Details on EtG Tests

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What is EtG testing?

When used properly, EtG testing is a reliable and accurate method of verifying abstinence from alcohol use and of detecting alcoholic beverage consumption. EtG testing reveals alcohol use up to three-and-a-half days from the time of the urine collection.

How accurate is EtG testing?

  • EtG testing is not subject to adulteration, fermentation, or cross-reactivity; it is simple, precise and reliable. EtG testing reveals alcohol exposure from the prior approximately 80-hours; the actual “window of detection” will, of course, vary from person to person, related to dose, individual metabolism, and test sensitivity.
  • There are over 100 peer-reviewed articles on EtG, published in major international scientific journals. Compared to other alcohol testing systems that claim continuous monitoring, EtG testing has by far the most scientific validity.
  • Because alcohol is ubiquitous in the environment, (see a list of products containing alcohol) inadvertent alcohol exposure, typically related to frequent use of high-alcohol content cleaning products, has been known to create innocent positives. Such cases are relatively rare, but must be considered when reviewing a non-negative EtG test result. As in all substance abuse testing, professional assessment of non-negative test results is always appropriate.

How is EtG testing used?

  • EtG testing is used to monitor impaired health professionals, recovering from alcohol and other addictions, throughout the United States.  Doctors, dentists, nurses, pharmacists and other health care professionals all benefit from the routine verification of abstinence provided by EtG tests.
  • It is used increasingly by treatment agencies, courts and community corrections programs.
  • It is used in accident investigations, when alcohol consumption is considered a potential contributing factor. See, for example, UPDATE ON THE INVESTIGATION OF THE CAPSIZING OF THE ETHAN ALLEN IN LAKE GEORGE, NEW YORK.

What about the different levels of EtG testing?

Three different test levels are commonly available:

  • 100 ng/ml LC/MS/MS testing – This level of sensitivity is most commonly used to monitor individuals for professional or clinical reasons, such as impaired health professionals. Testing at this level will occasionally (about 1 non-negative in 500) pick up incidental exposure.
  • 250 ng/ml LC/MS/MS testing – This level of testing will detect about 97% of episodes of alcohol use (as compared to 100 ng/ml testing). This level has a high enough cut-off to avoid most incidental exposure.
  • 500 ng/ml LC/MS/MS testing – This level of testing will detect about 90% of episodes of alcohol use as compared to 100 ng/ml testing.  This level is commonly used for routine clinical and forensic applications as most “innocent positives” (that is, non-negative results due to inadvertent alcohol exposure) occur below the 500 ng/ml level.

What about confirmation?

All reputable EtG test providers automatically confirm non-negatives at no additional charge. Some providers also simultaneous detect both EtG and EtS, another alcohol marker, allowing for immediate confirmation, saving time and getting the report to the requesting agency quickly.

What is the significance of the EtG level reported in a positive result?

As with all drug test results, it is best to think of EtG results as simply Negative or Non-Negative. The level of EtG reported, which might, for example, be as low as 600, or as high as 100,000 does not necessarily reflect greater or lesser drinking.  Many factors can affect the level of EtG detected in an individual’s urine sample, so it is best to avoid making undue assumptions based on EtG detection level reports.

Why use EtG tests?

  1. Shadow of a drunkIndividuals with alcohol problems have trouble stopping drinking.
    • Denial and minimization make it hard for alcohol abusers to recognize their drinking problem.
    • Many excessive drinkers are poorly motivated to stop drinking.
    • Despite agreement to stop drinking, secret drinking is a common problem.
    • Episodes of secret drinking are often hard to detect.
  2. EtG testing allows for detection of secret drinking.
    • When persons with alcohol problems know that secret drinking will be detected, they usually stop drinking.
  3. EtG testing reduces alcohol abuse.
    • In organized treatment programs, routine testing for drugs of abuse (including EtG alcohol) results in greatly reduced rates of substance abuse.
    • Drug courts that use EtG testing report greatly reduced alcohol abuse rates:
      • Initial EtG tests typically detect drinking in ~50% of participants.
      • When EtG testing becomes routine, the drinking rate falls to 5% or less.
  4. EtG testing confirms alcohol abstinence.
    • When alcohol abusers stop drinking, it is often difficult for others to trust that they are truly sober. EtG testing provides an external verification of abstinence – it allows programs, treatment professionals and families to “trust but verify.”

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