Justice-involved clients pose challenges

It is becoming more prevalent for criminal courts, drug courts, family courts, and youth and family services agencies to order random drug and alcohol monitoring of individuals. Clients may be tested anywhere from weekly to monthly, often for periods of up to a year.

Hair testing has become a popular alternative to urine screens in this environment, because of its convenience, minimization of the threat of use of adulterants, and an extended “look back” period of three months for head hair and 12 months for body hair (urine screens go back only 72 hours to 4 weeks depending on the substance, the amount used, metabolism, and other factors). Testing nail clippings, with a look back of four to six months, also is becoming more popular in the courts, although it often takes much effort to convince justice system leaders to try newer procedures for testing.

Amid the more widespread use of testing in the judicial arena, those who work with justice-involved clients must be aware of several issues that can affect success in monitoring this population.

Client issues

Clients usually are annoyed or antagonistic about a court order to be drug tested. Under random testing, clients might see a familiar ID on an incoming phone call and not return the call for six to eight hours, or even until the next day. This will negate any possibility of “catching” an active alcoholic for testing, and it can buy an extra day of metabolizing one's drug of choice to fall below an established cutoff level, thus resulting in a negative.

Clients who are struggling financially are often unable to pay for testing. In my home state of New Jersey, there are no public funds available for mandated drug testing. Clients who do not pursue testing because of a lack of resources are declared noncompliant, and face added legal complications in their lives. This results in a missed opportunity in monitoring that would help protect families and the general population.

In addition, it is a frequent phenomenon to have clients test negative because their level is just below the cutoff, but of course these clients still have drugs in their systems. It is frustrating to try to convince attorneys and judges that the behavior of a person in this category is unchanged and inappropriate (and often poses a danger), even though the lab report shows a negative.

Technological opportunities

New technologies should continue to improve opportunities for monitoring justice-involved clients. There is a fairly new process for alcohol monitoring called ethyl glucuronide (EtG) testing. The test consists of a urine sample tested for the metabolite EtG. It has a look back of up to 80 hours. The concern at this point is that the sensitivity of this test is still too high. Any contact with internal or external alcohol will read as a positive, so any intentional or accidental use of a product such as hair spray or hand sanitizer will generate a positive.

It is vitally important for agencies that monitor clients who face life-changing consequences for positive tests not to use instant-testing “dipstick” devices offered by the “lowest bidder.” Too often there is no chain of custody and no confirmatory lab tests with these procedures—only a verbal “you're positive.” Unfortunately, this is a prevalent practice and many people fall victim to the consequences.

One of the attractive options available, to those who can afford the cost, is the hair test. “Hair follicle test” is a misnomer, by the way. In order to achieve a 90-day look back, the hair must be 1.5 inches in length, and it should be cut at the scalp from the crown area of the head.

Finally, there remains a critical need for research to find better ways to monitor alcohol intake in general. When our company receives a referral for this type of testing, I shudder as I anticipate the outcomes. If clients are drinking late into every night—endangering their children and others—and then go to sleep, they probably will be 0.00 or close to it when tested the next day on a state-of-the-art Breathalyzer.

I want to close by acknowledging the efforts of the Drug and Alcohol Testing Industry Association (DATIA). This organization has elevated the credibility of drug testing by working with governmental agencies and by offering education, training, and certifications. We need to continue to pursue testing systems that are accessible, accurate, and fair.