And Another Thing

In my last blog post I referenced two reasons we don’t use forensic drug testing, and I addressed the first: cost. You can read that blog here: https://4csofaddiction.com/2024/02/22/ask-and-it-shall-be-answered/

“So, what’s the second reason we don’t use forensic drug testing, Guida?” Oh, I’m so glad you asked! It’s because we don’t REALLY believe that addiction is a disease. And by “we” I mean the professionals who are supposed to be both the experts on it and the ones treating it.

The Anonymous People, a feature-length documentary produced in 2013 about the “23.5 million Americans living in long-term recovery from alcohol and other drug addiction,” references all the voters who live in families where someone has an addiction – 2/3 of families in the US.

You can watch The Anonymous People here: https://www.amazon.com/People-Kristen-Johnston/dp/B00IX1KCGA for three bucks, or, if you don’t have the 90 minutes or money to spare, you can read a brief overview in about 2 minutes for free here: https://www.minnpost.com/mental-health-addiction/2014/02/anonymous-people-are-anything-anonymous/

In my estimation, this documentary is the single best explanation of the problem society has understanding addiction. The fact that it’s already more than a decade old but we’re still facing the same problems that Bill W. and Dr. Bob faced in 1935 illustrates that problem even more clearly.

Addiction is a disease, a chronic, progressive, lethal disease. But society still doesn’t seem to understand that, and that’s because the professionals may not either. We’ve whitewashed the language of addiction to the point of ridiculousness. In fact, only a medical doctor can diagnose you with “addiction.” Well, a doctor or that guy next to you in the 12-step meeting who introduces himself as an alcoholic or a junkie. The rest of us, even those of us who are completely qualified to use any number of screening tools that determine the same, we have to say that you have a “substance use disorder.” And that doctor you’re waiting on a diagnosis from…yeah, that doctor has had one class on addiction, if we’re lucky.

I don’t blame the doctors. They’re doing the best they can, and they have a LOT to do. This is a bigger problem of our insurance system. I’m guessing all of us have been victim to a miscoded service that results in our being expected to pay a bill rather than our insurance company picking it up. This is one part of the problem with the language of addic— oh, I mean substance use disorders.

So who should be the voice of reason in this mess? The professionals in the field of addiction should. We’re the problem; it’s us.

When we don’t have the tools to tell someone that ze suffers from addiction, how do we expect family members or society in general to do so? When we let our clients determine their own paths because we don’t like conflict, how do we think the clients will get better?

Testing. That’s how.

Just as we test for cancer, diabetes, and heart disease, let’s embrace testing for addiction. Clients can absolutely direct their own paths; and we should be there to help! We do that through forensic testing. Those with addictions minimize their use in self-reporting. We don’t get accurate information, but we have the tools to help them see that!

“When’s the last time you drank alcohol?”

“Ohhhhhh, it’s been a looooooong time.” Or “Oh, I only had ONE drink!”

And then we test to verify that. There’s no test that gives information about time, dosage, or frequency of use. Direct biomarker tests using fingernails that have positive results indicate that a person tested positive for a substance, but a positive test cannot say when the substance was used, how much of the substance was used, nor how often the substance was used. Learn more here: https://www.youtube.com/watch?v=RVvjosieeA0

So why bother to test? Because testing indicates whether or not a person tests positive for a substance, and when someone suffers from the disease of addiction, that information all on its own is enough.  If a person is experiencing addiction, chances are that the solution is abstinence from all mood-altering substances. Testing, better than any self-report ever will, tells us whether or not abstinence is being achieved.

But what if the client/patient has decided that abstinence isn’t the goal? Sure, we know that exercise helps those with heart disease and a better diet helps those with diabetes, but not everyone wants to work that hard. Absolutely true. But we don’t stop testing for those other diseases, do we? Then why do we stop testing for the disease of addiction? Why do we say, “Well, this was the decision the client made. What can I do about it?”

We can mitigate bad decisions with additional information. A person who continues to test positive for mood-altering substances isn’t a lost cause. We don’t simply decide that their outcomes no longer matter. We do direct biomarker testing to determine if use has gone up or down over time. For example, the PEth test is a bloodspot that tests for alcohol use with a lookback period of up to approximately two to four weeks. If we test someone and the results are positive, we can test again in about four weeks to determine if use has continued.

And here’s the beauty of working with this population: a person with active addiction is not going to maintain “social use” over any extended period of time. No, we won’t be able to say that the person abstained. Tests don’t tell us that. And we won’t know if a person used a lot on one day and none on many days. A positive test will simply show that a person with an addiction is continuing to exacerbate the outcome of zir disease. Many positive tests will show that the progression of the disease continues.

Addiction is a chronic, progressive, lethal disease. Just as with any other disease, testing helps us educate the person so afflicted.