“How’d you do on the English test?”
“I failed it.”
“How’d you do on that glucose test?”
“Yeah…I failed that one, too.”
Testing is used to assess and monitor progression of disease and to thereby monitor recovery, just as with cancer, diabetes, and heart disease. Doctors order a multitude of tests to determine what sort of intervention and treatment is needed. To that end, there are some amazing tests available that help monitor progression and recovery of the disease of addiction, but a person with a disease – any disease – never fails a test.
No one “fails” a colonoscopy or a glucose test or any sort of blood test. Doctors don’t warn us to prep for the test lest we “fail” it, and when we receive a less than great result, no one sanctions us. We don’t immediately get sent to the hospital or the nutritionist, and we certainly don’t get sent to lock up. So why do professionals who SAY that they believe that addiction is, indeed, a disease, instead treat the disease as a weakness of character?
The American Society of Addiction Medicine says “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases” (“What”).
So let’s say that professionals working in the field of addiction believe the experts and accept the disease model. And let’s not use space here to consider why those who don’t believe it’s a disease work in this field.
Mayo Clinic explains, “Diagnosing drug addiction (substance use disorder (SUD)) requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they’re not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery” (“Drug”). Still, too often people suggest that someone suffering from severe substance use disorder is the only person who can make that diagnosis.
Is there any other disease society says the person suffering from has to diagnosis? Has anyone EVER gone to a doctor and been told, “I’m not sure what’s wrong with you. You’ll have to diagnosis it yourself.” I’m going out on a limb here and saying “no.”
Because addiction is a disease, it can be diagnosed by an expert, just like experts can diagnosis other diseases like cancer, diabetes, and heart disease.
There is no blood test that diagnoses the disease of addiction, but there are tests that monitor treatment and recovery. There is no test that monitors abstinence that those in recovery from addiction are aiming toward, but there are tests that put the urine test to shame. Urine tests are notoriously misused; too often they aren’t confirmed, causing improper results to be reported. That is, a presumptive positive isn’t positive, and a negative test doesn’t guarantee a lack of use.
Hair testing, on the other hand, has a longer lookback period and can better help monitor treatment and recovery for those with a diagnosis of the disease of addiction. Those who suffer from addiction typically cannot maintain social use, so hair testing will generally show results looking back up to about three months for drugs of abuse. Fingernail tests are even better, though, showing results for drugs of abuse of up to about six months and alcohol use up to about three months. Further, unlike hair, fingernails are the same races and are more difficult to adulterate with cosmetic treatments than hair, and are therefore more reliable. And the laboratory makes a difference, too. The best labs, like USDTL, require confirmation testing before reporting results because presumptive positive is NOT positive. In order to monitor treatment and recovery, samples must be confirmed, not merely assumed.
These tests will not confirm a lack of use, but they will confirm a lack of misuse, and for a population who have the disease of addiction, that’s what’s needed. Tests that help determine progression of disease and recovery are never intended to be pass/fail. When someone suffers from a chronic, progressive, lethal disease – like cancer, diabetes, heart disease, and even addiction – testing helps determine whether or not that disease is in remission or if further intervention is needed.
Chronic, progressive, lethal diseases need maintenance. In the SUDs field, that’s typically called “case management.” Maintenance is ongoing care, which typically includes testing. Patients with heart disease are subject to countless blood tests. Patients with cancer are subject to countless scans. Patients with diabetes are subject to countless finger sticks. Patients with addiction, it follows, would be subject to that thing that shows whether or not they are in or still in remission: fingernail testing.
Addiction is a disease, a chronic, progressive, lethal disease. It should be treated as such. Those with other diseases are helped in the care and remission of their diseases, and those with addiction should be treated the same. The tools to provide case management are available. The only barrier is actually using them by the professionals in the field of addiction who give lip service to the belief that addiction is a disease. People with diseases deserve the best care available. Fingernail testing is that care for those with addictions.
References
“Drug Addiction (Substance Use Disorder) Diagnosis.” MayoClinic.org, Mayo Clinic, 4 Oct. 2022, https://www.mayoclinic.org/diseases-conditions/drug-addiction/diagnosis-treatment/drc-20365113.
“What Is the Definition of Addiction?” American Society of Addiction Medicine, 15 Sept. 2019, https://www.asam.org/quality-care/definition-of-addiction.
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