Credibility in Urine Screening by Gary D. Carr. MD, Medical Director

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Credibility in Urine Screening by Gary D. Carr. MD, Medical Director

Editor’s Note: This commentary was written to the participants of a program in Mississippi. Even though the references are to PHN, his comments are valid and applicable to those participants in the MPHP.

Part of early recovery for PHN-monitored professionals, and most others in monitored recovery, includes periodic, random urine screening for alcohol and other drugs of abuse. Sometimes people may feel a little resentful of this process, viewing it as someone trying to “catch” them. I have always looked at toxicology screening differently, and want to share those thoughts with you.

If you are a professional in recovery, random drug and alcohol screens are an opportunity to document your honesty, accountability, and responsible behavior for whomever might need to see it. It is right there in black and white. It’s insurance for you -- money in the bank.

...There are at least two reasons why a professional recovering from alcoholism (as an example) needs screens to rule out other drugs of abuse. First, this is a known relapse prevention technique. Second, a skeptic could look at a string of negative alcohol screens and say, “Well, yeah, he didn’t drink but what else might be have been taking?” Again, your negative screens are insurance against suspicion and accusation. As a matter of course, whenever I’m called by a professional with any situation at work (i.e., verbal confrontation with a co-worker), I always tell them to give a screen. It protects you.

Occasionally, the first indicator of relapse is a positive drug screen. More commonly, we learn of relapse through self-disclosure or through the report of someone concerned about behavior changes that seem “different” or inconsistent with recovery. In any case, anyone in relapse is fortunate when relapse is discovered before “illness” has an opportunity to morph into overt “impairment”.

..[A screen] is the cost of documenting the changes you’ve worked so hard to bring about for yourself and your family. We are documenting your recovery and the responsible decisions you have made to take care of yourself. But if you are in relapse, we want to know - the sooner the better. But just as importantly, we want to help you demonstrate your commitment to recovery and do that in a way that can withstand the scrutiny of people who may not understand addiction, treatment, and recovery. PHN’s mission includes both monitoring AND earned advocacy. Our screens are conducted in a fashion that accomplishes both parts of that mission.

A Comment by Robert Bondurant, MPHP Program Coordinator:

Dr. Carr’s insights about toxicology screening are certainly consistent with my experience in the MPHP and I believe all PHPs across the country. These random screens are utilized to promote our advocacy for our physicians rather than to “catch” a physician.

These tests are valuable in a similar way to cancer screening. Early detection does save lives and in the case of addiction promotes recovery. The earlier a relapse is identified, the easier and less intensive the response needs to be. If the relapse is not detected early, it may progress to a very dangerous level resulting in criminal charges, loss of medical license and even death.

Toxicology screening is a basic tool of monitoring. It is necessary and fundamental to all successful monitoring programs. The monitored physician can feel safer and more protected. In fact, some professionals in recovery who have completed their five year monitoring agreements have requested continuation of their alcohol/drug testing to help support their recovery and avoid relapse.