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EtG (Ethyl Glucuronide) testing, a popular urine
screening test used with workers by laboratories to determine
whether alcohol exposure or ingestion has occurred, is not as
reliable as once thought. According to the Substance Abuse and
Mental Health Services Administration (SAMHSA) in the September 2006
Substance Abuse Treatment Advisory, the alcohol biomarker EtG
does not provide “sufficient proven specificity” to determine that
an individual “has been truly drinking.”
It has always been a workplace challenge to
determine whether an employee has alcohol in his or her system since
alcohol moves quickly through the body. Urine tests, considered the
standard in workplace drug testing, screen for metabolites, which are
the drug residues that remain in the system after the effects of a
substance have worn off. EtG, an alcohol biomarker, is a byproduct of
metabolized ethanol, a component of alcoholic beverages, and can stay in
a person’s system for up to 5 days. The primary purpose of using the
alcohol biomarker is to reduce relapse with alcohol use. In the
advisory, SAMHSA states that the use of an EtG test alone in determining
abstinence is unreliable because the EtG test is highly sensitive and
can detect exposure to alcohol that is present in many daily use
products (e.g. hand sanitizer), resulting in a positive test. Further,
they state that “legal or disciplinary action based solely on a positive
EtG…is inappropriate and scientifically unsupportable at this time.”
For alcohol exposure identification purposes,
SAMHSA recommends using both alcohol biomarkers and self-report measures
of drinking (e.g., the National Institute on Alcohol Abuse and
Alcoholism single-question screen, the Alcohol Use Disorders
Identification Test, Michigan Alcoholism Screening Test, and CAGE) since
self-report measures and biomarkers may identify somewhat different
individuals and that their use in combination is desirable. Within a
drug-free workplace program, it is recommended that alcohol biomarkers
be used therapeutically (e.g., by a health professional/EAP to monitor
compliance), and that the EAP or other health professional be the one to
decide when it is time to alert the company/organization of treatment
failure and non-compliance with any return-to-work agreement.
More information about alcohol biomarkers and
SAMHSA’s recommendations is located in the
Substance Abuse Treatment Advisory. The U.S. Department of Labor’s
Working Partners for an Alcohol- and Drug-Free Workplace provides
resources about drug-free workplace programs, including how to write a
policy and information on drug testing and EAP or other
health-professional support.
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