The limitations of current technology in detecting smoking, alcohol use, and illicit substance use are well documented and further contribute to difficulty in identifying patients in need of treatment. Cotinine, a metabolite of nicotine, is detectable in blood and urine, but the window for detection is only 48 h [6,7]. Exhaled carbon monoxide has an even shorter window of detection with a half-life of 4.5 h [7,8]. Similarly, there are serious deficiencies in current algorithms to detect problematic alcohol use, including biomarkers such as serum aspartate aminotransferase, carbohydrate-deficient transferrin, and gamma-glutamyl transferase, which are limited by invasiveness of testing (blood versus urine), poor sensitivity and specificity, and high cost [9]. For other substances, screening generally relies on urine testing, for which urine immunoassays exist but have similar limitations, including a number of potential false-positives and false-negatives [10]. In the case of a positive result on urine immunoassay, which is currently recommended as the first-line screening test for illicit substances [10], confirmatory testing can be done using gas chromatography/mass spectrometry (GC/MS), which is more accurate but substantially more expensive and time
