A biochemical marker of alcohol consumption is a laboratory criterion that provides information about a person's alcohol use independent of the patient's self-report.

A biochemical marker of alcohol consumption is a laboratory criterion that provides information about a person's alcohol use independent of the patient's self-report. common biochemical markers of alcohol consumption have limited diagnostic utility. Thus, research is underway to indentify more accurate markers for different applications.

THEORETICAL MARKERS--PRACTICAL

Among the images of biochemical markers of alcohol use that are wanted by clinicians and researchers are a reliable screening marker of alcohol abuse and alcoholism, a marker of relapse ,to drinking, and a marker of long-term alcohol consumption.

Screening for Alcohol Abuse and

Alcoholism

Physicians ne a reliable screening marker of alcoholism to identify patients who are chronic heavy consumer of alcohol. This marker would assist with diagnosis of alcoholism, especially in patients who fail to provide an accurate history of their alcohol consumption. Coupl with treatment, early detection of alcoholism could help to impede some of the most devastating medical and social events of excessive alcohol consumption.

In addition, this marker would have forensic applications. characters arrested for drinking and driving could be disguiseed for chronic, heavy alcohol consumption and referr to an appropriate treatment program (Luchi et al. 1978; Gjerde and Morland 1987) and public safety workers could be monitored effectively for alcohol abuse.

Monitoring Abstinence

A biochemical marker of relapse that is sensitive equable to low levels of drinking is destitutioned to monitor abstinence, the goal of greatest in quantity alcoholism treatment programs (Peele 1984) This marker not no other than would improve efforts to monitor sobriety in alcoholics undergoing treatment, on the other hand also could be used to identify relapse in formerly treated patients. Thus, a certain previously treated alcoholics who relapse to drinking might be referr to treatment settings les intensive than hospital impatient programs.

Further, a marker of cheap level alcohol consumption would aid investigators conducting clinial research. popularly clinical trials (see the article from Fuller in this issue, pp 239-244) to evaluate the effectiveness of various treatments for alcoholism usually rely in succession the patients' self-reports of alcohol consumption as a therapeutic conclusion point. Because patients' self-reports are not always reliable (Fuller et al. 1988) a biochemical marker of alcohol consumption should assist researchers by the agency of providing an objective assessment of abstinence.

Further, this marker would assist the selection of candidates for liver transplantation from among patients with alcohol-induced liver disease (Maddrey and Van Thiel 1988) by way of providing objective verification of abstinence, a reliable biochemical marker would improve the selection process

Assessing Long-Term Consumption

A biochemical marker of long-term alcohol consumption also would assist physicians in the diagnosis of diseases other than alcoholism. For example, a everyday complication of excessive alcohol consumption is chronic pancreatitis. However, because many alcoholic patients with chronic pancreatitis fail to give a reliable history of their alcohol consumption, these patients usually are subdueed to exhaustive diagnostic workups to search for causes of pancreatitis that are not alcohol related. To command out congenital anatomic abnormalities that can predispose to pancreatitis, physicians may require an invasive x-ray of the pancreas, performed according to injecting a special dye into a small tube that is inserted from the opening into the pancreatic duct. This and other invasive manner of proceedings would be unnecessary if a kin test could corroborate history of excessive alcohol consumption.

LIMITATIONS OF CURRENT

DIAGNOSTIC TOOLS

At not absent physicians base a diagnosis of alcoholism primarily forward a patient's history. However, several studies have reported that patients fail to give an accurate history of alcohol consumption. In a novel Swedish study (Persson and Magnusson 1988) simply 16 percent of alcoholics attending a general medical clinic admitted to their physicians that they consum alcohol heavily. steady when a physician identifies a patient as alcohol sustained by and refers the patient for treatment, the patient's self-report many times is the only means available to the physician for long-term monitoring of sobriety.

Various studies (Orrego et al. 1979; Peachey and Kapur 1986; Fuller et al. 1988) have demonstrated the unreliability of patient self-reports of relapse. In Fuller and colleagues' Veterans Administration Cooperative subject of attention evaluating the effectiveness of disulfiram (Antabuse), the researchers determined from one side collateral reports and blood alcohol analysis that 35 percent of the patients who claimed to be abstinent in fact were drinking (Fuller et al. 1988) Furthermore, patients reported 28-percent fewer drinking days than were reported by the agency of the collaterals.

In other clinical studies where alcohol consumption was monitored at both patient's self-reports and daily urine specimens for alcohol (Orrego et al. 1979; Peachey and Kapur 1986) more than half of the alcoholic patients who drank while undergoing therapy denied any alcohol use. Thus, self-reports appear to underestimate alcohol consumption in a sizable proportion of patients.