Alcohol Testing

Alcohol testing designed specifically for the Family Court process.

The Forensic Testing Service (FTS) have developed a model of best practice for alcohol testing that is specifically designed for family court investigations.

Our model of best practice gives social workers and legal professionals assurance that they are making decisions based upon a forensic investigation that achieves the civil standard of proof (a balance of probabilities).

Results are derived from a unique selection of testing methods to build an accurate picture of usage over time.

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    FTS Model of Best Practice

    It is not appropriate for decisions concerning the future of children to be based around a simple screening process for drugs and/or alcohol.

    Although this might be appropriate in other sectors, the strict use of cut-off levels in hair strand testing, in many cases has the potential to give unclear and/or inaccurate results.

    A comprehensive client questionnaire

    To provide as much context as possible we have developed our own client questionnaire. This includes the client’s use of alcohol for the previous 12 months and all factual influences that can affect our results. This is by far the most detailed questionnaire in the industry.

    A unique testing profile for greater accuracy

    In order to consider all factors and to provide the most detailed report possible we recommend the following testing:

    1. Hair strand testing for EtG and EtPa
    2. Blood testing for LFT, CDT, GGT-CDTr, MCV and Peth
    3. Urine testing for EtG
    4. Nail testing for EtG

    Using only blood tests or hair tests individually cannot usually be relied upon or provide the detailed information required for clear and unambiguous interpretation and meaningful recommendations.

    This profile allows us to differentiate between those who are consuming alcohol excessively or not.

    A dedicated FTS case manager to guide you through the process

    We recommend that you speak with one of our case managers before instructing us so that we can advise you as to what is the most appropriate profile of testing and best use of public funds. Regardless of which profile is recommended all of our costs are in accordance with the LAA’s codified rates.

    We are also able to provide you with an example Part 25 application and Court Order to ensure that the testing ordered by the court is appropriate for the evidence, which you are trying to obtain.

    FTS Alcohol Testing Case Study Vanillin

    Analysis of Vanillin in a Bespoke Alcohol Assessment

    Finding the source of ethanol consumed in complex child-case proceedings.

    Case Study

    How do I arrange testing and sample collection?

    Please follow the link below to get a quote, make an instruction or request testing.

    Complete our simple online forms or download a PDF copy to complete digitally or by hand.

    You can also call our customer services team to register your case over the phone.

    A member of our team will be in touch to arrange sample collection.

    Mobile Collection Service

    FTS is one of the only testing providers with mobile collection vehicles. This means our collection team can meet your client at a convenient time and place without the pressure of a fixed location. Please let us know if you would like to use this service during your application.

    fts mobile collection unit 2
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    Download our free PDF whitepapers and guides

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    Are Cut Off Levels Relevant for Child Protection?

    FTS Services Summary

    FTS Service Summary

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    FTS Parliamentary Review Best Practice Representative

    Alcohol Testing Information & FAQs

    Excessive drinking is defined by the World Health Organisation to be drinking more than 60g of alcohol per day (slightly lower for women), for simplicity FTS use a definition of average units per week. To define the point at which drinking becomes excessive FTS use a general cut-off of >60 units per week for men and >55 units per week for women, which equates approximately to 4 or 5 pints of beer, 1 to 1.5 bottles of wine or one third of a bottle of spirits per day.

    The tests used to identify excessive alcohol consumption depend on the application or purpose of the testing. For example, whether we are assessing levels that would impact on health, safety, or social responsibility, although clearly these are all interrelated. There are two types of tests that can be used:

    Direct markers
    These are produced as a direct result of exposure to alcohol and are therefore very specific to alcohol use. The two routine direct tests provided by FTS are EtG and EtPa, measured in hair to cover a 3 or 6 month history. For certain circumstances, which would be advised as required by FTS, alcohol and / or EtG can also be tested in urine to cover from 1 and up to a 4 day history.

    Indirect markers
    These are produced as a response to the toxicity of alcohol, causing impairment of normal body functions, particularly impairment of the liver. The routine indirect tests recommended by FTS are Blood tests for LFT’s, CDT, GGT-CDT ratio and MCV, generally to cover a 3 to 8 week history. However, these markers can be influenced by other factors and are therefore not specific to alcohol and do not always respond to excessive alcohol use.

    Importantly there is no single test that can provide all the answers, the results of any one of these tests independently are generally quite poor at differentiating normal from excessive alcohol use.

    The combined profile of blood tests and hair tests should be selected for all new cases where there is no reliable previous testing history.

    Alcohol Profile:

    Blood tests for: LFT, CDT, GGT-CDTr and MCV
    Hair tests for: EtG and EtPa
    Urine test for: EtG*
    *A urine test for EtG is also included where it is necessary to establish complete abstinence from drinking.

    The Alcohol Profile, together with a detailed history taken from the client, provides the best starting point to differentiate social drinkers from excessive alcohol users. This profile can be selected to cover the previous 3 or 6 months history and extended to 9 months in some circumstances. Importantly it also provides sufficient information to make a recommendation as to whether further testing is required, and if so provide a guide for the profile required and when this testing needs to be carried out.

    Where this profile identifies potential issues or where on-going monitoring for alcohol use is required, then best practice is to carry out at least two further tests at 4 to 6 and 8 to 12 weeks or on a rolling 6 weekly basis for as long as required as follows:

    1st Alcohol profile
    2nd Blood only Alcohol profile at 4 to 6 weeks
    3rd Full Alcohol profile at 8 to 12 weeks
    FTS have demonstrated that following this alcohol-testing profile is the most reliable way to differentiate excessive from acceptable drinking and a case can then be resolved in a short and controlled time scale. This saves costs and ensures decisions are taken on the most reliable and clear evidence available.

    Using only blood tests or hair tests individually cannot usually be relied upon or provide the detailed information required for clear and unambiguous interpretation and meaningful recommendations.

    FTS have established a unique approach to testing body hair

    FTS’s accumulated knowledge and experience of body hair testing provides the opportunity to obtain reliable evidence on drug and alcohol misuse. Using body hair as an alternative to scalp hair, FTS are able to differentiate excessive from non-excessive drinking. FTS now have sufficient data to establish cut-off’s for body hair and to provide an assessment of the period covered for each specific body hair sample tested for both drugs and alcohol.

    Body hair testing also has the benefit that it is less susceptible to external influences such as hair treatments and also is often more protected from the risk of passive environmental contamination from drugs such as cannabis, cocaine and heroin.

    Body hair cannot be segmented but can still monitor changes over time

    Body hair samples cannot be segmented to provide reliable information on drug or alcohol use. However, FTS have now developed new techniques to help establish drug and alcohol use over specific time periods:

    • Collecting two or more sequential body hair samples over 1 to 3 month periods can establish changes in patterns of drug or alcohol use.
    • Shaving body hair from the same collection site each time also provides an accurate and defined history for substance misuse as an alternative to segmentation of scalp hair.
    • Testing hair from more than one specific site on the body (leg, arm, chest, back, face) at the same time, enables differentiation of time periods since each site has its own specific growth profile.

    Background information on Body Hair testing
    Although body hair grows at a similar rate to hair on the scalp its growth varies from approximately 0.65cm every 28 days to 0.9 cm every 28 days depending on the specific body site, compared to an average 1.0 cm every 28 days for scalp hair. However, the most significant difference is the much higher proportion of dormant or non-growing hair (telogen) present in body hair compared to the scalp. Telogen hair can remain attached to the skin from around 2 to 9 months before dropping out.

    Body hair contains between 40% to 80% telogen hair depending where it is on the body. This means that a significant proportion of the hair that was growing 2 to 9 months ago, and which contains the drug and alcohol markers from this earlier period, is now mixed in with the growing hair, which represents drug or alcohol levels from the recent history. The length of the body hair also influences the history it represents. Consequently, FTS apply a calculation to include hair length and the approximate percentage of telogen hair for each body site, to establish the approximate history covered by each sample tested.

    The resulting levels in body hair therefore represent an average of drug or alcohol use over an extended period but unlike scalp hair there is a bias to the older history, which can result in more carry over from earlier drug or alcohol use. When drug use is regular it can also lead to a concentration of levels in the hair relative to the amount of drug or alcohol use compared to scalp hair.

    FTS Collection Officers are very experienced and familiar with these difficult situations. Local topical anaesthetic can be used and also if necessary extra fine needles to minimise discomfort and ensure most blood collections succeed without causing anxiety to the client.

    Hair tests, being direct Markers, are mostly specific to excessive alcohol use, particularly EtG and generally provide a good screening tool to identify excessive drinking. However, for a variety of reasons it is extremely important not to rely on hair alone, for the following reasons: A blunt instrument – Hair tests can only provide an average of alcohol consumption over approximate 3 or 6 months periods. Therefore, they can be a “blunt instrument” when trying to establish changes in the pattern of alcohol use (increasing, maintenance of, or decreasing use).

    Below is an example of the issues that can arise from using hair tests alone:

    • Client A drinks very heavily, over 100 units per week and subsequently stops or significantly reduces their drinking for the 6 to 8 weeks prior to testing.
    • Client B drinks excessively at around 60 to 70 units per week for the entire period of 12 or more weeks up to the point of testing.
    • Client C has been teetotal for several months but relapses and begins drinking heavily again, over 100 units per week for around 5 to 6 prior to testing.
    • Client D drinks at a dangerous level of >150 units per week, has for many years and is entirely dependent on alcohol.

    Despite the very different drinking profiles these clients would generally produce the same Positive EtG and EtPa results and it would not be possible to differentiate one from the other. Clearly these are very different patterns of use, resulting in different recommendations and outcomes. Combining the use of blood markers, which can react quickly to changes in alcohol use, enables the Expert to differentiate between these profiles and provide appropriate recommendations to help the courts come to the right decision.

    EtG and EtPa can provide different answers

    EtPa and EtG are different with regards to their methods of incorporation into the hair, stability, and distribution along the hair shaft, therefore these markers have different sensitivity and specificity profiles. EtPa migrates along the hair shaft away from the scalp over time concentrating in the older hair, EtG tends to be higher in recently grown hair, and therefore recent periods of reduced alcohol use or abstinence can cause the EtPa levels to fall more quickly than EtG, which can cause a discrepancy in the EtPa and EtG results in around 20% of cases.

    Hair is exposed to various external, environmental, and genetic factors that can influence the presence or absence, or the levels of EtPa and/or EtG found in the hair. Different types of hair treatments and the frequency with which they are used have been shown to have a significant influence on the levels of either EtPa and/or EtG, causing the results to be understated or overstated, which, in the extreme, can give rise to False Positive or False Negative test results.

    Furthermore, these treatments affect EtG and EtPa very differently and therefore testing both markers is usually recommended particularly in women to provide a more reliable outcome. However even with the results of both EtG and EtPa it is important that they are interpreted in the context of blood test results, which are not exposed to the same external influences.

    Scalp hair not always available or of sufficient length

    Certain individuals do not have any scalp or even body hair for testing and scalp hair is not always long enough to provide the optimal 3 cm sample for EtG or the mandatory minimum 3 cm sample for EtPa testing, which is required for optimal results interpretation.

    Summary – Because of the various issues described above, there are conflicts between EtPa and EtG results in more than 20% of cases leading to uncertainty. These conflicts can often be resolved by putting the results into context with the blood test results. Without the blood test results, in a significant number of cases, the results would remain inconclusive, and no progress could be made without further testing, with the resulting wasted costs and time.

    Blood tests are extremely well established, and a significant amount of data has been accumulated over many years, hence they are well understood. Unlike hair tests they cannot be adulterated or influenced by external or environmental factors, and they also provide shorter defined periods over which they can identify excessive alcohol use.

    Certain blood markers can also provide an indication as to whether there may have been a previous history of chronic alcohol abuse with resulting liver damage, this is very helpful since it provides an indication as to how serious the alcohol abuse might be and whether this is deep-seated or a more normal transient pattern. It also helps to understand the risk of re-occurrence, therefore blood tests make an essential contribution to alcohol testing. However, being predominantly indirect markers, they are less specific than hair tests, in that all the blood markers tested are affected by influences other than alcohol, with the exception of CDT, which has a very low false positive rate. Each marker is generally affected by different influences and therefore using a profile of several blood tests minimises this problem, but cannot eliminate it. Like the hair tests there is also inter-individual variability in response to these influences, therefore blood tests cannot always provide a reliable understanding of the amounts of alcohol consumed but become very useful when interpreted in the context of the results from hair tests.

    Below are examples of the issues that can arise from using blood tests alone:

    • A range of commonly prescribed or pharmacy purchased medications such as Paracetamol and Statins can cause certain LFT’s to be raised above the normal range mimicking the effects of alcohol, certain diseases such as Hepatitis can also cause raised LFT’s like alcohol. If these results are taken out of context this can give rise to False Positive results.
    • CDT is more specific than the LFT’s and although it can become raised for other reasons, raised CDT is normally associated with excessive alcohol in >95% of cases. However, it is less sensitive and is only raised in around 60% of males and 50% of women following excessive alcohol use over the recent 2 to 3 weeks. Again, taken out of context this can give rise to False Negative results.
    • MCV (Mean Corpuscular Volume) is not a liver enzyme and is typically influenced by different factors than LFT’s and CDT, however as with the LFT’s and CDT it will not always be raised by excessive alcohol use and can become raised for certain conditions unrelated to alcohol. However, when combined with the other blood markers it becomes a good indicator for excessive drinking.

    Like hair testing, because of the various issues described above there are sometimes conflicts between the blood test results. When this occurs, it can often be resolved by putting into context with the results from the hair tests. Without the addition of the hair tests, on a significant number of cases, the results would remain inconclusive.

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    Get In Touch

    Call: 01924 480272
    Email: expert@forensic-testing.co.uk

    Office Hours:
    Monday – Friday: 08:30 – 17:30
    Saturday: closed
    Sunday: closed

    Location

    Our head office is located at Wheatley Park in Mirfield in the beautiful West Yorkshire Countryside.

    Forensic Testing Service Ltd
    The Watermill, Wheatley Park, Mirfield,
    West Yorks WF14 8HE

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    **By opting in to our newsletter, you agree to be contacted via SMS, email, or phone for the purpose of providing a quote and/or marketing other products/services offered by Forensic Testing Service Ltd. Please note that your data will never be sold to third parties by us.