You Can't Test For It! Part II

You Can't Test For It: Recovery Cannot Be Detected in Urine (part 2 of 4)

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 told me I was a "nice guy," that he could tell that by the way I said hello to him when we passed in the hall. This was the reason, he told me, that he agreed to come to the first session. He said he was a complicated case and while I was probably a fine counselor, he would prefer to return to someone he had worked with before. I disclosed that I knew something of his case and had in fact requested him for my caseload. I told him I'd only been a licensed counselor for a year but that made me more experienced than most of the others with openings on their caseloads. Also I was older than the others. I agreed to transfer him immediately if he still wanted and told him that he could still check in with me if he thought it would help. He seemed surprised, and his face momentarily twisted from his usual grimace, it softened. "Well that changes things" he replied "you got two weeks."

Remembering my own recovery I found the accountability of the random UDS helped me avoid some unnecessary experiments. I had endorsed that any alcohol use would put me at risk, but I wasn't convinced about weed. I didn't care much for weed, and only smoked it little more than one a year but knowing it would be detected helped me put it out of my mind. I didn't like it much anyway so why even bother. Each successful screening was a boost to my confidence, my feelings of self efficacy increased, I began to address other issues that were getting in my way. I imagine this is the case for many in early recovery, at least those who achieve abstinence early on. Even some  that struggle at first seem to find encouragement in the first "clean" urine. One client who struggled for months with abstinence is now almost giddy when required to do a random screen. Each clean urine is like a liquid gold star that month after month marks his progress. 

But what about clients who are not as successful with abstinence goals? We test all the clients with the assumption that some of them are not accurately reporting their use. When the sceenings indicate the clients is using, we the clinicians provide interventions that provide the client with a more realist view of their use which results in greater compliance with the treatment program and more successful outcomes. There are many problems with this theory.

1) Getting the clients to submit to a screening can quickly become a power struggle. Most of the more explosive behaviors from both clients and staff that I have witnessed came as a result of such power struggles.

2) The interventions are often punitive and shaming. Even when the treatment team goes out of their way to be nurturing and supportive the clients who has been reporting abstinence can be devistated when caught in a lie. Rather than improve the clients treatment this may make the client feel isolated.

3) The tests are sometimes wrong. False positives happen. This can put even a high functioning clients at risk.

4) Perhaps the most disturbing aspect of the screenings is the assumption of guilt. Clients that are doing well and clients who try to hide the fact that they are struggling report the same thing. Truth must be proved and proved repeatedly or it doesn't exist. The message we send to clients is that addicts are inherently unworthy of trust, and the clients more than anyone take this to heart. What do we get for this, we learn what we already know, that some clients continue to use while others do not.

I am not arguing that drug screenings have no place in the treatment of chemical dependency. I am challenging chemical dependency professionals to examine the way they use the screenings and to ask themselves how much they are truly being used for the benifit those who come to us for help. 

To be continued...