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SAMHSA News - November/December 2006, Volume 14, Number 6


Lab Tests for Alcohol Abuse: SAMHSA Advisory

SAMHSA has issued an Advisory that cautions licensure bodies, other monitoring organizations, and staff in criminal justice settings that a widely used test for alcohol consumption is "scientifically unsupportable" as the sole basis for legal or disciplinary action.

The EtG (ethyl glucuronide) urine test, often used to detect alcohol use among individuals legally prohibited from drinking because of their job or parole status, is "inappropriate" as the sole basis for a definitive, life-altering decision.

According to the SAMHSA Advisory, "The Role of Biomarkers in the Treatment of Alcohol Use Disorders," the EtG urine test is one of an evolving group of highly sensitive tests for the ingestion of alcohol.

The EtG test and other similar highly sensitive tests are not able to distinguish between alcohol absorbed into the body from exposure to many common commercial and household products containing alcohol or from the actual consumption of alcohol. Calling such a test "positive" for consumption or relapse, especially at low concentrations, could have devastating consequences for someone who signs an alcohol abstinence contract or is required to be abstinent by law.

"This Advisory is a clarification," said addiction psychiatrist Kenneth Hoffman, M.D., M.P.H., of SAMHSA's Center for Substance Abuse Treatment Division of Pharmacologic Therapies. "The Agency wants officials to know that the EtG test, for example, is fine for use in clinical settings. But it should not be used as a stand-alone test in a forensic situation where someone's job is at stake."

The EtG test, identified as a "direct biomarker," is highly sensitive, Dr. Hoffman explained. (See What Are Alcohol Biomarkers?) "For example, there's a popular hand sanitizer that's about 64-percent ethanol. That alcohol can be absorbed through the skin and metabolized to EtG and EtS (ethyl sulfate)," he said. "With tests highly sensitive to detecting EtG or EtS, that might mean that these tests are reported positive for other reasons, even though no alcohol was consumed. A positive EtG or other similar highly sensitive test alone may have nothing to do with relapse or inappropriate use of alcohol."

To order a copy of "The Role of Biomarkers in the Treatment of Alcohol Use Disorders," call SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). Ask for NCADI number MS996. Online, for more information on the Advisory or to view the full text in PDF format, visit www.kap.samhsa.gov/products/manuals/advisory.

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What Are Alcohol Biomarkers?

Alcohol biomarkers are physiological indicators of alcohol exposure or ingestion. SAMHSA's recent Advisory focuses on "indirect" and "direct" biomarkers.

Indirect biomarkers. Traditional alcohol biomarkers are generally considered "indirect." Indirect biomarkers suggest heavy alcohol consumption by detecting the toxic effects that alcohol may have had on organ systems or body chemistry. Indirect measures generally screen for elevations of specific liver serum enzymes—which may result from heavy drinking—or changes in red blood cells—which reflect nutritional problems related to alcohol use.

Direct biomarkers. Breath or blood alcohol tests used by police officers to identify potentially drunk drivers are familiar examples of a direct alcohol biomarker. These tests reliably determine a motorist's blood alcohol concentration. An evolving group of tests for alcohol—"direct" biomarkers, or analytes of alcohol metabolism—are now available through some laboratories for either clinical or forensic use. Tests for EtG (ethyl glucuronide) and EtS (ethyl sulfate), typically measured in urine, can be used to screen individuals for alcohol exposure or use. These tests may be reported positive after even low-level exposure to alcohol and may remain detectable for several days. Tests for indications of heavy alcohol use have proven helpful in clinical treatment settings and can complement self-report measures of drinking.

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