Frequently Asked Questions: AbuseCheck™ Hair Alcohol Test (HAT)

How much alcohol constitutes alcohol abuse?

In Britain alcohol abuse correlates to the consumption of at least 60 grams of alcohol per day. In the UK, alcohol is based on units to allow drinkers to establish their alcohol consumption. One unit is 8 grams (10 ml) of pure alcohol. However, the amount of drink that equates to 60 grams depends on how strong the drink is. On average, one pub measure of wine, one half pint of average strength beer, and one “shot” of spirit are all one unit. So seven of these units provide 7 x 8 = 56 grams of alcohol. A 750 ml bottle of wine with 13% alcohol by volume would contain 9.75 units.

Can we tell if an excessive drinker really has stopped drinking?

We can see after 1-2 months if an excessive alcohol drinker has ceased drinking (i.e. if he/she is abstinent). In some cases the fatty acid ethyl ester (FAEE) values sink below cut off values after only one month of abstinence and at most after two months. Following 3 months of abstinence the values will increasingly liken to those of social drinkers and teetotalers. Please note: for this test we also require, where possible, 6 cm of head hair (standard conditions).

Can we monitor a reformed alcoholic?

According to a 2004 study by Pragst et al, in cases where a relapse follows a period of abstinence of more than one year, binge drinking lasting several weeks is sufficient to give a positive finding over the whole length of hair. We also find that a relapse can be detected after two to four weeks. Note: For this test we also require, where possible, 6 cm of head hair (standard conditions).

Is hair testing for alcohol an imprecise science?

Hair testing is not an imprecise science and is subjected to the same rigors and decisions that apply to other branches of testing such as blood alcohol levels in drivers, for example.

In many areas of medicine and science most testing is done to establish a level and then that level is compared with the best available ‘threshold’ at the time. For example, drunk driving evaluations are carried out against an accepted ‘cut off level’ which in the UK is 35 micrograms of alcohol in breath, 80 milligrams per 100 ml in blood, or 108 milligrams in urine, even though these figures to not correlate to each other in any one individual at any one time. In the future the cut off level may reduce to 50 milligrams per 100 ml of blood. Each country has their own standard, in Scandinavia for example, the driving limit is only 20 mg per 100 ml of blood.

Similar alcohol misuse thresholds in the UK are currently 60 grams per day or the equivalent in binge drinking.

Drunk driving limits have been established by physical tests which identify response times and concentration abilities in individuals compared to blood alcohol level. In practice there is a large amount of ‘results scatter’ because alcohol affects different people in different ways, but having a better response to alcohol than one’s fellow road users is not a valid defense.

Similarly, the 60 grams of alcohol per day cut off level has been related to the quantities of hair alcohol markers detected in a very large number of trial subjects. Our results are based on current cut off levels. Undoubtably some people who are classified as alcohol dependent by our test will no doubt consider they are not dependent, in the same way that many drivers caught with an excess of alcohol in their blood will argue it improves their driving.

Is there a risk of false positives?

Mitigating circumstances could include a serious abnormality in the metabolism of the donor or abnormal hair growth conditions such as hirsutism, or recent donor hair transplantion. While we can offer constructive advice on such occasions, they are not encountered or required very frequently. Consumer Genetics/Trimega Labs has led the field in this work and is the only organisation worldwide to offer this service coupled with a thorough and considered medical review, and as such is committed to offering as much information and advice as possible to clients.

Can hair treatments affect results?

Recent alcohol application to the scalp for head lice will not affect test results. Cosmetic hair products and shampoos do not influence results but there may be extreme cases that should be considered (example: hair modeling where the hair is constantly being styled). Our experience in this field would allow us to offer constructive advice on such occasions.

Why do we use FAEEs and the FAEEs combined with Etg but not Etg alone to indicate alcohol abuse or abstinence over longer time periods?

Etg alone is still not practicable!

FAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude higher than (the relevant order of magnitude of) Etg (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, whereas the technique for measuring (the relevant range of) Etg is still in its infancy.

In practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are not significantly affected by such treatments (Hartwig et al., 2003a). So far no similar systematic investigations have been carried out for Etg.

FAEE concentrations in hair from other body sites can be interpreted in a similar fashion as scalp hair (Hartwig et al., 2003b). No similar studies have been done for Etg.

Extensive studies involving over 1000 donors have been carried out since 2000. These have enabled us to establish reliable reference ranges for FAEEs with respect to drinking habits of various groups:

There are no reliable reference ranges for Etg from comprehensive studies. Further investigations are in progress to examine the applicability of the method in practice of the detection of alcohol abuse.

Additional Information:

• Science Behind the Hair Alcohol Abuse Test
• FAQs About the Hair Alcohol Abuse Test
• Sample Hair Alcohol Abuse Report (PDF)
• Silke Report on HAA Test (PDF)
• HAA Chain of Custody Form (PDF)
• HAA Test Collection Instructions (PDF)