Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

346 IV. SPECIAL POPULATIONSemployer to the proximity of the work location to areas high in drug trafficking.One should even determine the type of beverages served at company functions.There may be a need to discuss perceptions of permissiveness and of the actualwritten or unwritten consequences of legal or illicit substance use during workhours.Is some cases an organization may choose to become a “drug-free workplace.”The implications of this go beyond psychiatric consultation and requirelegal advice. The Drug Enforcement Agency (2004) has provided a guidelinefor implementing this standard.Random Drug TestingPreemployment and periodic mandatory, random urine testing for illicit drugshas become a controversial topic in recent years. The main argument in favorof mandatory urine testing is deterrence of illicit drug use, both at work and athome. Random testing is mandated by federal regulations for the transportationindustry, for example. Those who are opposed to mandatory urine testing saythat it is a violation of constitutional rights to privacy. And even with safeguards,concerns are also raised about reporting errors and potential breaches ofconfidentiality. An employee’s right to privacy must be balanced with society’sbest interests. As mentioned earlier, any testing program needs to be developedin concert with legal consultation.The third party must be reminded that urine tests do not distinguish druguse from drug abuse or dependence. This can only be done with a comprehensivemedical and psychiatric history, and physical examination. At best, laboratorytests are adjunctive and provide diagnostic confirmation. It is accepted inthe treatment community that urine testing is a useful adjunct in the treatmentof the drug-dependent individual, but not all drug users are abusers.Nonrandom TestingThere are a number of situations in which testing is done on a nonrandombasis, including when there is reasonable suspicion, after an accident or violence,or as a part of a posttreatment follow-up. Employees seem to favor testsfollowing accidents (Howland, Mangione, Lee, Bell, & Levine, 1996).Brief InterventionsAfter an assessment has been made, brief interventions are sometimes the requisitenext step. It can be immensely helpful to have the individual’s family be apart of the intervention. The family is the mediator between the individual andhis or her culture, and the family environment is where attitudes toward drugsare first learned.