als that were suspected of chronic alcohol consumption. Over the past several years, use of EtG hair assays has been gaining popularity in various family court jurisdic- tions across the United States. Another area that has found EtG hair
testing useful is the initial evaluation process for addiction treatment programs. Years ago, these programs found value in conducting a hair test as a measure to provide an objective 3-month history for new patients upon admission. Previously, the program relied on self-report, which has obvious limitations; and urine testing, which has a relatively short detection window of 2-5 days, when compared to hair which has a detection window of up to approximately 3 months. Treatment is improved with full knowledge of the patient’s drug abuse history, including alcohol. Furthermore, many programs have found that hair testing, including EtG hair testing, to be a valuable tool in the overall strategy to monitor patients during and aſter treatment. Recent articles have been published de-
scribing the effective use of EtG in hair to identify patients in relapse prior to and af- ter receiving organ transplants, specifically liver and kidney (Haller et al, 2010; Stewart et al, 2012). Binge drinking is a leading reason for organ transplantation; therefore demonstration of positive lifestyle change is a requirement of most programs before receiving an organ. Similarly, clandestine drinking confounds the management of other long-term chronic diseases, such as diabetes, hypertension and gastroenteritis. Healthcare professionals struggle with these patients, wasting time and money, to gain control of the symptoms when clandestine binge drinking is the culprit the whole time. Another exciting opportunity for EtG
hair testing was recently announced in Kansas City where EtG hair monitoring of high school students will be initiated next fall (Robertson, 2013). In the opinion
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of this author, this is a perfect use of this test as all of the subjects are underage and should not be consuming alcohol at all, much less binge drinking. Tis also represents an opportunity for the local col- lection facility to expand their commercial offerings in addition to having a positive impact on their local community.
What does a positive Hair EtG mean? One of the most frequent questions
concerning a positive EtG hair result is how much drinking did it take to achieve a certain level. Tere are several studies published in the scientific literature that we may reference to draw our conclusions. Several studies have investigated specific groups of subjects that were expected to be positive such as alcohol-related post mor- tem cases and alcohol addiction treatment entrance evaluations. Other studies have evaluated the relationship between the con- centration of EtG in hair and self-reported alcohol consumption. As one would expect, the concentrations
of EtG in hair for alcohol-related post-mor- tem cases tend to show the highest levels of EtG in hair reported in the literature. Levels as high as 13, 800 pg/mg have been reported in the autopsy analyses of people with known alcohol dependence issues (Skopp et al, 2000; Janda et al, 2002). In- dividuals undergoing treatment for alcohol misuse are not quite as high but may still be rather elevated. Janda et al (2002) reported levels as high as 984 pg/mg, Jurado et al (2004) reported levels up to 750 pg/mg, and Morini et al (2006) reported levels up to 434 pg/mg. It would be expected that these high-risk individuals would have high levels of EtG in hair because while the subject was actively abusing alcohol the EtG concentrations would approach steady state, where formation of EtG in hair and the disappearance of EtG are equilibrated. On the other end of the spectrum, the most common concern is how much drinking is
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As one would expect, the concentrations of EtG in hair for alcohol-related post-mortem cases tend to show the highest levels of EtG in hair reported in the literature.
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