Alcoholism Blood Test Results

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Alcoholism Blood Test Results

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KEY TAKEAWAYS

Blood test results indicate alcoholism where ethyl glucoronide and ethyl sulphate levels are between 500-1,000 ng/mL
Gamma GT levels are over 71 iU/l
PEth readings are over 210.48 ug/L [1].

Lab Tests For Alcoholism Are:

Complete Blood Count (CBC)

The blood count of alcoholics shows reductions in haemoglobin, white blood cells, red blood cells and haematocrit in the blood count of alcoholics [2].

Blood count test results indicative of alcoholism are:

Red blood cell count- readings lower than 4.35 trillion cells/L for men and 3.92 trillion cells/L for women indicate alcoholism
Haemoglobin count- readings lower than 13.2 grams/dL for men and 11.6 grams/dL for women indicate alcoholism
Haematocrit count- readings higher than 48.6 percent in men and 44.9 percent in women indicate alcoholism
White blood cell count- readings lower than 3.4 billion cells/L indicate alcoholism [3]

Carbohydrate Deficient Transferrin (CDT)

A CDT reading over 10% indicates extreme alcohol abuse [normal range 0.1-1.6%].

If there is alcohol consumption over 5 units a day, transferrin is unable to take iron molecules from the intestine to areas of the body that need iron, creating a higher reading [4].

Mean Corpuscular Volume (MCV)

An MCV value of over 100 fl is an indication of recently ingested alcohol [normal range 80-100 fl] [5] [6].

This test analyses the average volume of red blood cells in a specimen of blood [7].

Ethyl Glucoronide & Ethyl Sulphate

Heavy alcohol consumption is indicated by readings over 1,000 ng/mL, with levels between 500-1,000 ng/mL indicating heavy drinking in the previous 3 days, light drinking in the past 24 hours or intense exposure to alcohol in the last 24 hours [8].

Liver Function Test (LFT)

Liver function tests evaluate different proteins and enzymes in the blood to check for a depletion in levels indicative of alcoholism:

Albumin- Readings lower than 35 g/L indicate alcoholism, kidney disease, inflammation or infection as a result of alcoholism [normal range between 35-50 g/L] [9]
Bilirubin- levels higher than 1.2 mg/dL indicate liver cirrhosis or hepatitis [normal range between 0.1-1.2] [10]
Lactate dehydrogenase- levels higher than 280 U/L indicate alcoholism [normal range between 140-280 U/L] [11]
Alanine transaminase- levels higher than 36U/L indicate liver disease [normal range between 4-36 U/L] [12]

Gamma GT (Glutyl amino transferase)

A reading above or below 10-71 iU/l is a potential indicator of alcohol consumption [13].

Phosphatidylethanol (PEth)

A PEth reading of over 210.48 ug/l indicates excessive or binge drinking in the last 30 days [normal range <20ug/l].

A reading above 35 ug/l indicates some alcohol consumption, whereas a reading between 35-210.48 ug/l suggests social drinking [14].

Alcoholism Blood Test Biomarker Summary

Lab Test	Normal Levels	Alcoholism Levels ( + Short Term)	Long Term Alcoholism	Chronic Alcoholism
CDT	0.1 - 1.6%	Over 1.6%	Higher Reading	10% or over [15]
MCV	80 - 100 fl [16]	Over 100 fl [17]	No	No
Ethyl Glucoronide & Ethyl Sulphate	Less than 500 ng/mL	Over 500 fl ng/mL	Over 1000 fl ng/mL [18]	No
GT	10-71 iU/l	Below 10 or over 71 iU/l	No	No
PEth	Less than 20 ug/l	Over 35 ug/l	Over 210.48 ug/l	No
LFTS	11-13.5 seconds	Over 13.5 seconds	No	No
CBCs	135-317 billion for women and 157-371 billion	Less than 135 billion for women and 157 for men	Lower Platelet count	Lower Platelet Count

Diagnostic Criteria

As findings in MCV or GGT tests may be influenced by vitamin deficiencies or medication, more specific markers such as PEth tests must be used to confirm abnormalities suggesting alcohol use [23].

In GGT tests, a change in levels appears after 70 drinks per week for several weeks and returns to normal after 2-6 weeks, whereas CDT test changes appear after 60 drinks per week for at least two weeks and return to normal after 2-4 weeks, creating varying results [24].

In CDT tests, women have higher levels than men regardless of previous drinking, giving the tests greater scope for inaccuracy [25].

Full Blood Test vs Liver Function Test

	Full Blood Test	Liver Function Test
Measures red blood cells, white blood cells and platelets?	Yes [26]	No [27]
Measures enzymes and proteins?	No	Yes
Testing for anemia and blood clotting?	Yes [28]	No [29]
Monitoring responses to treatment?	Yes	Yes
Testing for liver infections?	No	Yes
Medically unexplained symptoms?	Yes	No
Heavy drinking?	Yes	Yes
Family history of live disease?	No	Yes
Medication that can harm liver?	No [30]	Yes [31]

Short Term vs Chronic Alcoholism Biomarkers

Ethyl Glucuronide and ethyl sulphate are indicative of alcohol ingestion up to to 36 hours in the blood and 5 days in urine [32].

Serum albumin, bilirubin and prothrombin time tests indicate long term alcoholism, and evaluate the liver for cirrhosis and chronic liver disease [33].

What Alcohol Blood Testing Is Not

As blood alcohol tests are typically at their most accurate 6-12 hours after the last drink, social drinkers, stress drinkers and binge drinkers are behaviours that are harder to identify through blood tests [34].

Alcohol blood tests cannot track historic alcohol abuse, or how long an alcoholic has been abstinent for, before the most recent alcohol use [35].

Interpreting Blood Alcoholism Test Results

Clinicians look for physical signs of alcoholism alongside test results:

Redness in the face
Consistent infections
Skin sores
Numbness or tingling in the feet or hands [36]

The CDT test has an accuracy rate of 77%, the MCV test being 44% and the PEth test being the most accurate at 99% [37].

Clinicians complete a psychological evaluation and evaluate drinking habits to decide whether symptoms correlate to alcoholism [38].

The patient must be both physically and psychologically dependent on alcohol to be classed as having an alcohol use disorder.

A follow up blood test would be ordered if:

Clinicians believe that the alcoholic has purposefully not drank before the test to avoid a positive reading
Where physical symptoms indicate alcoholism but this is not shown in the test
If a test indicates high levels of alcohol consumption whilst no other physical symptoms are present [39].

False Negatives

Liquid Intake

Drinking around 1 litre of water may lower the concentration of substances in the body and lead to a false negative [40].

It is still necessary to drink water, as dehydration causes the possibility of a false positive, but not over 1 litre [41].

Medication

Warfarin means the blood is less likely to clot, creating the potential for a false negative in a PT test [42].

Other drugs that may cause a false negative include:

Sodium valproate
Topiramate [43]
Citalopram

Sertraline [44]
Amobarbital
Butalbital [45]

False Positives

Food And Drink

Yeast with sugar, apple juice, non-alcoholic wine or beer and ripe bananas have been known to cause false positive readings due to alcohol content, meaning they should be avoided before any blood test, particularly those that require fasting beforehand [46].

Dehydration causes increased levels of haemoglobin and haematocrit, meaning drinking water avoids a false positive result [47].

Products Containing Alcohol

Mouthwash, hand sanitisers, hairspray and cosmetics contain alcohol, meaning regular use may lead to a positive test result and should be avoided before a blood test [48].

Medication

Paracetamol causes an increase in bilirubin, creating a false positive, particularly in LFTs.

Clinicians should be aware of the amount paracetamol taken before a test [49].

Smoking

Smoking causes increased haematocrit, haemoglobin and mean corpuscular volume, that may be mistaken for a positive alcohol consumption reading [50].

Nicotine and cotinine, the chemicals in cigarettes, leave the blood stream after 10 days, so a clinician will need to be made aware if they are performing a blood test on a smoker [51].

Follow Up / Further Testing

Follow up tests may look for:

Liver cirrhosis - through imaging tests, including ultrasound, CT and MRI scans, or an endoscopy
Liver fibrosis- via biopsy [52].

Last Updated: May 3, 2023

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Peter Szczepanski (Clinical Lead).

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