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Workshop: Phosphatidylethanol: The "Hemoglobin A1c" for Alcohol Use Disorder?
Abstract

Excessive alcohol use kills 140,000 Americans each year and is the leading risk for premature death and disability for adults under 50. Most alcohol use disorder (AUD) care is directed toward drinking-related consequences (e.g., motor vehicle injuries, cirrhosis, heart disease, stroke, HIV/AIDs, cancer, violence, acts of self-harm and overdose) while AUD frequently goes
unaddressed. Here, addiction psychiatrists can play a vital role using a sensitive and specific biomarker detecting recent alcohol use: phosphatidylethanol (PEth).

PEth is analogous to Hemoglobin A1c (HgbA1c) in that it forms in red blood cells, is obtained via serum, and provides a quantitative estimate of recent ethanol exposure (e.g., <20=minimal alcohol use; 20-200=moderate; >200=heavy). PEth has a narrower detection window (2-4 weeks) than HgbA1c (8-12 weeks). PEth's clinical use has expanded. It is now recognized as a gold standard for alcohol detection in forensics and for safety assurance among high-stakes service personnel (e.g., airline pilots, physicians).

Addiction psychiatrists may order the assay or be asked to interpret it during patient care. Its sensitivity is 70-100%, outperforming other alcohol biomarkers. For example, in pre- and post-transplant liver patients use of PEth doubled the alcohol detection rate of drinking within the last week. PEth has been validated in cirrhotic patients with or without kidney disease, and no sources of false positives have been identified, which may broaden its use and clinical implications. In this 90-minute workshop, 3 psychiatrists from different institutions address pertinent and practical aspects of this biomarker relevant to all addiction clinicians.

Learning Objectives
  • Explain phosphatidylethanol (PEth) physiology, technical specifications, indications for use, safety implications, and interpretation
  • Define interpersonal aspects of PEth use: therapeutic communication and results interpretation for patients, families, and medical teams
  • Apply PEth knowledge to various patient populations with whom addiction psychiatrists may interact: inpatients and outpatients with substance use disorders, transplant candidates and recipients, impaired health professionals, and patients with altered mental status
Keywords / Topics
  • Phosphatidylethanol
  • Alcohol
  • Liver Transplant
Presenters
Gerald Winder, MD, Chairperson

 

Dr. Gerald Scott Winder is an associate clinical professor in the Departments of Psychiatry, Surgery, and Neurology at the University of Michigan. 


Joji Suzuki, MD, Co-Chair

Akhil Shenoy, MD, MPH 

 

Akhil Shenoy MD MPH is the Director of Transplant Psychiatry at Columbia University Medical Center and an Associate Professor of Psychiatry. His research focus includes AUD and other addictions in the context of alcohol related liver disease and the psychosocial outcomes of transplant.


David Hathaway, MD, Presenter

 

David Hathaway, MD, is a Board-Certified Psychiatrist and Addiction Psychiatrist. He is the Medical Director of Measurement-Based Care for Brigham Psychiatric Specialties and the Co-Director of the Harvard Medical School Course in Addiction Psychiatry / Medicine and Motivational Interviewing. 
Summary
Availability: On-Demand
Cost: FREE
Credit Offered:
1 CME Credit
1 Other Professionals Credit
Recommended
 
American Academy of Addiction Psychiatry
The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.


 
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