Sixth Slice of Cheese: Testing

Memo to Self: “Build a paper trail"

Recovery Management, like safety science, requires the collection of objective evidence of the status of the patient or the performance of the aircraft (or aircrew). We base our decision-making on that evidence. We don’t guess!


Presently, there are only a two kinds of laboratory tests to determine the sobriety status of a person in recovery: screening tests for drug use, and confirmation testing of those screening tests. It’s vital to know what these tests can tell us, and what they cannot.


Testing (also called “monitoring”) is an essential and indispensible part of any serious Recovery Management plan. If you’re not testing, you’re guessing - and that’s unsafe.


Drug Testing: A White Paper of the American Society of Addiction Medicine (2013)


What we did at Le Mont with regard to testing: We tested every day. Every day our residents had a witnessed urine collection for a twelve-panel immunoassay for drug use, and breathalyzer for testing. The Le Mont staff tested on a weekly basis.


If a result was positive, we submitted the specimen for conformation testing and went to the resident’s Relapse Plan. Once detoxed and/or stabilized or medically cleared, residents and staff sat down together to lend support to the resident and help them problem solve. Rarely did we have to ask anyone to leave the house for refusal to remain abstinent.


U.S. Department of Transportation (2014) Urine Specimen Collection Guidelines

I have strong feelings about testing because I remember how lonely and frightened I was when I relapsed in treatment, and how risky the situation was since no one knew about it but me, and my treatment center made if very clear that if I relapsed they would notify my probation officer. I don’t want anyone else to ever be in that situation, and when I ran our recovery residence/recovery management program I vowed that I would do everything I could to prevent it.


That’s why I believe frequent testing (at least 8 to 10 times monthly, preferably more) coupled with clinical (not punitive) consequences was the standard of care we maintained at Le Mont. If my opinions seem extreme, it is because I applying the same reasoning I would if I were a doctor treating any other patient with any other chronic disease. We don’t test randomly in medicine, and we test as frequently as necessary to prevent clinical deterioration.


At Le Mont, our residents has an unassailable record of how hard they had worked to stay sober. The average length of stay at our home was 98 days, which meant that when a resident graduated they had around 100 consecutively negative drug tests that they could use to confirm their sobriety.


Memo to Self: “Build a paper trail.”

Bill White discusses how long should drug and alcohol testing (monitoring) should last for a person in recovery.

Dr. Bill Haning describes how a Professional Health Program (PHPs) would handle relapse in one of its’ monitored physicians.