Monitoring the use of alcohol—A critical overview of the state‐of‐the‐art biomarkers

Abstract

The use of alcohol, despite it being a psychoactive substance, is widely accepted. This acceptance and the ease of access may lead to alcohol abuse and dependence. Misuse of alcohol is one of the leading causes of preventable illness, injury or death, has social consequences, and can be linked to various types of criminal activities. Upon monitoring alcohol consumption, the question is not necessarily solely whether or not someone is or was abstinent, but may also imply what kind of drinking behavior or patterns are displayed. To reveal the answer, a portfolio of different biomarkers for alcohol (ab)use has been established. A distinction is made between indirect and direct markers. Indirect biomarkers are proteins, enzymes, or cells of which the level or activity undergoes typical changes as a result of (excessive) alcohol intake [e.g., carbohydrate‐deficient transferrin (CDT)], while direct biomarkers are ethanol itself and molecules which are directly related to the metabolism of alcohol [e.g., ethyl glucuronide (EtG), ethyl sulphate (EtS), fatty acid ethyl esters (FAEE), and phosphatidylethanol (PEth)]. These direct biomarkers have the potential to differentiate between drinking behaviors because they allow a higher sensitivity and specificity, in particular for the detection of abstinence or any drinking, and because they can be measured in different matrices, with different detection windows. These assets open the possibilities for testing strategies based on a combination of different markers that can be used both in retrospective and prospective assessments of alcohol intake. This article is categorized under: Toxicology > Alcohol

Blood microsampling technologies: Innovations and applications in 2022

“…One of the routine forensic toxicology practices is the assessment of alcohol intoxication using the blood alcohol concentration in cases of driving under the influence or traffic incident deaths. However, due to the short half‐life of ethanol in blood, typically between 4 and 5 h, other markers are evaluated to determine drinking behaviours and patterns 147 . Phosphatidylethanol (PEth) is a unique direct ethanol biomarker with a broad detection window to determine alcohol consumption or abstinence.…”

The complementarity of phosphatidylethanol in whole blood and ethyl glucuronide in hair as biomarkers for the monitoring of alcohol use

“…Due to its formation only in the presence of ethanol, PEth became a favoured direct alcohol biomarker. Phosphatidylethanol 16:0/18:1 is the most abundant (37%) of all 48 known PEth homologues that are formed through ethanol exposure 18,20–22 . PEth 16:0/18:1 has a detection window of 2–4 weeks, with an elimination half‐life ranging from 3.7 to 10.4 days 18 .…”

“…Although hEtG offers the advantage of an extended detection window, there is an inherent lag time between ethanol consumption and the hair to reach the surface of the scalp 21 . Consequently, measurement of hEtG does not allow the detection of relatively recent alcohol consumption (i.e., within the last 1–2 weeks).…”

“…Phosphatidylethanol 16:0/18:1 is the most abundant (37%) of all 48 known PEth homologues that are formed through ethanol exposure. 18,[20][21][22] PEth 16:0/18:1 has a detection window of 2-4 weeks, with an elimination half-life ranging from 3.7 to 10.4 days. 18 Therefore, PEth has gained a lot of interest, as it can be classified between short-and long-term alcohol use biomarkers.…”

“…19,24 Although hEtG offers the advantage of an extended detection window, there is an inherent lag time between ethanol consumption and the hair to reach the surface of the scalp. 21 Consequently, measurement of hEtG does not allow the detection of relatively recent alcohol consumption (i.e., within the last 1-2 weeks). However, in a clinical and medico-legal context, it is often fundamental to be able to have a complete picture of alcohol use over the last weeks to months.…”