The use of biomarkers in monitoring drinking and for the treatment of alcohol use disorders - focus on results from the 2026 German evidence and consensus-based S3 Guideline on Alcohol

Kurzzusammenfassung in leicht verständlicher Sprache

Screening and measurement of alcohol intake are of importance for early identification and intervention regarding alcohol use and alcohol use disorders.

Besides questionnaires such as the AUDIT, in the last decades, studies on biomarkers (direct ethanol metabolites) have been made. There is a large body of evidence suggesting the use of biomarkers besides questionnaires. This knowledge is condensed in the new German S3 Guideline Alcohol. In particular, results from this Guideline – which supports the use of these biomarkers - will be presented.

Abstract

Hintergrund und Fragestellung
Screening and measurement of alcohol intake are of importance for early identification and intervention reagarding alcohol use and alcohol use disorders, e.g. in contexts where alcohol use is not appropriate as well as to monitor treatment. Besides questionnaires such as the AUDIT, in the last decades, studies on direct ethanol metabolites have proven high evidence for these markers which therefore are recommended also by guidelines. The practical application of the tests has over time reached a routine level, so that the markers can be used in everyday practice on a large scale.

Methoden
After an introduction, results and recommendations for screening and diagnosis of the German S3-Guideline Alcohol (2026) will be highlighted. For both versions of the Guideline, a systematic review was performed. Of the 1869 publications found in a systematic search in 2014, one hundred and seven have met the criteria for inclusion. For the current guideline the search was restricted to meta-analyses and systematic reviews (SR). 2 new guidelines and 3 SR have been considered as well as additional studies.

Ergebnisse
The high levels of recommendation for the direct ethanol metabolites (mostly A) have been confirmed in the current guideline. In particular, the database for the use of phosphatidylethanol (PEth) has increased significantly in the last years. Furthermore, a recommendation regarding the use of PEth and fatty acid ethyl esters for screening during pregnancy and oft he newborn (FASD) respectively has been added.

Diskussion und Schlussfolgerung
The evidence strengthens the importance and usefulness of direct ethanol metabolites for the measurement of alcohol use. The role of traditional markes also will be disussed. For a widespread use of the guideline the implementation through various organisations is crucial. Furthermore, questions in the context of clinical use, establishing adapted cut-offs and issues regarding analytical caveats will be discussed.

Interessenskonflikte sowie Erklärung zur Finanzierung
Ich bzw. die Koautorinnen und Koautoren erklären, dass während der letzten 3 Jahre keine wirtschaftlichen Vorteile oder persönlichen Verbindungen bestanden, die die Arbeit zum eingereichten Abstract beeinflusst haben könnten.