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

CHAPTER 4Laboratory Testingfor Substances of AbuseDAVID A. BAROND. ANDREW BARONSTEVEN H. BARONFor the professional working in clinical settings and in consultative roles(including sports, criminal/forensic, and occupational settings), there willalways be a need for corroborative sources of information. Testing of human tissuesusually provides invaluable, albeit not definitive, information in workingwith substance-using individuals. This information may assist in diagnostic orin therapeutic decisions, which are especially important in this population,because drugs are illegal and drug-abusing individuals often present in denial oftheir problem. Furthermore, this is particularly relevant when comorbid psychiatricsymptoms are present. Drug testing can also aid in determining whetherpresenting symptoms are primarily psychiatric or substance-induced. Drug testingmay be utilized as part of an initial treatment contract between the patientand treating clinician. Coercion often helps to improve treatment outcomes.This is especially so in methadone maintenance programs, where testing is typicallymandatory. There is evidence to suggest that testing deters use. For example,prior to testing in 1981, 48% of military personnel used drugs, but this ratedeclined to 5% after 3 years of testing, and this appears to have occurred amongathletes as well.A number of questions must be contemplated before settling on a finaldecision:63