Alcohol biomarkers in applied settings: Recent advances and future research opportunities

Alcoholism: Clinical and Experimental Research

Volumn 34, Issue 6, 2010, Pages 955-967

  Litten, Raye Z ^a   Bradley, Ann M ^a   Moss, Howard B ^a  

^a NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM   (United States)

Author keywords

Alcohol Biomarkers; Alcohol Sensors; Alcohol Use Disorders

Indexed keywords

5 HYDROXYINDOLEACETIC ACID; 5 HYDROXYTRYPTOPHOL; ACETALDEHYDE; ALANINE AMINOTRANSFERASE; ALCOHOL; AMINE OXIDASE (FLAVIN CONTAINING) ISOENZYME B; ASPARTATE AMINOTRANSFERASE; BETA N ACETYLHEXOSAMINIDASE; BIOCHEMICAL MARKER; BIOLOGICAL MARKER; CARBOHYDRATE DEFICIENT TRANSFERRIN; CLUSTERIN; DOLICHOL; ETHYL GLUCURONIDE; ETHYL SULFATE; FATTY ACID ESTER; GAMMA GLUTAMYLTRANSFERASE; HIGH DENSITY LIPOPROTEIN; PHOSPHATIDYLETHANOL; SIALIC ACID; UNCLASSIFIED DRUG;

ALCOHOL CONSUMPTION; ALCOHOLISM; BIOSENSOR; CLINICAL RESEARCH; CRIMINAL JUSTICE; DIAGNOSTIC ACCURACY; HUMAN; MEAN CORPUSCULAR VOLUME; NONHUMAN; PREDICTION; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; PSYCHOMETRY; REVIEW; SCREENING TEST; SELF REPORT; SENSITIVITY AND SPECIFICITY; VALIDATION STUDY; WORKPLACE; ALCOHOL-RELATED DISORDERS; CRIMINAL LAW; DRINKING BEHAVIOR; DRUG DEPENDENCE TREATMENT; MEDICAL RESEARCH; METABOLISM; PRIMARY HEALTH CARE; TRENDS;

ALCOHOL DRINKING; ALCOHOL-RELATED DISORDERS; BIOLOGICAL MARKERS; BIOMEDICAL RESEARCH; CRIMINAL LAW; HUMANS; PRIMARY HEALTH CARE; PSYCHOMETRICS; SUBSTANCE ABUSE TREATMENT CENTERS; WORKPLACE;

EID: 77952931598     PISSN: 01456008     EISSN: 15300277     Source Type: Journal    
DOI: 10.1111/j.1530-0277.2010.01170.x     Document Type: Review

References (98)

1. Ait-Daoud N, Roache JD, Dwes MA, Liu L, Wang XQ, Javors MA, Seneviratne C, Johnson BA (2009) Serotonin transporter genotype predict craving in alcoholism? Alcohol Clin Exp Res 33 : 1 7.
2. Anton RF (2001) Carbohydrate-deficient transferring for detection and monitoring of sustained heavy drinking: what have we leaned? Where do we go from here? Alcohol 25 : 185 188.
3. Anton RF, Lieber C, Tabakoff B (2002) Carbohydrate-deficient transferring and gamma-glutamyltransferase for the detection and monitoring of alcohol use: results from a multisite study. Alcohol Clin Exp Res 26 : 1215 1222.
4. Anton RF, Youngblood M (2006) Factors affecting %CDT status at entry into a multisite clinical treatment trial: experience from the COMBINE study. Alcohol Clin Exp Res 30 : 1878 1883.
5. Anttila P, Jarvi K, Latvala J, Blake JE, Niemela O (2003) A new modified gamma-% CDT method improves the detection of problem drinking: studies in alcoholics with or without liver disease. Clin Chim Acta 338 : 45 51.
6. Aradottir S, Asanovska G, Gjerss S, Hansson AP, Alling C (2006) Phosphatidylethanol (PEth) concentrations in blood are correlated to reported alcohol intake in alcohol-dependent patients. Alcohol Alcohol 41 : 431 437.
7. Arndt T, Gierten B, Gussregen B, Werle A, Gruner J (2009) False-positive ethyl glucuronide immunoassay screening associated with chloral hydrate medication as confirmed by LC-MS/MS and self-medication. Forensic Sci Int 184 : e27 e29.
8. Bearer C, Jacobson JL, Jacobson SW, Barr D, Croxford J, Molteno CD, Viljoen DL, Marais AS, Chiodo LM, Cwik A (2003) Validation of a new biomarker of fetal exposure to alcohol. J Pediatr 143 : 463 469.
9. Beck O, Helander A (2003) 5-Hydroxytryptophol as a marker for recent alcohol intake. Addiction 98 (Suppl 2 63 72.
10. Beck O, Stephanson N, Bottcher M, Dahmen N, Fehr C, Helander A (2007) Biomarkers to disclose recent intake of alcohol: potential of 5-hydroxytryptophol glucuronide testing using new direct UPLC-tandem MS and ELISA methods. Alcohol Alcohol 42 : 321 325.
11. Bendroth P, Kronstrand R, Helander A, Greby J, Stephanson N, Krantz P (2008) Comparison of ethyl glucuronide in hair with phosphatidylethanol in whole blood as post-mortem markers of alcohol abuse. Forensic Sci Int 176 : 76 81.
12. Bergstrom JP, Helander A (2008) Clinical characteristics of carbohydrate-deficient transferring (% disialotransferrin) measured by HPLC: sensitivity, specificity, gender effects, and relationship with other alcohol biomarkers. Alcohol Alcohol 43 : 436 441.
13. Borg S, Beck O, Helander A, Voltaire A, Stibler H (1992) Carbohydrate-deficient transferring and 5-hydroxytryptophol, in Measuring Alcohol Consumption (Litten RZ, Allen JP eds pp 149 159. Humana Press
14. Borucki K, Dierkes J, Wartberg J, Westphal S, Genz A, Luley C (2007) In heavy drinkers, fatty acid ethyl esters remain elevated for up to 99 hours. Alcohol Clin Exp Res 31 : 423 427.
15. Bottcher M, Beck O, Helander A (2008) Evaluation of a new immunoassay for urinary ethyl glucuronide testing. Alcohol Alcohol 43 : 46 48.
16. Conigrave KM, Davies P, Haber P, Whitfield JB (2003) Traditional markers of excessive alcohol use. Addiction 98 (Suppl 2 31 43.
17. Conigrave KM, Saunders JB, Whitfield JB (1995) Diagnostic tests for alcohol consumption. Alcohol Alcohol 30 : 13 26.
18. Costantino A, DiGregorio EJ, Korn W, Spayd S, Rieders F (2006) The effect of the use of mouthwash on ethylglucuronide concentrations in urine. J Anal Toxicol 30 : 659 662.
19. Dahl H, Stephanson N, Beck O, Helander A (2002) Comparison of urinary excretion characteristics of ethanol and ethyl glucuronide. J Anal Tox 26 : 201 204.
20. Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ (2005) Recovery from DSM-IV alcohol dependence: U.S. 2001-2002. Addiction 100 : 281 292.
21. Del Boca FK, Darkes J (2003) The validity of self-reports of alcohol consumption: state of the science and challenges for research. Addiction 98 (Suppl 2 1 12.
22. Dierkes J, Wolfersdorf M, Borucki K, Weinmann W, Wiesbeck G, Beck O, Borg S, Wurst FM (2007) Determination of glucuronidated 5-hydroxytryptophol (GTOL), a marker of recent alcohol intake, by ELISA technique. Clin Biochem 40 : 128 131.
23. Dillie KS, Mundt M, French MT, Fleming MF (2005) Cost-benefit analysis of a new alcohol biomarker, carbohydrate deficient transferring, in a chronic illness primary care sample. Alcohol Clin Exp Res 29 : 2008 2014.
24. Fleming MF, Anton RF, Spies CD (2004) A review of genetic, biological, pharmacological, and clinical factors that affect carbohydrate-deficient transferring levels. Alcohol Clin Exp Res 28 : 1347 1355.
25. Fleming M, Bhamb b, Schurr M, Mundt M, Williams A (2009) Alcohol biomarkers in patients admitted for trauma. Alcohol Clin Exp Res 33 : 1777 1781.
26. Fuller RK, Hiller-Sturmhofel S (1999) Alcoholism treatment in the United States. Alcohol Res Health 23 : 69 77.
27. Gnann H, Weinmann W, Engelmann C, Wurst FM, Skopp G, Winkler M, Thierauf A, Auwarter V, Dresen S, Bouzas NF (2009) Selective detection of phosphatidylethanol homologues in blood as biomarkers for alcohol consumption by LC-ESI-MS/MS. J Mass Spectrom 44 : 1293 1299.
28. Goll M, Schmitt G, Ganmann B, Aderjan RE (2002) Excretion profiles of ethyl glucuronide in human urine after internal dilution. J Anal Toxicol 26 : 262 266.
29. Gunnarsson T, Karlsson A, Hansson P, Johnson G, Alling C, Odham G (1998) Determination of phosphatidylethanol in blood from alcoholic males using high-performance liquid chromatography and evaporative light scattering or electrospray mass spectrometric detection. J Chromatogr B 705 : 243 249.
30. Hannuksela ML, Liisanantti MK, Nissinen AET, Savolainen MJ (2007) Biochemical markers of alcoholism. Clin Chem Lab Med 45 : 953 961.
31. Harasymiw J, Bean P (2001) The combined use of the early detection of alcohol consumption (EDAC) test and carbohydrate-deficient transferring to identify heavy drinking behavior in males. Alcohol Alcohol 36 : 349 353.
32. Harasymiw J, Bean P (2007) The Early Detection of Alcohol Consumption (EDAC) test shows better performance than gamma-glutamyltransferase (GGT) to detect heavy drinking in a large population of males and females. Med Sci Monit 13 : PI19 PI24.
33. Hartmann S, Aradottir S, Graf M, Wiesbeck G, Lesch O, Ramskogler K, Wolfersdorf M, Alling C, Wurst FM (2006) Phosphatidylethanol as a sensitive and specific biomarker - comparison with gamma-glutamyl transpeptidase, mean corpuscular volume and carbohydrate-deficient transferrin. Addict Biol 12 : 81 84.
34. Helander A, Beck O (2005) Ethyl sulfate: a metabolite of ethanol in humans and a potential biomarker of acute alcohol intake. J Anal Toxicol 29 : 270 274.
35. Helander A, Dahl H (2005) Urinary tract infection: a risk factor for false-negative urinary ethyl glucuronide but not ethyl sulfate in the detection of recent alcohol consumption. Clin Chem 51 : 1728 1730.
36. Helander A, Zheng Y (2009) Molecular species of the alcohol biomarker phosphatidylethanol in human blood measured by LC-MS. Clin Chem 55 : 1395 1405.
37. Hermansson U, Helander A, Brandt L, Huss A, Ronnberg S (2002) The alcohol use disorders identification test and carbohydrate-deficient transferring in alcohol-related sickness absence. Alcohol Clin Exp Res 26 : 28 35.
38. Hermansson U, Helander A, Huss A, Brandt L, Ronnberg S (2000) The Alcohol Use Disorders Identification Test (AUDIT) and carbohydrate-deficient transferring (CDT) in a routine workplace health examination. Alcohol Clin Exp Res 24 : 180 187.
39. Hietala J, Koivisto H, Anttila P, Niemela O (2006b) Comparison of the combined marker GGT-CET and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers. Alcohol Alcohol 41 : 528 533.
40. Hietala J, Koivisto H, Latvala J, Anttila P, Niemela O (2006a) IgAs against acetaldehyde-modified red cell protein as a marker of ethanol consumption in male alcoholic subjects, moderate drinkers, and abstainers. Alcohol Clin Exp Res 30 : 1693 1698.
41. Hodgkinson CA, Yuan Q, Xu K, Shen PH, Heinz E, Lobos E, Binder EB, Cubells J, Ehlers CL, Gelernter J, Mann J, Riley B, Roy A, Tabakoff B, Todd RD, Zhou Z, Goldman D (2008) Addictions biology: haplotype-based analysis for 130 candidate genes on a single array. Alcohol Alcohol 43 : 505 515.
42. Hoiseth G, Bernard JP, Karinen R, Johnsen L, Helander A, Christophersen AS, Morland J (2007) A pharmacokinetic study of ethyl glucuronide in blood and urine: applications to forensic toxicology. Forensic Sci Int 172 : 119 124.
43. Hoiseth G, Bernard JP, Stephanson N, Normann PT, Christophersen AS, Morland J, Helander A (2008) Comparison between the urinary alcohol markers EtG, EtS, and GTOL/5-HIAA in a controlled drinking experiment. Alcohol Alcohol 43 : 187 191.
44. Jansen AM, Bell LB, Sucher MA, Stoehr JD (2004) Detection of alcohol use in monitored aftercare programs: a national survey of state physician health programs. J Med Licens Discipl 90 : 8 13.
45. Javors MA, Johnson BA (2003) Current status of carbohydrate deficient transferring, total serum sialic acid, sialic acid index of apolipoprotein J and serum β-hexosaminidase as markers for alcohol consumption. Addiction 98 (Suppl 2 45 50.
46. Javors MA, Pichot JT, King TS, Anton RF (1997) Search for biological markers, in Drug Addiction and Its Treatment: Nexus of Neuroscience and Behavior (Johnson BA, Roache JD eds pp 205 230. Lippincott-Raven Publishers
47. Jeppsson JO, Arndt T, Schellenberg F, Wielders JPM, Anton RF, Whitfield JB, Helander A (2007) Toward standardization of carbohydrate-deficient transferring (CDT) measurements: I. Analyte definition and proposal of a candidate reference method. Clin Chem Lab Med 45 : 558 562.
48. Johnson BA (2008) Update on neuropharmacological treatments for alcoholism: scientific basis and clinical findings. Biochem Pharmacol 75 : 34 56.
49. Junghanns K, Graf I, Pfluger J, Wetterling G, Ziems C, Ehrenthal D, Zollner M, Dibbelt L, Bachaus J, Weinmann W, Wurst FM (2009) Urinary ethyl glucuronide (EtG) and ethyl sulphate (EtS) assessment: valuable tools to improve verification of abstention in alcohol-dependent patients during in-patient treatment and at follow-ups. Addiction 104 : 921 926.
50. Kapoor A, Kraemer KL, Smith KJ, Roberts MS, Saitz R (2009) Cost-effectiveness of screening for unhealthy alcohol use with % carbohydrate-deficient transferrin: results from a literature-based decision analytic computer model. Alcohol Clin Exp Res 33 : 1 10.
51. Kip MJ, Spies CD, Neumann T, Nachbar Y, Alling C, Aradottir S, Weinmann W, Wurst FM (2008) The usefulness of direct ethanol metabolites in assessing alcohol intake in nonintoxicated male patients in an emergency room setting. Alcohol Clin Exp Res 32 : 1284 1291.
52. Kissack JC, Bishop J, Leatherwood A (2008) Ethylglucuronide as a biomarker for ethanol detection. Pharmacotherapy 28 : 769 781.
53. Korzec A, de Bruijn C, van Lambalgen M (2005) The Bayesian Alcoholism Test had better diagnostic properties for confirming diagnosis of hazardous and harmful alcohol use. J Clin Epidemiol 58 : 1024 1032.
54. Korzec S, Korzed A, Conigrave K, Gisolf J, Tabakoff B (2009) Validation of the Bayesian Alcoholism Test compared to single biomarkers in detecting harmful drinking. Alcohol Alcohol 44 : 398 402.
55. Li TK (2007) Quantifying the risk for alcohol-use and alcohol-attributable health disorders: present findings and future research needs. J Gastroenterol Hepatol 23 (Suppl 1 S2 S8.
56. Litten RZ, Allen JP (1998) Clinical application of biochemical markers of alcohol consumption, in Use of Carbohydrate Deficient Transferrin Among General Practitioners (Allen JP, Poldrugo F eds pp 7 26. ICCA Publication
57. Litten RZ, Allen JP, Fertig JB (1995) Gamma-glutamyltranspeptidase and carbohydrate deficient transferring: alternative measures of excessive alcohol consumption. Alcohol Clin Exp Res 19 : 1541 1546.
58. Litten RZ, Fertig J (2003) Self-report and biochemical measures of alcohol consumption. Addiction 98 (Suppl 2 iii iv.
59. Litten RZ, Fertig J, Mattson ME, Egli M (2005) Development of medications for alcohol use disorders: recent advances and ongoing challenges. Expert Opin Emerg Drugs 10 : 323 343.
60. Mayfield RD, Harris RA (2009) Gene expression profiling in blood: new diagnostics in alcoholism and addiction? Neuropsychopharmacology 34 : 250 251.
61. McLellan AT (2007) Reducing heavy drinking: a public health strategy and a treatment goal? J Subst Abuse Treat 33 : 81 83.
62. Miller PM, Ornstein SM, Nietert PJ, Anton RF (2004) Self-report and biomarker alcohol screening by primary care physicians: the need to translate research into guidelines and practice. Alcohol Alcohol 39 : 325 328.
63. Miller WR, Walters ST, Bennett ME (2001) How effective is alcoholism treatment in the United States? J Stud Alcohol 62 : 211 220.
64. Miners JO, McKinnon RA, Mackenzie PI (2002) Genetic polymorphisms of UDP-glucuronosyltransferases and their functional significance. Toxicology 181-182 : 453 456.
65. Moore C, Jones J, Lewis D, Buchi K (2003) Prevalence of fatty acid ethyl esters in meconium specimens. Clin Chem 49 : 133 136.
66. National Highway Traffic Safety Administration (2007) Evaluating Transdermal Alcohol Measuring Devices: Final Report. NHTSA
67. National Institute on Alcohol Abuse and Alcoholism (2007) Helping Patients Who Drink too Much: A Clinician's Guide, Updated 2005 edition, US. Department of Health & Human Services, National Institutes of Health
68. Neumann T, Gentilello LM, Neuner B, Weiss-Gerlach E, Schurmann H, Schroder T, Muller C, Haas NP, Spies CD (2009) Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use. Alcohol Clin Exp Res 33 : 970 976.
69. Neumann T, Helander A, Dahl H, Holzmann T, Neuner B, Wei-Gerlach E, Muller C, Spies C (2008) Value of ethyl glucuronide in plasma as a biomarker for recent alcohol consumption in the emergency room. Alcohol Alcohol 43 : 431 435.
70. Niemela O (2007) Biomarkers in alcoholism. Clin Chim Acta 377 : 39 49.
71. Oslin DW, Berrettini W, Kranzler HR, Pettinati H, Gelernter J, Volpicelli JR, O'Brien CP (2003) A functional polymorphism of the μ-opioid receptor gene is associated with naltrexone response in alcohol-dependent patients. Neuorpsychopharmacology 28 : 1546 1552.
72. Pichini S, Morini L, Marchei E, Palmi I, Rotolo MC, Vagnarelli F, Garcia-Algar O, Vall O, Zuccaro P (2009) Ethylglucuronide and ethylsulfate in meconium to assess gestational ethanol exposure: preliminary results in two Mediterranean cohorts. Can J Clin Pharmacol 16 : e370 e375.
73. Pragst F, Auwaerter V, Sporkert F, Spiegel K (2001) Analysis of fatty acid ethyl esters in hair as possible markers of chronically elevated alcohol consumption by headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC-MS). Forensic Sci Int 121 : 76 88.
74. Pragst F, Yegles M (2008) Determination of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in hair: a promising way for retrospective detection of alcohol abuse during pregnancy? Ther Drug Monit 30 : 255 263.
75. Rosano TG, Lin J (2008) Ethyl glucuronide excretion in humans following oral administration of and dermal exposure to ethanol. J Anal Toxicol 32 : 594 600.
76. Saady JJ, Poklis A, Dalton HP (1993) Production of urinary ethanol after sample collection. J Forensic Sci 38 : 1467 1471.
77. Sakai Jt, Mikulich-Gilbertson SK, Long RJ, Crowley TJ (2006) Validity of transdermal alcohol monitoring: fixed and self-regulated dosing. Alcohol Clin Exp Res 30 : 26 33.
78. Salaspuro M (2007) Interrelationship between alcohol, smoking, acetaldehyde and cancer. Novartis Found Symp 285 : 80 89.
79. Sarkola T, Dahl H, Eriksson CJP, Helander A (2003) Urinary ethyl glucuronide and 5-hydroxytryptophol levels during repeated ethanol ingestion in healthy human subjects. Alcohol Alcohol 38 : 347 351.
80. Sillanaukee P, Olsson U (2001) Improved diagnostic classification of alcohol abusers by combing carbohydrate-deficient transferring and gamma-glutamyltransferase. Clin Chem 47 : 681 685.
81. Skipper G, Weinmann W, Wurst FM (2004) Ethylglucuronide (EtG): a new marker to detect alcohol use in recovering physicians. J Med Licens Discipl 90 : 14 17.
82. Stewart SH, Reuben A, Brzezinski WA, Koch DG, Basile J, Randall PK, Miller PM (2009) Assessment and detection: preliminary evaluation of phosphatidylethanol and alcohol consumption in patients with liver disease and hypertension. Alcohol Alcohol 44 : 464 467.
83. Stibler H (1991) Carbohydrate-deficient transferring in serum: a new marker of potentially harmful alcohol consumption reviewed. Clin Chem 37 : 2029 2037.
84. Substance Abuse and Mental Health Services Administration (2006) The role of biomarkers in the treatment of alcohol use disorders. Subst Abuse Treat Advisory 5 : 1 7.
85. Swift R (2003) Direct measurement of alcohol and its metabolites. Addiction 98 (Suppl 2 73 80.
86. Tabakoff B, Snell L, Pridzun L, Herion D, Heilig M (2009) Platelets proteins as markers for hazardous/harmful alcohol consumption. Alcohol Clin Exp Res 33 : 304A.
87. U.S. Department of Justice (1998) Bureau of Justice Statistics: Alcohol and Crime. U.S. Government
88. Varga A, Hannson P, Johnson G, Alling C (2000) Normalization rate and cellular localization of phosphatidylethanol in whole blood from chronic alcoholics. Clin Chim Acta 299 : 141 150.
89. Varga A, Hansson P, Lundqvist C, Alling C (1998) Phosphatidylethanol in blood as a marker of ethanol consumption in healthy volunteers: comparison with other markers. Alcohol Clin Exp Res 22 : 1832 1837.
90. Willenbring ML (2009) Helping patients who drink too much: an evidence-based guide for primary care physicians. Am Fam Physician 80 : 1 7.
91. Wojcik M (2008) A continuous alcohol monitoring device and its use in criminal justice settings. Alcohol Clin Exp Res 32 : 312A.
92. Wojcik MH, Hawthorne JS (2007) Sensitivity of commercial ethyl glucuronide (EtG) testing in screening for alcohol abstinence. Alcohol Alcohol 42 : 317 320.
93. Wurst FM, Dresen S, Allen JP, Wiesbeck G, Graf M, Weinmann W (2006) Ethyl sulphate: a direct ethanol metabolite reflecting recent alcohol consumption. Addiction 101 : 204 211.
94. Wurst FM, Dursteler-MacFarland AKM, Auwaeter V, Ergovic S, Thon N, Yegles M, Halter C, Weinmann W, Wiesbeck G (2008c) Assessment of alcohol use among methadone maintenance patients by direct ethanol metabolites and self-reports. Alcohol Clin Exp Res 32 : 1 6.
95. Wurst FM, Kelso E, Weinmann W, Pragst F, Yegles M, Poromaa IS (2008a) Measurement of direct ethanol metabolites suggests higher rate of alcohol use among pregnant women than found with the AUDIT - a pilot study in a population-based sample of Swedish women. Am J Obstet Gynecol 198 : 407.e1 407.e5.
96. Wurst FM, Skipper GE, Weinmann W (2003) Ethyl glucuronide-the direct ethanol metabolite on the threshold from science to routine use. Addiction 98 (Suppl 2 51 61.
97. Wurst FM, Wiesbeck GA, Metzger JW, Weinmann W, Graf M (2004) On sensitivity, specificity, and the influence of various parameters on ethyl glucuronide levels in urine - results from the WHO/ISBRA study. Alcohol Clin Exp Res 28 : 1220 1228.
98. Wurst FM, Yegles M, Alling C, Aradottir S, Dierkes J, Wiesbeck GA, Halter CC, Pragst F, Auwaerter V (2008b) Measurement of direct ethanol metabolites in a case of a former driving under the influence (DUI) of alcohol offender, now claiming abstinence. Int J Legal Med 122 : 235 239.