How Substance Use Testing and Treatment Work
Testing
Substance use testing makes use of technology to detect ingestion of alcohol or illegal substances. Testing of the urine, sweat, or breath of an individual are examples of testing methods that are randomly administered to help monitor and detect drugs and/or alcohol use. [1]
Substance Use Testing
Urine Testing
There are two main types of urine testing for the use of illegal substances: (1) immunoassay, and (2) gas chromatography/mass spectrometry (GC/MS). Often, immunoassay testing is used as a first-level screening, with GC/MS being used to confirm a positive screen.[2]
Below are three examples of urine testing methodologies used by federal probation and pretrial services offices:
(1) Non-Instrumented Drug Test (NIDT) Devices
NIDTs are handheld immunoassay testing devices that are available in many forms, including cups, cassettes, slides, and dipsticks. NIDTs are used for the first level of urine screening. If a result is positive and contested by the person under supervision, the sample must be submitted to the national drug testing laboratory for GC/MS confirmation.
(2) On-Site Laboratories
On-site laboratories use instrumented immunoassay testing devices that are used for the first level of screening. If a result is positive and contested by the person under supervision, the sample must be submitted to the national drug testing laboratory for GC/MS confirmation.
(3) National Drug Testing Laboratory
The contracted national drug testing laboratory provides immunoassay, specimen validity testing, and GC/MS confirmation.
Sweat Patch Testing
The sweat patch is a device that detects the presence of drugs in perspiration.[3] Although it does not produce the immediate results of on-site urinalysis, the methodology provides a means of continuous detection and is less intrusive for officers and persons under supervision.
Alcohol Testing
Breath Testing
Breath testing can be done to detect alcohol in a person’s body. The testing is administered by an officer or a treatment program.
Urine Testing
Urine testing for alcohol can be done the same way as urine testing for the use of illegal substances, as described above. However, urine testing for alcohol, even if random, is unlikely to provide an accurate window of use because alcohol leaves the body quickly, at a rate of approximately one ounce per hour.
Alcohol Monitoring Devices
Alcohol monitoring devices (AMD) allow individuals with abstinence conditions to be continuously monitored for alcohol use. AMDs include both remote alcohol testing devices and transdermal alcohol monitoring devices.
Available Treatment Services
There are many judiciary treatment services available for use by federal probation and pretrial services offices for substance use disorder, as well as additional services available for co-occurring disorders.
Both inpatient and outpatient services may be available, depending on the individual’s geographic region. Outpatient services, commonly known as community-based treatment services, may include therapy sessions or self-help groups. These outpatient services are appropriate for individuals whose substance use disorder can most effectively be treated in an outpatient setting. Inpatient treatment tends to be more costly than outpatient services, but inpatient treatment may be preferred method for individuals exhibiting particularly severe addiction.
The following chart summarizes the major services currently available for persons on federal supervision:
| Program | Overview | When to Use |
|---|---|---|
| Case Management Services | Methods of coordinating the care and services of those with substance use disorder. | Linking a reentry program to the clinicians and service providers who are involved with the care of those under supervision. |
| Intake Assessment and Report |
A comprehensive biopsychosocial intake assessment and report conducted by a state certified substance use disorder counselor or a clinician who meets the standards of practice established by his or her state’s regulatory board. The assessment is based upon the most current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), as well as the person under supervision’s strengths, weaknesses, and readiness for treatment. |
Identifying the substance use severity of the person under supervision. |
| Manualized Cognitive Behavioral Group Counseling |
Cognitive behavioral counseling groups led by a trained facilitator that offer a structured approached to address the criminal thinking component of substance use. Examples include: Moral Reconation Therapy®, Thinking for a Change®, Choices & Changes®, and The Change Companies®. |
Addressing substance use issues through specifically designed curriculum that aids in interventions with a person under supervision who has a substance use disorder.[4] |
| Substance Use Counseling |
Clinical interactions between the person under supervision and a trained and certified counselor. The interactions are deliberate and based on various clinical modalities. Clinical interactions can include: individual counseling, group counseling, family counseling, group family counseling, intensive outpatient counseling, and a treatment readiness group. |
Changing behavior in a person with a substance use disorder. |
| Integrated Treatment for Co-Occurring Disorders | An integrated treatment service that provides individuals with substance use counseling and mental health services. The individual receives treatment from the same clinician and/or team in the same location to address both substance use disorders and mental health issues. | Helping individuals with co-occurring disorders, such as substance use and mental health disorders. |
| Residential Substance Use Treatment | In-house residential treatment facility where an individual remains for the duration of the program. | Providing a highly structured environment that incorporates counseling, drug testing, and other approaches that involve cooperative living for people receiving treatment. |
| Medication-Assisted Treatment | The use of medications in combination with counseling to treat specific forms of a substance use disorder. | Providing physical stabilization to improve the success of treatment when traditional therapies are not effective in isolation. |
As noted above, medication-assisted treatment (MAT) is one service available to persons on federal supervision who suffer from substance use disorders. MAT can provide the necessary physical stabilization to improve the success of treatment of alcohol use disorder and opioid use disorder when traditional therapies in isolation are not effective. Below is a chart summarizing the most used medication for MAT services:
| Drug Name | Treatment Use | How It Works | Distribution Center | Objective |
|---|---|---|---|---|
| Methadone | Opioid use disorder | Full opioid agonist* |
Only in federally approved opioid treatment programs. Typically, the individual needing the medication must take it at the clinic where it is dispensed. |
All opioid receptors on nerve cells in the brain are fully activated, resulting in a relief of cravings, blocking of the euphoric effects associated with opioids, and preventing withdrawal. |
| Buprenorphine | Opioid use disorder | Partial opioid agonist** | Physicians who obtain specialized training may prescribe it at their private practice or their affiliated substance use disorder treatment facility or programs. | Opioid receptors on nerve cells in the brain are activated until a plateau is reached and maintained, reducing cravings and causing those with opioid addiction to not experience withdrawal symptoms. |
| Naltrexone | Opioid use disorder | Opioid antagonist*** | It may be prescribed by a licensed physician. | Opioid receptors on nerve cells in the brain are blocked, thereby preventing neurons from responding to opioids. This ultimately results in a reversal of the effects of opioids and aids in the prevention of relapse. |
* An opioid agonist is a drug that activates the opioid (mu) receptors on nerve cells in the brain. A full opioid agonist continues to produce effects on the receptors until all receptors are fully activated or until the maximum effect is reached.
** A partial opioid agonist is a drug that activates the opioid (mu) receptors, but not to the same extent as a full agonist. The effects increase until a plateau is reached.
*** An opioid antagonist is a drug that binds to the opioid receptors with greater affinity than agonists but blocks the receptors instead of activating them.
Last Updated: March 2020
Explore the other sections of the Substance Use Testing and Substance Use Disorder Treatment Reference Guide.
[1] For persons on post-conviction release pursuant to a conviction for a felony or offense described in 18 U.S.C. § 3563(a)(4), the Director of the AO, under 18 U.S.C. § 3608 and in consultation with the Attorney General and Secretary of Health and Human Services, must, if funding is available, establish a program of drug testing of federal offenders on post-conviction release. The program must include standards and guidelines that the Director determines necessary to ensure the reliability and accuracy of the drug testing programs. The chief probation officer of the judicial district must arrange for the drug testing.
[2]18 U.S.C. § 3563(e) and 18 U.S.C. § 3583(d) require that a drug test confirmation for an initial positive test result be a urine drug test confirmed using gas chromatography/mass spectrometry techniques or another test that the Director of the AO, after consultation with the Secretary of Health and Human Services, may determine to be of equivalent accuracy. Other than the sweat patch, liquid chromatography/mass spectrometry, and liquid chromatography/mass spectrometry/mass spectrometry, no other types of testing have been approved for use.
[3]18 U.S.C. § 3563 requires that a urinalysis test be confirmed by GC/MS or any other test that the Director of the AO, in consultation with the Secretary of Health and Human Services, determines to be of equivalent accuracy. Sweat patch testing has met this approval.
[4] To ensure that officers have a common understanding of evidence-based practices, including cognitive behavioral techniques, the AO contracted with the University of Cincinnati Corrections Institute (UCCI) in 2016 to develop curricula for four audiences (treatment providers, officers, persons under supervision, and the families of persons under supervision) in five areas. Four of the areas pertain to the leading criminogenic needs identified in the federal supervisee population: antisocial thinking, antisocial networks, education and employment deficits, and alcohol and drug abuse. The fifth area relates to mitigating the risk of violence. The curricula supplement treatment provider and officer knowledge of how to address criminogenic needs and provide persons under supervision and others in the person’s social network with resources that address specific criminogenic needs.