Patients With an SUD

If the practitioner is providing substance abuse treatment for Substance Use Disorder (SUD), Urine Toxicology Testing can:

  • Objectively monitor abstinence from drugs or alcohol;
  • Monitor response to treatment;
  • Corroborate self-reports;
  • Help address denials of substance use; and
  • Identify relapse to substance use.

The patient and practitioner need to negotiate a plan of action to address the patient’s substance use and monitor progress. Any medical problem other than substance use should also be monitored, as should any abnormal biological markers.

A practitioner using drug tests may seem intrusive to some patients, whereas other patients welcome the discipline imposed. The practitioner and patient should negotiate the use of any form of objective monitoring beyond self-reports of substance use. Biological monitoring should be viewed as an informative measure, not cause for punitive action against the patient. Repeated positive urine drug test results mean that the treatment plan is not working and that another approach should be considered.

Monitoring treatment compliance is a trust issue, and trust is important for the development of the therapeutic alliance. The practitioner needs to create an environment in which the patient feels safe to report honestly how he or she is progressing in recovery. Relapses are a normal part of the natural history of recovery, and how the practitioner responds to them is essential to building a therapeutic alliance and trust. The practitioner should be clear early on that addiction leads some patients to be dishonest about their drug use, so a policy of “trust yet verify” is used—drug testing and corroboration from family can help verify the patient’s reports.

If positive results continue and the patient is not progressing, the patient may need referral to more intensive treatment. However, if the patient readily admits to a relapse and seems fully committed to continuing treatment, the practitioner should support the patient’s recommitment to recovery. Each patient needs to be assessed as an individual.