David R. Spiegel, MD Associate professor of clinical psychiatry and behavioral sciences, director of consultation-liaison services Department of psychiatry and behavior sciences Eastern Virginia Medical School Norfolk
Neetu Dhadwal, MD Resident Department of psychiatry and behavior sciences Eastern Virginia Medical School Norfolk
Frances Gill, MD Resident Department of psychiatry and behavior sciences Eastern Virginia Medical School NorfolkDisclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
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Coulton S, Drummond C, James D, et al. Opportunistic screening for alcohol use disorders in primary care: comparative study. BMJ 2006;332:511-7.
Bottom line
Because CDT—the most accurate biomarker—is not available at most hospitals, we recommend using combinations of other measures to detect unreported recent alcohol consumption. If GGT and MCV are elevated, GGT is elevated and AST:ALT is >2:1, or MCV is elevated and AST:ALT is >2:1, consider initiating alcohol withdrawal precautions.
Acknowledgement
The authors acknowledge Daiana Radac, BA, a third-year medical student at Eastern Virginia Medical School, for her contributions to this article.