From the Guidelines
Ethyl glucuronide (EtG) testing is a crucial tool in managing alcohol use disorder, providing objective evidence of abstinence or relapse, and should be integrated into a comprehensive treatment approach. EtG testing serves as a valuable monitoring tool in alcohol use disorder management by detecting alcohol consumption for up to 80 hours after drinking, compared to standard breath or blood tests that only detect recent use 1. The test can be performed using urine, hair, or blood samples, with urine being most common in clinical settings. For monitoring purposes, testing is typically conducted randomly 1-3 times weekly during early recovery, with frequency potentially decreasing as recovery progresses. Some key points to consider when using EtG testing include:
- EtG testing helps clinicians adjust treatment plans based on objective data rather than self-reporting alone, which may be unreliable in this population 1.
- The test has limitations including potential false positives from alcohol-containing products like mouthwash or hand sanitizers, and it cannot distinguish between a single drink and heavy consumption 1.
- For optimal effectiveness, EtG testing should be integrated into a comprehensive treatment approach that includes behavioral therapy, medication (such as naltrexone, acamprosate, or disulfiram when appropriate), and regular counseling rather than being used punitively or in isolation 1.
- Combining EtG testing with other direct alcohol markers, such as phosphatidylethanol (PEth), may provide a more comprehensive picture of a patient's alcohol use 1.
- A recent study found that PEth testing is a sensitive and specific biomarker capable of detecting a single drinking episode for up to 12 days and a semi-quantitative measure of chronic heavy use for up to 6 weeks 1. However, the most recent and highest quality study 1 suggests that PEth testing may be a more reliable and sensitive biomarker for detecting alcohol use, and should be considered as an adjunct to EtG testing. In terms of specific guidelines, the 2025 position statement by an expert panel on alcohol-related liver disease recommends using EtG testing as part of a comprehensive assessment of alcohol use, including quantification of alcohol use, drinking patterns, and potential socio-economic consequences of alcohol use 1. Overall, EtG testing is a valuable tool in managing alcohol use disorder, but should be used in conjunction with other biomarkers and a comprehensive treatment approach to provide the best possible outcomes for patients.
From the Research
Role of Ethyl Glucuronide Testing
- Ethyl glucuronide (EtG) testing plays a significant role in managing alcohol use disorder by providing an objective measure of recent alcohol consumption 2, 3, 4, 5, 6.
- EtG is a non-volatile, water-soluble, direct metabolite of ethanol that can be detected in body fluids and hair for an extended time period after the complete elimination of alcohol from the body 3, 4.
Predicting Treatment Outcomes
- Pretreatment EtG levels can predict response to contingency management interventions for alcohol use disorders among adults with serious mental illness 2.
- EtG cutoffs equivalent to heavy and very heavy drinking can predict outcomes in contingency management interventions 2.
Detection of Recent Drinking
- Urinary EtG and ethyl sulfate (EtS) testing can detect recent drinking in outpatient treatment programs for alcohol and drug dependence 5.
- EtG testing can identify alcohol use by health professionals recovering from substance use disorders, even when standard testing is negative 6.
Clinical and Forensic Implications
- EtG has a specific time frame of detection intermediate between short- and long-term markers of alcohol consumption, making it a useful tool for relapse control and monitoring abstinence 3, 4, 6.
- EtG testing can strengthen abstinence-based monitoring programs by providing an objective measure of recent alcohol consumption 6.