Drug testing is currently used, and can be employed in ways to markedly improve care in three phases of addiction treatment: 1) screening and diagnostic evaluation, 2) formal treatment, and 3) long-term monitoring after initial intensive phases of addiction treatment.

Addiction Screening and Diagnostic Evaluation

An obvious occasion to employ drug testing in addiction medicine is as part of the initial assessment. Drug testing provides an objective source of information to compare to the patient’s self-report. In cases where there is a discrepancy between the patient’s subjective report and the objective drug test result, the clinician is in a position to engage the patient over this discrepancy, using motivational interviewing techniques, with the goal of enhancing accuracy of the diagnosis and the appropriateness of the treatment plan. Moreover, drug testing is an important clinical tool to assist the evaluating physician, counselor, or other health care professional to determine the risk the individual manifests for acute withdrawal and the indication for withdrawal management (“detoxification”).

The reality in addiction treatment is that drug testing is currently underutilized. Many initial assessments, conducted by a counselor or even by an addiction specialist physician, do not include information available from drug testing.

Drug testing should be a key component of assessment and treatment planning, especially when integrated with other clinical information gathering, such as a substance use history, physical and mental status examinations, withdrawal severity scores, and standardized laboratory assessments of metabolic, neurologic, and psychiatric status. A knowledgeable clinician can use drug testing to verify self-reports, confirm diagnoses, identify denial and minimization of drug and alcohol use, enhance motivation for treatment, measure biological adaptation, assist in development of treatment planning, monitor treatment response, document treatment effectiveness and outcomes, support patient advocacy by validating abstinence from alcohol and drug use, and validate adherence in taking prescribed controlled substances.

Intensive Addiction Treatment

Drug testing is used in the initial, often intensive, phase of addiction treatment,sometimes referred to as “primary treatment.” Primary treatment includes intensive psychosocial services to assist patients in establishing abstinence; psychoeducational activities to assist patients in understanding their disease; psychotherapeutic interventions to help them overcome shame and guilt and to accept their circumstances without minimization, denial, or bargaining; and cognitive-behavioral interventions to help patients manage cravings and identify drug-use triggers. These are usually performed in residential treatment facilities. Random and frequent drug testing should always be an important component of primary addiction treatment.

In outpatient primary treatment settings, the opportunities for the use of alcohol or other drugs are much greater. Thus, the need for frequent random drug testing is greater than for patients in residential treatment. The detection of substance use in an outpatient setting should be used to revise treatment plans, including using additional strategies to help the patient establish and maintain a drug-free state. Termination from treatment is seldom appropriate for a single positive drug test, but repeated positive tests are incompatible with continuing in many outpatient treatment programs. Just as new information about disease severity in the treatment of another chronic medical or psychiatric illness would lead to treatment plan adjustments (usually intensification and addition of new elements), positive drug test results are a manifestation of the severity of illness, or the inadequacy of treatment, and signals the need to reevaluate and readjust treatment plans.

Monitoring in Addiction Treatment

Chronic disease management of other health conditions often involves having patients return for professional contacts to monitor their status of remission. The monitoring phase after formal addiction treatment has been completed can last for varying lengths of time; however, at the center of this phase is continued random drug and alcohol testing. After primary addiction treatment, patients should be followed using models of chronic disease management, with the treatment goal of long-term, even lifetime, recovery that includes abstinence from alcohol and drug use. As an intermediary step, programs often seek to reduce the frequency and severity of relapses, and to minimize functional impairment should any substance use resume. Relapse is most common in the first 90 days after completion of primary treatment. When patients are still engaged with a clinician and they return to alcohol or other drug use, they are often too embarrassed or ashamed to admit it. Drug testing can help both the patient and the clinician operate with the “facts.” It is unfortunate when clinicians or case managers view drug testing as appropriate only during phases of active treatment and not as an approach that can have great utility after intensive phases of treatment are no longer needed.

About Elite Diagnotics

Elite Diagnostics is a Highly Complex CLIA certified Lab based in Crown Point, Indiana. We use state of the art technology coupled with rigorous quality control guidelines to provide prompt and reliable test results for physicians and their patients.