Abstinence: what it means and how to prove it objectively

Abstinence means complete avoidance of a substance, so not cutting down but stopping entirely. The word is used for alcohol, drugs, medication and smoking, and can be temporary or permanent. In a CBR procedure or a recovery period it is also something you have to be able to demonstrate.

That last part is where it goes wrong. You can find the definition in any dictionary, and almost nobody covers how to prove it.

We get that question weekly: how do I show that I have used nothing for three months? The answer depends entirely on which period you need to cover.

What exactly does abstinence mean?

Abstinence is the complete avoidance of a substance. It differs from cutting down, where someone keeps using but less, and from controlled use, where someone holds to fixed limits. In recovery programmes and legal procedures, abstinence is usually the standard that applies.

There is a practical difference between the two forms. Temporary abstinence, such as a month without drinking, is a reset. Permanent abstinence is a long-term choice.

To a laboratory that distinction matters little. To the question of which test you need, it matters entirely.

How do you prove abstinence objectively?

With a marker matched to the period you need to cover. For alcohol there are three practical options with very different look-back times: urinary EtG covers days, CDT in blood covers weeks, and hair EtG covers months. For drugs the same principle applies, with urine for days and hair for months.

That three-way split is the heart of this subject, and it is rarely explained this way.

CDT and EtG were developed for exactly this purpose and are used that way in forensic and clinical settings (PMID 29807559). In research on drivers whose alcohol use was monitored, hair EtG and CDT were compared directly as instruments for abstinence monitoring (PMID 20373230).

If you need the longest look-back, hair is the material. Diagnostic studies show that hair EtG can distinguish abstinence from use over a longer period (PMID 21910015).

Why is a urine test usually the wrong instrument here?

Because urine only looks back a few days. Someone who has to show three months of abstinence proves with a urine test, at most, that they used nothing this weekend. That is a correct result which does not answer the question asked.

Picture someone who stops on 1 March and is asked on 1 June to demonstrate it. A urine test on 1 June covers late May. The 89 days before that stay invisible.

A hair analysis does cover that period.

There is one way urine can still do this: repetition. A series of dated results across three months tells a story together, where a single test does not. That is exactly the set-up that helps during the recidiefvrije periode.

What can go wrong in an abstinence check?

Incidental exposure to ethanol can raise a urinary EtG without any drinking. Hand gel, mouthwash, some alcohol-based medicines and alcohol-free beer all contain small amounts of ethanol. At low cut-offs that can produce a measurable result.

That is not a theoretical risk. For someone in a CBR process it is a real problem, and it is exactly the kind of detail you would rather know beforehand than afterwards.

Practically: in the days before an EtG check, watch mouthwash, hand gel and alcohol-free drinks, and declare any medication used. What a cut-off value is and why it exists is covered in what a cut-off value is.

With CDT the picture differs. There, causes other than alcohol can also produce an abnormal value, which we cover in CDT too high.

How do you record it yourself?

By testing at fixed intervals and keeping the dates. One result is a snapshot; a series of dated results is a pattern. For alcohol, CDT is the most used marker for this in the Netherlands, because it looks across weeks instead of days.

You can have an alcohol CDT test done without a doctor's referral, and only you see the result. For several substances, you can build your own panel and choose per substance.

Be realistic about the limits. No marker proves that nothing was used in a particular hour, and no result says anything about why someone is abstinent or how well it is going.

What a dated series does do is move the conversation from believing to measuring. I think that, for most people in a CBR process, is the real gain rather than the result itself.

RIVM publishes the Dutch figures on alcohol and drug use, and Thuisarts.nl describes when to see a GP about problematic use.

To understand what happens physically in the period before abstinence becomes routine, read withdrawal symptoms by substance and alcohol withdrawal. Exactly how far a hair analysis looks back is set out in the EtG hair test.

Every blood test result at Zuivertest includes a professional assessment by a BIG-registered doctor. Discuss your results with your GP before making treatment decisions.

Sources

• Andresen-Streichert H, Müller A, Glahn A et al., "Alcohol Biomarkers in Clinical and Forensic Contexts", Deutsches Ärzteblatt International, 2018 (PMID 29807559)
• Appenzeller BMR, Schuman M, Wennig R, "Abstinence monitoring of suspected drinking drivers: ethyl glucuronide in hair versus CDT", Traffic Injury Prevention, 2010 (PMID 20373230)
• Pirro V, Valente V, Oliveri P et al., "Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers", International Journal of Legal Medicine, 2012 (PMID 21910015)
• Bertol E, Vaiano F, Boscolo-Berto R et al., "Hair ethyl glucuronide and serum carbohydrate deficient transferrin for the assessment of relapse in alcohol-dependent patients", Clinical Biochemistry, 2016 (PMID 26851349)
• RIVM, figures on alcohol and drug use in the Netherlands (rivm.nl)
• Thuisarts.nl, information on cutting down and stopping alcohol (thuisarts.nl)