Laboratory Testing for Substances of Abuse

DAVID A. BARON D. ANDREW BARON STEVEN H. BARON

For the professional working in clinical settings and in consultative roles (including sports, criminal/forensic, and occupational settings), there will always be a need for corroborative sources of information. Testing of human tissues usually provides invaluable, albeit not definitive, information in working with substance-using individuals. This information may assist in diagnostic or in therapeutic decisions, which are especially important in this population, because drugs are illegal and drug-abusing individuals often present in denial of their problem. Furthermore, this is particularly relevant when comorbid psychiatric symptoms are present. Drug testing can also aid in determining whether presenting symptoms are primarily psychiatric or substance-induced. Drug testing may be utilized as part of an initial treatment contract between the patient and treating clinician. Coercion often helps to improve treatment outcomes. This is especially so in methadone maintenance programs, where testing is typically mandatory. There is evidence to suggest that testing deters use. For example, prior to testing in 1981, 48% of military personnel used drugs, but this rate declined to 5% after 3 years of testing, and this appears to have occurred among athletes as well.

A number of questions must be contemplated before settling on a final decision:

1. For what drugs ought we to test?

2. What biological sample should be tested: urine, blood, sweat, saliva, hair, and so forth?

3. How fast do we want to see the results?

4. How much of our resources should be spent on testing?

This chapter reviews testing methodologies and the fundamental aspects of planning effective testing procedures in both clinical and consultative settings.

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