DrBill -

I read an interesting article on the sensitivity of EtG tests, but the article was published in 2007 and apparently the study was conducted in 2005 or 2006. Are you aware of how these tests have changed since then? The claim is that the EtG test will confirm within an 80 hour window... however I have seen information that this window only catches the most extreme cases and likely someone with a slow metabolism.

Generally, for the EtG test to be most effective it would have to be conducted every 24 hours or within about a 48 hour window. Do you have any further insight?

Thanks,

There has been no change in the test, per se. It is conducted with gas chromatography/mass spectrometry (GC/MS) and High-performance Liquid Chromatography (HPLC) both of which isolate specific molecules, in this case Ethylglucuronide (EtG).

There have been a couple of additions to the test. Some laboratories are now expanding the technology to detect Ethylsulfate (EtS) in addition to EtG. Another addition, beginning in 2008 some laboratories now claim to be able to apply the process to hair testing. Tri-mega, London, was the first in 2008 and that has now spread to the US although I don't know how many labs currently use the hair test. Greg Skipper, the doctor that first promoted EtG testing in the US, in 2004, takes a dim view of the hair testing claims. See EtG, Skipper

The 80 hour claim is more of a promotional theme than scientifically reliable fact. In fairness it was lifted from a Study by F. Wurst, the Swedish doctor that first established the validity of EtG as a bio-marker. His statement was "upto 80 hours."

The fact that 80 hrs is not a constant is easy to calculate: EtG is a by-product of metabolism. Clearly metabolizing one drink creates less metabolites than 2 drinks. EtG is eliminated (rate unknown) therefore the greater the amount of EtG present the longer it takes to eliminate it. There are some studies that tracked how long EtG remained in the system from various quantities but the interindidual variation was so great as to render the results meaningless. (Ex: 1 drink showed no EtG at 3 hrs in one individual and in another it was detectable at 30 hr)

Your information as to the window of detection is pretty close. Depending on the amount of alcohol consumed 24-48 hours is as good as any for an estimate.

Another confounding variable is that the amount of EtG produced from the alcohol metabolic process probably varies from individual to individual (just as basic metabolic rates vary), although that is currently an unknown factor.

The science behind the test seems to be sound and the techology used (GC/MS) is reliable and highly sensitive. The massive problems that have emerged are related to unregulated use, lack of standardized cut off levels and improper interpretation of low level findings.

Thank you for your response, you seem to be the most informed of the blog posters on this issue. I have read a number of the scholarly articles that I could find and it seemed to me that if the labs were consistently catching people at the 80 hour marker and were catching somewhat less at the 100 hr marker, they would be advertising it as an "up to 100 hr test"...

It seems to me also that a credible monitoring program that would not want to deal with arguing false positives would more than likely set the threshold at 500 ng/ml?

In your view, how does size, weight and exercise affect the results? i.e. how does a bigger individual with a higher % of fat fare compared to a smaller individual with a lower % of fat.

Establishing a cut off level at any threshold would bring some uniformity to the field. However, incidental exposure to environmental ethanol creates readings in the 300-800 range (average), according to the court testimony of Greg Skipper, MD (see FindACase™ | Johnson v. State Medical Board of Ohio) That means that total abstainers can test in that range. As example I have been advised that Arizona sets a threshold of 2000, although I've been unable to substantiate, to date.

All of the factors you mention contribute to absorption, distribution and elimination of systemic alcohol, the metabolic cycle for ethanol. Any condition or activity that influences metabolism necessarily influences metabolites.

Unfortunately the scientific literature is under-developed and the advertising claims overblown in relation to EtG testing. Much of the information you read on the subject is simply wrong, particularly the propaganda generated by the testing industry. Stick with the peer reviewed studies, court cases where you can find them, and question even the studies as some of the researchers have a financial interest (check the required disclosures at the top or end of the study).

Also, are you by chance familiar with the lab affinity?

There is a process typed lab affinity, there is a laboratory called Affinity, and a program known as Affinity Lab---clarify that for me.

Is there a way to have an offboard discussion? Could you email me at my board name at Yahoo?

There is a way to private message me with confidential info and I think you click on my user name. Think so. If not let me know.

It does not seem to be activated...

I am -91 when it comes to websites and computers. I get private messages and I checked and it seems to be working. I don't know how to transmit confidential info otherwise.

For some reason I cannot currently get the message function to work... thank you for the information. The sources of information were very valuable for my research.

DrBill you gave the following example earlier: (Ex: 1 drink showed no EtG at 3 hrs in one individual and in another it was detectable at 30 hr) -

Do you know what the physical makeup of each individual was?

Not that particular. In that study I do recall that the drinks were measured in proportion to body weight and it involved social drinkers as opposed to detoxing alcoholics. I can look back through some info and try to find a list of the research to date. It strikes me there are only 9 studies, some are case reports (1 individual) and some are as few as 3. It is really sparse research.

It'll probably be tomorrow before I get to it.

No worries, thank you. I am trying to make comparisons between overweight inviduals that don't really exercise and skinny individuals that exercise on a regular basis and would have ostensibly a high metabolism. I know there is not enough data, but I would assume that the outliers that typically test positive at 80 hrs out would be those that are overweight, do not exercise and have a relatively slow metabolism.

Quote:

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Originally Posted by lsd_lsm

no worries, thank you. I am trying to make comparisons between overweight inviduals that don't really exercise and skinny individuals that exercise on a regular basis and would have ostensibly a high metabolism. I know there is not enough data, but I would assume that the outliers that typically test positive at 80 hrs out would be those that are overweight, do not exercise and have a relatively slow metabolism.

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Don't think so. First there is a difference in male v female alcohol metabolism due to an intestinal enzyme called ADH, (alcohol dehydrogenase). Men have it, women don't (or very little). Second, women eliminate alcohol at a faster rate then men despite the fact that they have higher body fat. Third, frequency and amount of consumption play a significant role in metabolism due to a liver function called MEOS (Microsomal Ethanol Oxidizing System). This is like an overdrive system that is operative in regular drinkers but not in occasional drinkers. Some studies indicate it is also activated by the amount of alcohol in the system as well (overload/intoxication).

In addition, none of the studies to date have controlled for liver function (or pathology) despite being performed on chronic alcoholics. While the factors you mention play an indirect role in EtG production via metabolism there is no way to correlate that information without a fixed ratio for EtG production in relation to quantity of systemic alcohol.

Contrary to your theory, my experience would indicate that those who test highest would be thin, under-nourished, suffering from vitamin deficiency, fatty liver and gastrointestinal problems. My profile fits chronic Type II alcoholism but may not hold true for EtG.

So your theory is equal to mine. I'm certainly interested in anything you find.

Let me see if I am folloiwng you here - you say - Third, frequency and amount of consumption play a significant role in metabolism due to a liver function called MEOS (Microsomal Ethanol Oxidizing System). This is like an overdrive system that is operative in regular drinkers but not in occasional drinkers. Some studies indicate it is also activated by the amount of alcohol in the system as well (overload/intoxication). --

So are you thereby saying that occasional drinkers don't have the ability to metabolize as quickly as regular drinkers?

But your next statement would seem to indicate that skinny stage II alcoholics that are enaging in regular active drinking would test the highest?

Yes. Regular drinkers do metabolize at a faster rate than occasional drinkers.

Yes skinny alcoholics who drink to excess constantly would probably test higher for EtG, certainly their metabolism often slows down. This has nothing to do with morphology but a lot to do with pathology. The liver is overworked and damaged. That is where 80+ of metabolism occurs. The gastrointestinal tract is stripped of enzymes where maybe 15-20% of alcohol metabolism occurs via ADH. Over utilization of the MEOS system is believed to contribute to liver disease. To further clarify, Type II alcoholism is advanced long-term chronic drunkenness (some refer to this as skid row type). The extreme end of the alcoholic typologies.

I am also interested in this 80 hour claim and how it affects differently situated classes of people. If you were to make a generic observation from your studies - for occasional drinkers who would be the prototypical individual that would fail at the outer 80 hour band given either a moderate or heavy drinking episode ending at hour 1 in the 80 hour band?

It is relatively safe to say that consumption of up to 5 drinks will not be detectable after 48 hours regardless of the drinking history or physical characteristics of the imbiber (excepting pathology). That isn't based on my knowledge of the physiological mechanisms involved. It is an observation derived from various studies and reported elimination times. It is a guess based on the fact that the more alcohol consumed the higher the level of EtG.

Few of the research projects have involved females (1, 2 at most) which is unusual as the male v female variance in metabolism is well established as are gender enzyme discrepancies. So that leaves a black hole in the EtG literature.

To the best of my knowledge there has been no attempt to correlate EtG production or elimination with individual metabolic rates. Another big question mark.

The only mention of physical characteristics has been the administration of ethanol based on body weight. Even there the body weight is not stated.

Therefore I have nothing to go on. It would be my thinking that the system of a regular but healthy drinker would eliminate faster than a healthy infrequent drinker, holding constant basic metabolic rate, gender and pattern of consumption. That is based on the assumption that one reaches "0" BAC faster than the other and therefore shifts the time to first drink rather than point of elimination of ethanol (0 BAC). When you start the process at 0 BAC then there is another question mark. If they each had the same amount of EtG in their system would one eliminate at a faster rate than the other? The question that overshadows that is would they have the same amount of EtG in their system? Probably not, I think, but don't know for sure.

You are correct in relation to exercise in that anything increasing the BMR will speed up all metabolic processes and should eliminate EtG at a correspondingly faster rate. There is no research on that and isn't likely to be.

In order to reach the 80+ limit requires extreme intoxication in an otherwise healthy individual. A BAC of from .25 and up.

Now, how many people do you know that can use up a full page while not answering your question?

Thank you for indulging me, the intellectual banter kept my day interesting.

When you have time, could you elaborate on this statement -

That is based on the assumption that one reaches "0" BAC faster than the other and therefore shifts the time to first drink rather than point of elimination of ethanol (0 BAC). When you start the process at 0 BAC then there is another question mark. If they each had the same amount of EtG in their system would one eliminate at a faster rate than the other?

I understand that the regular drinker would get to 0 BAC faster, but how does the analysis differ from the point of the last drink to some point later of 0 BAC with respect to the 80 hour band. Is this band based on when the last drink is finished or when the individual gets to 0 BAC?

Thanks again - you have quite a wealth of knowledge.

Just FYI.

Requesting off board contacts is prohibited by this site, the discussions need to be for all the public to see, how else can the site continue to share information?

See site rules for a reference to this post.

Good point there, KBC!

I would like to add, that once a thread has been started, that yes, all information needs to stay on the thread so that others with similar questions can benefit by the information that's exchanged.

A person can generally word things in such a way on a thread as to make the information appropriate for all to see.

Thanks!

On your last point, concerning an invidual with a .25% and up giving a positive reading at 80+... how would the different specificities play into that? i.e. 100, 250, 500 and 1000... I know you said it is highly unregulated and not standardized, but do you have any idea what level most other monitoring agencies set this level at? From the info given you have given, Ohio is at 250 and AZ potentially at 2000... Do you know where other states fall in at?

Quote:

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Originally Posted by lsd_lsm

On your last point, concerning an invidual with a .25% and up giving a positive reading at 80+ ... how would the the different specificities play into that? i.e. 100, 250, 500 and 1000 ... i know you said it is highly unregulated and not standardized, but do you have any idea what level most other monitoring agencies set this level at? From the info given you have given, Ohio is at 250 and AZ potentially at 2000 ... Do you know where other states fall in at?

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The majority of testing labs use 100 as a cut off. It's a big money business and the overall sales pitch is "we will find more drugs than the lab you're using now." As to the cut offs by state I don't know. Most states do not regulate testing labs.

Of course the exception to the above non-regulated is any federally mandated test. They are strictly regulated and each cutoff specified.
See: https://www.askmehelpdesk.com/altern...st-477501.html

There does not appear to be a federal cut off point for alcohol, only drugs... did I miss it?

I don't know if you saw this question so I thought I would repost it...

When you have time, could you elaborate on this statement -

That is based on the assumption that one reaches "0" BAC faster than the other and therefore shifts the time to first drink rather than point of elimination of ethanol (0 BAC). When you start the process at 0 BAC then there is another question mark. If they each had the same amount of EtG in their system would one eliminate at a faster rate than the other?

I understand that the regular drinker would get to 0 BAC faster, but how does the analysis differ from the point of the last drink to some point later of 0 BAC with respect to the 80 hour band. Is this band based on when the last drink is finished or when the individual gets to 0 BAC?

In doing some more research on the metabolism of ethanol, I found literature stating that there may be a fructose effect that would speed up the rate of ethanol can be metabolized... have you run across this?

Thanks again - you have quite a wealth of knowledge.

Quote:

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Originally Posted by lsd_lsm

In doing some more research on the metabolism of ethanol, I found literature stating that there may be a fructose effect that would speed up the rate of ethanol can be metabolized ... have you run across this?

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Fructose accelerates the metabolism of alcohol

Fructose is the only known substance that has been scientifically proven to speed up metabolism of alcohol. Literature on this phenomenon dates at least to 1937 (Carpenter & Lee). Subsequent research has confirmed the fact but seem to disagree on the percentage of acceleration (Brown et al, 1972 = 50%; Rogers et al, 1987 = 80%; Rawat, 1974 = 100%). Mascord et al, 1991 observed a greater range of individual variations from a 13% decrease to a 300% increase in the ten subjects studied. There is a 2004 study from Nigeria that is easy to read, informative and covers all the bases. See Onyesom and Anosike, 2004

I haven't overlooked your other question. I'll get to it. Trying to phrase everything so it will be understandable to subsequent readers. EtG testing is an important subject that is effecting a lot of lives at the moment. So bear with me.

Quote:

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Originally Posted by lsd_lsm

there does not appear to be a federal cutoff point for alcohol, only drugs ... did I miss it?

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Alcohol, EtG and federally regulated testing programs.

As relates to alcohol the federally regulated drug testing program(s) test only for impairment and therefore do not use bio-markers. In September 2006 Health and Human Services (HHS) issued an Advisory in relation to bio-markers including EtG:

Currently, the use of an EtG test in determining abstinence lacks sufficient proven specificity for use as primary or sole evidence that an individual prohibited from drinking, in a criminal justice or a regulatory compliance context, has truly been drinking. Legal or disciplinary action based solely on a positive EtG, or other test discussed in this Advisory, is inappropriate and scientifically unsupportable at this time...their use in forensic settings is premature.

Complete publication at: HHS 2006

Federal departments such as Dept of Transportation, FAA, etc. may promulgate rules in relation to the level of impairment for their particular branch. Airline pilots are considered impaired at .02 for instance. But all departments must comply with basic HHS Guidelines. Federal employees can also be tested for Reasonable suspicion, post accident and return to duty. Any such test is by alcohol content (degree of impairment) not past use. These regulations also extend to services regulated by an agency. Therefore commercial truck drivers, regulated by DOT are subject to the same rules and rights as a federal employee.

So the standards are much different under federal testing mandates than those accorded to private sector employees.

The difference are all the state licensed employees whether healthcare or legal...

Dr. Bill, you are awesome!!

If I have an 80-hr. test coming up, and I'm on the cusp, is there anything I can do to help my cause? How about exercising a lot (sweating) in the next couple days, or doing the sauna? How about drinking a lot of water/soda the day of my test?

Also, if I was heavily intoxicated (.20 BAC), but back to 0 BAC by 82 hours, am I probably OK? Thanks!!

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Originally Posted by AbbiJ

Also, if I was heavily intoxicated (.20 BAC), but back to 0 BAC by 82 hours, am I probably ok? Thanks!!!

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Your question is confusing. It wouldn't require 80+ hrs for alcohol elimination (0 BAC)". Please provide the interval between the time of last drink to time of test.

There are no studies that address increasing elimination of EtG.

Dr. Bill, sorry to have been vague:

Basically what I meant was: if I am tested 82 hours from the time at which my BAC returned to 0, should I be OK?

In other words, at 95 hours before my test, I was heavily intoxicated. But by 80 hrs. my BAC was down to 0.

There should be no EtG remaining from that experience.

Thanks Bill... the reason I asked was, I'd been drinking fairly heavily for two nights (stupid, I know)... But I was smart enough to stop drinking in time for the 80-hours to begin.

By my estimates, 95 hrs. before my test, my BAC was probably around .20. So by 80 hrs. before the test, the BAC should've dropped down to 0. My fear was that, due to the back-to-back binging, I could still produce measurable EtG's...

I've read about (and the counselors scare us with stories of) people still testing positive even 90+ hrs. out. But I'm going to assume they either a) have a bad liver or b) they were so severely intoxicated that their bodies were still metabolizing the alcohol well within the 80-hr. window.

Looks like you've done your research. There are examples of EtG detection at 130 hrs, 110 hrs. These tests, like most of the early research, drew from detoxing chronic alcoholics and in the most extreme examples, as above, were attributed to both liver and kidney damage beginning with a BAC >.30.

However, EtG tests regularly produce erratic results that are left unexplained by the research. Measured alcohol consumption regularly produces results varying by factors >7X.

But even that variability pales in the presence of the fact that most positives fall in the range of 100 - 250 ng range (a fact proudly promoted by testing labs) even though it is well established that incidental exposure to ethanol containing products (particularly personal hygiene) can and frequently does create levels in the range of 300-800 ng.

The danger in this test resides in interpretation of results. It is completely unregulated, there are no uniform standards, no certification or training required to administer the test. Ergo, a prescription for personal disaster.

I'm sure you must feel more secure now.

As an afterthought, sequential extreme intoxication (to the point of .20) is a bad sign. This degree of use can create acute reactions, gastrointestinal inflammation, if a frequent practice, also leads to fatty liver, all of which impede metabolism through the depletion of enzymes. Women are more vulnerable to these conditions than men and the development is more rapid.

Bill, once again - you are AWESOME. I can't even tell you!

If anyone feels they're on the border of passing or failing, is there anything they can do to "tip the scales" in their favor? I know dilutes are bad news (our court considers them a positive). But how about moderate/heavy amounts of coffee or tea shortly before the test? Or sweating a lot (sauna) in the 2 days before the test? Is there evidence to suggest you can give yourself a slight edge?


Also by chance, do you know what cutoff most court testing uses?

The most widely promoted cutoff is 100 ng. There is no standard within the industry.

EtG, like the parent ethanol, is hydrophilic (is attracted to and rapidly incorporates into water) and in order to avoid false positives from environmental exposure I often recommend simply drinking water but not on the day of the test. I offer this as advice for self protection against a pattern of documented problematic misinterpretation not as a means to beat a test. My concern is for the individual that loses his job, children or freedom because (s)he ate some of grandma's cookies, polished the furniture, gargled, used deodorant or regularly washed their hands.

I have no knowledge of commercial products that claim to detoxify. Although I'm skeptical of the claims I can't tell you from experience or study whether they work or not.

Ok, thanks. I need to curtail my drinking episodes, but when my friends come calling, sometimes I just can't resist. I'm fully aware that I need to address my weekend binges. Funny thing is, I can go all week without drinking fine. But if I go out on Fri./Sat. nights - look out. I won't have just one or two; I'm going to binge.

My court-mandated sessions are on Wed. (when I might get tested), so I know how to time my drinking on Sat. nights to coincide with the 80-hr. window. But the other day a counselor tried to scare us by saying they sometimes catch people at 90 or 100 hrs. so that freaked me out a little...

The thing is, I couldn't imagine sitting around on a Fri./Sat. night and not drinking. Maybe when I get older and have kids, but not now. I'd feel like the walls were closing in on me. I just couldn't see myself sitting through a sober weekend - that'd be like sitting in jail.

Truthfully, the alcohol counselors are a joke... they are so obsessive about it, that it gets to be a joke among the clients there. It's like these people have no life and never had one, so they want to take all the fun out of everyone else's. Several are losers; my counselor is a 40-year old virgin type. The thing is, they are so creepily obsessive on the topic of drugs/alcohol - they want us to abstain completely, forever - that we actually don't really take them seriously.

I get it; having a DUI with a high BAC (.18) was a serious offense on my part. But they way a lot of people treat us like scum just makes us even more bitter and resentful. The counselors, the court people, the cops, etc. all treat us like animals, and we have to endure that for months on end. It pisses me off - almost to the point that, when this program is finished, I want to go drink more just to say "f- you" to all of them...

Whether you drink and how much you drink is a personal decision that you must make. Restrictions on where you drink and under what conditions are asserted by law, although compliance is still your choice. It's my personal belief that lecturing and coercion is ineffective in most cases. So you'll get none from me.

I will however point out a flaw in your operational reasoning. The course you have chosen and your rejection of the temporary constraints placed on you is the very action that will keep you under the control of those that you resent. You run a high probability of detection or re-offense which will perpetuate the very treatment you so vehemently protest. That seems self-defeating. Almost as though you're cooperating with them in their mistreatment of you and looking for ways to make sure it doesn't end. On the upside it keeps the legal system churning.

I wish you the best of luck.