Thursday, January 28, 2016

You Can't Test For It! Part I

You Can't Test For It: Recovery Cannot Be Detected in Urine

The views expressed here are my own and are not necessarily shared by any employer or educational institution I may be affiliated with...but they probably should be.



He was a young man in his early 30s with shoulder length blond hair and an angry scowl chiseled permanently on his features. He had been at the clinic for several years, had struggled with his abstinence goals and had a reputation as a difficult client. He arrived on time for his first scheduled meeting with me as his new counselor. We exchanged greetings and each took a seat, after a short pause he looked me in the eye and said  "no offense, but I don't think this is gonna work." 

In every treatment program I have worked or trained at the Urine Drug Screen or UDS has played an important role. Chemical dependency professionals use the UDS for several reasons such as to show compliance to state and federal agencies, for safety reasons, and as evidence of compliance or non compliance to a given program. Many counselors swear by the UDS as a therapeutic tool which allows them to know for certain that a client is reporting their substance use accurately and to provide interventions for the client if illicit use is detected, especially if this use contradicts the clients report. It is also considered the most important indicator by everyone involved including clinicians, concerned 3rd parties, medical staff, and of course the clients themselves that what we are doing is working. A "clean" UDS is looked at as the most convincing evidence that the recovery process has begun and multiple "clean urines" are looked on as clear scientific proof that progress is being made. On the other hand "dirty" urines are considered proof that the clients is not making progress in recovery. If the client is consistently "dirty" it eventually overrides all other factors in deciding if the client is really invested in the program, if they " really want it enough." 

But even when a client is considered "clean" there is some suspicion, that they are providing someone else's urine, that they are just lucky and the substance is out of their system by the time they are tested, or perhaps that they are using a substance that is difficult to test for. This leads to the practice watching the clients as they pee and ever more expensive testing for the more elusive substances. It can become quite a chess game between clinical staff and the struggling client with both going to extremes to either catch, or get away with something respectively. For-profit labs will charge thousands for a single UDS and even send their own staff to observe the client and deliver the specimen. This costs the programs that contract them nothing as they bill the client's insurance company directly and the companies usually pay, sometimes once every week. Why shouldn't we be thrilled with this system? Sure it's expensive, but we catch the bad apples and send them away and for our wonderful "clean" clients we get that undeniable proof that all of our efforts really matter. My problem with this is that abstinence is only one goal of recovery, and in many cases it's not the most important goal. Addiction, or recovery from it, is not something that can be detected in urine. 

To be continued 

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