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Hair Alcohol Testing: A Long Term View of Alcohol Consumption

alcohol testing device is typically used to determine if someone is currently under the influence of alcohol, a hair test provides a long- term, three-month view of consumption and helps determine the level of use during that time period.


What Challenge Does It Solve? Although alcohol is a legal substance in many countries, the rate of heavy use/abuse by adults is more than twice the rate of adults using illicit drugs.1

Te challenge in screening individuals for

substance abuse is trying to identify a behavioral indicator versus current impairment. Having an alternative assessment tool that identifies drinking behaviors can aid in evaluating and diagnosing use and abuse. A hair alcohol test is generally used to get definitive answers about alcohol abuse, as it gives an indicator of those dependent on alcohol.


Te hair is measured for levels of ethanol metabolites/biomarkers, which are produced when alcohol is metabolized. Alcohol is not directly deposited into the hair—instead it breaks down into ethanol byproducts and is measured through ethyl glucuronide (EtG) or faty acid ethyl esters (FAEEs). According to the Alcohol Marker Consensus passed by the Society of Hair Testing, EtG should be the first choice in abstinence assessment.2

lcohol testing has come a long way in the last decade, and one method that is growing in popularity is the use of hair testing to measure alcohol consumption. While a breath

Elements of a Sound Test A sound hair alcohol test will generally follow these overall guidelines: • Results Assessment: EtG and FAEEs can be used alone or in combination for chronic excessive alcohol consumption assessment, but it is not advisable to use the results of hair testing for alcohol markers in isolation; all relevant factors surrounding a case should be considered and occasional drinking cannot always be excluded.2

• Sample Collection: Head hair is the preferred sample type; however in instances where head hair is not available, body hair can be accepted.

• Wash Criteria: Just like with hair drug testing, the use of an effective wash procedure is an important step in the testing process in order to eliminate external contamination.

• Results Review: Just like with the actual hair drug test, it is recommended that results be reviewed by an expert who can combine case history with test result data.

• Accredited Laboratory: Te test should be performed by an accredited hair testing laboratory.

• FDA Approval: FDA approval is not applicable for tests going direct to mass spectrometry confirmation.

Details Behind How It Is Measured EtG is measured in pg/mg and it is recommended that testing labs follow the guidelines determined by the World Health Organization in association with the Society of Hair Testing. The EtG hair test can be used to identify those consuming little to no alcohol on a weekly basis. The test also identifies those who would be considered in the “mild to moderate” consumption category, consuming approximately 8–16 alcoholic drinks on average per week (this represents a level of approximately 15 pg/mg). To be considered in the category of “excessive alcohol consumption” and falling into the category of 30 pg/mg or greater, an average of at least 4–6 alcoholic drinks per day would have to be consumed over an average of 3 months. Currently, according to the World Health Organization and a literature survey, chronic excessive alcohol drinking corresponds to an average consumption of 60 g of pure ethanol per day over several months.2 Below is an example of an EtG hair alcohol test results chart.3

With this particular chart, if the level is below the lower limit of quantitation, the results will state that the sample was “Below Reliable Quantifiable Level.” While it is possible that some drinking occurred, it is below the level of detection.

48 datia focus summer 2016

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