A Growing Epidemic of Alcohol Problems
Previous studies have shown that the combination of biological markers and CAGE questionnaires is an efficient tool in determining alcohol abuse.
Among the laboratory tests used to determine biological markers of alcohol abuse, it has been found that the most sensitive marker is the level of carbohydrate-deficient transferrin (CDT) (Viitala, 1998; Yersin et al., 1995).
CDT is a protein which is found out to be a sensitive marker of disease of the liver caused by excessive alcohol intake.
Among the commonly used biological markers are detection of the level of ethanol and acetate, mean corpuscular volume (MCV), gamma glutamyl transferase (GGT) and glycosylated hemoglobin (Hb A1c) (Hoeksema & Bock, 1993). The CAGE questionnaire was made by Dr. John Ewing to identify alcoholics. It is consist of four questions scored as 0 or 1 and alcoholism is considered to be significant if the individual in question scores two or greater.
In a certain study conducted to compare the sensitivity and specifity of CAGE questionnaire, plasma levels of ethanol and acetate, mean corpuscular volume, gamma glutamyl transferase and glycosylated hemoglobin, it was found that the it is through the use of CAGE questionnaire that the alcoholic patients are most accurately distinguished against nonalcoholic and patients with non-alcoholic hepatic disease with 90%sensititvity and 99% specificity (Girela, Villanueva, Hernandez-Cueto, & Luna, 1994).
Socio-demographic factors are also commonly included in studies conducted to ascertain alcoholic problems for it has been shown in some studies that it is related to alcoholic abuse.
Age, sex, educational attainment and economic status are among the factors commonly observed. In a study conducted by Bataille (2003) to identify heavy drinkers in a large population, he included the use of socio-demographic factors as one way of identification.
Results of his study show that there is no significant difference in age, sex, arterial hypertension but educational level and smoking habits proves to have significant differences in the population observed. Those with lower educational background and frequent smoking habits relates to greater alcohol consumption (Bataille et al., 2003).
Although there have been lots of studies that used biological markers, CAGE questionnaires and evaluation of socio-demographic factors but there is a lack of substantial findings that elucidate the interrelationships of these indicators in identifying alcohol problems. Thus, there is need to conduct a study regarding this matter
III. Conceptual Framework
A. Nominal Definition/Meaning of Concepts
According to Viitala (1998) “alcohol abuse refers to heavy drinking that results into health consequences, social problem or both and patients of this kind suffer from mental or physical complications brought on by alcohol even though the criteria for alcoholism may not have been fulfilled while alcoholism is the most severe problem related to alcohol consumption and it is a disease where severe dependence and increased tolerance has been developed.”
According to Peterson (2004), “a biological marker or biomarker is a compound or series of compounds that can be used to measure the progress of a disease or the effects of treatment.” Among the currently used biomarkers for detecting alcohol intake are serum gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and carbohydrate-deficient transferrin (CDT) which are all liver enzymes.
N-acetyl-β-hexosaminidase (beta-Hex) which indicates break down of carbohydrates in liver cells and other cells of the body is also used as a biomarker.
Mean corpuscular volume (MCV) which is a measure of red blood cell volume is also used as a biomarker (Peterson, 2004). In this study the biomarker that will be used is CDT. CDT is a form of glycoprotein transferrin which carries iron in the bloodstream but without carbohydrate sialic acid. Normally different forms of transferrin are available in the body but the one that is most abundant among heavy drinkers of alcohol is CDT.