Diagnostic of alcoholism: How useful is the combination of gamma glutamyl transferase with different biochemical markers?

The present paper analyses the alterations in sensitivity, specificity and in the positive predictive value (PPV) of GGT as a state marker of alcohol abuse when used either alone or in combination with glutamate pyruvate transaminases (SGPT), glutamate oxalacetate (SGOT) and mean corpuscular volume (MCV). The results obtained with an alcoholic (n = 70) and non-alcoholic sample (n = 63) showed that the best combination considering sensitivity was obtained when GGT was combined with MCV (80%). However, this combination produced the largest decrease in PPV. The relevance of taking into account not only sensitivity but also PPV when the markers are to be used as screening tests in unselected populations is discussed.     

Effect of combined substance use on laboratory markers of alcoholism

This article examines the commonly used laboratory indicators of heavy alcohol use (elevated MCV, GGTP and AST values) in subgroups of drug-using and non-drug-using alcoholic men admitted to an inpatient alcoholism treatment program. A total of 380 consecutive admissions meeting DSM-III diagnostic criteria for alcohol use or dependence were studied. Of these subjects, 75% used both alcohol and drugs. The most frequently used drugs were marijuana, cocaine, amphetamines and tranquilizers. Overall, subjects who used drugs with alcohol had significantly lower MCV and GGTP values than subjects who used alcohol alone. More specifically, cocaine use was associated with lower MCV values, marijuana use with lower AST values and heroin use with higher AST and GGTP values. These differences between drug-using and non-drug-using alcoholics were significant even after controlling for variables that affect the laboratory values such as age, quantity, frequency and duration of alcohol consumption. These findings indicate that any study of laboratory markers of alcoholism needs to consider concomitant illicit drug use patterns.     

Sex differences in personality traits and coping styles of hospitalized alcoholics

Forty inpatients on an alcohol detoxication unit of a large municipal hospital were administered a battery of tests consisting of a Coping Styles scale, a Personality Profile scale, a Depression scale and the Brief MAST. A demographically comparable comparison group of 40 outpatients attending the medical screening clinic at the same hospital also completed the battery. The two groups did not differ in terms of age, education or the ratio of men to women. There were significant differences in coping styles and personality characteristics between alcoholics and nonalcoholics and, to a large extent, between men and women within the alcoholic group. Practically no significant differences were found between the men in the two groups, but female alcoholics differed greatly from nonalcoholic women in terms of coping styles, personality variables and also in terms of conflict. These findings indicate that the differences between alcoholic and nonalcoholics in the sample were due largely to patterns uniquely characterizing the female alcoholic group. Results are discussed in terms of cultural expectations.     

Verbal and nonverbal abstracting--problem-solving abilities and familial alcoholism in female alcoholics

Women alcoholics (N = 54) had significantly worse performance on clusters of verbal and nonverbal abstracting - problem-solving tasks than peer nonalcoholic controls (N = 48). On the nonverbal cluster, alcoholic women with an alcoholic parent or sibling (FH+) performed significantly poorer than peer alcoholics without such a family history (FH-) and nonalcoholic FH+ and FH- groups. On the verbal cluster, FH+ alcoholics performed significantly worse than the nonalcoholic groups. FH- alcoholics did not differ significantly from the nonalcoholic groups on either of the clusters. There were no differences between FH+ and FH- nonalcoholics on the two types of tasks. The results suggest that female alcoholics have a generalized deficit on cognitive tasks involving abstracting and problem-solving, and that these deficits tend to be more pronounced in alcoholic women with a positive family history of alcohol abuse. Whether these deficits are due to a premorbid lowering of abstracting - problem-solving abilities in the FH+ individuals who subsequently become alcoholics, or are the result of a selective vulnerability of these cognitive processes to the effects of alcohol abuse in such subjects, or some combination of these factors, remains to be investigated.     

The tridimensional personality questionnaire and the inherited risk for alcoholism

The Tridimensional Personality Questionnaire (TPQ) (Cloninger, 1987c) was administered to four groups of young men. The first group was composed of nonalcoholic sons of male alcoholics with extensive multigenerational family histories of male alcohol abuse. The second was made up of nonalcoholic men with alcoholic fathers. The third group was composed of nonalcoholic men with no family history of alcoholism, taken from the general population. The fourth group contained male undergraduates with no family history of alcoholism. There were no significant differences between the mean scores obtained by members of all four groups on the three major subscales of the TPQ.     

A comparison of alcoholic and nonalcoholic drug abusers

A group of 329 hospitalized drug abusers were evaluated for a current or past diagnosis of alcoholism. The alcoholic drug-dependent patients (n = 169, 51.4%) were then compared with the nonalcoholic patients (n = 160, 48.6%) with regard to sociodemographic, clinical and family history characteristics. The alcoholics were significantly more likely to receive a DSM-III diagnosis of major depression, with melancholia; other Axis I diagnoses were equally distributed between the two groups. Antisocial personality disorder was also significantly more prevalent among the alcoholic patients. The alcoholics had somewhat longer drug histories and more vivid memories of their first drinking experiences; polydrug abuse, however, was no more common in this group. Finally, the first-degree relatives of the alcoholics had significantly more alcoholism than the first-degree relatives of the nonalcoholic patients. Implications regarding the relationship of alcoholism and other forms of substance abuse are discussed.     

Early detection of harmful alcohol consumption: comparison of clinical, laboratory, and self-report screening procedures

This report describes the conceptual and empirical basis for the development of a screening instrument to identify persons with potentially harmful alcohol consumption. As part of a larger project sponsored by the World Health Organization (WHO), alcoholic (N = 65) and nonalcoholic (N = 187) research volunteers completed a battery of assessments that included laboratory tests, a physical examination, a diagnostic interview, personality measures, and two standard self-report screening questionnaires. The data were analyzed to evaluate the validity of diagnostic measures that could subsequently be used to develop a briefer screening test. The results of a construct validity analysis indicated that the new diagnostic measures correlated well with generally accepted alcoholism screening tests (the MAST and MacAndrew scales) and with measures of hypothetical vulnerability (e.g., sociopathy and childhood problems). Analysis of discriminant validity indicated that alcohol-specific self-report measures differentiated well between male risk groups, but were less effective in identifying high risk females. In general, alcohol-specific measures differentiated best, followed by clinical and laboratory tests and vulnerability assessments. It is concluded that no single procedure is universally suitable for the early identification of harmful drinkers. The design of a screening test will depend on the purpose of screening, the groups to be identified, the resources available and the level of cooperation to be expected from the population screened.     

Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients

The sensitivity and specificity of several screening instruments including the CAGE, brief MAST, AUDIT, TWEAK, RAPS, and Trauma Scale, were evaluated against both ICD-10 and DSM-IV criteria for alcohol dependence and for harmful drinking and abuse in a probability sample of 586 Hispanic emergency department patients. Screening instruments were not as sensitive for females as for males, for those in the low acculturation group, or for non-dependent drinkers. Acculturation was positively associated with the likelihood of being a current drinker and among current drinkers, was positively associated with alcohol dependence and with harmful drinking or alcohol abuse.     

Maximizing Scarce Service Resources in a Rural Mental Health Clinic: Should Alcoholics Be Treated in Separate Programs?

One hundred nineteen patients at rural community mental health centers were divided into three diagnostic groups and compared to determine if alcoholic and nonalcoholic patients differ significantly in terms of psychopathology. The three diagnostic groups were (1) primary diagnosis of alcoholism (N = 34), (2) primary diagnosis of emotional disturbance (N = 39), and (3) “other” diagnoses (N = 46). These groups were compared with respect to demographic variables, alcohol drinking patterns, psychopathology, and attitude toward treatment. The alcoholic patient group tended to be single, male, and inpatients; while the nonalcoholic group tended to be married, female, and outpatients. These groups differed significantly with respect to alcohol consumption and drinking patterns and effects, but did not differ significantly with respect to their attitudes toward mental illness or their MMPI profiles. The results of the “other” diagnostic group generally fell between those of the alcoholic and nonalcoholic groups, suggesting that it was a heterogeneous group of subjects. The total subject population evidenced elevated MMPI profiles, indicating the presence of a high level of psychopathology, but there was no clear distinction between the alcoholics and the other groups in terms of type or degree of psychopathology. Implications for treatment are discussed.     

Diagnostic validity of the MAST and the alcohol dependence scale in the assessment of DSM-III alcohol disorders

The comparative validity of the Michigan Alcoholism Screening Test (MAST) and the Alcohol Dependence Scale (ADS) in screening for current DSM-III alcohol abuse/dependence disorders is evaluated. These scales were administered to 501 patients presenting for treatment of alcohol or drug problems. DSM-III alcohol disorders are diagnosed using the Diagnostic Interview Schedule. Receiver Operating Characteristic (ROC) analysis is used to determine optimum threshold scores for the MAST and ADS and to compare the screening ability of the two instruments. Optimum cut points for the MAST and the ADS are 12/13 and 8/9, respectively. The overall accuracy of classification for both instruments using these threshold scores is 88%. The areas under the ROC curves are .91 and .90 (SD = .02) and there are no significant differences between the MAST and the ADS in their ability to screen for alcohol abuse or dependence in this population. The MAST and the ADS correlate highly with each other (.79). The results reported in our study should be applicable to the revised DSM-III since a field trial found a high level of agreement on alcohol disorders between the diagnostic systems. Categorical versus dimensional approaches to the assessment of alcoholism are discussed.     

Effect of chronic ethanol abuse on the physico-chemical properties of erythrocyte membranes in man

Chronic alcoholics (greater than 150 g/day) showing minor serum and histological changes have been studied, compared to healthy non alcoholic subjects, and the following parameters have been considered: S. (Serum)cholesterol (CH), S.phospholipids (PH), S.folate level, and mean corpuscular volume (MCV). Erythrocyte ghosts have been studied for CH and PH content and membrane fluidity using diphenylhexatriene as a probe. All alcoholics showed decreased fluidity of red cell membrane with increased CH/PH ratio, even in patients showing normal MCV or minimal alterations of functional tests, suggesting that changes in red cell membrane fluidity represent an early sign of ethanol abuse. These likely reflect the diffuse interaction of ethanol with biological membranes. The administration of N5-Methyltetrahydrofolate produced an increase of membrane fluidity over the 3 weeks considered, associated with modest changes of MCV. The latter were delayed with respect to changes in fluidity. If changes of red cell membrane fluidity are a sensitive index of alcohol abuse, they could be a useful marker for detection and follow-up of chronic alcoholism.     

Effectiveness of the CAGE questionnaire, gamma-glutamyltransferase and mean corpuscular volume of red blood cells as markers for alcohol-related problems in the workplace

OBJECTIVE: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV), as well as that of the CAGE questionnaire, in workplace screening for alcohol abuse/dependence. METHODS: A total of 183 male employees were submitted to structured interviews (Structured Clinical Interview for DSM-IV 2.0 and CAGE questionnaire). Blood samples were collected. Diagnostic accuracy and odds ratio were determined for the CAGE, GGT and MCV. RESULTS: The CAGE questionnaire presented the best sensitivity for alcohol dependence (91%; specificity, 87.8%) and for alcohol abuse (87.5%, specificity, 80.9%), which increased when the questionnaire was used in combination with GGT (sensitivity, 100% and 87.5%, respectively; specificity, 68% and 61.5, respectively). CAGE positive results and/or alterations in GGT were less likely to occur among employees not presenting alcohol abuse/dependence than among those presenting such abuse (OR for CAGE=13, p<0.05; OR for CAGE-GGT=11, p<0.05) or dependence (OR for CAGE=76, p<0.01; OR for GGT=5, p<0.01). Employees not presenting alcohol abuse/dependence were also several times more likely to present negative CAGE or GGT results. CONCLUSIONS: The use short, simple questionnaires, combined with that of low-cost biochemical markers, such as GGT, can serve as an initial screening for alcohol-related problems, especially for employees in hazardous occupations. The data provided can serve to corroborate clinical findings.     

Substance use and mental health problems among sons of alcoholics and controls

Data from a questionnaire sent to 864 university male students and nonacademic staff were used to compare self-reports of substance intake patterns and problems as well as family histories of depression and substance abuse across four groups: Group 1, 682 men (79%) who had no alcoholic first or second-degree relative; Group 2, 101 men (12%) who reported an alcoholic second-degree relative only; Group 3, 59 men (7%) who reported an alcoholic first-degree relative only and Group 4, 22 men (3%) with alcoholism in both first- and second-degree relatives. Although few men were already alcoholics or drug abusers and the groups did not differ significantly on the quantity and frequency of alcohol intake, there was an increase in the personal history of alcohol-related problems from Group 1 to Group 4. There were no significant differences across the groups on the proportion of nonalcoholic relatives demonstrating drug abuse or depressive disorders.     

The MacAndrew Scale: clinical application and theoretical issues

The research literature on the MacAndrew (MAC) Scale was surveyed to identify factors that influence the scale's usefulness as a screening device for alcohol misuse, and to explore the meaning of MAC Scale scores. Although the MAC Scale's ability to discriminate alcoholic and substance misuse groups from nonalcoholic psychiatric groups is well documented, the scale may not discriminate between alcoholics and antisocial individuals, or between patients with combined alcoholic psychiatric diagnoses and nonalcoholic psychiatric patients. Recommendations for future research and for the clinical application of the MAC Scale are provided.     

Serum gamma-glutamyl transpeptidase as a diagnostic aid in problem drinkers

Blood samples of 41 individuals (16 female and 25 male) identified as having alcohol-related life problems of from 1 to 44 yr duration were assayed for gamma-glutamyl transpeptidase (GGTP) and glutamic-oxalacetic transaminase (SGOT) activities. Information on individual drinking habits was obtained at the onset of the study along with GGTP and SGOT determinations. Individuals' drinking habits and enzyme activities were compared at onset, at 3 and at 12 months following termination. At the onset of the study none of the individuals exhibited GGTP activities within the normal range; however, as the study progressed from 3 to 12 months an increasing number of individuals' enzyme activities fell within the normal range. At 1 yr a significant correlation was found between the amount of alcohol consumed and GGTP. The binding characteristics of serum GGTP from subjects consuming large amounts of alcohol and from those consuming no alcohol were examined on Con A chromatography. The elution profile for individuals consuming large amounts of alcohol showed the presence of two forms of the enzyme, GGTP. The abstinent individuals had only one of the isoenzymatic forms of the enzyme in the serum. The significant correlation of GGTP with alcohol consumption and more importantly the presence of multiple enzyme forms may be of value as a diagnostic aid and as an outcome assessment with problem drinkers.     

Screening for drug use disorders in the emergency department: performance of the rapid drug problems screen (RDPS)

Little research is available on brief screening instruments for identify those meeting diagnostic criteria for drug dependence or abuse. A brief, four-item screening instrument, called the rapid drug problems screen (RDPS), was developed from a similar instrument for alcohol use disorders, the rapid alcohol problems screen (RAPS). Performance of the RDPS was evaluated against DSM-IV and ICD-10 criteria for drug dependence and for dependence or abuse in a sample of 703 emergency department patients in Mexico City. Among males, sensitivity and specificity were 91 and 96%, respectively, for dependence and 93 and 96%, respectively, for dependence or abuse. Neither of the two females meeting diagnostic criteria for dependence or abuse were identified by the RDPS. Area under the receiver-operating characteristic curve indicates an optimum cut point of 1. The data suggest that the RDPS may hold promise as a brief screening instrument for substance use among males, but should be tested in larger populations of females meeting diagnostic criteria for drug use disorders, and across ethnic subgroups in other geographic locales.     

Effects of intoxication on alcoholics' marital communication and problem solving

The effects of intoxication on the marital interactions of treatment-motivated alcoholics and their nonalcoholic spouses were studied in eight couples (two of which had an alcoholic wife). In half of the sessions, the alcoholics were given enough alcohol to reach a blood level of 10 mg/dl. Couples engaged in three 10-min conflict-resolution discussions of varying intensity counterbalanced for alcohol and no-alcohol sessions. Couples expressed significantly more positive verbalizations in the alcohol sessions than in the no-alcohol sessions. This was true especially for the nonalcoholic spouses, who doubled their rate of positive verbal behavior when interacting with an intoxicated partner. Alcoholics spoke more and tended to make more problem-describing statements while intoxicated than while sober. The alcoholics made a greater number of problem-solving statements than did their spouses. Alcoholics were significantly more negative and less positive in nonverbal behaviors than were their spouses, but neither self-report of marital satisfaction nor observations of verbal behavior reflected this. The models of both social-learning theory and systems theory for the relationship of marital factors to the etiology and maintenance of alcoholism are supported.     

Methodological issues in genetic studies of human substance abuse

This paper described a number of critical assumptions and methodological issues that influence the interpretation of data from family, twin and adoption studies of substance abuse. Also, using data from a recent study, it examined the role of one methodological issue (method of zygosity determination) and one critical assumption (representativeness of twins as research subjects) to determine the validity of data in twin studies of substance abuse. The accuracy of the questionnaire methods for zygosity determination in alcoholic twins was similar to that previously reported for nonalcoholic twins. Also, alcoholic twins were found to be representative of both nonalcoholic twins and alcoholics in general.     

Methodological Issues in Genetic Studies of Human Substance Abuse

This paper described a number of critical assumptions and methodological issues that influence the interpretation of data from family, twin and adoption studies of substance abuse. Also, using data from a recent study, it examined the tole of one methodological issue (method of zygosity determination) and one critical assumption (representativeness of twins as research subjects) to determine the validity of data in twin studies of substance abuse. The accuracy of the questionnaire methods for zygosity determination in alcoholic twins was similar to that previously reported for nonalcoholic twins. Also, alcoholic twins were found to be representative of both nonalcoholic twins and alcoholics in general.     

Protective effect of Indigofera aspalathoides against CCl4-induced hepatic damage in rats

The alcoholic extract of stem of Indigofera aspalathoides was evaluated for its antihepatotoxic activity against CCl(4)-induced hepatic damage in rats. The activity was evaluated by using biochemical parameters, such as serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), alkaline phosphatase (ALP), total bilirubin and gama glutamate transpeptidase (GGTP). The histopathological changes of liver sample were compared with respective control. The extract showed remarkable hepatoprotective effect.