Clinical Management of Drug & Alcohol Testing

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When discussing best practices in helping people with substance use disorders, the subject of drug testing is seldom discussed beyond noting its importance. However, managing drug testing within a clinical environment can be tricky. A thoughtful approach to managing drug testing is crucial because if it is handled well, it can enhance treatment process and outcomes, but if it is handled poorly, it can get in the way of effective interventions. In this article I will discuss the pros and cons of drug testing and detail some local resources useful for integrating drug testing into your clinical practice.

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.

A second barrier to effective use of drug testing is clinicians placing too much value on the drug test results. Drug testing should be treated as a piece of a larger puzzle.A negative drug test does not necessarily mean the person is doing well, nor does a positive test necessarily mean they are doing poorly. Testing results are only a bit of information to be incorporated into a larger clinical picture. Many people outside of clinical practice have difficulty understanding this; however, treating drug testing information as the determinate of “successful” treatment is a mistake.
There are several benefits to incorporating drug testing in your treatment of people with substance use disorders:
  1.  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.
  2. 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.
  3. 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.
In order for drug testing to be helpful, it must be accurate and accessible. If you work in a clinic or agency with onsite testing capabilities, be sure to make use of your resources. However, if you work in a setting where you need to go outside your agency for resources, there are several options:
  • 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.
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  • 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.
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  • 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.
Certainly the options for drug testing are varied, and you may need very different testing protocols for different treatment conditions. Whether for a comprehensive substance use disorder evaluation, active treatment, or ongoing monitoring, the thoughtful use of drug testing is an important part of treating people with substance use disorders. However, the stigma of drug testing and the potential for it to be used in a punitive way challenges us to be careful about its application. Properly managed, drug testing is an affirmative tool for helping the people we work with expand their options and receive the help they need.