Different Methods of Alcohol Testing

Alcohol is the fourth leading cause of preventable deaths in the United States. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly 88,000 people die from alcohol-related causes per year. Statistics further reveal that in 2014, approximately 16.3 million American adults of ages 18 and older were found to have alcohol use disorder.

What is Alcohol Use Disorder (AUD)?

Alcohol use disorder (AUD) is a medical condition characterized by compulsive drinking patterns that cause the user distress or harm. The drinking habits often interfere with various aspects of his life including his health, occupation, family and social life, and financial stability.

Under the fifth edition of the Diagnostic and Statistical Manual (DSM-5) prescribed by the American Psychiatric Association (APA), the ailment may be classified as mild, moderate, and severe. Furthermore, DSM-5 removes the distinction between “alcohol abuse” and “alcohol dependence”, and instead integrates these conditions into a single disorder called AUD.

Why do people abuse alcohol?

Several genetic, environmental, and risk factors can influence the development of alcohol abuse. Here is a brief discussion of some of the components that affect a person’s decision to engage in habitual alcohol use:

Genetic predispositions

According to some researchers, biologic predispositions may influence alcoholism. Some studies have shown that inheriting a gene called D2 dopamine receptor could increase a person’s chances of developing alcohol abuse. Those who have this genetic makeup are also more likely to start drinking alcohol at an earlier age compared to those who don’t have the predisposition.

Early initiation of alcohol consumption

Drinking during the adolescent years has been linked with an increased risk of AUD in later years. One study found that one-third of men who start drinking before the age of 15 are four times more likely to develop alcohol dependence. The concept is the same with other cases of substance use disorders. As the addictive properties of a drug or substance affect regions of the brain that are associated with pleasure and reward, the mind recalls the experience and seeks to have it repeated. This encourages chronic use which can lead to dependence.

Family history

Individuals who have parents, elder siblings or relatives with a drinking problem are at increased risks of becoming alcoholics. This is especially true of children who are exposed to alcohol use in the home. Lack of guidance coupled with emotional issues during their childhood and adolescent years can establish a belief that drinking is acceptable. Taking alcohol can also become a form of escape or distraction from the problems in the home.

Psychological factors

Elevated stress levels, anxiety, and emotional disturbances are also some factors that influence a person to drink. Individuals who have poor coping mechanisms usually turn to alcohol for comfort or stress relief. Over time, the drinking habits aggravate and the users eventually develop alcoholism.

Social and cultural factors

Peer pressure, environmental exposure, and media campaigns could prompt a person to consume larger amounts of alcohol. Increased social interaction at clubs, parties, or events could lead to binge drinking among teenagers or excessive drinking among adults.

Symptoms of alcohol abuse

A person is diagnosed to have mild alcohol abuse disorder when he manifests any two of the symptoms within any given 12-month period. If he has four of them, he has a moderate disorder while if he has six or more, he is diagnosed to have a severe condition. These symptoms are:

Inability to limit the amount of alcohol consumed;

Inability to control the time allocated to drinking activities;

Repeated unsuccessful attempts to reduce or cease alcohol consumption;

Having strong, uncontrollable cravings for alcohol;

Reducing or avoiding social activities, hobbies, and interests to favor alcohol use;

Consuming alcohol in risky situations such as when driving or when operating dangerous machinery;

Failure to fulfill school, work, or family obligations due to alcohol use;

Developing a tolerance for the substance such that larger amounts need to be consumed to get the desired or same effect;

Persistent alcohol use despite knowledge or existence of problems arising from repeated alcohol use;

Experiencing withdrawal symptoms such as dizziness, tremors, insomnia, agitation, and anxiety whenever alcohol use is ceased;

Experiencing legal issues or problems as a result of alcohol use.

AUD is characterized by alternating periods of intoxication and withdrawal. Alcohol intoxication results when the person has increased amounts of alcohol in his bloodstream. It can cause temporary impairment in mental abilities and trigger changes in behavior. Some of the symptoms of intoxication include slurred speech, impaired reasoning and judgment, unstable moods, reduced inhibitions, poor coordination, lack of muscle control, lack of concentration, and confusion. High levels of blood alcohol content (BAC) can lead to blackouts, coma, and even death.

Chronic use of alcohol encourages the development of tolerance and dependence. When a person becomes addicted to the substance, he will often experience withdrawal symptoms whenever he attempts to cease alcohol use or to reduce the amounts consumed. Among these symptoms are sweating, rapid heartbeat, tremors, nausea, vomiting, insomnia, restlessness, anxiety, and agitation.

Effects of alcohol abuse

AUD is associated with various problems that affect the abuser’s physical and mental health, family, social, and economic life. Here are some of the undesirable long-term effects of alcohol abuse:

Health risks

Chronic drinking reduces a person’s life expectancy by at least 10 years. It increases risks for developing serious medical conditions such as malnutrition, weakened immune system, hypertension, cardiac disease, stroke, cirrhosis of the liver, alcoholic liver disease, pancreatitis, epilepsy, peptic ulcers, gastritis, gastrointestinal bleeding, brain atrophy, brain damage, certain cancers, and sexual dysfunction.

Studies have shown that women develop alcohol-related complications earlier than men do. Excessive drinking can severely compromise their reproductive health. AUD can increase women’s risks of breast cancer, anovulation, menstrual irregularity, and early menopause.

Alcohol use during pregnancy can result in miscarriage or premature birth. It can also cause the unborn child to develop fetal alcohol syndrome (FAS). As a result, the child may be born with physical defects such as facial abnormalities. He may also have problems associated with the central nervous system. According to the National Council on Alcoholism and Drug Dependence, about 5000 babies are born with severe FAS each year.

Psychiatric issues

Excessive alcohol use has been linked to a number of mental health problems. For instance, heavy or prolonged drinking accounts for approximately 10 percent of all dementia cases, making it the second leading cause of dementia.

Psychiatric disorders have been observed to differ according to gender. Women who have AUD are often diagnosed with major depressive disorder, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), and borderline personality disorder.

Men, however, are often diagnosed with psychiatric conditions that include narcissistic personality disorder, bipolar disorder, schizophrenia, and attention deficit disorder.

In both genders, other ailments such as chronic depression, confusion, insomnia, and psychosis have been observed to be common co-occurring conditions.

Social and economic outcome

The effects of alcohol intoxication promote pathological changes in behavior that negatively impacts family and interpersonal relationships. It can be a cause of marital discord, separation, and divorce. As the abuser becomes preoccupied with drinking habits, he can neglect his family responsibilities which can lead to child neglect, child abuse, and loss of custody of the children.

The disruption in the home can have lasting effects on the psychological and emotional wellbeing of the children. They can develop high-stress levels, anxiety, depression, anti-social personality disorder, and low self-esteem.

Alcoholism also causes underperformance at work, work-related accidents, increased tardiness, and absenteeism. This can result in loss of employment and financial difficulties. This can lead to homelessness and dependence on social welfare.

Alcohol use is also associated with an increased risk of committing crimes and misdemeanors such as drunk driving, public disorder, domestic violence, child abuse, rape, assault, and burglary. In fact, alcohol has been found to be involved in 40 percent of motor-vehicle crashes, 70 percent of drownings, 50 percent of suicides, and 40 percent of violent crimes.

Alcohol Testing Methods

Several tools are currently available to help healthcare professionals screen for possible AUD. These include the following:

Psychological evaluation

The physician will usually ask a person some questions relating to his drinking habits. To conclude a diagnosis of substance use disorder, doctors and healthcare professionals need to refer to the criteria prescribed by the APA under the DSM-5 to check if the patient manifests the given symptoms.

The patient may be asked to fill out some questionnaires to determine some behavioral patterns that indicate alcoholism. Some of these common tools are:

CAGE questionnaire

Under the CAGE method, the patient is asked to answer several questions. If he answers “yes” to two or more, then he is likely to have AUD. The questions are:

1. Have you felt that you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you felt bad or Guilty about your drinking?
4. Have you ever had to drink the first thing in the morning as an eye-opener to steady your nerves or get rid of a hangover?

TACE questionnaire

The TACE test poses questions similar to those in the CAGE tool. These are:

1. Does it Take more than two drinks to get you high?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt you ought to Cut down on your drinking?
4. Have you ever had a drink first thing in the morning as an Eye-opener to steady your nerves?

Other detailed forms are sometimes used to distinguish drinking patterns and to determine the proper sentence for alcohol-related offenses. These include the Alcohol Dependence Data Questionnaire, Alcohol Use Disorders Identification Test (AUDIT), and Michigan Alcoholism Screening Test (MAST).

In addition, the evaluation may involve speaking to family members and close friends to verify behavior or attitudes that may indicate that the patient is at high risk for AUD.

Urine Test

Any alcohol that is consumed within the past 2 hours would be passed as urine by the person’s body. This is the most unreliable means of testing the level of alcohol in the body of a person because of the following reasons:

• It is only effective 2 hours from the time that the person consumes an alcoholic beverage because it would need first to be metabolized by the body. So even if the person might be physically impaired by alcohol, the alcohol urine test can still show alcohol levels that are within the legal limit.
• The amount of alcohol in the urine is dependent on how fast a person’s body systems are able to eliminate alcohol from the body.
• The urine sample of a person with a high level of sugar in his or her body would have the same result as an intoxicated person even if the person has not consumed any alcohol.

Further research eventually resulted in the discovery of other alcohol biomarkers that can indicate the presence of alcohol long after the ethanol itself can no longer be measured or detected. These days when using alcohol EtG urine testing, certain biomarkers must be present. These include EtG, EtS or GTOL/5-HIAA. These biomarkers have longer detection times than ethanol itself, and in the case of EtG has become the biomarker of choice for alcohol.

Ethyl Glucuronide (EtG)

Because alcohol (ethyl alcohol/ethanol) passes rapidly through the system, urine tests had to be done immediately after alcohol consumption otherwise the accuracy of the test will be questionable. This has rendered the urine test generally not helpful in detecting alcohol beyond a certain period of time. But that was before EtG.

EtG was first described in the early 1950s, but it wasn’t until 2001 that it was identified as an alcohol marker by two doctors, Dr. Gregory Skipper (USA) and Dr. Friedrich Wurst (Switzerland) when they did a study of alcoholics in a psychiatric facility in Germany. Their findings showed how EtG in urine compared to ethanol was a more sensitive and reliable indicator of both drinking and abstinence.

Ethyl Glucuronide (EtG) is a minor, non-oxidative byproduct of alcohol (ethyl alcohol or ethanol). EtG is used as a marker or surrogate for ethanol in the body because of its much longer half-life compared to ethanol itself. A standard urinalysis for alcohol can possibly detect it up to 48 hours after ingestion. EtG on the other hand is aptly nicknamed the “80-hour” test because subject to a person’s age, weight, gender, general physical condition, how much alcohol was consumed and what the person ate etc., EtG can still be detectable in urine within 3-5 days, which is long after ethanol is eliminated by the body. As a result, EtG has emerged as the biomarker of choice for alcohol in recent years. EtG also remains stable in urine for more than 4 days at room temperature. More recent experiments show that EtG’s stability even increases when the urine is heated 100° Celcius. It shows that EtG does not break down with heat. Additionally, by fortifying stored urine with 1% ethanol, no artificial formation of EtG was observed even after prolonged storage at room temperature.

Ethyl Sulfate

Ethyl sulfate (EtS) is another direct metabolite of ethanol and has been shown as a suitable biomarker for recent alcohol intake.

When ethanol undergoes sulfate conjugation, it produces ethyl sulfate (EtS). Sulfate conjugation is a normal but minor (< 0.1%) metabolic pathway for ethanol in humans. This establishes that following alcohol intake, EtS is a normal constituent in the urine and that it remains detectable many hours longer than the parent compound, again depending on many factors including the amount of ethanol ingested. It is important to note that urinary EtS concentration can be significantly reduced by simply drinking large amounts of water or other fluids prior to testing. To address this, EtS is routinely expressed as a ratio to creatinine to counteract the effect of the (intentional) dilution.

It has been shown that of clinical urine samples that tested positive for EtG and/or EtS more than 90% were positive for both and the rest were positive only for either compound. It is therefore recommended to do a concurrent determination of both EtG and EtS with LC-MS to improve the overall sensitivity for the detection of recent alcohol intake.

GTOL/5-HIAA

GTOL/5-HIAA is the ratio between 5-hydroxytryptophol-glucuronide and 5-hydroxyindole-3-acetic acid. This ratio is suggested as another biomarker for recent ingestion of alcohol. GTOL/5HIAA was detected in urine approximately 5 hours longer than ethanol itself. EtG and EtS were some 25 hours longer than ethanol, but GTOL/5-HIAA still exhibited 100% sensitivity as an alcohol biomarker.

Blood Alcohol Concentration Test

For this test, the concentration level of alcohol in the bloodstream that is measured and compared against a chart to determine the level of intoxication of the person. The test determines the concentration of alcohol in the body by drawing a sample of blood and testing it with the use of gas chromatography. It is commonly used by forensic scientists during autopsies.

One of the drawbacks of using this method is that it takes some time before the results are derived. Those who are heavy or frequent drinkers usually have higher blood tolerance levels.

Breath Alcohol Testing

This is the most common form of alcohol testing used by highway patrol officials. A driver suspected to be under the influence of alcohol breathes through a mouthpiece. The approximate amount of alcohol is then compared to a chart providing the range of what the state would consider as the “legal alcohol level.”

It is the most favored method by highway officials because:

• The components are disposable so the same device could be used by just simply changing the mouthpiece
• It provides fast and reliable readings
• It is very easy to use
• It’s affordable for the government’s budget
• It is portable, so it could be easily administered anywhere

Saliva Alcohol Testing

Just like breath alcohol testing, this method uses disposable devices to determine the level of alcohol in a person’s body. Many experts have found a direct relationship between the level of alcohol in a person’s saliva and in the blood. However, this is the most sensitive form of testing because the reliability of the test can be affected by air temperatures. This could result in false readings or even make the device useless, especially when used during the summer months.

Hair Test

Alcohol gets deposited directly into human hair. Therefore, alcohol testing on hair samples looks for direct ethanol metabolites. When a part of the alcohol reacts with fatty acids, they produce esters (fatty acid ethyl esters or FAEEs), that are used as indicators of alcohol consumption. The amounts found in hair are expressed in nanograms (1/1billion grams). The capability to measure FAEEs began in 1993, right around the time that EtG was first being detected in hair. In comparison, EtG in hair can be detected in pictograms (1 picogram = 0.001 nanograms.

Studies prove that FAEEs are not significantly affected by hair treatments. Further, FAEE concentrations in body or facial hair can be interpreted in the same manner as scalp hair.

Testing for EtG can be performed on hair and nails, with detection windows of as far back as 3 months. A recent Italian study reported that EtG on hair can be completely destroyed by bleach or significantly reduced by exposure to pool water or chlorine. Similar to urine testing, hair testing for alcohol will not provide evidence of impairment at the time of the test. It will only indicate recent ingestion. Privacy issues do not figure in hair testing as it is the least invasive form of all the alcohol and drug testing methods.

Sweat Test

The skin patch alcohol sweat test is another method for detecting alcohol consumption. The patch is like a large adhesive bandage that is applied to the skin and worn for a certain length of time. It has a gas-permeable membrane that protects the test spot from contaminants like dirt. The patch collects accumulating sweat and can be worn for up to 4 weeks little discomfort. The risk for false positive is somewhat an issue with this type of test because of environmental contaminants that contain alcohol. It is very easy to use but is not a popular workplace testing method. It is more favored by law enforcement to monitor parole and probation compliance.

Other diagnostic tests

The doctor may order other laboratory exams such as liver function tests and blood chemistry tests to assess whether the patient has acquired some diseases linked to excessive alcohol use.

Treatment Options

AUD can be managed and treated using a combination of various methods that have been proven effective in preventing relapse and sustaining sobriety. Most medical and counseling experts have recommended that a holistic approach that integrates elements of behavioral and pharmacologic remedies be taken to successfully manage substance abuse.

The treatment can take months and or years. Some patients will even need maintenance therapies. The entire recovery process is usually divided into the following stages:

Detoxification

This is the initial phase of treatment that involves abrupt cessation of alcohol consumption. A team of doctors or health care professionals is usually engaged during this phase to stabilize the condition of a patient who is experiencing withdrawal symptoms. Patients who manifest mild to moderate symptoms may be treated on an outpatient basis while those with more severe conditions should be required to receive medical attention at hospitals or treatment centers.

One of the most dangerous phases of alcohol withdrawal is that called delirium tremens (DT) which can occur within 72 hours from the last use of alcohol for up to 10 days thereafter. This stage is characterized by thorough confusion, hallucinations, agitation, sweating, high blood pressure, and palpitations. In some cases, the patient becomes violent and may need to be physically restrained. DT is considered a medical emergency and could result in death.

Another potentially serious withdrawal symptom is a condition called alcoholic ketoacidosis (AKA) that is manifested by physical signs that include nausea, vomiting, abdominal pain, and dehydration. It usually begins within two to four days after alcohol consumption. This occurs when the body starts to “burn” fats and proteins into acidic bodies called “ketones” for energy. Ketones tend to accumulate in the blood, and as such, AKA requires immediate medical attention.

Among the medications prescribed to relieve the effects of withdrawal are sedatives such as benzodiazepines, which may be administered orally, intravenously, or by injection. Patients are also treated with IV fluids to reverse the effects of AKA, as well as with thiamine supplements to address the vitamin deficiency that commonly occurs among alcoholics.

Detoxification does not in itself treat alcoholism but only addresses the immediate condition of the patient and initiates the treatment process. It should be followed up with intensive rehabilitation programs.

Rehabilitation

Various treatment centers offer both outpatient and inpatient drug rehab programs that last from four weeks to several months. The activities that are undertaken during this period usually incorporate several psychotherapy approaches that provide counseling, support, education, skills-training, and long-term planning to prevent relapse.

Long-term residential programs are recommended for those with a severe disorder. Being committed to a facility places those individuals under the care of experts who are better experienced at handling the condition. It also keeps them isolated from the community to avoid exposure to risky circumstances that could court relapse episodes.

During rehabilitation, some medications may also be administered to prevent alcohol cravings. Some of the pharmacologic preparations include Naltrexone, Acamprosate, and Disulfiram. These drugs block the rewarding effect or feelings induced by alcohol consumption.

Support programs

Aftercare programs are also an essential component of maintenance therapy. After undergoing rehabilitation, the patient struggles to cope with lifestyle changes. Joining support groups can provide him with continuous motivation and encouragement to remain sober. These support groups include Alcoholics Anonymous (AA), Women for Sobriety, LifeRing Secular recovery, and Secular Organizations for Recovery.

Outpatient individual, group, or family counseling can also be maintained especially for those who have come out of a structured, in-house treatment.

Lifestyle changes

A person recovering from alcohol abuse must firmly resolve to quit using alcohol at all costs. This means making significant changes in his lifestyle to avoid situations that could unnecessarily expose him to the temptation to return to the habit. These lifestyle modifications include:

• Keeping the home free from alcoholic beverages;
• Developing a support system of family and friends that are committed to his recovery;
• Avoiding old drinking buddies and hangouts;
• Keeping away from activities that involve alcohol and replacing social drinking activities with involvement in other interests such as sports;
• Observing good nutrition, regular exercise, and healthy sleeping patterns;
• Attending support group meetings or counseling sessions regularly;
• If medication is prescribed, taking the same diligently and meeting the physician or counselor for follow-up;
• Resorting to alternative remedies such as yoga, meditation, and acupuncture if these are found helpful.

How To Help Someone With a Drinking Problem

Most alcohol abusers often deny that they have a problem and will avoid confrontation. Family members, close friends, and co-workers who are concerned for the individual should seek help to address the issue immediately. Prolonging the situation could increase the dangers to which the alcohol user is exposed.

Here are some steps to be taken to help someone with a drinking problem:

Be informed

The first step is to be equipped with information and resources about alcohol addiction, including its signs and symptoms, effects, and treatment alternatives. Being able to recognize the early warning signs of alcohol abuse can be valuable in staging a timely intervention.

Be observant

Observe the person’s behavior and assess whether there is a drinking problem. Based on readings, try to figure whether he meets some of the criteria for alcohol abuse. Also, share these observations with other family members or friends to compare thoughts or reactions regarding the situation.

Seek professional help

Reach out to an addiction counselor, therapist, or physician and describe the person’s behavioral patterns and drinking issues. Provide as much pertinent information as possible and get professional advice.

Talk to the person

Confrontation may be difficult but it cannot be avoided and must be undertaken as soon as possible if treatment for the abuser is to be sought. The affected person may be caught in denial and may not be ready to voluntarily seek help. Having a loved one express concern and support may help him address the problem.

Follow the advice of the professionals on how to handle this. Avoid serious confrontations when he is under the influence of alcohol, and always come from a place of concern.

Don’t expect change without treatment

The abuser may promise to change his habits, cut back on his drinking, or go cold turkey. This may be shallow commitments that usually result in failed efforts. Alcohol addiction is a chronic disease that needs to be treated and managed with the aid of experts. It is best to enroll the individual in a structured detoxification and rehabilitation program which incorporates the appropriate treatment approaches to guide him towards recovery and sustained abstinence.

If he refuses help, then it is time to plan a staged intervention. Employ the assistance of professionals who have experience and expertise to handle such situations.

Support the long-term process

The road to sobriety is a long process and could not be accomplished by the abuser through his own efforts. It requires commitment, support, and patience from all those who are close to him. Express encouragement and actively participate in the process by attending family counseling or group meetings.

Join a support group

Some support groups such as Al-Anon and Alateen are intended for family members and people who are affected by the alcoholism of someone close to them. It provides an avenue to share similar experiences. It helps to encourage, support, and comfort those who are assisting their loved ones or close friends fight alcoholism.

Myths and Truths About Alcohol Use

Alcohol use can begin with social drinking or with occasional beers on a weekend. Most users believe numerous misconceptions about alcohol consumption and convince themselves that their habits are nothing out of the ordinary. Over time, the drinking becomes an addiction.

Here are some common myths that alcohol users or abusers often tell themselves:

Myth 1: I can stop drinking whenever I want.

When the dependence develops, the user will find it extremely difficult to stop taking alcohol. The cravings for the substance will compel him to find means to consume it despite his knowledge of its harmful effects. Furthermore, he will want to avoid experiencing the discomfort of withdrawal symptoms. These factors will make quitting voluntarily extremely challenging.

Myth 2: I can drink and stay in control.

Alcohol intoxication impairs reasoning, concentration, and judgment. It can promote risky behavior such as engaging in unprotected sex, being involved in criminal offenses, and drunk-driving.

Myth 3: I can still drive well because I only had a few drinks.

A rise in blood alcohol level impairs judgment and slows down reaction time. A blood alcohol content of 0.03% can impair a driver’s steering skills. At 0.04%, his focus on the road is significantly affected and he will probably fail to respond to street signs, traffic signals, and pedestrians. At 0.05%, he will be driving erratically.

Myth 4: I can sober up quickly by drinking coffee.

Coffee is a stimulant. While it can make one feel awake, it does not make him sober. The only way to wear off the alcohol in the system is to wait for it to be eliminated from the body. Depending on the body weight and the amount of alcohol consumed, it can take an average of two to three hours before one can get sober from consuming a single drink.

Myth 5: It is okay for me to drink beer. It does not contain as much alcohol as hard liquor.

A 12-ounce bottle of beer contains the same alcohol concentrations as a shot of an 80-proof liquor or 5 ounces of wine. Any kind of alcoholic beverage, when consumed frequently can impair mental acuity, and cause damage to the digestive system, heart, liver, brain, and other organs.

Myth 6: Drinking is a lot safer than using drugs.

Alcohol is also considered a “drug.” Alcoholism is just as damaging as drug addiction. It causes changes in the brain and in the body that can lead to serious medical and psychological consequences.

Myth 7: It’s common to pass out from drinking. It’s not a big deal.

A person passes out when the amount of alcohol consumed can no longer be tolerated by the body. This occurs when the alcohol intoxication has depressed the central nervous system and the brain. It can lead to slowed heart rate and respiratory depression.

Myth 8: Drinking is my personal problem. It doesn’t affect or harm anybody else.

Alcoholism produces behavioral changes that affect the people who surround the abuser. It can lead to marital differences, disruption in the home, and disagreements among peers or co-workers. It is also associated with criminal offenses, domestic violence, and motor vehicle crashes.

Effect of Alcohol Use in the Workplace

Many studies have consistently demonstrated the negative effects of alcohol use on production costs, employee safety and public safety. Chronic and situational alcohol misuse have been associated with absenteeism, industrial accidents, high job turnover, poor performance, poor interpersonal relationships, lack of initiative, poor job satisfaction, vandalism, theft, personal injuries and death.

In the past, employers depended on supervisors to identify employees with drinking problems. They would look for telltale signs like poor work habits, deteriorating job performance, accidents, absenteeism and many other behaviors that may drive management to investigate possible alcohol misuse. This approach was very subjective and hardly based on facts. Supervisors often avoided confrontations because of their own personal relationship to the employees in question and were therefore ineffective in addressing the problem for the company. Alcohol and drug abuse cost employers a staggering $100 billion annually.

In the 1980s, employers began impairment testing programs as a way to address substance misuse in the workplace. These testing programs were mainly intended to detect illicit drug use but were also used to detect inappropriate alcohol consumption among employees. By the late 1980s, the U.S. Supreme Court approved the alcohol and drug testing of job applicants and current employees. Further, the Drug Free Workplace Act of 1988 began requiring most federal contractors and grantees to establish and maintain drug-free workplace policies.

Today, the transportation industry mandates testing regulations for employees in safety-sensitive positions such as pipeline workers, airline crews, truck drivers, and train crews; the Department of Defense tests all workers in security-sensitive positions and many private corporations have developed their own drug-free workplace programs locally and in their locations abroad.

Here are some facts about alcohol in the workplace:

• Employees with alcohol problems are 2.7 times more likely to have injury-related absences compared to employees without drinking problems.
• A study done by a hospital ER showed that 35% of patients with work-related injuries were at-risk drinkers.
• 16% of ER patients with work-related injuries tested positive in a Breathalyzer test.
• 11% of workplace fatalities had been drinking.
• 24% of workers admitted to drinking while at work at least once in the past year.
• 20% of employees report negative impact on their productivity and safety because of a co-worker’s drinking on or off the job.

Best Practices for Workplace Alcohol Testing

Because alcohol is a legal substance, employers are only authorized to perform alcohol testing on employees at these times:

• before the employee begins his/her duty
• while the employee is at work
• before the employee leaves the work area

There are actually very few federal laws that cover drug & alcohol testing for private corporations with non-safety-sensitive employees, but some stipulations in the Labor Law do address alcohol testing. These laws state that private employers must have a written policy available to all employees outlining the following:

• When will alcohol testing be done (pre-employment, upon reasonable suspicion, random, post-accident, return-to-duty, follow-up)?
• Who is subject to testing?
• When is drinking or being under the influence is prohibited?
• What are the consequences of a positive alcohol test?

DOT Drug and Alcohol Testing

For the Department of Transportation, SAFETY is a top priority. This means that the very foundation of their Safety Policy lies in ensuring that transportation providers only employ 100% drug-and-alcohol-free operators.

Employees are advised on the consequences of alcohol misuse both on a personal and professional level. Supervisors are trained to spot the telltale signs of drug and alcohol use.

It is critical for people holding safety-sensitive positions like pilots, ship captains, truck drivers, pipeline controllers, subway operators, locomotive engineers, airline mechanics and bus drivers to be alert and clearheaded at all times while on duty.

The Omnibus Transportation Act of 1991 requires DOT Agencies to test safety-sensitive transportation workers.

Non-DOT Post-Accident Alcohol Testing

Post-accident testing generally means all drug & alcohol tests done on employees who figured in accidents during work hours or on company time. These accidents include those that the employee caused directly or contributed to that involved:

• Personal injury that required medical attention or lost work time
• Injury to others that required medical attention or lost work time
• Damage to company property

Employees involved in said accidents are required to submit to post-accident testing. Should these employees need to leave the scene of the accident for emergency treatment, they should make all effort to notify the company of their location and come in for a post-accident test as soon as they are able. Failure to report work-related accidents will be considered a violation of the company policy, subject to disciplinary action and/or termination.

The post-accident alcohol test aims to establish impairment at the time of the accident and should be performed at the soonest possible time preferably within 2 hours and not exceeding 8 hours after the accident occurred. This is because alcohol tests are more time-sensitive than standard drug tests.

If for any reason the alcohol test was not performed within the prescribed time frame, no further attempts should be made and the reason for it duly documented. Company policy will then dictate the nest course of action. Typically if the test could not be performed due to logistical or practical reasons, just like DOT post-accident practices, most employers do not take action against the employee.

Should the employee involved in the accident refuses to submit to testing, just like DOT post-accident policies, most employers have policies that will treat refusal to test as a positive test and take action accordingly.

Sample Post-Accident Workflow

Step 1: Determine When to Test

Step 2: Obtain Appropriate Management Approval

Step 3: Notify Employee of the Required Test

Step 4: Determine if Medical Assistance is Needed

Step 5: Notify Collection Site

Step 6: Provide Employee with Required Testing Materials

Step 7: Complete Post-Accident Report

Conclusion

Like drug addiction, alcohol abuse is a serious chronic disorder that poses a number of dangerous consequences. It affects several aspects of the user’s life and harms those who are immediately close to him. It even threatens economic and social order.

With alcohol being one of the most widely available substances with a potential for abuse, individuals who take to alcohol consumption on occasion must ensure observance of moderation. People close to them must likewise be watchful of signs that indicate a risk for abuse to avoid the societal ills that arise from alcoholism.