Alcohol & Drug Test Interpretation: What Every Decision-Maker Should Know

⚠️ The Risk of Misinterpretation

Courts, employers, licensing boards, and child-welfare agencies often rely on drug and alcohol testing to make high-stakes decisions. However, multiple studies and federal advisories show that non-experts frequently misunderstand test results—with consequences for careers, licenses, and families.

📌 Evidence from Research & Policy

• Physician Knowledge Gaps A study in Journal of Opioid Management found only 20% of family physicians could correctly interpret more than half of urine drug testing scenarios . If clinicians struggle, non-clinicians almost certainly will.

• Erroneous Interpretations Are Common A Journal of General Internal Medicine review found provider misinterpretation is common even with advanced LC-MS/MS confirmatory testing, underscoring the need for expert toxicology input .

• SAMHSA Warning on EtG Alcohol Tests The federal agency cautioned: “Action based solely on a positive EtG is inappropriate and scientifically unsupportable.” (SAMHSA Advisory, 2006) . Despite this, EtG is still misused in employment and disciplinary cases.

• Child-Welfare Guidance The U.S. Children’s Bureau states: “Drug tests cannot diagnose a substance use disorder or provide enough information for substantiating allegations of child abuse or neglect.”

• Case Law Example In Johnson v. State Medical Board of Ohio (2008), a physician’s license was jeopardized based on EtG alone; the appellate court overturned the decision, criticizing the board’s reliance on an “experimental” test .

🚫 Common Misconceptions

• “A positive test proves addiction.” False. A test shows exposure, not a diagnosis.

• “Negative means no use.” False. Detection windows are limited and vary by drug.

• “All tests are 100% reliable.” False. Each test type has false positives/negatives and environmental interferences.

• “Hair or nail tests prove chronic use.” False. They detect exposure over time, but cannot distinguish occasional from dependent use without expert analysis.

✅ Best Practices for Decision-Makers

• Require Confirmatory Testing (GC/MS or LC-MS/MS) before acting.

• Avoid Sole Reliance on a single biomarker (e.g., EtG, PEth, CDT).

• Consult Experts (forensic toxicologists, medical review officers).

• Consider Context—medical history, medications, and exposure.

• Follow Federal Guidance (SAMHSA, NIAAA, SoHT, ASAM).

🔎 Key Takeaway

Drug and alcohol testing is complex science. Misinterpretation is well-documented, even among trained physicians. Attorneys, judges, HR managers, and licensing boards must seek expert input before making career- or custody-altering decisions based on lab results.