A higher peak on an ankle monitor can reflect more than a larger reported alcohol dose. In a 2021 study of 43 people, Richards and colleagues examined 183 drinking days that SCRAM detected. They compared the recorded peak and area under the transdermal alcohol curve with reported drink counts and participant characteristics.
Higher reported drinks per drinking day and elevated aspartate aminotransferase (AST) were associated with a higher peak in the adjusted analysis. Reported drink count and female sex were associated with area under the curve in the adjusted model for that outcome. The relationship between AST and peak was observed in a small sample, and drink counts came from a retrospective interview.
AST is a clinical measurement with multiple possible explanations. A group association offers no patient-specific adjustment to a SCRAM trace. A review that compares peaks across people should state which endpoint it uses, identify the basis for any proposed dose estimate, and explain how its uncertainty accounts for individual variation and self-reported exposure.
Richards et al., Alcoholism: Clinical and Experimental Research, 2021