotting the transdermal Frontiers in Psychiatry 04 frontiersin.org ...
Background
Heavy alcohol use in people living with HIV (PLWH) has widespread negative effects on neural functioning. It remains unclear whether experimentally-induced reduction in alcohol use could reverse these effects. We sought to determine the effects of 30-days drinking cessation/reduction on resting state functional connectivity in people with and without HIV.
Methods
Thirty-five participants (48.6% PLWH) demonstrating heavy alcohol use attempted to stop drinking for 30 days via contingency management (CM). MRI was acquired at baseline and after thirty days, and functional connectivity across five resting-state fMRI (rsfMRI) networks was calculated with the Conn toolbox for Matlab and examined in relation to transdermal alcohol concentration (TAC) recorded by the ankle-worn secure continuous remote alcohol monitor (SCRAM) and self-reported alcohol use (timeline follow-back; TLFB). Associations between alcohol use and reduction, HIV status, functional connectivity, and change in functional connectivity across five major rsfMRI networks were determined relative to the pre- and post-CM timepoints.
Results
Baseline resting-state functional connectivity was not significantly associated with average TAC-AUC during the pre-CM period, though higher self-reported alcohol use over the preceding 30 days was significantly associated with higher baseline connectivity within the Dorsal Attention Network (DAN; p-FDR < 0.05). Baseline connectivity within the Salience network was significantly negatively related to objective drinking reduction after intervention (DAN; p-FDR < 0.05), whereas baseline connectivity within the Limbic network was positively associated with self-reported drinking reduction (p-FDR < 0.05). Change in between-networks functional connectivity after intervention was significantly positively associated with biosensor-confirmed drinking reduction such that higher reduction was associated with stronger connectivity between the limbic and fronto-parietal control networks (p-FDR < 0.05). PLWH with lower DAN connectivity at baseline demonstrated poorer alcohol reduction than those with higher DAN connectivity at baseline.
Discussion
Lower resting-state functional connectivity of the Salience network significantly predicted stronger drinking reduction across all participants, suggesting a potential biomarker for reduced susceptibility to the environmental and social cues that often make alcohol use reduction attempts unsuccessful. Increased between-networks connectivity was observed in participants with higher alcohol reduction after CM, suggesting a positive benefit to brain connectivity associated with reduced drinking. PLWH with lower baseline DAN connectivity may not benefit as greatly from CM for alcohol reduction.
... Согласно результатам другого исследования концентрация ФЭ в крови абстинентов ниже уровня определения (0,001 мкмоль/л), в крови социальных пьяниц 0,006-0,085 мкмоль/л (4,2-60 нг/мл), в крови «тяжелопьющих» 0,89-5,29 мкмоль/л (630-3700 нг/мл) [21]. В Швеции первоначально для гомолога ФЭ 16:0/18:1 в качестве порогового уровня злоупотребления алкоголем была предложена концентрация 0,20 мкмоль/л [22]. Позже, с целью повышения специфичности, пороговый уровень для злоупотребления алкоголем был повышен до 0,30 мкмоль/л (210 нг/мл), в то время как концентрация >0,05 мкмоль/л (35 нг/мл) была принята в качестве порога для социального пьянства [23]. ...
... Active excessive alcohol consumption has been recognized as one of the most frequent causes of acute-on-chronic liver failure (ACLF) [9]. Higher total bilirubin, AST, ALT, and GGT serum levels are known as biological markers of active excessive alcohol consumption [10][11][12]. The fact that AST, ALT, and GGT levels were elevated and GGT levels decreased within the first week after admission in the CPA3/CPA12 groups in this study suggested active excessive alcohol consumption at the time of admission, which could have been the cause of liver failure. ...
Alcoholic liver disease is a risk factor for non-virus-related hepatocellular carcinoma (HCC), which is increasing in prevalence. This study aimed to identify the factors for recovery from alcoholic liver failure. Sixty-two consecutive patients hospitalized for alcoholic liver failure at Okayama City Hospital were enrolled. The characteristics of patients who survived to the 1-month follow-up and whose liver function improved to Child-Pugh A at 3 months (CPA3) and 12 months (CPA12) were compared with the rest of the patients. The survivors at 1 month (50 patients) were significantly younger than the deceased patients and had better liver and renal function with higher levels of γ-glutamyl transferase (GGT). The same factors, except renal function, were correlated with achieving CPA3. High AST, ALT, and GGT levels as well as short spleen length, total abstinence, and good Child-Pugh scores at admission were identified as factors for achieving CPA12. The extent of alcohol intake before admission was not identified as a risk factor in any analysis. In conclusion, baseline liver function is crucial for survival and achieving CPA3, whereas high transaminase and γ-GTP levels, the absence of splenomegaly, and total abstinence are significant factors for achieving CPA12.
... One consideration that emerged from those studies is that the noradrenergic system is affected by different factors, such as hemodynamic parameters (Haass-Koffler et al., 2017), pharmacogenetics (Zhang et al., 2019), family history of AUD (Kenna et al., 2016), sex differences (Guinle & Sinha, 2020), and alcohol withdrawal symptoms (Sinha et al., 2021). Those factors may individually, or in combination, be responsible for different responses to AUD treatment (Litten et al., 2010). The results from trials targeting the noradrenergic system highlight the need to tailor pharmacotherapies to different endophenotypes within the AUD spectrum and to identify biomarkers for use in monitoring the medication response (Haass-Koffler et al., 2018). ...
... Objective measures of alcohol use can provide researchers and clinicians with the ability to identify potential alcohol misuse and monitor an individual's progress during treatment (Litten et al., 2010), reflected in their change in alcohol use. Objective measures provide a useful compliment to self-reported alcohol use, which is often underreported or misreported due to social desirability or recall biases (Davis et al., 2010;Greenfield & Kerr, 2008). ...
... Unlike PEth, which provides one value to represent alcohol use at a specific period of time, transdermal alcohol biosensors measure alcohol use continuously and in near real-time (Davis-Martin et al., 2021). The SCRAM-CAM (Secure Continuous Remote Alcohol Monitor Continuous Alcohol Monitoring; Alcohol Monitoring Systems, Inc., Littleton, CO) anklet is the most commonly used and well-validated alcohol biosensor available (Greenfield et al., 2014;Litten et al., 2010;Wang et al., 2019). The SCRAM-CAM works by measuring the approximately 1% of ethanol that is eliminated through the skin, providing observers with a transdermal alcohol concentration (TAC) reading every 30 min (Swift, 2003). ...
Alcohol use can be measured in many ways, including objectively through transdermal alcohol biosensors (e.g., transdermal alcohol concentration; TAC) or blood biomarkers (e.g., phosphatidylethanol; PEth), or subjectively through self-report (e.g., with the timeline followback; TLFB). However, it is unclear which measures best indicate changes in alcohol use within individuals following intervention, and if they have concurrent validity. In the context of contingency management (CM) with a goal of 30-day abstinence (n = 45, 60% male, 80% Black; Mage = 56.7; 58% with HIV), we examined relationships among changes in TAC-AUC (area under the curve, reflecting volume consumed), PEth, and self-reported number of drinks. The Secure Continuous Remote Alcohol Monitor Continuous Alcohol Monitoring (SCRAM-CAM) biosensor was used to collect TAC-AUC during a pre-CM period (∼7 days) and over a 30-day CM period. PEth was collected at baseline and 30-day follow-up. Number of drinks was self-reported through a 30-day TLFB at baseline and follow-up. Daily TAC-AUC and number of self-reported drinks were calculated for the pre-CM period and for the last 7 days of the CM period. Linear regression models controlling for baseline values revealed that change in TAC-AUC was significantly associated with change in PEth (β = 0.33, p < .0001) and with change in number of self-reported drinks (β = 0.34, p < .0001). Change in PEth was significantly associated with change in number of self-reported drinks (β = 0.85, p < .0001). We conclude that all three measures may be appropriate for measuring within-person change in alcohol use, while controlling for baseline values, in the context of a study testing an intervention such as CM.
