Clinical Management of Drug & Alcohol Testing
The primary barrier to the effective use of drug testing in counseling is the perception that it is punitive. Indeed, in many environments the person being testing has nothing to gain and everything to lose. In the criminal justice system, workplaces, and even some treatment programs a positive result on a drug test can mean incarceration, a lost job, or an unsuccessful discharge from treatment. Chief concerns in these situations are that the person being tested has a loss of privacy and loss of control over the use of the test results. Furthermore, these uses color people’s ideas of the purpose of drug testing. Therefore, clinicians using drug testing need to specifically address this perception and correct any misunderstandings about the use of test results.
- It takes the conversation about your client using or not off the table. Self-report is not always the best measure of actual drug use for people with substance use disorders, so having reliable objective data on a person’s drug use is extremely helpful in both assessment and ongoing treatment phases.
- It allows people to make current decisions that will affect their future self. Often people struggling to stop using drugs are able to make a decision to not use while in their therapist’s office but later, in the moment, have difficulty following through with the decision. On-going drug test monitoring helps people keep themselves accountable to the decisions they make when they are not in using situations.
- It allows people to demonstrate they are doing well. This is especially true with frequent drug testing in active treatment phases. Often it is a comfort for people in couples or family counseling to know that their loved one is doing okay. Indeed, I have worked with many people who ask to be drug tested for just this purpose.
- Boyce and Bynum: Boyce and Bynum is located on Stadium and Broadway in Columbia. Clinicians must first set up an account with them before sending people to their facilities. All of their samples are sent to a lab, results are usually available in three days, and results are mailed directly to clinicians. They also have access to a wide range of testing. For example, they can test for ethyl glucuronide (EtG), which is a metabolite of alcohol that may indicate recent alcohol consumption, even after ethanol is no longer measurable in the blood.
website / - Providence Urgent Care: Providence Urgent Care has several locations and offers several options for drug testing. They can usually get a person in quickly and will FAX onsite ultra-rapid test results to counselors on request. Clinician’s do not need to have an account with Providence Urgent Care to refer people for testing.
- Home Tests: Several companies sell home drug testing kits over the counter. You can purchase them at local retailers and online. However, I do not recommend them to people I work with for two reasons: they are not very accurate and are easy to misread, resulting in false positives; their use puts a family member in the position of determining when and why to test and can lead to confusion and unnecessary conflict.
- Other Options: National Toxicology Specialists (NTS) and Quest Diagnostics are national testing services with local collection sites. I have also used Secure Continuous Remote Alcohol Monitor (SCRAM) technology in my practice. Available locally through EMASS, these monitors are worn on an ankle and continually sample alcohol content through trans-dermal sampling of sweat.
NTS / SCRAM / EMASS