Diagnosing Alcoholism in High-Risk Drinking Drivers: Comparing Different Diagnostic Procedures With Estimated Prevalence of Hazardous Alcohol Use

Abstract

In several European countries, drivers under influence (DUI), suspected of an alcohol use disorder (AUD, 'alcoholism') are referred for diagnostic examination. The accuracy of diagnostic procedures used in diagnosing AUD in the DUI population is unknown. The aim of this study was to compare three prevalence estimates of AUD based on a structured clinical interview (SCID), a restrictive diagnostic procedure (RDP) and usual clinical diagnostic procedure (CDP), with a prevalence estimate based on sensitivity and specificity data of biological markers of excessive use of alcohol in non-judicial samples. The latter unbiased estimate provides an external yardstick against which the biased patient-based prevalence estimates in this special sample can be evaluated. The unbiased estimate derived from sensitivity and specificity data resulted in a prevalence estimate of excessive use of alcohol between 74 and 82%, which is much higher than the three diagnostic procedures. SCID identified maximally 5% of alcoholics found with the unbiased estimate. RDP identified > or =31% of the unbiased estimate, while CDP identified > or =60% of the unbiased estimate. The high chance of false positive diagnosis, however, makes CDP unacceptable in the legal context of AUD diagnosis in DUI populations.

The Bayesian Alcoholism Test had better diagnostic properties for confirming diagnosis of hazardous and harmful alcohol use

“…With the exception of AP, these biochemical markers are known indicators of enzymatic induction or cellular damage due to alcohol, and are predictive of adverse health outcomes [48]. For details concerning the analytical procedures, see our report on diagnosing alcoholism in drinking drivers [21]. In the present study, we used another CDT test (ChronAlcoI.D.…”

“…There is evidence that alcoholic patients who deny or who are not aware of their condition can benefit from the feedback of abnormal laboratory results [17,18]; there is also some evidence that physicians hesitate to confront patients without robust confirmatory evidence [19,20]. In forensic [21,22], insurance [23], occupational [24], and preoperative settings [25,26] there is a strong need of a confirmation test of alcoholism.…”

Assessment of machine-learning techniques on large pathology data sets to address assay redundancy in routine liver function test profiles

“…Urate has been associated with chronic alcohol abuse [22,23], although this has been debated for a Japanese male population [24]. GGT, AST, mean corpuscular volume (MCV) and carbohydrate-deficient transferrin (CDT), with and without reference to other clinical data, have been nominated for the diagnostic and monitoring utility of alcoholics, with prediction accuracies of 75% (0.75) claimed from this profile [2,25]. Less expected, as an elevated GGT predictor was serum cholesterol, although GGT has been identified as a predictor of cardiovascular disease, CVD and also of subsequent mortality.…”

The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers

“…Changes in chronic excessive alcohol use at T1 and T2 from baseline were used as outcomes and detected using two blood biomarkers with established sensitivity obtained by venous puncture: gamma-glutamyl transferase (GGT in international units per liter [IU⁄L]) and mean corpuscular red blood cell volume (MCV in femtoliters [fl]; Allen & Litten, 2003;Hietala, Koivisto, Anttila, & Niemela, 2006;Korzec, Bar, Koeter, & de Kieviet, 2001). Samples were analyzed with a Beckmann automated clinical chemistry instrument at St. Mary's Hospital, McGill University, Montreal.…”