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Different settings, different standards

June 1, 2010
by Lindsay Barba, Associate Editor
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Drug testing protocols at various levels of treatment evolve with the individual's recovery

Drug testing is almost always used as a primary means of assessing a client upon admission to an addiction treatment program. Following admission, progressive drug testing protocols are needed to ensure that an appropriate level of information, feedback, and reinforcement is available to clients at their current level of recovery, as well as to the clinician striving to provide effective treatment.

As the client's recovery status changes upon completion of successive levels of treatment-inpatient, outpatient, sober living, and aftercare-drug testing protocols must change in terms of sensitivity, frequency, and rationale.

Inpatient treatment

Drug tests are generally administered to all clients upon admission to inpatient treatment programs. These not only provide a baseline from which clinicians can judge a client's progress, but also a check that helps clinicians to see if clients have neglected or forgotten to provide other drug-use information.

“It's a way for us to help assist them with getting honest with what they're doing,” says Jeanne Mahoney, director of nursing at Seabrook House in Seabrook, N.J. “Sometimes it's not that they're lying; they just really don't remember because everything got so chaotic.”

Initial drug tests are typically comprehensive in scope, screening for cocaine, opiates, methadone, THC, amphetamines, PCP, benzodiazepines, barbiturates, and alcohol. However, because these tests usually do not detect Suboxone or buprenorphine use, additional testing may be needed. Additional testing is given to clients who self-report or are suspected of using these substances.

Table. Effective and efficient drug testing protocols in various treatment settings. According to the authors of Hazelden Publishing's Drug Testing in Treatment Settings: Guidelines for Effective Use (Robert L. DuPont, Richard A. Newel, and Paul R. Brethen), there are several options for effective and efficient means of drug testing clients at various levels of treatment.1 Though urine drug testing is the method of choice for the organizations that contributed to this article, the above protocols may also work to achieve the recovery and organizational goals in place at inpatient, outpatient, sober living, and aftercare facilities.

 

Treatment setting

Test administered

Frequency

Rationale

Inpatient

Urine or oral fluid test

One or two times monthly and upon suspicion; randomized

Testing methods provide immediate results; results determine client's commitment to treatment.

Outpatient

Hair test for long term, or urine or oral fluid test upon suspicion

On a routine basis and upon suspicion

Hair tests are cost efficient and only needed four times a year, while urine and oral fluid tests provide immediate results upon suspicion. Testing provides positive reinforcement to client or detection of relapse for organization.

Sober living

Patch test

Upon suspicion

Patch testing provides ongoing monitoring without the collection of many samples; it is too costly for sober living programs to test consistently.

Aftercare

Hair test

Ongoing, infrequent, and random testing, or no testing at all

Clients at this level are responsible for their own recovery, but may need the extra motivation. Hair testing provides long-term results with infrequent sample collection.

Baseline screenings may also be used to identify false reports of substance use. Robin Parsons, director of adult services at Fairbanks in Indianapolis, says that many new patients claim to use a particular drug in order to obtain a certain detox medication. In such cases, baseline drug screens help the clinician evaluate the patient's claims and determine the correct course of detox or treatment.

After this initial, baseline screening, drug testing frequencies may vary from program to program. For instance, while Seabrook House and Fairbanks conduct additional drug tests only for clients suspected of using, Rosecrance in Rockford, Ill., conducts random, daily drug tests on 15 percent of its inpatient population, as well as upon suspicion.

“It's not uncommon for us to do [a drug test] if there are behaviors or information that would [indicate it],” says Parsons. She adds that “the first baseline may be the only drug test a person would receive” because the 24-hour restricted environment makes obtaining substances virtually impossible.

Outpatient treatment

When clients leave the closely-monitored environment of an inpatient program to enter outpatient treatment, drug testing standards typically become more stringent. Seabrook House, Fairbanks, and Rosecrance all report testing their outpatient clients using randomized weekly tests. So, while patients may know that they are going to be tested, they don't necessarily know when. “Obviously, we don't want people to plan and structure their use around a scheduled drug screen,” Parsons says. “For a lot of clients, they will not use just because they know that drug screen is there.”

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