[canecarrie]

Dr.Bill, I have been researching both the validity and dangers of false positives and negatives of this test as it is used for criminal, employment, and child custody reasons. In addition to the variant cut-offs, incidental exposures, etc. I am flabbergasted by the amount of conflicting info out there - claims AND disclaimers by labs, in addition to the limited research despite the seeming "trust". So my questions:

I have read research that 1 drink - GENERALIZED - can be detected about 21 hours; 3 all the way to 5 (huge difference!) drinks just (avg.) 48?hrs. And that all at only measure at 100ng/ml cutoff. Nothing at 500 cut-off... or more importantly, correlated to actual urine levels detected vs. time and cut-offs...

Similarly, I have read lab disclaimers of like, 3 drinks to 40 or so hours. Finally, I just read the following of a Forensic Testing Services Site:

"The EtG test has become known as the “80 hour test” for detecting any amount of consumed ethyl alcohol. This is not totally true. The presence of EtG in urine is a definitive indicator that alcohol was ingested. It is true that EtG can be detected in chronic drinkers for 80 hours or even up to 5 days. During this period of chronic use, the EtG level can exceed 100,000 ng/mL. Two primary factors to determine the window of detection is based on volume of alcohol consumed and the time between each drink. A person that consumes 3 drinks can only have a detectable level of EtG for approximately 20 to 24 hours and peaks at approximately 9 hours with an EtG level around 15,000 ng/mL."

Interesting, but accurate? Is there an "average" you can extrapolate for EtG per drink, despite variations in individual? I know you've scrutinized much of the info out there, what do you think? Would this be equivalent of say 3-5 drinks, 500 cutoff, 48 hours on average? Or some ridiculous admission - or omission - or reality? (I think this is a direct-to-customer communication, not to "drinker"... )

Thanks!

[DrBill100]

Interesting, but accurate? Is there an "average" you can extrapolate for etg per drink, despite variations in individual? I know you've scrutinized much of the info out there, what do you think? Would this be equivalent of say 3-5 drinks, 500 cutoff, 48 hours on average? Or some ridiculous admission - or omission - or reality? (I think this is a direct-to-customer communication, not to "drinker"...)

There is no average and there never will be!

EtG is a metabolite of ethanol that is synthesized in the liver by a specific set of enzymes. The presence and quantity of those enzymes are controlled by genetics (polymorphism). One person will create a lot of EtG, another not so much and some none at all. That is a genetic endowment and not the property of the chemical.

Therefore, my method is to focus on the longest time for clearance that isn't clearly an aberration.

It is now becoming apparent that EtG elimination differs among chronic heavy drinkers and moderate drinkers.

Most of the studies focusing on heavy chronic drinkers were conducted on detox patients, often with multiple hospitalizations for alcoholism, without controlling for liver dysfunction or other physical disorders. Likewise, these studies have timed elimination from admission to the hospital, not last drink or BAC=0.

As for the range of detection around the three drink mark, while I estimate high at 48 hrs the mean average is probably closer to 26-32 hrs. Bear in mind that these low consumption tests have been conducted using healthy social drinkers using measured amount of alcohol. As opposed to the heavy consumption tests that have used hospitalized diagnosed chronic alcoholics based on BAC with no idea of how much they drank or over what period.

All of the elimination studies have used very small cohort groups Most in the range of 1-20. There has never been a large scale population study.

When interpreting the various studies (never rely on articles) it is imperative that you compare, dose (amount of alcohol); time interval, ex: Is the time calculated from 1st drink, last drink, or BAC=0. That alone will alter outcome by 10-12 hours in some instances. And also if the results reflect a return to EtG=0 or below the cutoff. That also may differ by many hours. I see you already check the cutoff (100-500). That will alter time by 20-40%.

Following are four studies that deal with consumption in the range of 3-5 drinks. The quantity is generally expressed as grams .5 - .8 in relation to body weight in kilograms (g/kg).

Moore (2010) (on p. 1) .08 BAC. 32 hr
Hoiseth (2008) 3 drinks vodka. Ave 30 hr
Helander & Beck (2004) approx 3 drinks (g/kg) 28+ hrs.
Halter (2008) approx 3 drinks (g/kg/M2 BMI) 26-36 hrs

These studies bring lower amounts of EtOH into a little clearer perspective but, as you will note, most of these have an outlier that significantly exceeds the average. Halter (above) for instance.

NOTE: I currently have a research assistant tracking the first mention of "80 hours" as well as "5 day" claims. The claim dates at least to 2002 in Europe and possibly to 1995. EtG has only been used in the US since 2004 and proliferation of the claims is traceable to Skipper (2004) and Wurst & Skipper (2003). Skipper introduced the test in US, Wurst in Europe.

[canecarrie]

Thanks for the response Dr. Bill.

I had a couple of follow-up questions, mainly regarding the difference between the cut-off levels and their corresponding detection. In the study, for example, where 9 drinks averaged 78 hours elimination, I believe that was a cut-off of 100? If this were a 500 cut-off, what would be the approximate hours of detection?

Similarly, generalized, how many hours would the variation/deviation be for 500 vs. 100 for the 3-5 drink studies cited above (understanding these are averaged)?

Lastly, what level of incidental exposure might raise EtG to false positive on a 100 cut-off test? For household cleaners, for example, would it have to be same day or daily, longterm exposure?

Thanks again!

[DrBill100]

The only part of the question I can answer immediately is incidental exposure. That is usually short lived, 3-13 hours elimination following exposure. It isn't cumulative but is additive. Like if you had one drink at noon and another at 1 there would be a little left over from the noon drink and the later would add to what was already there. Other than those who have constant exposure, such as in a bar, auto repair, roofing, lawn care, there isn't much danger due to building up high levels. If inhalation occurs within proximity to the test, say within 12 hours, then even mouthwash, shaving lotion, food, dodorant etc. in small quantity and brief exposure can pose a danger.

Tell me which study you are looking at that has 9 drinks/78 hours. Maybe that will save some time. There are several studies that have elimination graphs so I'll probably have to let you review the graphs and compare the time lines.

In broad terms a 500 cutoff eliminates about 23% of the samples positive at 100.

[canecarrie]

I was looking at a study previously mentioned on this board, "Borucki, 2005".

It sounded like they might have used 2 cut-offs, but I found it difficult to decipher all of the technical terms and charts. If this is the case, was the 78hrs for the lower the cut-off?

I realize only 18% of the 9-drink subjects tested positive at this time, but that is a big leap between 77% at 54hrs, and very hard for me to extrapolate - with my very limited knowledge on the subject - any kind of trajectory of decline in these 24 hours (e.g. somewhere around 60hrs-65hrs).

I've also read on this board that 60 is is a lower-end avg. mark for clearing EtG at higher consumption rates, and not certain if that is:
a) copacetic with this study
b) based on the 100 or 500 cutoff
c) how the "hour" count would differ if the former (... sounds like 23% difference, if the case, would make avg. 60-72 more like 57-68?)

Thanks again. You, your knowledge and its sharing are truly assets to the topic and site.

[DrBill100]

Let me take you away from Borucki and switch to a more recent study. Helander, 2008. (We go back to Borucki because he used measured amounts of alcohol) Otherwise, the Helander study answers many of the questions you are interested in.

1) Are the estimated times of elimination misstated to make the test seem to be more effective than it actually is?

2) Helander's study had 32 participants. Larger than most.

3) Deals with individuals (detox patients) that were .10 BAC up to .44 BAC

4) It used a Level of Quantification (LOQ) of 50 ng and cutoff of 500 ng. By looking at left line of graph you can gauge 100 ng and compare to 500.

5) Contains a table of elimination times by dose of alcohol compiled from previous studies, see Table 1.

This study, Helander, is cited as demonstrating that EtG clearance time ranges from 40-130 hours. Study the graphs (Figure 2, A, B) and see where the 130 hour figure comes from. Then look at where the majority end (you'll have to open in separate window and magnify)

We don't know how many drinks any of these individuals had. Only their BAC at admission. The elimination time began at admission... not BAC=0. But the study also provides that figure as well.

Take the time to read this thoroughly. You can skip all of the instrument technicality.

[Robertg263]

Dr. Bill, I had 3 drinks and must do an EtG test by redwood labs. Using a cut off 100 ng.
How long will it take to clear 3 drinks from my system? I did the test abou 65 hours after the 3 drinks. Thank you!

[Robertg263]

I'm 210 lbs and 6'.