Screening and Assessment of Co-Occurring Disorders in the Justice ...

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frequency of drug testing may be tapered off as the individual demonstrates theability to remain abstinent.Drug testing can present some interesting challenges when working with justiceinvolvedindividuals who have co-occurring disorders. For example, among personswith mental disorders, drug testing can lead to distrust of treatment providersand reluctance to actively engage in treatment. It is important to carefullydiscuss drug testing expectations, parameters, and consequences, and to adhereconsistently to drug testing guidelines and to reconfirm these on a regular basis.This approach enhances the perception that drug testing is a part of the overalltreatment plan and is therefore a beneficial intervention.Frequency of Drug TestingTwo types of testing schedules are typically used once it is determined that drugtesting is appropriate for a particular individual (Robinson & Jones, 2000). Spottesting is usually performed if it is suspected that an individual is currentlyintoxicated and particularly if a certain incident or event occurs, such as a crimeor accident. These tests are unscheduled and use methods that can be administeredeasily and inexpensively on site. The most accurate types of testing to determinecurrent intoxication are either blood or saliva testing. A breathalyzer may also beuseful in this instance, as well as examination for physical and behavioral signs ofdrug effects, such as cognitive or hand-eye performance testing.Random drug testing allows programs to discourage use while minimizing thecost of consistent and frequent testing. Individuals do not know when they willbe called in for testing, and as a result they are less likely to tamper with the drugtesting process. Most often, participants are required to call in every morning tolearn if they have to submit to a drug test that day. If they are given such notice,they have to report for drug testing within 10–12 hours. Random drug testing isthe most controversial type of drug testing, but is the most effective at deterringuse because the threat of detection is very high. Critics of this method, however,feel that random testing introduces a presumption of guilt and should not beadmissible in court.Regardless of the schedule of drug testing, any on-site testing should be sent to alab for confirmation of a positive result to ensure the results are legally admissible.This is particularly important for alternative drug testing methods, such as hair,sweat, or saliva testing, which are less established procedures. Confirmatory labtesting is rarely performed, however, due to the expense of testing each individualtwice. Despite this, it is important to have the capability of confirming drugtesting, as it may become necessary to produce these results in court.Types of Drug TestingThe various types of drug testing provide differing levels of accuracy andeffectiveness and vary in their intrusiveness, but are generally quite reliable.Six types of drug testing are typically used in criminal justice settings: urine,blood, hair, saliva, sweat, and breath. Detailed information about each type ofdrug testing is included in Appendix A. Table 1 also compares key features, and17
advantages and disadvantages of the different types of drug testing. Standardprocedures used by most drug testing companies include the SAMSHA 5(previously known as the NIDA 5), which provides testing for five commonlyused illegal drugs whose detection was standardized by the National Institute onDrug Abuse (NIDA) because of their frequency of use (Clark & Henry, 2003). TheSAMSHA 5 includes:•y•y•y•y•ycannabinoids (marijuana, hash)cocaine (cocaine, crack)amphetamines (amphetamines, methamphetamines, speed)opiates (heroin, opium, codeine, morphine)phencyclidine (PCP)Standardization of drug testing procedures occurred while NIDA was responsiblefor overseeing the National Laboratory Certification Program (NLCP), whichcertifies all nationally recognized drug testing laboratories. This organization isnow under the jurisdiction of the Substance Abuse and Mental Health ServiceAdministration (SAMSHA), a division of the U.S. Department of Health andHuman Services. These five categories of drugs, however, do not cover the fullspectrum of drugs used in the U.S., so many certified drug testing laboratoriesTable 1. Comparison of Alternative Drug Testing MethodologiesSample18Invasiveness ofSample CollectionDetectionTimeUrine Intrusion of privacy Hours todaysBlood Highly invasive Hours todaysHair Noninvasive Weeks tomonthsSweat Noninvasive Days toweeksSaliva Noninvasive Hours todaysCutoff Levels Advantages Disadvantages CostYesVariable limitsof detectionVariable limitsof detectionScreeningcutoffsVariable limitsof detectionBreath Noninvasive Hours No, except forethanolHigh drugconcentrations;establishedmethodologies;quality control andcertificationCorrelates withimpairmentPermits long-termdetection of drugexposure; difficultto adulterateLonger time framefor detection thanurine; difficult toadulterateResults correlatewith impairment:provides estimatesof blood levelsEthanolconcentrationscorrelate withimpairmentCannot indicateblood levels; easyto adulterateLimited sampleavailability;infectious agentPotential racialbias and externalcontaminationHigh inter-individualdifferences insweatingContamination fromsmoke; pH changesmay alter sampleVery short timeframe for detection;only detects volatilecompoundsLow to moderateMedium to highModerate to highModerate to highModerate to highLow to moderateSource: Robinson, J. J., & Jones, J. W. (2000). Drug testing in a drug court environment: Common issues toaddress (NCJ Publication 181103). Washington, DC.
Page 1: Screening and Assessmentof Co-Occur
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Page 32 and 33: should be determined by the severit
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Page 36: suicide screening is important for
Page 39 and 40: Maintaininga staff ofdiverse ethnic
Page 41 and 42: The MHSF-III and the GAIN-SS were f
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Page 45 and 46: •y•y`` Vocational and education
Page 47 and 48: approximately two hours. Either the
Page 49 and 50: Texas Christian University Drug Scr
Page 51 and 52: & Cirimele, 2006). Hair testing can
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Page 55 and 56: Suicide Probability Scale (SPS)The
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Page 67 and 68: Availability and CostThe CAMH-CDS i
Page 69 and 70: and one Axis II disorder (antisocia
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•yThe instrument has not been use
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Appendix H: Screening Instruments f
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Positive Features•y•y•y•y
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have you felt you ought to Cut down
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Concerns•y•y•yThe DALI was de
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Concerns80•y•y•y•y•y•y
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Concerns•y The validity of the SS
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Appendix I: Recommended Instruments
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Concerns•y•y•y•yReliabiliti
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•y•y•y•yScales and profile
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•y•yand non-interpretable resul
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Appendix L: Assessment Instruments
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Philadelphia, PA 19106, (215) 399-0
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treatment setting. Treatment progra
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Concerns•y•y•yThe CIDI is qui
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•y•y•yThe PDSQ has been used
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Both a Research Version and a Clini
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Bastiaens, L., Riccardi, K., & Sakh
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Carey, K. B., Carey, M. P., & Chand
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Demmel, R., Beck, B., Richter, D.,
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Gray, B. T. (2001). A factor analyt
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Kessler, R. C., Wittchen, H. U., Ab
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McLellan, A. T., Cacciola, J. S., &
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Nochajski, T. H., & Stasiewicz, P.
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Rollnick, H., Heather, N., Gold, R.
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Teitelbaum L. M., & Mullen, B. (200
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Zimmerman, M., & Sheeran, T. (2003)
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