Table 1.

Advantages and Disadvantages of Alcohol Biomarkers

	Advantages	Disadvantages
Self‐report, clinical interviews, questionnaires	Inexpensive, easy, and quick	Dependent on patient candor
Routine laboratory parameters
Liver function tests (ALT, AST, GGT) Mean corpuscular volume	Inexpensive, widely available AST/ALT ratio is useful	Nonspecific; severe liver disease can interfere
Carbohydrate‐deficient transferrin	Long‐term consumption	Confounders: liver disease, smoking, low body mass index, female sex
Direct markers
Ethanol detection in serum, urine, body fluids	Gold standard	Short half‐life of ethanol
Ethanol levels in saliva	Quick and cheap	No good correlation with blood alcohol concentration
Ethanol breath detection	Rapid results	Only acute consumption; sensitive to breath pattern and meals
Transdermal alcohol sensor	Continuous monitoring	Not tested in liver disease
Methanol detection in blood	Measurable when ethanol is no longer available	Endogenous production
Indirect alcohol biomarkers
EtG	Age, sex, ethnicity, and severity of liver disease have no influence Long‐term consumption	Unable to detect low levels of alcohol consumption Bacterial degradation (urine) Laboratory sample Influencing factors: age, cannabis consumption, renal impairment
Ethyl sulfate	Age, sex, ethnicity, and severity of liver disease have no influence No degradation by microbes	Reduced kidney function
FAEE	Measured with EtG increases validity of hair analysis	Fat production may depend on age/sex/hormones Capillary treatments/cosmetic can induce false determination
PEth	Good correlation with amount consumed No influence of liver disease	Generation postsampling in presence of ethanol (solved with dried blood spots)