EtG Testing for Alcohol Abstinence
The question we are asked most frequently, year after year for 30+ years, is “How long after drinking can alcohol be detected?” The answer we give has always been based on the assumption that a breath alcohol or saliva test device will be used to detect the presence of alcohol in the blood. When the alcohol has been eliminated from the body (in two to 20+ hours, depending on how much alcohol the individual has had to drink) a breath or saliva test can no longer detect the alcohol. The relatively short window of detection for blood alcohol makes it difficult to effectively monitor abstinence with a breath or saliva test unless an individual is tested at least once a day.
EtG (Ethyl Glucuronide) is a direct metabolite of ethyl alcohol and has a half-life of two to three days, much longer than ethyl alcohol. EtG has long offered hope for a more effective way to monitor abstinence. For example an EtG test administered on a Monday could confirm that an individual abstained from alcohol use over the weekend, something that a breath alcohol test cannot do.
Negative EtG Results Confirm Abstinence
Even though EtG testing has been around for at least ten years it is still a relatively new alcohol testing methodology. SAMHSA (Substance Abuse and Mental Health Services Administration) issued two advisories on EtG testing, the first in 2006 and most recently in 2012. The advisory makes it clear that SAMHSA does not believe that a positive EtG test by itself is sufficient to definitively identify an individual who consumed alcohol. However, a negative EtG test gives convincing evidence that an individual did not consume alcohol for one or two days prior to testing.
What About Positive EtG Test Results?
As we noted above, SAMHSA does not recommend that an agency use a positive EtG test as stand-alone evidence that an individual consumed alcohol. They recommend that there be additional corroborating evidence of alcohol use to support a positive EtG test. This could be the individual’s own admission of alcohol use or confirmation with another testing methodology. The reason for this position is that incidental contact with products that contain alcohol – such as mouthwash, hand sanitizers, etc. – can result in a positive EtG test. A high cut-off level of at least 500 ng/mL should rule out incidental contact as the cause for a positive test, but SAMHSA still believes there should be corroborating evidence of alcohol use.
In spite of the recommendation not to use positive EtG results as a definitive indicator of alcohol consumption, the 2012 SAMSHA Advisory does include the following preliminary guidance on what positive results may indicate.
>1,000 ng/mL:
– Heavy drinking on the same day or previously (e.g., previous day or two).
– Light drinking the same day.
500–1,000 ng/mL:
– Previous heavy drinking (previous 1–3 days).
– Recent light drinking (e.g., past 24 hours).
– Recent intense “extraneous exposure” (within 24 hours or less).
100–500 ng/mL:
– Previous heavy drinking (1–3 days).
– Previous light drinking (12–36 hours).
– Recent “extraneous” exposure
On-site EtG Testing
Until very recently EtG testing could only be accomplished in a laboratory. In the past year several manufacturers introduced instant tests for EtG. As with all tests of this type, instant tests are designed to give preliminary results; presumptive positives should be confirmed with a laboratory. As of this writing in July 2015 none of the instant EtG tests have received FDA clearance, but are for forensic use only in corrections and law enforcement.
John Schwalb says
I am looking at a drug/alcohol test that shows EtG of 9400 ng/ml and EtS of 1910. I there any correlation with that and consumption, in other words would the person have been loaded or impaired or can that be said of such a level.
Jennie Lee-Pace says
Given that the cut-off levels for ETG testing is 500 ng, there is no question that there was alcohol in the person’s system. That consumption could have taken place in one or two instances or spread out over a period of 80-hours. The ETG test detects alcohol in the system for only 80-hours. So I don’t think you can take the result and deduce that the person was necessarily “loaded” or “impaired” at some point. The purpose of the ETG test is to show if there is alcohol in the system. If your policy is a 0 tolerance program or if your testing is being used for the purpose of abstinence monitoring, then the subject has failed the test. And “intoxication” level is a non-issue. Hope that helps.
Torsh Johansen says
Yes, since ETG can accumulate faster than alcohol in your system, someone could be “slow drinking” over a long period of time and never get drunk and still fail a test, given a certain period of time.
However, one of the myths is that ETG tests (500ng is standard) will show up for 80 hours. That’s extreme. People vary more than their BAC readings, so they’re taking the highest % people who are lethargic, not drinking fluids, metabolism being slow, etc.
In one study, on average, the handful of test subjects stopping drinking at .08 BAC, didn’t register on an ETG test 36 hours later. On average 32 hours after they blew .00 BAC later on. Of course, this is a 1-session drinking situation where although not “slamming” drinks, it wasn’t slow drinking or anything (which can accumulate more ETGs without hitting a high BAC).
In the end, most people report with excessive water and exercise after a night of partying, it’s more like getting over the 48 hour hump to be able to pass a standard 500ng test, not 72.
Chris says
Thanks alot that helps
Robet says
THanks for the help. Very inciteful
John says
Is ETG cumulative? In other words, do ETG levels build from day to day if one drinks every day? If the body eliminates ETG at a specific rate then it stands to reason that there would become a backlog of ETG awaiting elimination if one drinks one or two drinks every day–never intoxicated but failing ETG tests due to build up over time.
Jack Singleton says
We would not say that EtG is cumulative over time. EtG is eliminated at a steady, although slower, rate than the parent alcohol molecule. In the scenario that you described of a person drinking one or two drinks a day, EtG would always be present in the person’s system. The EtG would be eliminated from the system after the person had several days of abstinence from alcohol.
J. Richards, MD says
Hi
I’m am a psychiatrist with significant experience in addiction treatment. The goal in our treatment program is NOT to punish or shame those who come to us for help and/ or relapse during their recovery. However, I have made it a concerted effort on my part to abolish using the EtG/EtS urine test.
My rationale: Those who choose to use alcohol, even to excess, must be honest if they want help.
Using this test only furthers to create the shame and guilt these patients feel. It is also too expensive.
The new rapid tests have not yet been approved by the FDA and require further confirmation if deemed positive. (the people who read the rapid tests, by the way, are often unexperienced professionals. This allows for further error). Further expense and more shame are the result.
So, just use the traditional urine test to determine alcohol use within the past 12-18 hours. By then the patient will be sober and NOT BE A DANGER TO HIM/HERSELF OR OTHERS with proper assessment. SAMHSA only sanctions this test for DOT and professionals directly involved with patient care
(healthcare providers, including prescribers), not those involved in the legal system (lawyers, judges, police)
Jennie Lee-Pace says
Mr. Richards,
You make some very good points. And we thank you for your insights.
Sobriety like all good choices is just that…a choice. One can argue the 24/7 sobriety programs, are also seeing some successes, not just for maintaining the safety of the general public but also for the individual who typically is court ordered to participate. This particular EtG test is FDA cleared and currently for law enforcement use only…typically court ordered for individuals with DUI offenses.
I agree that if someone comes to you acknowledging the need for help, they have volunteered to be part of your program and the use of an EtG test would be somewhat offensive and may create some distrust in the doctor/patient relationship. In this scenario chances for treatment success are pretty good.
Unfortunately, there are individuals who suffer from the same addiction who are resistant to help. The EtG will help professionals tasked with monitoring their behavior and choices to keep both the DUI offender and the general public a little safer.
Drea Martinez says
I work as a Professional Barber. I use alcohol on my clients after a haircut, and also use hand sanitizer through out the day. Say I had to test Wednesday, I used alcohol on my clients and hand sanitizer the day before will it show up on my ETG?
Jennie Lee-Pace says
Hello Mr. Martinez.
It is our understanding that the EtG metabolite test only detects and reports the metabolite processed by your body as a result of internal alcohol intake. External products are not detectable.
K. Ridgeway says
I have a urine test report with EtG results of 18,253 ng/mL and EtS result of 5408 ng/mL. These seems incredibly high given the cutoffs and standard levels indicative of consumption. Is a measure in the 18,000 range even feasible? Or could this possibly be an error in the test?
Jennie Lee-Pace says
Hello.
We have never focused on results on the high-end, instead focusing on results on the low-end. We would recommend contacting the lab with this question as they would better know the implications of a high cut off level.
Jessica says
What does a blank EtG test mean? (No lines appeared on the urine test)
Jennie Lee-Pace says
No line would be a positive test result. No line in the “control” panel would be an invalid test.
Murray says
Why would a individual test show positive after an individual donates plasma @500 to 1000 ng/ml. They also haven’t drank in 9 months.
Jack Singleton says
A negative EtG test confirms abstinence from alcohol. A positive EtG test suggests consumption or possible exposure to alcohol; there should be corroborating evidence to definitively say a person consumed alcohol. We wouldn’t expect that the procedure of donating plasma would create a positive EtG test. EtG cut-off levels are set high to rule out typical exposure to alcohol on the skin.
Reba says
I am trying to gather facts to gain an understanding. There was a test done on a certain day. The person’s results came back at a level of 430. They said they were not in any vicinity of alcohol, but admitted to being sick and taking over the counter medicines to get better and also had documentation proving such. The EtG testing that was done at that time was not the 500>, it was the 100<.
Muriel Stamand says
EtG Testing for Alcohol Abstinence: Best Practices – AlcoPro
Drug rehab tackles more than the compulsive behaviour that sustains the addiction, it also tackles the emotional triggers and re-teaches fundamental life expertise like relaxation.
Torsh Johansen says
Reba: You mean it wasn’t a 500ng+ threshold to fail, but an under 100 to pass, right? Which means very sensitive. Those uber-sensitive tests actually are more prone to give False Positives, which is one reason why most places stick to 500ng or even 1,000ng to eliminate any false-positive possibilities.
Second — 430ng is pretty solid. It’s not like they hit 150-200. Here’s the thing — over the counter medicene isn’t going to affect it unless it has alcohol. Nyquil does have a good % of alcohol in it, 10%! Holy cow, right? 2x the strength of beer! Except it’s 30ml. Which is less than a standard shot’s worth of super-strong Beer. In a nutshell, it’s not even CLOSE to having even a lite beer! And 1 lite beer will be out of your ETG system in about 12 hours! Theoretically they could have hit a sizeable # like 430 if they took a double-dose of Nyquil, didn’t sleep hardly much, so they could run and take the ETG test in the morning (why in the hell do that?).
In the end, they’re lying. 🙂 And, they’re told NOT to take stuff like NyQuil anyway — but it’s a totally safe bet they’re BSing anyway. 🙂
Charles Lewis says
I just got a result from a test which says the Ethyl Glucuronide result is >5000 ng/ml with a 550 ng/ml cutoff. what would you make of that result. Also there is a Ethyl Sulfate result of >2500 ng/ml with a 250 ng/ml cutoff. Would that indicate that a person has a high tolerance if there are continued results at that rate?
Jennie Lee-Pace says
Certainly the EtG test result suggests the subject consumed alcohol most recently. We are not sure if the ethyl sulfate result is enough information to suggest tolerance levels.
Jeffrey S McGraw says
The half life for etg is 2-3 hours, not 2-3 days.
Michelle says
I am a treatment provider and have a client that is under court probation on a “no drink” order. She has a positive etc of 670 ng and is reporting her husband cooked food with alcohol and she ate it and this is why the test is positive. Court cut off for incidental a, Ohio. Contact is 500 ng or less
What is your opinion of this level with this client and could it be consistent with alcohol in food.
Jennie Lee-Pace says
Hi Michelle.
Alcohol typically cooks out of food and is usually only used in very small amounts, so this assertion may be a stretch. How the alcohol is consumed should not really be the argument here. If the court has ordered abstenance, I would think the consumption of alcohol (whether by food, drink, pill or medicine), should be disallowed.
Tim says
Hello and thank yo for this blog. I am a professional under an absitnate alcohol program. I recently received a “non negative”. My ETG cutoff limit was 100ng. My result stated 165. Additionally my ethyl sulfate was negative. Unfortunately on this day I was quite dehydrated and my creatine was 347 with a ph of 6.5. Are you aware if quest diagnostics makes the appropriate adjustments for such a high creatine? Thank you for the insight.
Jennie Lee-Pace says
Hi Tim,
Unfortunately, I do not know what, if any, adjustments are made for such things.
Cathy Lopez says
I’m curious as to how the etg half lives work and how are these tests read? So if an individual drinks 1 beer, how long does it take for them to clear that out of their system for an etg test?
Jack Singleton says
The EtG test is best used to monitor abstinence. A negative EtG test is strong evidence of that a person has not been drinking in the previous few days. The EtG test can detect alcohol use one to three days after drinking. Onsite EtG urine tests are pass/fail tests, while laboratory EtG tests may report the level of EtG when the level exceeds the cut-off level to be considered positive.
Bill says
When an ETG Urine – Alcohol test is requested from a lab, are other substances tested for when a sample is given?
Jennie Lee-Pace says
An EtG test only checks for the alcohol metabolites.
Ranie says
A person tested positive on an alcohol test at Levels (ETG 1350, ETS 103). Their UA results on 11/14/18 was negative. They stated that they did not consume any alcohol, but was taking some over the counter medication for cold & flu symptoms that contained 10% alcohol.
Does this level of ETG and ETS seem plausible with cold medication?
Thanks for any help you can provide in advance.
Jennie Lee-Pace says
It is plausible, especially if the consumption was very recent. If the subject is part of a zero tolerance program, possibly a pressing question is why are they consuming products with alcohol? There are non-alcohol based cold and flu medications available.
Ralph says
What cutoff levels do most phmp programs use. From what i am reading 500ng is standard. 100 is pushing for false positives even. I have read that a person can have anywhere from 20 tp 80 ng naturally, and even light exposure can push someone over the 100 cutoff. Also, etg varies so much between indiividuals, all the research i have read has shown such a variance how can a monitoring program justify the testing, even tests such as peth in the blood?
Jack Singleton says
The primary benefit of an EtG test is to demonstrate sobriety. A negative EtG test is solid evidence that the individual is maintaining sobriety. On the other hand, a positive EtG result does not necessarily mean an individual has been drinking. The SAMHSA Advisory of 2012 makes it clear that programs should use additional corroborating evidence of drinking rather than relying only on a positive EtG result.
We are not knowledgeable about the EtG cut0ff levels that are typically used by Professional Health Monitoring Programs. The research articles to which we have provided links below advocate using cutoff levels of 100 ng or 200 ng to maximize sensitivity and the probability of detecting alcohol use. Using these lower cutoff levels, however, decreases the specificity of the results, which increases the probability of false positives.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400217/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663163/
Bobbie says
Hello-
If a urine sample submitted for Etg test was delayed in being ran by a few days, is there a possibility the results could be skewed when the test is eventually ran? I had a patient whose urine sample was sent to the wrong lab and was delayed in being ran (unclear how long). The results were quite positive: ETG 1700 ETS 600. The patient is adamant she did not drink however is not the most reliable historian. Just curious if the delay could skew the results? Thank you!
Jennie Lee-Pace says
Hi Bobby.
I cannot speak for laboratory based Etg testing. The instant Etg tests that we sell are meant to be used once you obtain a specimen and they render instant results in front of the subject. Perhaps the best course of action is to conduct another surprise test on your subject. I would encourage you to pose this question to the laboratory. They may best be able to address the elevated levels and the integrity of the specimen over time.
Amy says
If the patient has consumed a lot of water and the test may have beeen diluted how would you know on an instant etg test? I know the laboratory based test checks creatineine levels but, the rapid does not, correct?
Jennie Lee-Pace says
Amy, that’s correct. A rapid etG test alone will not test for creatinine or pH. It is simply not possible for the rapid test to determine dilute or super dilute specimens. However, an instant adulterant test strip like the UrineCheck 7 will detect abnormal levels of creatinine, pH, nitrite, etc., so you can determine adulteration.
Maria says
Hi, If you read these test results, would your impression be that the individual consumed a lot of alcohol within 3 days. If not, what would your opinion be?
Ethyl Glucuronide Not detected EIA 300 ng/mL
Ethyl Glucuronide (EtG) DETECTED EIA 100 ng/mL
Ethyl Glucuronide (EtG) DETECTED LC/MS/MS 100 ng/mL
Ethylglucuronide (EtG) > 10,000 ng/mL.
Ethyl Sulfate (EtS) DETECTED (3060 ng/mL) LC/MS/MS 25 ng/mL
Thanks in advance.
David says
I had a client who admitted to taking a sip of a whiteclaw (5% alc.) around 10:30pm, and she took an ETG the following day around 6:30. She’s very adamant that it was a sip just to try it, will she be fine with her ETG?
Jennie Lee-Pace says
It all depends upon the amount in the “sip” and the cut off levels of the EtG test itself. Our instant EtG test detects at 300 ng/mL. The only way to tell is to administer the test.
Brian says
Hello,
I’m interested in a less invasive test for our employees rather than urine. Is there a saliva test that can test for etg/ets beyond 24-48 hrs after consumption?
Thank you
Jennie Lee-Pace says
I am not aware of a saliva etg test that detects alcohol consumption over an 80 hour period. We do have saliva drug tests with an alcohol panel that will detect present alcohol consumption but it does not detect alcohol once it metabolizes. http://alcopro.com/product/orawell-6-panel-oral-fluid-drug-test-with-alcohol-panel/
Christopher says
Many great viewpoints expressed here. It seems most disturbing why the United States FDA (Food and Drug Administration) fails to develop a definitive law dictating one cuttoff level standard to be used, as opposed to the present situation which is a hodgepodge of Laboratory Defined Standards (LDS) with no government regulation or oversight, and leaving interpretation of the number of nanograms concentration stated in any given lab-report up to anyone to interpret however they wish. Some states like Arizona consider any EtG test result under 2000ng to be unreliable, yet some laboratories set cuttoff points as low as 100ng, and in theory, someone could consider even 1ng to pe positive proof a person has consumed alcohol. In addition, the existence of scientific papers and case-law expert-testimony indicating that typical household products may cause test results between 300ng to 800ng, and that some foods create some EtG naturally upon digestion, it clearly seems something must be done at the Federal government level, and that the FDA is not doing their job very well…your tax-dollars at work as usual.
Jennie Lee-Pace says
Christopher.
Excellent points. We have found that the EtG products that claim detection levels at 300 ng/mL and lower are also not very reliable. The most reliable abstinence programs that rule out ingestion of foods and other substances that may register as the EtG metabolite is breath alcohol testing. I believe states like North Dakota have such 24/7 detection programs and claim reported success.
Thomas says
EtG results indicated a level of 150,000, and an EtS result of 38,000. That sounds as though the person would be dead from alcohol use. Could this have been through operator error (something like leaving calibration fluids in the system, not properly flushing the system, etc) ? Thank you
Jennie Lee-Pace says
Hi Thomas.
The EtG test is a urine dip test and does not use calibration fluids. It’s not like a breathalyzer, which requires a calibration and the use of a dry gas or liquid alcohol.
Edward says
Hello there, I have found this page to be so helpful. I’m a Med student writing a paper on Alcoholism, and I’ve recently found findings that false positives are more usual than I was lead on to believe. I dealt with a client who recently had a urine drug test and his ETG was 435 ng and ETS 410 ng. He said that he had no consumption of alcohol but that it could have been the medication he was taking, when asked what medication he said Benadryl.
Is this possible?
Jennie Lee-Pace says
Hi Edward.
I am not familiar with the ingredients in Benadryl. Some medications may contain up to 25% alcohol. There is also the variable of cutoff levels. Tests with a 300 ng/mL may turn up presumptive positive if one is taking certain medications. The best way to rule out medication or false positives is to use a test with a 500 ng/mL cutoff level.