Friday, September 07, 2007

EtG: 84% is good enough...

It seems just yesterday these people claimed there were no false-positives and anyone with a read was treated as if they were in denial while they children were taken away, jobs hung in the balance, possibly jailed and of course my favorite more EtG testing. Is this vicious circle finally spinning out of orbit? A quote from http://www.ethylglucorinide.com/ states," In one analysis of 25 positive EtG levels 21 (84%) were from admitted use of alcohol. 11 of these were admitted use within 24 hours of initial confrontation regarding the positive test and 10 were admitted over the following days, weeks, and months of continued monitoring. 4 positives continue to be outstanding and are currently not known if they were from drinking or not." Still no mention of how many were confessing for a lesser punishment even though there was no drinking episode. I know of one SCRAM case where the defendant was facing a bond violation and a confession meant a $250 fine. Sixteen of one hundred, would you ride the roller coaster if you knew 16% of the riders died? Now, would you take your family? It is more than just a previous offender that suffer from false-allegations, leaving me to believe that the witch hunt for the "problem" drinker hurts more than it helps.
To continue with the MADDness, they add:
With these facts in mind respond to a positive EtG test in the following way:
Irregardless of the level, contact the individual and notify them affirmitavely that their test has shown that they were drinking alcohol (In our experience approximately half will admit drinking. This depends in large part on the perceived consequences of admitting it. If perception consequences can be reduced a higher admission rate will be achieved.)
Let the individual know that the primary goal in notifying them is to obtain assistance for them and support to them and that the consequences for drinking will be less if they can be truthful (now or in the immediate future) and admit their drinking.
If drinking is denied and there are no other significant indicators of relapse then be sure the individual is advised regarding avoiding all ethanol containing products and continue regular monitoring with EtG/EtS testing. (At least weekly for 1 month and then monthly thereafter).
If drinking is denied and there are other significant indicators of possible relapse (ie poor attendance at group meetings, reports of AOB, etc) then refer for specialized evaluation (can be performed initially as an outpatient evaluation to determine if further intensive evaluation is needed (to possibly include Phosphotidyl ethanol, CDT, polygraph, trails of exposure to alleged source of "incidetnal exposure" to ascertain if similar EtG level can be achieved, test for "auto-brewery syndrome", contact with collateral sources of info, physical exam, other lab w/u (LFTs, MCV, etc), etc)
Translation- Push them in a corner and jab, if this doesn't work tell them we will help them even though were just here for there money (Do you care if the neighbor drinks his liver into a mushy goo?) Now if there are no other indicators we'll try again but if there is and the defendant is still denying, give him/her a polygraph!!! This might be why our forefather's added the Right to Privacy in the Constitution.