But don’t expect the answer to be accurate when you’re asking those with addictions.
The Big Book of Alcoholics Anonymous calls alcohol “cunning, baffling, powerful.” By extension, addiction is said to be a cunning, baffling, powerful disease like no other. It’s the disease that knocks on the door – bangs on it – and everyone in the home, even the pets, hit the floor, pretending it can’t be heard. “Shhhhh! Don’t answer the door! Don’t acknowledge it, and it will go away.” But it doesn’t go away. It keeps knocking, pounding, banging, calling on the phone until it’s a presence we can no longer ignore, try though we may. And we may…and do.
And so the lies begin. People with addictions are notoriously dishonest, and so are their loved ones. See this link for more information about why: https://www.verywellmind.com/my-addicted-loved-one-lies-all-the-time-22118.
The lies are varied: “It’s not that bad.” “I can stop whenever I want.” “What’s the point of drinking if you don’t get drunk?” “He’s cutting down.” “She’s only using a little.”
David Sheff, in Beautiful Boy: A Father’s Journey Through His Son’s Addiction, wrote “An alcoholic will steal your wallet and lie to you. A drug addict will steal your wallet and then help you look for it.” He didn’t originate this aphorism – it’s been around for ages – and, despite the stigmatizing language, it’s still spot on.
And that’s why simply asking a person with the disease of addiction whether or not ze is using or how much is being used is nonsensical. Addiction is a disease, and we know it’s cunning, baffling, and powerful. It’s a disease just like cancer, diabetes, and heart disease in that it’s chronic, progressive, and deadly. But it’s different, too. It’s the disease that everyone pretends not to have. It’s the disease we don’t talk about. It’s the disease that destroys entire families even though only one person actually has it.
Tests have been developed to determine health for those who suffer from diseases. Those with cancer receive scans; those with heart disease are given cardiac event monitors; those with diabetes have regular glucose monitoring. Far too often, that’s what’s missing with the disease of addiction: rather than test, we simply ask.
Imagine the death rates if we simply asked those who suffer from the more-recognized diseases how their diseases are being managed. Rather than a scan, the doctor says to the person with cancer at the yearly exam, “How you feeling…good?” End of interview. Or the person with diabetes is asked, “You’re doing a good job with your diet, right? Good. Keep it up.” Meanwhile, the cancer spreads, and the person with diabetes starts experiencing worse effects, and the inevitable result is death. Because that’s how diseases without intervention end.
And the disease of addiction is no different. Without intervention, the end result is death. And, the test to determine health for someone who has addiction has been developed: it’s a direct biomarker test. Rather than asking if a person is using or how much is being used, we can test using a forensic drug testing laboratory.
One of the benefits of forensic drug testing is that there is always confirmation of a presumptive positive result. That is, an iCUP test result is CONFIRMED; it’s not just a quick screen that is subject to an awful lot of human error.
“Ohhhhh, but that’s too expensive! We just use self-report in our practice. That way, we show that we trust our clients/patients.”
If we believe that addiction is the disease we say it is, why aren’t we using the tests available to address it? We don’t accept self-report for any other disease, so why this one? It’s certainly not because we don’t have tests available. We do!
I submit there are two reasons that we don’t use forensic drug testing, and the first is cost. Asking someone certainly is cheaper than any kind of test. And testing and getting a confirmation, as any forensic test requires, is even more expensive, but is it more expensive than death?
Back to the disease model: would we accept that a person with cancer gets an x-ray because it’s cheaper than a scan? Would we accept that a person with heart disease only has an EKG once a year rather than a heart monitor as needed? Sure, these are cheaper options, and you absolutely get what you pay for.
Check out this training to learn the REAL expense of different methods of testing: https://www.youtube.com/watch?v=RLyvigeqpZo&t=15s; I think you’ll be surprised that forensic fingernail testing is the most reliable and cheapest over the course of a year.
Testing for those who have addiction – as it is with any disease – is the only responsible way to determine whether or not the effects of the disease are being ameliorated. Self-report – that is, simply asking if someone’s disease is getting better – will never result in accurate information.
If we believe addiction is a disease…as we say we do…then let’s start treating it as one.
Guided by Guida 
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