Support recovery through direct ethanol biomarker testing
Alcohol, or ethanol, is the most commonly abused drug in the world and is regularly consumed by more than half of adults in the United States. Excessive alcohol consumption, which includes binge drinking and heavy binge drinking, is the leading cause of preventable death in the U.S. Alcohol use disorder (AUD), defined as a pattern of alcohol use involving inability to control drinking, preoccupation with alcohol, and continued use even when it causes problems, ranks among the leading health problems worldwide and is estimated to affect 300 million people.1
Because hazardous drinking practices and associated morbidity remain underdiagnosed, routine screening for unhealthy alcohol use is recommended by the U.S. Preventive Services Task Force as a cost-effective, clinical preventive service. Further, the incorporation of alcohol biomarker testing is recommended by the American Society of Addiction Medicine and the American Psychiatric Association to help diagnose AUD and support patient recovery.2
By the numbers
14.8 million Americans have AUD3
140,000 deaths in the U.S. each year caused by excessive alcohol use4
Annual financial burden of AUD was $249 billion in 20104
Mayo Clinic Laboratories offers a menu of direct ethanol biomarker testing to accurately assess alcohol use and AUD. As opposed to the limited sensitivity and specificity of indirect ethanol biomarker testing, direct biomarker testing offers heightened sensitivity and specificity to identify AUD. This methodology enables detection of even small amounts of ethanol eliminated via non-oxidative pathways into ethyl glucuronide (EtG), ethyl sulfate (EtS), and phosphatidylethanol (PEth).6 Because these direct alcohol biomarkers have a longer half-life and extended detection window, alcohol consumption over a period of several days can be more accurately assessed.
Additional benefits of biomarker testing include:
Improved analysis of the specific role alcohol plays on an individual’s health.7
Test results clarify actual amounts of recent consumption, which, combined with questionnaires, can support initiating clinical interventions.
Our urine alcohol testing offers clinical specificity to evaluate for alcohol use through the detection of EtG and EtS. In addition, we offer blood biomarker testing to evaluate for PEth, which provides an expanded window of detection to identify ethanol consumption. PEths, a group of phospholipids formed in the presence of ethanol, phospholipase D, and phosphatidylcholine, are incorporated into the phospholipid membrane of red blood cells. Based on blood concentrations of PEth, it is possible to determine recent alcohol consumption and how much has been taken for several weeks following the last use.
Detects EtG, which is a direct metabolite of alcohol formed by enzymatic conjugation of ethanol with glucuronic acid. Alcohol in urine is normally detected for only a few hours, whereas EtG can be detected in the urine for up to five days.
Testing begins with a screening assay. If positive, then the liquid chromatography-tandem mass spectrometry confirmation with quantification (Mayo ID: ETGC) will be performed at an additional charge.
Care should be taken when interpreting results, since there are many factors (e.g., fluid intake) that might influence the urine test result. It is possible that substances other than those investigated in the specific study may interfere with the test and cause false positive or false negative results.
Paul Jannetto, Ph.D., describes Mayo Clinic Laboratories' new direct biomarker test for alcohol consumption. PETH is a blood test with a window of detection of about two to four weeks — compared with five days for urine-based screening for alcohol use.
Chaudhari R., Moonka D., Nunes F. Using biomarkers to quantify problematic alcohol use. J Fam Pract. 2021 Dec;70(10):474-481. doi:10.12788/jfp.0317.
Kapur B, Aleksa K., What the lab can and cannot do: clinical interpretation of drug testing results. Crit Rev Clin Lab Sci. 57:8, 548-585. doi:10.1080/10408363.2020.1774493
Niemela, O. Biomarker-based approaches for assessing alcohol use disorders. Int J Environ Res Public Health. 2016 Jan 27;13(2):166. doi:10.3390/ijerph13020166
Hakim F, Wiart JF, Ménard O, Allorge D, Gaulier JM. Dosage sanguin du phosphatidyléthanol [Phosphatidylethanol blood analysis]. Ann Biol Clin (Paris). 2019 Dec 1;77(6):638-644. French. doi:10.1684/abc.2019.1499. PMID: 31859640.
Ulwelling W, Smith K. The PEth blood test in the security environment: what it is; why it is important; and interpretative guidelines. J Forensic Sci. 2018 Nov;63(6):1634-1640. PMID: 30005144