Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

ADVISORY

Spring 2012 • Volume 11 • Issue 2

The Role of Biomarkers in the Treatment 

of Alcohol Use Disorders, 2012 Revision
 

This Advisory is a revision of the 2006 Substance 

Abuse Treatment Advisory, The Role of Biomarkers in 

the Treatment of Alcohol Use Disorders. The revision 

was necessitated by increased scientific knowledge 

about alcohol biomarkers and requests from clinical 

and judicial professionals for greater clarification on 

the use of biomarkers. This Advisory reviews recent 

scientific biomarker data and discusses their relevance 

for clinical, medical, and forensic purposes. Potential 

strategies for the use and interpretation of biomarkers in 

varying circumstances such as clinical, criminal justice, 

and impaired healthcare provider settings are discussed. 

This Advisory does not discuss the measurement of 

the physical presence of alcohol in expired air, blood, 

or saliva; nonoxidative alcohol metabolites in hair or 

other tissues; or behavioral and cognitive performance 

measures that may be affected by alcohol use. 

What are alcohol biomarkers? 

Alcohol biomarkers are physiological indicators of 

alcohol exposure or ingestion and may reflect the presence of chronic and/or high level of use of alcohol. Most 

readily measurable biomarkers are indirectly correlated 

with alcohol problems, such as alcohol dependence. 

Some of the newer biomarker tests can directly measure alcohol exposure or use. Key characteristics of the 

biomarkers discussed in this Advisory are presented in 

Exhibit 1 (see page 2). Exhibit 1 also provides a rough 

index of sensitivity (the ability of the test to correctly 

identify those individuals with the condition of interest 

when used on an affected population) and specificity (the 

ability of the test to correctly identify those individuals 

among the individuals without the condition of interest). 

Low represents values approximately 40 percent or less 

and high represents values usually above 70 percent. 

Sensitivity and specificity also depend on what defines 

the condition of interest and the cutoff value being used 

for the test. 

Why are alcohol biomarkers 

needed? 

Alcohol biomarkers are not a substitute for self-report 

measures or information that would otherwise be 

gathered from a comprehensive patient history and 

physical by an appropriately trained health professional. 

They can, however, make a unique and important 

contribution in serving as objective measures and are 

helpful as (1) outcome measures in studies to evaluate 

new medications or behavioral interventions for alcohol 

problems; (2) screens for possible alcohol problems in 

individuals unwilling or unable to provide accurate selfreports of their drinking or its effects; and (3) evidence of 

abstinence in individuals prohibited from drinking. 

Alcohol biomarkers and self-report measures of 

drinking such as the National Institute on Alcohol 

Abuse and Alcoholism1

 Single-question screen, 

Alcohol Use Disorders Identification Test;2

 Michigan 

Alcoholism Screening Test;3

 and CAGE4 should be 

considered complementary because self-report measures 

and biomarkers may identify somewhat different 

individuals.5 Thus, their use in combination is often 

desirable. 

What are the categories of 

alcohol biomarkers? 

Traditional alcohol biomarkers have generally been of 

an indirect nature because they suggest heavy alcohol 

consumption by detecting the toxic effects that alcohol 

may have had on organ systems or body chemistry.6 

Included in this class are the blood-based measures of 

gamma glutamyl transferase (GGT), aspartate amino 

transferase (AST), alanine amino transferase (ALT), and 

mean corpuscular volume (MCV). The first three are 

serum enzymes produced by the liver. GGT elevation 

is caused by liver enzyme induction by alcohol, 

liver damage, or many drugs including prescription
	
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ADVISORY

Exhibit 1. Characteristics of Several Alcohol Biomarkers6,7,8,9,10,11 

Biomarker Type of 

Drinking 

Characterized 

Sensitivity/ 

Specificity 

Examples of 

Possible Sources of 

False Positives 

General Comments 

Aspartate Amino 

Transferase (AST), 

Alanine Amino 

Transferase (ALT) 

Unknown, but 

heavy and 

lasting for 

several weeks 

Moderate/Moderate 

(somewhat lower 

sensitivity than 

GGT as screen for 

heavy drinking) 

See GGT. Excessive 

coffee consumption 

can lower values. 

Primarily reflects liver damage 

that is often related to alcohol. 

ALT seems less sensitive than 

AST. Ratios of AST to ALT 

greater than 2 may suggest 

liver damage that is alcohol 

related. Performs best in 

adults ages 30 to 60 years. 

CarbohydrateDeficient 

Transferrin (CDT) 

Probably 

at least 5 

drinks/day for 

approximately 2 

weeks 

Moderate/High (as 

screen for alcohol 

dependence) 

Rare genetic 

transferring variant, 

primary biliary 

cirrhosis, chronic endstage liver disease, 

fulminant hepatitis 

C. Values are also 

altered due to 

smoking or obesity. 

Equal to, or possibly slightly 

better than GGT, but much 

more specific. Biomarker of 

relapse to heavy drinking 

following a period of 

abstinence. Likely less 

sensitive for women and 

younger people. 

Ethyl Glucuronide 

(EtG), Ethyl 

Sulfate (EtS 

Perhaps as 

little as a single 

drink 

High/High (as 

indicator of relapse) 

Extraneous alcohol 

exposure, such 

as alcohol in 

medications, hygiene 

products, cosmetics, 

foods, etc., can 

elevate values of 

biomarkers. 

As direct analytes of 

nonoxidative breakdown 

of alcohol, highly sensitive. 

Probably little gender, age, 

or ethnicity effect. New, but 

promising biomarkers; more 

research is warranted. 

Gamma Glutamyl 

Transferase (GGT) 

Probably at 

least 5 drinks/ 

day for several 

weeks 

Moderate/Moderate 

(as screen for 

heavy drinking) 

Liver and biliary 

disease, smoking, 

obesity, diabetes, and 

medications inducing 

microsomal enzymes. 

Most commonly used 

traditional biomarker. Primarily 

reflects liver damage that 

is often related to alcohol 

consumption. Performs best in 

adults ages 30 to 60 years. 

Mean Corpuscular 

Volume (MCV) 

Unknown, but 

heavy and 

lasting up to 

several months 

Moderate/Moderate 

(sensitivity 

somewhat below 

GGT as screen for 

heavy drinking) 

Hemolysis, bleeding 

disorders, anemia, 

folate deficiency, 

hypothyroidism, 

hyperglycemia, and 

medications reducing 

folate. 

Poor biomarker for relapse 

because of sluggish response 

to drinking. Higher sensitivity 

in women than men. Performs 

best in adults ages 30 to 60 

years. 

Phosphatidyl 

Ethanol (PEth) 

Possibly 3 or 4 

drinks/day for 

several days 

High/High 

(additional research 

is needed) 

None likely but still 

unknown due to 

paucity of research. 

Probably little gender, age, 

or ethnicity effect. Linear 

dose–response relationship 

with recent drinking levels. A 

new but promising biomarker; 

more research is warranted. 

medications. AST and ALT elevations often indicate injury 

and death of liver cells. Such elevations may be a result 

of heavy drinking, but none of these tests are specific for 

alcohol. MCV refers to the average size of red blood cells 2

and is measured in whole blood. Elevated MCV can be 

caused by many things, including heavy drinking. These four 

tests are not very sensitive, and many heavy drinkers may not 

have elevations. 
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The Role of Biomarkers in the Treatment of Alcohol Use Disorders, 2012 Revision

Spring 2012, Volume 11, Issue 2

A newer indirect alcohol biomarker, carbohydrate-deficient 

transferrin (CDT), is now widely available in the United 

States. Although the mechanisms responsible for elevation 

of CDT are not clearly understood, moderately heavy to 

heavy alcohol consumption for about 2 weeks can cause the 

transferrin molecule to be lacking in carbohydrate residue 

in some of its terminal chains. To “normalize” differences 

in total transferrin levels across individuals, CDT is usually 

measured in serum as the percentage of total transferrin that 

is carbohydrate deficient rather than as the absolute amount 

of CDT. CDT and GGT are approximately equal in their 

ability to identify alcohol problems. The particular advantage 

of CDT over GGT is that fewer factors other than alcohol use 

can cause elevation. However, CDT is also quite insensitive 

to episodic, heavy alcohol use, resulting in false negatives. 

Direct biomarkers of drinking have recently been developed. 

They are termed “direct” because they are analytes of alcohol 

metabolism. Although most alcohol that is consumed is 

metabolized by oxidative processes in the liver, a very small 

amount is broken down nonoxidatively, thereby creating 

analytes that can be measured for a longer period than when 

alcohol itself remains in the body and can be measured in the 

blood or urine. 

Among the more recently available direct biomarker 

laboratory tests are tests for ethyl glucuronide (EtG) and 

ethyl sulfate (EtS). Although present in all body fluids and 

tissues, EtG and EtS are usually measured in urine. EtG and 

EtS tests may become positive shortly after even low-level 

exposure to alcohol and may remain detectable in urine 

for 1 to 2 days.6,10 Because of the high sensitivity of these 

tests, exposure to alcohol that is present in many daily use 

products might also result in a positive laboratory test result 

for these biomarkers. Upper respiratory infections as well as 

beta glucuronidase hydrolysis may lower levels of EtG but 

do not seem to affect EtS. On the other hand, EtG levels may 

be raised by the presence of alcohol or glucose in the urine. 

EtG is used in monitoring abstinence in clinical and justice 

system settings. However, whereas EtG can be measured at 

very low concentrations in vivo, the source of EtG cannot 

always be determined. Many products used or consumed 

daily (e.g., hand sanitizers and mouthwash) contain alcohol. 

Extraneous exposures, such as these, can elevate EtG levels, 

creating false positive responses. False positive responses 

can be detrimental in medical and forensic settings where 

an individual’s freedom or career is in jeopardy. Recent 

investigations have aimed at identifying the degree to which 

extraneous exposures and conditions affect EtG levels to 

determine how EtG can be used successfully to indicate 

intentional alcohol use. In addition, more research is needed 

on how the test results may be influenced by various 

diseases, ethnicity, gender, genetic variation in enzyme 

systems, or the use of drugs. 

Phosphatidyl ethanol (PEth) is a direct serum-based 

biomarker. A test for PEth is promising because of PEth’s 

persistence in blood for as long as 3 weeks after even only 

a few days of moderately heavy drinking (about four drinks 

per day). There is still little research on PEth, which is only 

beginning to be studied by researchers in alcohol studies.12 

Because biomarkers have differing strengths and 

weaknesses, they are often used together, especially for 

screening for alcohol use problems. Common combinations 

include simultaneous use of CDT and GGT,13 GGT and 

MCV,14 sequential use of biomarkers,15 and mathematical 

combinations of various blood constituents.16 Biomarkers 

for monitoring abstinence that can be used in combination 

include urine alcohol, EtG, and/or EtS. EtG and EtS when 

used together seem to offer slightly greater sensitivity to 

alcohol use than either biomarker alone.17 

Interpreting even a very good alcohol biomarker test 

requires considerable knowledge of both the patient and 

the population of individuals similar to the patient. Tests 

should help a provider make a decision based on a variety 

of information gathered about the patient. It is important 

to precisely describe the condition that is to be detected 

by the test, such as early relapse, as defined by specific 

criteria related to alcohol consumption or drinking status. 

As noted earlier, a test’s sensitivity refers to the percentage 

of individuals with the condition that the test correctly 

identifies, for example, early relapse. On the other hand, 

determination of the positive predictive value of the test 

requires knowledge of its specificity (the percentage of 

people who have not relapsed and are negative on the test) 

as well as awareness of the prevalence of relapse in the 

group under consideration. The positive predictive value 

refers to the percentage of positive tests in which relapse has 

actually occurred. A test’s negative predictive value refers 

to the percentage of negative tests in which relapse has not 

occurred. 

Although sources of false positives have been identified 

for the traditional biomarkers and CDT, research continues 

to be needed on the new direct biomarkers, particularly 
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4 

ADVISORY

on the very sensitive biomarkers, EtG and EtS. At issue is 

whether exposure to alcohol or to the vapors of alcohol in 

many commercial products, such as personal care items, 

over-the-counter medications, cleaning products, desserts, 

wine vinegar, and the like or combinations of these products 

can cause elevation in EtG or EtS that could suggest the 

person has resumed drinking. Exposure to these products, 

combined with possible influences of individual variables 

such as gender, age, and health status on alcohol biomarker 

responses, is still being studied. 

Respective windows of assessment (i.e., the amount of time 

during which the biomarker remains measurable in the body 

after drinking ceases) are presented in Exhibit 2. 

How can alcohol biomarkers be 

used? 

Alcohol biomarkers can be used in several ways. Their major 

uses are: 

● Screening for alcohol problems. The role of alcohol 

in either causing or exacerbating medical problems is 

often missed even in medical care contexts where the 

prevalence of alcohol misuse is quite high, such as 

hospital emergency departments, psychiatric practices, 

and internal medicine clinics. Physician awareness of 

a possible co-occurring alcohol problem can improve 

differential diagnosis and treatment.18, 19 Biomarkers 

also may assist in differential diagnosis by determining 

the possible role of alcohol use in a disease process 

(e.g., hypertension or diabetes).20 Biomarkers, however, 

should not be used as the sole screening tool in light of 

their low-to-moderate sensitivity and specificity, and in 

the case of EtG, because of exposure to alcohol from 

sources other than drinking. 

● Motivating change in drinking behavior. An important 

goal of alcohol treatment is motivating a patient to 

reduce or cease drinking. Giving feedback on elevations 

in biomarkers and reviewing with the patient lowered 

scores in biomarker levels as treatment proceeds 

provides objective evidence of the patient’s personal 

need for and benefit of stopping or reducing alcohol 

use. Feedback focusing on levels of the traditional 

biomarkers may be especially compelling for drinking 

reduction because biomarker elevation can tangibly 

demonstrate serious physiological consequences.21 In a 

classic study,22 Kristenson, Trell, and Hood found that 

providing individuals recurrent feedback on their levels 

of GGT led to reduction not only in subsequent GGT 

levels but also in alcohol use, rates of hospitalization, 

days absent from work, and mortality. 

● Identifying relapse to drinking. Relapse is not 

unexpected in alcohol treatment and in the early stages 

of recovery. Frequent monitoring of the patient’s 

abstinence and addressing relapses as early as possible 

are important aspects of alcohol treatment. CDT has 

been shown to perform well as a relapse biomarker, 

sometimes elevating before the patient acknowledges 

a return to drinking.13 Interestingly, CDT seems to reelevate with lower amounts of alcohol use after a period 

of abstinence than the intensity of drinking initially 

required to raise it.23 

Exhibit 2. Window of Assessment for Various Alcohol Biomarkers6,11 
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The Role of Biomarkers in the Treatment of Alcohol Use Disorders, 2012 Revision

Spring 2012, Volume 11, Issue 2

Exhibit 3 summarizes some of the uses of biomarkers. 

How can alcohol biomarkers be 

used to document abstinence? 

This section addresses specific issues related to the use 

of alcohol biomarkers in settings where the individual 

participating in the test is required to abstain from consuming 

alcohol. The direct biomarkers, especially EtG and EtS, 

can be very helpful in monitoring individuals mandated to 

maintain abstinence. These groups of individuals include: 

● Individuals younger than the legal drinking age and 

members of the Armed Forces in combat zones where, 

regardless of age, drinking is prohibited. 

● Individuals on probation, including adolescents, who 

have committed alcohol-related crimes. 

● Individuals who have previous alcohol-related problems 

but have been allowed visitation with or custody of 

children with the stipulation that these individuals 

remain abstinent. 

● Motorists who have had alcohol-related traffic 

convictions and who are now required to abstain as a 

condition of maintaining driving privileges. 

● Medical personnel, pilots, attorneys, and others who, 

because of previous alcohol- or drug-related problems, 

have agreed to maintain total abstinence and accept 

ongoing monitoring as conditions for continued licensure 

or employment. 

What cautions should be 

observed in reviewing positive 

biomarker results of individuals 

mandated to be abstinent? 

Biomarkers provide an important indication of drinking 

status when used appropriately, but they must always be used 

with a clear understanding of their strengths and potential 

weaknesses. This is especially true when the consequences 

of misidentification of alcohol consumption are grave, such 

as for a healthcare provider whose license, livelihood, and 

reputation depend on demonstration of abstinence or for an 

individual who will be ordered to return to jail because of a 

positive test result. One strategy for minimizing this problem 

is to use a contract that stipulates that individuals for whom 

abstinence is required avoid using products that may result 

in a positive test, such as alcohol-based mouthwash, hand 

sanitizers, and hygiene products. 

What responses should be 

considered in response to positive 

biomarker results for individuals 

mandated to be abstinent? 

Establishing rapport and trust between the treatment provider 

or monitor and the patient is essential to encourage candor 

on the part of the patient. It is important for individuals in 

safety-sensitive positions to have supervisors who understand 

that fair evaluation, treatment, and eventual reinstatement 

are possible options. Although violations of abstinence must 

be taken very seriously, consideration may be given to a 

Exhibit 3. Summary Table of Alcohol Biomarkers by Particular Use6 

Biomarker Screening for 

Heavy Drinking 

Identify Relapse, 

Especially to Heavy 

Drinking 

Time To Return 

to Normal With 

Abstinence 

Monitoring 

Abstinence 

CDT   2–3 weeks 

EtG, EtS  1–3 days 

GGT  2–4 weeks 

MCV  Up to several months 

PEth  2–4 weeks 

Sensor Device  Continual 

SGOT/AST*  2–4 weeks 

SGPT/ALT**  2–4 weeks 

* Serum glutamic-oxaloacetic transaminase/aspartate transaminase 

** Serum glutamic pyruvic transaminase/alanine aminotransferas 
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ADVISORY

standard less rigid than “one strike, you’re out.” Reasonable 

consequences will encourage openness and earlier reporting 

of problems. The determination of drinking and the 

safeguarding of one’s livelihood ultimately involve informed 

human judgment based on all available relevant information. 

A cornerstone of recovery is honesty. A biomarker that is 

positive because of exposure or unintentional consumption, 

which results in an allegation of use or misuse, casts a cloud 

on the recovery process. False allegations provide incentives 

to disregard the intent of abstinence monitoring and may 

even provide incentives to use because the individual has 

“nothing to lose.” 

The response to positive tests on EtG and EtS in questionable 

cases should be reasonable and include: 

●		Considering clinical and other information about
	

the individual that may or may not be suggestive of
	

drinking.
	

●		Possibly increasing the frequency of testing to monitor 

drinking status. 

●		Possibly following up by using additional biomarkers, 

especially CDT. (PEth, when it becomes more available 

in the United States, would also be a good followup 

test. GGT might be used as a followup test because it 

is readily available. However, there are many sources 

for false positives on GGT, and GGT elevates only with 

considerable drinking). 

● Perhaps inviting the individual to undergo a controlled 

trial of exposure to the product or products he or she 

believes may explain the positive result. 

●		Possible monitoring by means of a transdermal alcohol 

sensing device. Transdermal sensing devices capture and 

record the vapors of alcohol extruded through the skin in 

sweat. 

● Forewarning the individual, perhaps a day in advance, 

that his or her EtG or EtS, or both, will be measured. 

Warning the patient not to use ethanol-containing 

products due to their potential impact on EtS and EtG 

measurements would allow the patient to be sure to 

avoid exposure to environmental products that may 

contain ethanol. This, however, could lead to increased 

risk of tampering. Tampering refers to intentional 

alteration of a urine sample through dilution or addition 

of components in an effort to pass a test. If a person is 

given a 24-hour notice, he or she could use different 

methods to dilute his or her urine. However, dilution can 

be caught by other measures such as testing the sample 

for creatinine and specific gravity. 

How should a test cutoff value be 

chosen? 

The cutoff value selected to distinguish specimens as 

positive or negative should consider the base rate of problem 

drinking in the population being evaluated, an individual’s 

likely exposure to products containing nonbeverage alcohol, 

and the consequences for the individual and society of the 

individual being erroneously labeled. Establishing a reliable 

cutoff with high positive predictive value (proportion 

of subjects with positive tests results who are correctly 

diagnosed) requires research in the population and discussion 

of the various contexts in which the test might be applied. 

Because of the common use of EtG to document abstinence 

in various settings and the grave consequences for false 

positive, much attention has been given to the cutoff values 

of EtG. Although further research is needed before firm 

cutoffs for EtG can be established, sufficient research has 

been completed to reach the following conclusions:24 

● A “high” positive (e.g., >1,000 ng/mL) may indicate: 

–	 Heavy drinking on the same day or previously (e.g., 

previous day or two). 

–	 Light drinking the same day. 

●		A “low” positive (e.g., 500–1,000 ng/mL) may indicate: 

–	 Previous heavy drinking (previous 1–3 days). 

–	 Recent light drinking (e.g., past 24 hours). 

–	 Recent intense “extraneous exposure” (within 24 

hours or less). 

● A “very low” positive (100–500 ng/mL) may indicate: 

–	 Previous heavy drinking (1–3 days). 

–	 Previous light drinking (12–36 hours). 

–	 Recent “extraneous” exposure. 

How are EtG and EtS best 

measured? 

For most purposes, EtG and EtS are best measured in 

urine because their window of detection is wider in this 

matrix than in saliva or blood. These biomarkers can also 

be measured in hair and recently a test was developed to 

measure them in nails. However, in these instances the 

window of detection may be too long or undefined for 

most applied purposes. It is possible that hair-care products 

can influence measured levels of the alcohol metabolites. 

Instructions for processing the urine specimen must be 

followed rigorously, especially the instructions that the 

specimen must be refrigerated within a specified period. 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

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The Role of Biomarkers in the Treatment of Alcohol Use Disorders, 2012 Revision

Spring 2012, Volume 11, Issue 2

 

The concern over refrigeration of specimens prior to analysis 

is more problematic for EtG than for EtS. However, it is also 

possible to use specimen containers that have been treated to 

retard bacterial degradation of the specimen. The method of 

analysis should be gas chromatography/mass spectrometry 

(GC/MS) or liquid chromatography-tandem mass 

spectrometry (LC/MS/MS). Enzyme immunoassay (EIA) 

analysis results in a fairly high number of false positives. 

If EIA is used and the urine sample tests positive, the result 

should be confirmed by the more accurate GC/MS or 

LC/MS/MS procedures. Because degree of hydration 

influences the concentration of EtG and EtS, reference 

laboratories should report scores corrected for level of 

creatinine or specific gravity. 

Currently, tests for EtG and EtS do not have approval of the 

Food and Drug Administration; it is hoped this situation will 

improve in the future to facilitate insurance reimbursement 

for and acceptance by the additional practitioners. 

How can biomarkers be used to 

evaluate interventions for alcohol 

problems? 

Alcohol biomarkers provide objective outcome data in 

clinical trials of either new medications25 or behavioral 

treatments to treat alcohol use disorders. Although in other 

instances, alcohol biomarkers must accurately identify 

specific individuals with alcohol problems, in clinical trials 

or evaluations of community alcohol treatment programs 

identification of the drinking status of particular subjects is 

usually not a primary issue; rather, the goal is determination 

of average differences between the experimental group and 

the control group. Thus, with a sufficiently large sample size, 

even biomarkers with fairly low accuracy can provide useful 

information about treatment efficacy. 

What research is needed on 

direct alcohol biomarkers? 

Direct measurement of the nonoxidative metabolites of 

the breakdown of alcohol is an emerging and exciting 

technology, but several lines of research are still needed. 

These include: 

●		Establishment of a cutoff that can clearly distinguish 

the consumption of beverage alcohol from exposure to 

alcohol in environmental products. 

●		Identification of possible factors, such as genetic 

differences, gender, age, ethnic group, medical or 

psychiatric comorbidity, disease, genetic polymorphism, 

and use of medications that may influence an 

individual’s biomarker response to alcohol use. 

●		Identification of the window of assessment associated
	

with varying levels of alcohol use.
	

●		Determination of the reliability of laboratory testing 

procedures. 

●		Determination of products that may give a positive test 

result at specific cutoffs. 

Notes 

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Patients Who Drink too Much: A Clinician’s Guide, Updated 2005 

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2 Saunders, J., Aasland, O., Babor, T., De La Fuente, J., & Grant, M. 

(1993). Development of Alcohol Use Disorders Identification Test 

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3 Kristenson, H., & Trell, E. (1982). Indicators of alcohol consumption: 

Comparisons between a questionnaire (Mm-Mast), interviews and 

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middle aged males. British Journal of Addiction, 77(3), 297–304. 

4 Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE questionnaire: 

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5 Hermansson, U., Helander, A., Huss, A., Brandt, L., & Ronnberg, S. 

(2000). Alcohol Use Disorders Identification Test and carbohydrate 

deficient transferrin (CDT) in a routine workplace health 

examination. Alcoholism: Clinical and Experimental Research, 

24(2), 180–187. 

6 Litten, R. Z., Bradley, A. M., & Moss, H. B. (2010). Alcohol 

biomarkers in applied settings: Recent advances and future research 

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34(6), 955–967. 

7 Conigrave, K. M., Saunders, J. B., & Whitfield, J. B. (1995). Diagnostic 

tests for alcohol consumption. Alcohol & Alcoholism, 30, 13–26. 

8 Fleming, M. F., Anton, R. F., & Spies, C. D. (2004). A review of 

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Experimental Research, 28(9), 1347–1355. 

9 Jeppsson, J.-O., Arndt, T., Schellenberg, F., Wielders, J. P. M., Anton, 

R. F., Whitfield, J. B., et al. (2007). Toward standardization of 

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10 Kissack, J. C., Bishop, J., & Leatherwood, A. (2008). Ethylglucuronide 

as a biomarker for ethanol detection. Pharmacotherapy, 28(6), 

769–781. 

11 Niemelä, O. (2007). Biomarkers in alcoholism, Clinica Chimica Acta, 

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ADVISORY

12 Isaksson, A., Walther, L., Hansson, T., Andersson, A., & Alling, C. 

(2011). Phosphatidylethanol in blood (B-PEth): A marker for 

alcohol use and abuse. Drug Testing and Analysis, 3(4), 195–200.

13 Allen, J. P., Litten, R. Z., Fertig, J. B., & Sillanaukee, P. (2000). 

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17 Wurst, F. M., Dresen, S., Allen, J. P., Wisebeck, G., Graf, M., & 

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18 Dillie, K. S., Mundt, M., French, M. T., & Fleming, M. F. (2005). 

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19 Spies, C. D., Kissner, M., Neumann, T., Blum, S., Voigt, D., & Funk, 

T. (1998). Elevated carbohydrate-deficient transferrin predicts 

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20 Sillanaukee, P., Strid, N., Jousilahti, P., Vartiainen, E., Poikolainen, K., 

Nikkari, S., et al. (2001). Association of self-reported diseases and 

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21 Conigrave, K. M., Davies, P., Haber, P., & Whitfield, J. B. (2003). 

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22 Kristenson, H., Trell, E., & Hood, B. (1981). Serum gammaglutamyltransferase in screening and continuous control of heavy 

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SAMHSA Advisory 

This Advisory was written and produced under contract number 270-09-0307 by the Knowledge Application Program (KAP), 

a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Center for Substance Abuse Treatment (CSAT), 

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services 

(HHS). Christina Currier served as the Contracting Officer's Representative. 

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Recommended Citation: Substance Abuse and Mental Health Services Administration. (2012). The Role of Biomarkers in 

the Treatment of Alcohol Use Disorders, 2012 Revision. Advisory, Volume 11, Issue 2.

Originating Office: Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center 

for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, 

Rockville, MD 20857.

SAMHSA Advisory

The Role of Biomarkers in the Treatment of Alcohol Use 

Disorders, 2012 Revision

HHS Publication No. (SMA) 12-4686 

First Printed 2006

Revised 2012