Alcohol Abuse Testing Problems

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Recent studies have identified two major problems when it comes to testing for alcohol abuse. Interestingly, they are at both ends of the spectrum – too accurate and not accurate enough.

An advisory issued by the Substance Abuse and Mental Health Services Administration (SAMSHA) criticizes the most accurate test for alcohol abuse. The Ethyl Glucuronide test, or EtG, finds a metabolite of alcohol in the urine. Since urine is produced over several hours, a sample that tests positive shows that alcohol consumption occurred sometime during that period. It is the most common test used in law enforcement (for parolees) and in many treatment programs. Particularly, it is used in the medical community for professionals who wish to demonstrate they haven’t been drinking – important in some cases for continued employment.

The problem with EtG is that it picks up alcohol metabolites at such a low level that environmental exposure can give a positive result, even when a person hasn’t been drinking. What’s environmental exposure? Hand washing with alcohol-based sanitizers is one. And that shows up preferentially in the medical community, a population that sanitizes many times during the working day. But environmental alcohol is also found in such innocuous things as very ripe fruits, mouthwash and breath fresheners. Without knowing how much alcohol a person has actually consumed, a positive EtG test can mean false accusations or even a dismissal from a job.

A second test, the CDT (Carbohydrate-Deficient Transferrin) is meant to overcome this problem by looking at the effects of chronic alcohol use. It wouldn’t pick up a single incident, but shows changes in the blood over time with alcohol consumption. The problem here is that this test doesn’t actually pick up a majority of abusers. A study of HIV patients, for whom alcohol consumption is contraindicated, gave an estimate of only about 36% for even heavy drinkers.

Currently, the only test that can be trusted completely is the BAC (Blood Alcohol Level) taken from a blood sample. But here too, there are concerns. This test can only show a snapshot of drinking behavior. Someone who sobers up for the test will not give a positive result. There is no way to “look back in time” as there is with a urine test.

The issue of accurate and reliable testing will continue because real world consequences follow from the results. It may be the difference between jail time and not, or whether someone remains employed.

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