Detection of Alcohol and Tobacco Addiction



Alcohol consumption can be detected by the measurement of ethanol concentration in blood or urine. Several markers have been proposed with different sensitivities to detect alcohol consumption. Ethyl glucuronide and ethyl sulphate in urine, phosphatidylethanol in blood and ethyl glucuronide in hair are new methods, besides carbohydrate-deficient transferrin measurements. We use these markers for the assessment of different intake patterns. Short-term assessment using alcohol breath analysis or alcohol in blood or urine is different to mid-term analysis (some days), like ethyl glucuronide, and to long-term assessment (14 days) with carbohydrate-deficient transferrin.

For the assessment of even longer periods, the hair analysis of ethyl glucuronide can be used.


  1. Armer JM, Allcock RL. Urine ethyl glucuronide and ethyl sulphate using liquid chromatography-tandem mass spectrometry in a routine clinical laboratory. Ann Clin Biochem. 2017;54(1):60–8.PubMedCrossRefPubMedCentralGoogle Scholar
  2. Aune D, Sen A, Leitzmann MF, Tonstad S, Norat T, Vatten LJ. Tobacco smoking and the risk of diverticular disease—a systematic review and meta-analysis of prospective studies. Color Dis. 2017;19(7):621–33.CrossRefGoogle Scholar
  3. Berlakovich GA, Windhager T, Freundorfer E, Lesch OM, Steininger R, Mühlbacher F. Carbohydrate deficient transferrin for detection of alcohol relapse after orthotopic liver transplantation for alcoholic cirrhosis. Transplantation. 1999;67(9):1231–5.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Bonte W. Begleitstoffe alkoholischer Getränke. Lübeck: Verlag Max Schmidt-Römhild; 1987.Google Scholar
  5. Bradley KA, Kivlahan DR, Bush KR, McDonell And MB, Fihn SD, Ambulatory Care Quality Improvement Project Investigators. Variations on the CAGE alcohol screening questionnaire: strengths and limitations in VA general medical patients. Alcohol Clin Exp Res. 2001;25:1472–8.PubMedCrossRefPubMedCentralGoogle Scholar
  6. Caputo F, Del Re A, Brambilla R, Grignaschi A, Vignoli T, Vigna-Taglianti F, Addolorato G, Zoli G, Cibin M, Bernardi M. Sodium oxybate in maintaining alcohol abstinence in alcoholic patients according to Lesch typologies: a pilot study. J Psychopharmacol. 2014;28(1):23–30.PubMedCrossRefPubMedCentralGoogle Scholar
  7. Chan AW, Pristach EA, Welte JW. Detection by the CAGE of alcoholism or heavy drinking in primary care outpatients and the general population. J Subst Abus. 1994;6:123–35.CrossRefGoogle Scholar
  8. Conigrave KM, Degenhardt LJ, Whitfield JB, Saunders JB, Helander A, Tabakoff B, WHO/ISBRA Study Group. CDT, GGT, and AST as markers of alcohol use: the WHO/ISBRA collaborative project. Alcohol Clin Exp Res. 2002;26(3):332–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. de Beaurepaire R, Lukasiewicz M, Beauverie P, Castéra S, Dagorne O, Espaze R, Falissard B, Giroult P, Houery M, Mahuzier G, Matheron I, Niel P, Padovani P, Poisson N, Richier JP, Rocher J, Ruetsh O, Touzeau D, Visinoni A, Molimard R. Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients. Eur Psychiatry. 2007;22(8):540–8.PubMedCrossRefPubMedCentralGoogle Scholar
  10. De Ritis F, Coltarti M, Giusti G. An enzymatic test for the diagnosis of viral hepatitis: The transaminase serum activities. Clin Chimia Acta. 1957;269(2):148–52.Google Scholar
  11. Ewing JA. Detecting alcoholism. The CAGE questionnaire. J Am Med Assoc. 1984;252:1905–7.CrossRefGoogle Scholar
  12. Hanak C, Benoit J, Fabry L, Hein M, Verbanck P, de Witte P, Walter H, Dexter DT, Ward RJ. Changes in pro-inflammatory markers in detoxifying chronic alcohol abusers, divided by Lesch typology, reflect cognitive dysfunction. Alcohol Alcohol. 2017;52(5):529–34.PubMedCrossRefPubMedCentralGoogle Scholar
  13. Hartmann S, Aradottir S, Graf M, Wiesbeck G, Lesch OM, Ramskogler K, Wolfersdorf M, Alling C, Wurst FM. Phosphatidylethanol as a sensitive and specific biomarker—comparison with gamma-glutamyl transpeptidase, mean corpuscular volume and carbohydrate-deficient transferrin. Addict Biol. 2007;121:81–4.CrossRefGoogle Scholar
  14. Helander A, Wielders J, Anton R, Arndt T, Bianchi V, Deenmamode J, Jeppsson JO, Whitfield JB, Weykamp C, Schellenberg F, International Federation of Clinical Chemistry and Laboratory Medicine Working Group on Standardisation of Carbohydrate-Deficient Transferrin (IFCC WG-CDT). Standardisation and use of the alcohol biomarker carbohydrate-deficient transferrin (CDT). Clin Chim Acta. 2016;459:19–24.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Hillemacher T, Bleich S. Neurobiology and treatment in alcoholism--recent findings regarding Lesch's typology of alcohol dependence. Alcohol Alcohol. 2008;43(3):341–6.PubMedCrossRefPubMedCentralGoogle Scholar
  16. Koller G, Soyka M. Biological and genetic markers of alcoholism—a psychiatric perspective. In: Wurst FW, editor. New and upcoming markers of alcohol consumption. Darmstadt: Springer; 2001. p. 3–16.Google Scholar
  17. Koob GF, Le Moal M. Neurobiology of addiction. 1st ed. London: Academic Press – Elsevier; 2006.Google Scholar
  18. Lallemand F, Ward RJ, Dravolina O, De Witte P. Nicotine-induced changes of glutamate and arginine in naive and chronically alcoholised rats: an in vivo microdialysis study. Brain Res. 2006;1111(1):48–60.PubMedCrossRefPubMedCentralGoogle Scholar
  19. Leitner A, Gierth L, Lentner S, Platz WE, Rommelspacher H, Schmidt L, Lesch OM. Untergruppen Alkoholkranker. Gibt es biologische Marker? Harmann- und Norharman- Befunde. In: P. Baumann, editor. Biologische Psychiatrie der Gegenwart. Springer, Wien New York. 1994. pp. 636–40.Google Scholar
  20. Lesch OM. Raucherentwöhnung – Tipps zur Prävention und Therapie in der Praxis. Bremen: Uni-Med Verlag; 2007.Google Scholar
  21. Lesch OM, Kefer J, Lentner S, Mader R, Marx B, Musalek M, Nimmerrichter A, Preinsberger H, Puchinger H, Rustembegovich A, Walter H, Zach E. Diagnosis of chronic alcoholism—classificatory problems. Psychopathology. 1990;23:88–96.PubMedCrossRefPubMedCentralGoogle Scholar
  22. Lesch OM, Walter H, Antal J, Heggli DE, Kovacz A, Leitner A, Neumeister A, Stumpf I, Sundrehagen E, Kasper S. Carbohydrate deficient transferrin as a marker for alcohol intake: a study with healthy subjects. Alcohol Alcohol. 1996c;31(3):265–71.PubMedCrossRefGoogle Scholar
  23. Lesch OM, Walter H, Antal J, Kanitz RD, Kovacs A, Leitner A, Marx B, Neumeister A, Saletu M, Semler B, Stumpf I, Mader R. Alcohol dependence. Is carbohydrate deficient transferrin a marker for alcohol intake? Alcohol Alcohol. 1996b;31(3):257–64.PubMedCrossRefGoogle Scholar
  24. Lesch OM, Walter H, Freitag H, Heggli DE, Leitner A, Mader R, Neumeister A, Passeg V, Pusch H, Semler B, Sundrehagen E, Kasper S. Carbohydrate deficient transferrin as a screening marker for drinking in a general hospital population. Alcohol Alcohol. 1996a;31(3):249–56.PubMedCrossRefGoogle Scholar
  25. Liskow B, Campbell J, Nickel EJ, Powell BJ. Validity of the CAGE questionnaire in screening for alcohol dependence in a walk-in (triage) clinic. J Stud Alcohol. 1995;56:277–81.PubMedCrossRefPubMedCentralGoogle Scholar
  26. Litten RZ, Allen J. Measuring alcohol consumption. Totowa, NJ: The Humana Press Inc; 1992.CrossRefGoogle Scholar
  27. Mackus M, van de Loo AJAE, Raasveld SJ, Hogewoning A, Sastre Toraño J, Flesch FM, Korte-Bouws GAH, van Neer RHP, Wang X, Nguyen TT, Brookhuis KA, Kraneveld AD, Garssen J, Verster JC. Biomarkers of the alcohol hangover state: ethyl glucuronide (EtG) and ethyl sulfate (EtS). Hum Psychopharmacol. 2017;32(5):e2624.PubMedCentralCrossRefGoogle Scholar
  28. Maisto SA, Saitz R. Alcohol use disorders: screening and diagnosis. Am J Addict. 2003;12:12–25.CrossRefGoogle Scholar
  29. Milcarz M, Polanska K, Bak-Romaniszyn L, Kaleta D. Tobacco health risk awareness among socially disadvantaged people—a crucial tool for smoking cessation. Int J Environ Res Public Health. 2018;15(10):2244.PubMedCentralCrossRefGoogle Scholar
  30. Nanau RM, Neuman MG. Biomolecules and biomarkers used in diagnosis of alcohol drinking and in monitoring therapeutic interventions. Biomol Ther. 2015;5(3):1339–85.Google Scholar
  31. Pettinati HM, Kranzler HR, Madaras J. The status of serotonin-selective pharmacotherapy in the treatment of alcohol dependence. Recent developments in alcoholism: an official publication of the American Medical Society On Alcoholism, the Research Society On Alcoholism and the National Council on Alcoholism. Recent Dev Alcohol. 2003;16:247–62. Review.Google Scholar
  32. Procopio DO, Saba LM, Walter H, Lesch O, Skala K, Schlaff G, Vanderlinden L, Clapp P, Hoffman PL, Tabakoff B. Genetic markers of comorbid depression and alcoholism in women. Alcohol Clin Exp Res. 2013;37(6):896–904.PubMedCrossRefGoogle Scholar
  33. Renz-Polster H, Krautzig G, Braun J. Basislehrbuch Innere Medizin. 3rd ed. Hamburg: Urban&Fischer; 2007.Google Scholar
  34. Samochowiec A, Chęć M, Kopaczewska E, Samochowiec J, Lesch O, Grochans E, Jasiewicz A, Bienkowski P, Łukasz K, Grzywacz A. Monoamine oxidase a promoter variable number of tandem repeats (MAOA-uVNTR) in alcoholics according to Lesch typology. Int J Environ Res Public Health. 2015;12(3):3317–26.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Saremi A, Hanson RL, Williams DE, Roumain J, Robin RW, Long JC, Goldman D, Knowler WC. Validity of the CAGE questionnaire in an American Indian population. J Stud Alcohol. 2001;62:294–300.PubMedCrossRefPubMedCentralGoogle Scholar
  36. Singer MV, Teyssen S. Alkohol und Folgekrankheiten. 2nd ed. Mannheim: Springer; 2005.CrossRefGoogle Scholar
  37. Sprung R, Bonte W, Lesch OM. Methanol, Ein bisher verkannter Bestandteil aller alkoholischen Getränke; Eine neue biochemische Annäherung an das Problem des chronischen Alkoholismus. Wien Klin Wochenschr. 1988;100(9):282–8.PubMedPubMedCentralGoogle Scholar
  38. Stibler H, Borg S. Carbohydrate composition of transferring in alcoholic patients. Alcohol Clin Exp Res. 1986;10:61–4.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Tominaga Y. Use of acetaldehyde and methanol as markers of alcohol abuse and their measurement. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2009;44(1):26–37.PubMedPubMedCentralGoogle Scholar
  40. Walter H, Hertling I, Benda N, König B, Ramskogler K, Riegler A, Semler B, Zoghlami A, Lesch OM. Sensitivity and specificity of carbohydrate-deficient transferrin in drinking experiments and different patients. Alcohol. 2001;25(3):189–94.PubMedCrossRefPubMedCentralGoogle Scholar
  41. Whitfield JB, Fletcher LM, Murphy TL, Powell LW, Halliday J, Heath AC, Martin NG. Smoking, obesity and hypertension alter the dose-response curve and test sensitivity of carbohydrate-deficient transferring as a marker of alcohol intake. Clin Chem. 1998;44:2480–9.PubMedCrossRefPubMedCentralGoogle Scholar
  42. Widmark EMP. Principles and applications of medicolegal alcohol determination. English translation of 1932 German edition, Davis Biomedical Publications; 1981.Google Scholar
  43. Winkler M, Skopp G, Alt A, Miltner E, Jochum T, Daenhardt C, Sporkert F, Gnann H, Weinmann W, Thierauf A. Comparison of direct and indirect alcohol markerswith PEth in blood and urine in alcohol dpendent inpatients during detoxification. Int J legal Med. 2013;127(4):761–8.PubMedCrossRefPubMedCentralGoogle Scholar
  44. Wurst FM. New and upcoming markers of alcohol consumption. Darmstadt: Steinkopff Verlag; 2001.CrossRefGoogle Scholar
  45. Wurst FM, Thon N, Aradottir S, Hartmann S, Wiesbeck GA, Lesch O, Skala K, Wolfersdorf M, Weinmann W, Alling C. Phosphatidylethanol: normalization during detoxification, gender aspects and correlation with other biomarkers and self-reports. Addict Biol. 2010;15(1):88–95.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Clinical Division of Social PsychiatryMedical University Vienna, Department of Psychiatry and PsychotherapyViennaAustria
  2. 2.Caritas der Erzdiözese WienViennaAustria
  3. 3.Department of PsychiatryUniversity of Connecticut Health CenterFarmingtonUSA
  4. 4.Neuroscience DepartmentHospital de Santa MariaLisboaPortugal

Personalised recommendations