Alcohol and Other Drug Testing: No Room for Gotchas

In continuing the theme of looking at addiction as the chronic, progressive, lethal disease that professionals say they believe it is, the question should be posed: why do we spring tests on people suffering from a disease?

My husband recently underwent heart surgery, and when the doctors need him to have lab tests, they make sure to tell him so: “Get to the hospital in the next 72 hours for a blood test.” “Make sure you have a chest x-ray within 48 hours of your appointment.” So why do we continue to use a color scheme or other randomization for urine testing? Is it because we really don’t believe that addiction is a disease, or are we trying to catch testers doing something they shouldn’t be?

Urine tests are as good as they can be…for what they are. They will tell us if there is alcohol or other drugs in someone’s system from the past approximately seventy two hours…give or take. There are lots of ways to adulterate these tests, and they are only as good as the person watching the sample collection, which is a whole other concern. Further, the tests should never be perceived as conclusive when there’s no confirmation done. That means that if during a quick screen in the office I see that a person is “positive” for a substance – cocaine, for example – I can’t say that person is positive for cocaine without that test being verified at a lab. And this step is far too often skipped.

Urine testing has been around since the early 1970s, coming into play to monitor Vietnam veterans undergoing methadone treatment when returning to the US. Under the Influence? Drugs and the American Work Force, which was written by the National Research Council/Institute of Medicine in 1994, already addressed the problem of the deterrence-oriented philosophy vs. the less punitive one: “One idea that motivates such widespread testing is the well-intentioned and generally popular goal of deterring the abuse of drugs among employed people and in other selected populations. There are, however, serious differences between the deterrence-oriented identify, catch, and punish philosophy and the less punitive identify, treat, and rehabilitate approach. These orientations often conflict and can seriously confound forensic toxicologists and medical review officers who are responsible for interpreting drug test results” (National). Today, almost thirty years later, we’re still blurring these philosophies.

Urine tests, while easy enough, are not the gold standard for testing for substances of abuse, particularly not for those with known substance use disorders. My sister suffers from the disease of diabetes, and no one sneaks tests on her. No doctor calls her at 10 o’clock in the morning and says, “You need to come here by the end of the day to test your insulin levels.” My dear friend is in recovery from the disease of cancer, and she can tell me six months ahead of time when her next scan will be. The American Society of Addiction Medicine, ASAM, uses this definition of addiction, and all but the most truculent sceptics fully accept it: “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 why do professionals in the field of addiction still treat testing as a gotcha? If it’s true that we accept that addiction is a disease, perhaps we should start treating it as such. That means that we should use testing that helps people in their recovery from their disease, much like testing helps my husband, sister, and friend manage their recovery from their respective diseases.

Direct biomarker testing such as that offered by USDTL in Des Plaines, Illinois, is truly the gold standard of testing. Fingernails have a detection window of up to approximately three months for alcohol and up to approximately six months for other drugs of abuse. For those providing the fingernails, adulterating the sample is difficult but for those observing collection the process is quite easy. For those with the disease of addiction, these windows are significant: if a person with an addiction can provide a negative fingernail sample, it’s likely that recovery is taking shape. On the flip side, if a person with an addiction has a positive test result, it’s likely that additional intervention is necessary.

Urine cups have a detection window of approximately three days, and a negative test isn’t conclusive evidence that a person isn’t using substances. It’s just evidence that substances were not used excessively during that timeframe. There is no such thing as a test for abstinence; no test will without a doubt provide evidence that a person isn’t using substances, but the gold standard of the nail test for those with the disease of addiction will certainly provide evidence that substances aren’t being abused. And for those who suffer with the chronic, progressive, and lethal disease of addiction, isn’t that really the best we can hope for?

References

National Research Council (US) and Institute of Medicine (US) Committee on Drug Use in the Work

Place; Normand J, Lempert RO, O’Brien CP, editors. Under the Influence? Drugs and the American Work Force. Washington (DC): National Academies Press (US); 1994. 6, Detecting and Assessing Alcohol and Other Drug Use. Available from: https://www.ncbi.nlm.nih.gov/books/NBK236259/

“What Is the Definition of Addiction?” American Society of Addiction Medicine, 15 Sept. 2019, https://www.asam.org/quality-care/definition-of-addiction.