Urine Drug Testing ~ Behavioral Health

LABORATORY TESTING IN BEHAVIORAL HEALTH

The use of psychoactive substances is a common experience associated with significant morbidity and mortality. Laboratory testing to identify clinical complications resulting from substance use disorders is an integral component of addiction recovery care.

DRUG TESTING AND PATIENT OUTCOMES

The decision to use this tool is grounded in the principles of improved patient care and outcomes. While evidence is limited that the use of drug testing in addiction treatment improves patient outcomes, ASAM’s expert panel cited extensive clinical experience supporting the use of drug testing to improve patient outcomes.

Two 2014 studies illuminated the currently unrealized role of drug tests in addiction treatment. Blum and colleagues looked at whether drug test results are useful indicators of patients’ progress in treatment and concluded testing for both prescribed addiction medications and illicit drug use can improve a provider’s ability to determine the effectiveness of the current treatment approach [7]. Drug testing should be used widely in addiction treatment settings and its use should be integrated into the process of making treatment decisions.

 DRUG TESTING AND EVIDENCE-BASED THERAPY

Although drug testing in addiction treatment settings is common, providers have heretofore received very limited guidance on how drug testing should be integrated with evidence-based addiction treatment.

The most extensively researched behavioral therapy used in conjunction with drug testing is contingency management. Contingency management can involve tying behavioral incentives to the result of a drug test and has been shown to be an effective approach to addiction treatment [9]. It is clear that the contingency management model fits well with drug testing [10] and the expert panel recommends combining the two. When using drug testing as part of contingency management, providers should also seek self-reported information from patients about substance use.

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DOWNLOAD ASAM’s Appropriate use of drug testing in clinical addiction medicine

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SUBSTANCE USE DISORDERS

There is an array of terms used to describe substance use disorders.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) divided these disorders into “substance abuse” and “substance dependence.” The DSM-5 has changed this into a single category: “substance use disorder,” with a spectrum of severity depending on the number of criteria met.

The World Health Organization’s International Classification of Diseases (ICD), the latest version of which is the ICD-10 divides them into two categories: “harmful use” and “dependence syndrome.”

Diagnostic codes for “mental and behavioral disorders” begin with the letter F and those due to “psychoactive substance use” begin with F10– F19, depending on the substance involved.

The substances are as follows: (F10) alcohol, (F11) opioids , (F12) cannabinoids, (F13) sedative hypnotics, (F14) cocaine, (F15) other stimulants, including caffeine, (F16) hallucinogens, (F17) tobacco, (F18) volatile solvents, and (F19) other psychoactive substances.

The codes are then categorized as follows: (F1x. 0) Acute intoxication, (F1x. 1) Harmful use, (F1x. 2) Dependence syndrome, (F1x. 3) Withdrawal state, (F1x. 4) Withdrawal state with delirium, (F1x. 5) Psychotic disorder, (F1x. 6) Amnesic syndrome, (F1x. 7) Residual and late-onset psychotic disorder, (F1x. 8) Other mental and behavioral disorders, and (F1x. 9) Unspecified mental and behavioral disorders.

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