Counselors’ Clinical Use of Definitive Drug Testing Results in Their Work with Substance-Use Clients: a Qualitative Study

Abstract

We conducted a psychotherapeutic examination of the use of definitive drug testing (liquid chromatography with tandem mass spectrometry) in the treatment of substance use disorders (SUD). Employing a generic qualitative method (Caelli et al. in International Journal of Qualitative Methods, 2(2), 2003; Merriam, 2009) we asked SUD counselors to provide narratives about cases where drug testing had revealed new or unexpected information about clients’ drug-taking behaviors. Semi-structured interviews with 12 SUD counselors were conducted by phone and analyzed for themes derived from the literature. These counselors reported many new positive drug tests in clients previously believed to be adherent with treatment. Key themes assessed in counselors’ narratives included initial client denial that was often followed by later acknowledgement of relapse and increased motivation, at times presenting new opportunities for clients to engage in treatment and enhance the therapeutic alliance. These results suggest that definitive drug testing can be used in a non-stigmatizing and therapeutic manner.

Opioid safety recommendations in adult palliative medicine: a North American Delphi expert consensus

“…However, widespread adoption of UDT is likely limited by their availability and cost, clinician knowledge about UDT result interpretation, and negative association with use in criminal situations. 44 45 Further research is highly recommended to determine which patients receiving PC should have UDT and at what frequency, especially in outpatient PC clinics. The other identified high-priority research areas are about use of pill counts and use of screening tools and DSM-5 OUD criteria to identify patients with life-limiting illnesses who have OUD and are at a high risk of opioid-related overdose.…”

“…These non-invasive tests can be used to monitor prescription opioid therapy compliance and detect non-prescribed and illegal drug use. However, widespread adoption of UDT is likely limited by their availability and cost, clinician knowledge about UDT result interpretation, and negative association with use in criminal situations 44 45. Further research is highly recommended to determine which patients receiving PC should have UDT and at what frequency, especially in outpatient PC clinics.…”

Enacting Alcohol and Other Drug (Testing)-Related Harms in an Australian Drug Court

“…Originally used in the military with returned Vietnam veterans (Campbell, 2005; Paik, 2006), alcohol and other drug testing has since extended to a variety of environments. It is now used in employment (American Society of Addiction Medicine, 2013), schools (Mosher & Akins, 2014), sports (Wilson & Derse, 2001), social services (Wincup, 2014), child custody (Campbell, 2005), addiction treatment (Rzetelny et al, 2016), and in the criminal justice system (Powell, Bankart, Christie, Bamber, & Arrindell, 2009; Seddon, 2005; Singleton, 2008; Wish & Gropper, 1990). According to Wish and Gropper (1990), this testing achieves four goals in the criminal justice system: detection of recently ingested substances, identification of “chronic” alcohol and other drug users, monitoring and deterrence of consumption among those on parole or community-based justice system populations.…”