In 2013, approximately 21.6 million Americans aged 12 and older met the criteria for substance abuse or dependency, as reported by the National Survey on Drug Use and Health (NSDUH).
Denial of a drug or alcohol problem is common in those battling a substance abuse disorder. A drug test can be a fairly accurate indication if substance abuse is occurring, and it may also be a useful tool to keep people from abusing substances in the first place. Drug testing can also hold those in recovery from a drug or alcohol abuse disorder accountable, thus potentially preventing relapse.
Drug tests may be used for a variety of reasons and administered in order to protect the health and safety of those who may be suffering from substance abuse and those surrounding them. Many employers require drug tests in order to ensure safety in the workplace, for example, and law enforcement officers may administer drug tests if impaired driving is suspected. Courts may mandate drug testing for certain offences, and sports teams or organizations may use drug tests to check for performance enhancers as well as substance abuse.
Drug tests may be used during an intervention as a tool to help a loved one seek treatment for a problem with drugs or alcohol.
It may not be easy to get a loved one to submit to a drug test, however. If being used during an intervention in order to get someone into rehab, drug testing should be a part of a more complete and well-planned intervention model that includes specific consequences if the agreed-upon actions are not followed. It is important to realize that not all drug tests are created equal, and that drug tests are not 100 percent reliable all the time. A positive, or negative, result may not be a complete indicator of a substance abuse disorder or lack thereof. Drug tests may, however, be a useful part of a more complete treatment model, as a method of helping someone to realize the need for treatment and maintaining honesty during rehab and recovery.
Types of Drug Tests
There are six main methods of drug testing, per the Substance Abuse and Mental Health Services Administration(SAMSHA):
- Urine: tests for the presence of drug metabolites in urine for a few days after ingesting
- Breath: breath-alcohol test determines the amount of alcohol currently in the bloodstream, or blood alcohol concentration (BAC), for a few hours after consumption
- Blood: can test for current levels of drugs or alcohol in the bloodstream for a short window of time, usually a few hours
- Hair: can provide a complete drug history for up to 90 days, not including current levels of impairment; longest testing window
- Oral fluids: can detect drugs currently in the system by a swab of saliva from the inner cheek, usually for a few hours after ingesting drugs
- Sweat: tests for the presence of drugs through a skin patch as long as the patch is worn, typically around seven days
Drug tests may be administered in clinics, at laboratories, in hospitals, at treatment facilities, or even at home. Federal guidelines set up by SAMHSA regulate drug testing for federal drug and alcohol programs and send samples to certified laboratories that follow rigorous testing procedures that increase the accuracy of the tests. These tests generally only test for five illicit drugs, including amphetamines, opiates, cocaine, THC, phencyclidine, and sometimes alcohol. Other panels may be ordered and the traditional eight-panel test will add benzodiazepines, barbiturates, and methaqualone to this list, while a 10-panel test adds methadone and propoxyphene. Other tests may also detect hallucinogens, inhalants, MDMA, anabolic steroids, or hydrocodone.
Urine testing is generally the most popular method of testing for illicit drugs, while testing breath is usually the most common way to determine the presence of alcohol. Not all the testing methods test for all types of substances, and each has different accuracy levels. The different types of tests will detect the presence of different substances depending on the half-life of the substance, type of test administered, and duration of abuse. Substances are detectable for longer periods in chronic abusers.
Urinalysis may detect amphetamines, methadone and barbiturates for two to four days, and marijuana, cocaine, codeine, and heroin for one to three days for occasional users. It can detect use for up to 30 days for chronic marijuana users and 12 days for chronic cocaine abusers, phencyclidine for two to seven days for occasional users and up to 30 days for chronic users, and benzodiazepines may be detectable for up to 30 days for long-acting benzodiazepines, as published in the Treatment Improvement Protocol by SAMSHA.
Accuracy of Drug Tests
A urinalysis is likely the most common form of drug test as it is usually the cheapest and one of the easiest to administer – all you have to do is urinate into a cup. Initial drug screening usually utilizes an immunoassay test that can rapidly detect the presence of cocaine and marijuana. It may be less accurate in detecting amphetamines and opioids, according to American Family Physician.
Certain medications or vitamin supplements may interfere with the validity of this test. Drug tests may provide false negative results as much as 10 to 15 percent of the time and false positives five to 10 percent of time, as reported by CBS News. Oxycodone and some sedative or hypnotic drugs may be regularly missed while cold medications or antibiotics may cause a false-positive result. Urinalysis drug testing kits can be purchased over-the-counter and used at home as an initial test with a fair amount of accuracy if used correctly.
If a positive result is obtained via an immunoassay screening test, often a more detailed chromatography test is ordered. This test is more expensive and takes longer to produce a result, but it is more accurate. Urine tests are also often tampered with or attempted to be beat by adding chemicals to the urine, diluting it with water, or ingesting substances that are known to interfere with the test. Many drug and alcohol facilities will require testing to be monitored closely in order to avoid tampering.
Hair tests may be more accurate than urine tests and provide a bigger drug abuse picture, although they are more expensive. Since hair grows slowly, it can take a few weeks for drugs to appear in hair follicles. Blood tests may be better at detecting drugs than urinalysis as well, although drugs may pass quickly from the bloodstream and only be detectable for a few days.
Oral drug tests may be very accurate at detecting amphetamines, cocaine and marijuana and determining current levels of impairment, although drugs are also not detectable for as long in saliva as they are in urine.
Sweat tests are administered by placing a large adhesive type bandage with a gas-permeable membrane directly on the skin and leaving it there for around a week. This test may a reliable way to determine compliance in a drug rehabilitation program, as reported in Current Medicinal Chemistry.
Drug Tests in Rehab and Recovery
Drug tests are used throughout the drug rehab and recovery process for a variety of reasons. Drug tests are generally administered prior to admission to a drug or alcohol program in order to determine the level of substances currently in one’s system and what they may be. Addicts may not be entirely honest when entering a program, and it is important to know what drugs may be in the system before facilitating detox or administering adjunct medications during treatment. Drugs may interact with each other, causing unintended and dangerous side effects; therefore, it is important to have a clear picture of exactly what and how much might be in the system before treatment can begin.
Drug testing may also be utilized at regular or random intervals during rehab and recovery in order to keep individuals accountable, honest and drug-free during treatment. Random drug tests are harder to predict and therefore harder to beat. Drug testing may also prevent dangerous relapsing episodes. Outpatient and inpatient treatment programs alike may use drug testing for positive reinforcement.
Drug testing is not a treatment method, but rather a tool that can be used before and during rehab and while in recovery to facilitate and encourage an abstinent lifestyle. Detox may be the initial step in a drug or alcohol treatment program after a positive drug test. After reaching a stable physical balance, behavioral therapies, individual and group counseling sessions, and peer support groups will all be incorporated into a successful treatment plan in order to facilitate a successful recovery program.
Drug testing may be more frequent at the beginning of treatment and less frequent during recovery. Drug tests can be specified to include certain or particular drugs of abuse as well.
The Oaks at La Paloma is a state-of-the-art substance use disorder treatment facility that offers comprehensive and individualized recovery plans. Call us to learn more about how drug testing can factor into your recovery plan.