Hair strand testing to detect parental substance misuse

Hair tests have helped social workers with difficult child protection cases involving parental substance misuse, but they have their limits, reports Ben Willis

Hair tests have helped social workers with difficult child protection cases involving parental substance misuse, but they have their limits, reports Ben Willis

Parental substance abuse remains a huge factor when it comes to putting children at risk in the UK. Research last year by Alcohol Concern and the Children’s Society estimated that 2.6 million children in the UK live with a parent whose drinking could lead to neglect or abuse.

For social workers it is notoriously difficult to know whether a parent who claims to have kicked their habit is being truthful and whether their new, reformed lifestyle can survive temptation. As a result, social workers are becoming more reliant on hair strand-testing to profile patterns of drug and alcohol use.

“It’s difficult to give numbers, but a significant proportion of [care] cases now use these tests,” says Jacqui Gilliatt, a family law barrister. “Drug-testing has been commonly used for a long time now, and is generally quite precise; alcohol hair-testing is increasingly in use as more and more people become aware of the possibilities of using it.”

“In almost all cases where drugs or alcohol are suspected, these tests are being used,” agrees Avi Lasarow, chief executive of one of the top hair-testing companies in the UK, Trimega Laboratories.

Lasarow’s company is looking to use the tests to map substance abuse among would-be adopters. They are also lobbying the government for the UK’s 35,000 or so foster carers to undergo drug and alcohol tests.

But are the tests reliable and accurate? For drugs, hair analysis can profile usage going back as long as the hair sample allows – as much as 12 months if it is long enough, says Graham Sievers, director of Trichotech, another leading hair testing company.

“It’s a very good way of analysing people who are still having a problem with drugs and those who have got over any problem and beaten the addiction. If someone with a known heroin addiction is now saying they’ve been clean for four or five months, and their hair is 12cm long, they can prove their case by having that length analysed. We can show where heroin was occurring in the sample 10-11 months ago and where over the last six months the drug has declined to zero.”

Tests for alcohol use

Tests for alcohol are not so conclusive. Hair strand tests for alcohol can look at one or both of two different chemical markers that indicate whether or not a person has been drinking. But because these markers can be deposited in the body through certain foods or be washed out through shampooing, hair strand tests revealing low levels of these chemicals are not conclusive.

“Hair alcohol tests are less definitive and can only really determine chronic excessive alcohol use,” says Sievers. “If they show elevated levels of the markers above a certain amount, that is a helpful indicator of someone who might have an excessive alcohol problem. But hair alcohol tests cannot be used for sobriety testing. So if a test is negative – ie below a cut off point – it doesn’t mean a person has not been drinking.”

This important distinction was underlined in a High Court case at the end of 2010 (see box). In essence the judgment concluded that because of the current limitations of hair alcohol testing at low levels of detection, such tests should only be used to prove excessive alcohol abuse.

For Gilliatt, hair alcohol testing should only ever be regarded as one piece of the evidence jigsaw in a childcare case. “This case showed that it’s very important to acknowledge these tests are part of a picture, but if everything else points in another direction, you shouldn’t just look at the numbers on one test.

“These procedures have come to be looked at almost like they’re a pregnancy test, showing a ‘yes’ or ‘no.’ They need to be seen as a much more subtle indicator that might point you in a particular direction,” she concludes.

Sievers agrees that, while a hair drug test can achieve something close to a ‘yes’ or ‘no’ answer on whether or not a parent is abusing, alcohol tests should be treated with more circumspection: “In child protection cases people want a black and white answer. But it’s imperative the courts understand you need a basket of tests, including a clinical assessment.”

But Lasarow maintains that a hair alcohol test is still invaluable in helping build up an overall picture of a case. “Back in 2006, all social services had to go on was how many empty bottles were in a person’s house, whether the house looked healthy, and so on. Now we are able to provide a bigger insight into a person’s background. So if that’s being used properly and not over-relied on, that’s a valuable tool.”

Case law: Richmond council v B

In November last year, Mr Justice Moylan ruled against the removal of a child from the care of a mother suspected by the London Borough of Richmond of alcohol abuse.

A test of the mother’s hair by TrichoTech suggested the mother had been drinking, although the levels were very low. However, a further test by Trimega gave a negative result.

Having heard evidence as to why the two different sets of results were contradictory, the judge made several points on the use of hair alcohol tests in future child protection cases.

He said both forms of hair alcohol tests available should be used. Trichotech had tested for one of the chemical markers associated with drinking – ethyl glucuronide (ETG) – while Trimega tested for both ETG and a second – fatty acid ethyl esters (FAEE). Each test has strengths and weaknesses.

The judgment also warned against the use of hair strand tests to measure low levels of alcohol use or even abstinence. He noted that at the moment, hair strand tests were unable to distinguish between abstinence and social drinking because there was a risk of false negatives. However, the judgment did acknowledge that in the future, with more research and empirical data, this could change.

In determining excessive alcohol consumption, the judgment said hair testing was still a reliable tool. However, this came with the caveat that a hair test should only form one element of the picture of evidence and that analysis of hair samples should cover a minimum three-month period.

Where a court is seeking to determine if a person is consuming alcohol at lower levels, the judge said other forms of testing – such as random urine or breathalyser tests – would be more helpful than a hair test. In both cases, the judgment said physical tests should be backed up by clinical observation.

Tips for best practice

Before requesting a test, first establish what it’s for – to prove abstinence, or to prove someone’s claims they had a one-off incidence of drug-taking three months ago? Understanding this will help determine the most appropriate test.

● Get legal representation to help interpret the test results and decide how to use it in evidence before a court.

● Consider other tests such as blood or urine to back up the findings of a hair strand test. Physical tests should be corroborated with a clinical assessment.

● Watch out for other signs of a parent’s possible substance misuse – although beware that some people’s breath can smell of alcohol even if they do not drink.

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Author Ruth McGovern, senior alcohol health worker, Newcastle University

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Author Emilie Smeaton, research directro, Paradigm Research

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