Dr. Bill100

I drank very heavily Thursday, Friday, and Sat. Night. 8-12 beers per night. (Friends Wedding) I am 5'7" and 175 lbs. More muscular than fatty. I will have had approximately, 114 hours since last drink. I've been drinking a lot of water, mainly carbonated with some flavoring (aspartame citric acid) basically flavored water. With urinating frequently, 114 hours, a relatively high metabolism, and everything else I've stated what are my chances of passing?

Ive read other results but no one I've seen has spoke of such a reckless weekend. Or given as much detail. I test Thursday around 7:30 and will make sure to go there well hydrated.

You are in a questionable range. The synthesis of EtG continues until your BAC reaches "0"... not last drink. Sequential, or continuous, intoxication has unpredictable physical consequences. It always perturbs gastrointestinal absorption and probably GI metabolism of the alcohol shifting more work to the liver.

In some drinkers this would slow metabolism and extend EtG synthesis. Yet in many alcoholics studied metabolism nearly doubles, accelerating EtG and elimination. No way to know in your case.

There is no way of predicting clearance time. You fall within a range of possible detection above (500 ng/mg), about 12% but that figure is based on very few subjects <100 and the range of detection is 30-110 hours.

If you engage in this pattern frequently it may be advisable to look into methods for controlling or reducing your alcohol consumption. There are many remedies currently available and it seems that coercive restraint isn't working in your case.

Isn't 130 hours after consumption the longest elimination period on file. And I thought that even after heavy drinking clearance times would less than the "80 hour window". I'm just a little confused. Could you please clarify? Thanks DrBill!

It sounds as though you have been doing a lot of reading. I'm happy to clarify my comments and hopefully the issue. 130 hrs seems to be the outer/upper limit for detection in the research literature. This was a test conducted in a detox setting with BAC levels on admission of .10-.34. In this same study, the average (mean) elimination period was 78 hours (range 40-130 hr). Therefore, the figures you mention above. There were only 32 subjects involved in this 2008 Swedish study. The cutoff used was 500 ng whereas many testing agencies still use 100 ng.

Interpreting this (and all EtG) studies requires a more discriminating review. For instance, the time spans noted above (and most often quoted) were calculated from time of admission. When calculated from "0" BAC upper window of detection fell to 110 hours and an average of 66 hrs (range 30-110). This "0" BAC was not determined by blood draw but by using Widmark's formula for estimation (this assumes standard elimination of ethanol based on population average not applicable to most heavy or problem drinkers).

Further, when applying urine dilution measure (normalizing creatinine) the upper limit fell to 70 hrs, an average of 56 (range 30-70). It is recommended this standard (U100EtG) See New Advisory) be applied but in fact it seldom is in commercial testing.

Virtually negating the predictive value of this particular study (in addition to the estimation noted above) is that urine was collected only once during each 24 hour period almost guaranteeing that the reported figures are over-estimates.

Nonetheless, in my opinion, the only safe method for projecting the elimination curve is to use the upper-limit figure. All of the literature has found about a 4-fold variance between subjects studied.

At best EtG tests provide very erratic results that cannot be correlated to the amount of alcohol consumed except by referring to these tested upper-limits.

My overall point is that any attempt to calculate EtG elimination across a given time for any individual really isn't possible based on current knowledge.

All of the foregoing is based on laboratory conditions, conducted by trained scientists using the most sophisticated instruments. They know how to interpret the results. Not considered are the many known problems with EtG: sample instability, environmental exposure to ethanol products, use of less reliable test products, inadequate training of personnel within the commercial testing industry and the fact that individuals synthesize EtG through a liver enzyme that is controlled by a genetic polymorphism.

Also, If I'm not mistaken, it seems as if the 130 hours was someone who had liver and kidney problems as well. I know that it's hard to caclculate EtG elimination times due to drinking, but I would think that based on the studies and assuming the person being tested is in good health, even after a heavy driking episode, the person would be clear of any EtG at 96 hours. The reason I'm asking is because my employer does weekly etg/ets testing, which I think is ridiculous. I drank last Wednesday (8/24) night into Thursday morning and was tested this morning at 8 am. This is the first time I've taken it. Do I have anything to worry about? Again, thanks DrBill for clarification above. I appreciate your insight on this matter.

Also, I wanted to add they do use 100/25. Does this make any difference if it's been about 8 days? Forgot to add to previous.

At 8 days the cutoff would make no difference in relation to your drinking. It makes a big difference from the standpoint of false positives. Thousands of common household products that are inhaled can create EtG above 100/25.

I've never heard of an employer requiring total abstinence, prohibiting drinking even while off the job.

The bad part is, DrBill, is that I'm a Healthcare Recruiter, and I'm on call 24/7 when I'm not in the office. I've never heard of such a thing. I don't know what they expect. But for the time being I'm stuck in the position I'm in and have to deal with it. I am going to say that I may drink on a Friday night, and not drink any times in between. I saw the response above at 114 being on the edge, what about 110 if I don't benge for 3 straight days?

Are you sure that this test is EtG and not a standard alcohol assay? The sample, procedure and container, would be the same. Are the results available on-site or sent to a laboratory, how long does it take to get results?

EtG testing is, to the best of my knowledge, used exclusively in settings where total abstinence is required: rehab, court programs, licensing boards in conjunction with provisional license restriction, etc. Except in the TA setting the test has no value.

EtG independently, for instance, could not determine if you were drunk at the time the test was taken. That requires a Blood Alcohol read. EtG can only determine that you have had (assumed consumption) alcohol in your system at some time in the past and in unknown quantity.

The purported purpose of EtG is to detect drinking after systemic alcohol has left the system.

Maybe this is all known to you but I find this practice reminiscent of the Temperance crusades of the 19th century.

As to your request about timing EtG, I really can't be any more clear about my inability to apply the research to a specific individual.

I can tell you in general terms that the key to EtG is moderation and spacing of drinks which also applies to ethanol metabolism. The elimination curves are almost identical offset by about 5 hours down to a very low level.

Elimination is an ongoing process (not cumulative), so when you have one drink it will be absorbed, distributed and eliminated in about one hour*, during distribution the BAC will peak at around .02. If you begin a second drink at the end of that hour your BAC will not register .04 (cumulative) but stay around the .02 range because first drink has been metabolized.

EtG is created in the final step, Phase II, of metabolism but as soon as it is synthesized it likewise begins elimination (EtG/EtS are not cumulative).

The amount of ethanol in your system at the time of final drink is key as opposed to the total number of drinks consumed. The controlling factor is time... but when it comes to EtG we don't know how much time and we don't know how much EtG is synthesized by any given individual.

*This is a commonly used estimate. In fact this time may vary by 350% by gender and drinking history alone.

Ok. It may be that their doing a regular alcohol test, of course I assumed it would be this test because that's all I've seen online and I have been doing research on it. I have ready the studies and have seen your responses to there questions regarding etg/ets testing. Of all the research that is online though, it seems as if most of the studies used a 100 cutoff though and I believe that I saw in one of your responses that only a few people on record ever tested over 102 hours. I'm really intersted in this... gotta love the commercialism up to 80 hours.

First you should understand that there aren't many elimination studies dealing with heavy alcohol use and those that do exist are generally conducted on unrepresentative populations such as detox patients, psychiatric units, etc.

The lack of uniform standards in research was noted by Wojcik & Hawthorne in 2007: ....many different limits of detection are used for differentiating between positives and negatives, and sensitivity and the window of detection was typically reported only in very general terms using phrases like ‘up to 80 h’, or ‘up to 5 days’, without the caveat that these detection windows apply only to the most extreme cases. .......The situation hasn't improved.

There are several studies that use 500 cutoff. That is now the recommended cutoff. Yet in the commercial testing services these recommendations are generally ignored. As a result there is no way of knowing what the cutoff is and/or how it is reported.

The test is currently being reviewed again by SAMHSA. They issued an advisory in 2006 pointing out the unreliatility of the test. Since that time almost every original claim of the original researchers (Wurst, etal) has been discredited. Yet use of the test increased in the private market. Millions of EtG tests are conducted each year. No uniformity. No regulation.

I see your point. I asked the question in regards to elimination because you seem to be an expert when it comes to EtG testing and I have read your repsponses to questions that people have asked regarding elimination or if they were in the good zone after a particular amount of time. I know at 8 days it would not pose a problem, because of the drinking no matter what the cut off is.

Sorry it took so long to get back to you guys... I passed.

Thanks for all the awesome feedback, and to you Dr. Bill for scaring me straight. Been abstinent since the wedding!