Using visual aids can deepen patients’ under-standing of motivational feedback. For example, displaying sequential test results on a timeline can reinforce motivation by showing how their drinking behavior has improved with continuing treatment and sustained effort.
Table 3
Self-report and biochemical measures of drinking: Pros and cons
| Measure | Strengths | Weaknesses |
|---|---|---|
| Self-report | Noninvasive Inexpensive High validity Flexible window of assessment Immediate results | Easily feigned Accuracy depends on patient’s verbal skills and memory |
| Biochemical | Objective Results may be more compelling to patients than self-reports May reflect organ damage Useful in tracking treatment progress | Window of assessment is limited to recent past Results often not immediately available May be more costly than self-report measures |
DETECTING RELAPSE
Although treatment for alcohol problems is often successful,23 relapse to some level of drinking is not uncommon, especially during the first 3 or 4 months after patients complete treatment.20 Recognizing relapse quickly can help you:
- decrease risk of harm from resumed alcohol use
- reduce the potential for drinking to again become habitual
- identify circumstances and cues that may have triggered the drinking episode, for use in tailoring future interventions.
In clinical practice, relapse is most often revealed via comments from the family, direct observation by the clinician, or voluntary acknowledgment by the patient. Interestingly, CDT has demonstrated a relapse “heralding effect,”24 meaning that it tends to rise well before a patient will admit he or she resumed drinking.24-26 Although other markers may also rise following relapse, their elevation tends to be delayed and less dramatic.
The sensitivity and specificity of CDT alone and with GGT in identifying relapse have been evaluated. Across male-only studies, CDT’s median sensitivity (percent of relapsed patients with elevated scores) was 0.73, with a specificity (percent of those not relapsed who had low scores) of 0.91. In the two female-only studies, median sensitivity and specificity for CDT were 0.32 and 0.86, respectively. For women, using CDT and GGT in combination substantially raised median sensitivity to 0.62, although specificity fell slightly to 0.80.27
Recommendation. When using biomarkers to identify relapse, examine the temporal pattern of test results to date. Assume that an increase of 30% or more above the lowest observed lab value indicates a relapse.28
Frequent testing—probably biweekly—is recommended during the first 3 or 4 months after patients complete treatment. If there is no indication of relapse, testing frequency could be tapered down.
- AUDIT. The Alcohol Use Disorders Identification Test. Guidelines for primary care use. Available at: http://www.who.int/substance_abuse/pubs_alcohol.htm
- Allen JP, Litten RZ. Psychometric and laboratory measures to assist in the treatment of alcoholism. Clin Psychol Rev 1993;13(3):223-39.
- Salaspuro M. Carbohydrate-deficient transferrin as compared to other markers of alcoholism: a systematic review. Alcohol 1999; 19(3):261-71.
Disclosure
Dr. Allen reports that he serves as a consultant to Axis-Shield ASA and Bio-Rad Laboratories, patent holder and U.S. distributor, respectively, of the carbohydrate-deficient transferrin (%CDT) reagent kit.
Dr. Anthenelli reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.