Published in The Doctor Weighs In, February 11, 2020. View the Article Here
There are many problems with how we approach the disease of addiction. A particularly troubling one from a medical perspective is the practice of random drug testing. This method of monitoring tends to treat many addiction sufferers punitively, instead of effectively addressing the underlying disease of addiction.
If we want to change the course of the addiction crisis in America changing the way we conduct drug testing should be an aspect we carefully consider. There are methods we can apply to substance use disorder (SUD) recovery, whether it coincides with an actual criminal offense or not, that would do away with the punitive approaches that are now ubiquitous in the treatment industry. Moreover, implementing more data-driven positive reinforcement methods would help reduce the stigma which is so damaging and hinders better treatment outcomes.
First step: Eliminate ‘Random’ Drug Testing
A healthy start to a transition away from punitive practices would be ending “random” drug testing and replacing it with planned and regular drug testing. Planned and regular drug testing fits within a strength-based clinical approach to treating the disease of addiction.
All other chronic diseases, like cancer or diabetes, have some form of ongoing deliberate and consistent testing in order to manage the condition. If we approached drug testing in the same way, it allows us to gather better data, helps to normalize the SUD diagnosis, and creates a trustworthy standard across the treatment spectrum in patients, their families, treatment providers, and officials.
This idea of “random” drug testing being counterproductive is not actually new by any means. This makes our current system seem even more archaic and outdated.
The United States military replaced “random” drug testing with what has been termed “consistent drug testing” almost a decade ago. This method has been used with incredibly effective results to treat certain service members suffering from SUD.
Dr. Kevin MacCauley, who started the Institute for Addiction Study, was first exposed to the military’s approach to drug testing and recovery from SUD while serving as a naval flight surgeon for airborne divisions of the Marine Corps. In this role, he witnessed many pilots self-report their addiction, get necessary medical treatment, and be returned to flying status under monitoring. As he puts it:
“These were charismatic and otherwise highly-capable, self-disciplined pilots who did come forward and ask for help – and they all got better and went back to flying! That just destroyed the prejudice I had picked up in medical school that addicts never ask for help and once an addict, always an addict.”
The willingness of these service members to be so forward about their addiction struggles was due, in large part, to the Navy’s policy of treating SUD primarily as a safety issue rather than a moral or criminal issue. Their treatment outcomes numbers far exceed those of the addiction treatment industry. So perhaps at the civilian level, we should adopt at least some of those measures to more effectively combat the addiction crisis in America.
Drug testing as a common practice in America, to some degree, finds its roots in the military. This is interesting given that the military is also leading a positive reform to the practice they introduced. After the Vietnam War, the military had to figure out how to deal with the plethora of veterans that came back home addicted to heroin.
This issue created the initial practice of monitoring recovering veterans through random drug testing. Unfortunately, the parts of civilian society which adopted this seemingly logical solution to monitoring substance abuse did so without the same infrastructure or goals of the American military.
Drug testing, by and large, was adopted by civilian society as a marker for punitive action. This is true in the justice system, the workplace, and other areas of society. Because of this, the first exposure that many individuals have to a SUD diagnosis is as a result of criminal charges or a punitive measure on behalf of employers.
This has created a system in the addiction treatment continuum that exacerbates the punitive aspects of treatment and monitoring, instead of focusing on the disease, its’ symptoms, and the legal and behavioral consequences that led to trouble in the first place. This creates a sort of endless cycle of negative reinforcement surrounding a SUD diagnosis.
Often, people, under this type of stress and threat, seek to hide the initial onset of the problem and their progressive suffering over time. The potential shame, embarrassment, and devastating effects of losing employment or going to jail actually keeps the addiction in the dark where it grows and becomes worse over time.
Random drug testing and the punitive actions that follow create a culture of secrecy and shame that keep people from reaching out for meaningful help. An entire industry has developed in support of hiding drug use and people spend significant resources in buying products to hide their use.
Because of this culture some SUD individuals entering treatment, either by choice or as a legal repercussion, directly associate any type of ongoing substance use monitoring as a punitive measure.
In addition, many times people in recovery are under threat of legal, financial, or other repercussions if they do relapse. This low or no threshold approach to relapse in recovery is one of the worst ways to approach treatment for any type of condition with a mental component. Especially for a chronic disorder like addiction that generally has been created in some part by past negative social determinants.
Beyond those who are introduced to their SUD diagnosis through legal trouble, even those who come to treatment as a result of family, friends, or professional environments—the idea of “random” drug testing inherently creates a negative consciousness. This is no surprise given the social image that’s been created around drug testing. This culture of testing deters people from entering treatment earlier or being forthcoming about substance issues they may have. This is because the system is built around punitive and psychologically discouraging measures.
Ongoing drug testing and extended recovery support can be approached in a more clinical manner through frequent and deliberate testing. This would reduce some of the negative aspects associated with our current system.
Instead of random drug testing, an individual in recovery would participate in consistent drug testing. This would be administered on an ongoing scheduled basis, and they would know the exact schedule on which they would be tested.
This is a more effective approach for multiple reasons, including:
Some might criticize this approach by saying if an individual in recovery knows exactly when they will be tested, then they are more likely to “cheat” on the test or resort to quick detox methods. However, the available data from this type of drug testing seems to show that the opposite is true. The Institute for Addiction Study conducted trials utilizing almost this exact type of approach and have shown more positive impacts on addiction recovery outcomes as a result.
Regardless, our current testing methods do not display outcomes data that support continuing to pursue those same methods if our goal is indeed to improve recovery. Any transition can bring with it unexpected bumps in the road. This would be countered by observing longitudinal data and adjusting testing methods over time.
Any responsible method of treatment is created and maintained through a foundation of positive longitudinal outcomes data. So, once we replace random drug testing with consistent drug testing there needs to be systems in place to monitor the outcomes data of those involved in such drug testing.
With any other disease that health care providers have eradicated or improved outcomes for, there has been an adjustment period for treatment methods that led to more positive outcomes. As of now, random drug testing is the primary monitoring option that we utilize, and the results of this method are not good. Consistent drug testing needs to be implemented on a larger scale so that we can test the efficacy of this method and the positive benefits it could hold in our efforts to combat the addiction crisis that is currently taking so many American lives.
In addition to implementing consistent drug testing on a larger scale, we also should utilize the data we already have from military treatment to educate the general public about the positive benefits of treating addiction as a chronic disease, a public safety issue, and not a moral failing. This would help destigmatize the disease of addiction further and help those who suffer silently in active addiction to be more willing to come forward and receive treatment.