Unfortunately, much workplace screening takes
the form of drug testing and is used for
compliance purposes. In this light, it frequently
is viewed as infringing on workers’ privacy;^193
workers may worry about the confidentiality of
their test results and whether they will be used to
deny employment or to impose other forms of
discrimination.^194 The drug-testing process can
be costly as well.^195 In conducting workplace
drug testing, the American Society of Addiction
Medicine (ASAM) recommends that a positive
drug test be used only as evidence that substance
use occurred, not as evidence of functional
impairment or addiction; the interpretation of
drug test results should include the use of a
credentialed Medical Review Officer; and
controlled prescription medications should be
included in the screening.^196
Government-Funded Social Service Systems ..............................................................
Government agencies can play an important role
in providing screening and brief interventions to
a range of clients including those receiving
housing, welfare and child protection, services
for the elderly, and in HIV and STD clinics.^197
Government-funded social service systems can
identify substance use risk in individuals
participating in their programs and provide
interventions, treatments or referrals to specialty
care when addiction is identified.
A significant proportion of individuals who
participate in government programs have many
risk factors for substance use and addiction and
can benefit from screening and brief intervention
services. Identifying individuals at risk and
providing effective interventions for those in
need may help to reduce their risk of further
substance use, job loss, domestic violence and
other crime and, ultimately, can lead to cost-
savings through decreased demand for
government services.^198 Despite the logic of this
approach, there is little research on the
effectiveness of screening and brief
interventions in these populations and, instead of
implementing these services, some states are
now imposing or considering drug testing as a
precondition for cash assistance and other
services and a basis for denying both program
eligibility and needed medical care.* 199Barriers to Effective Implementation of Screening and Brief Interventions
The failure of our health care providers, schools,
employers, justice programs and social service
programs to implement effective screening, brief
interventions and treatment referrals for those
who engage in risky use of addictive substances
represents a tremendous missed opportunity to
help countless Americans avoid the far-reaching
consequences of risky use and the disease of
addiction. A significant barrier to change is the
fact that services aimed at preventing and
addressing risky use and addiction traditionally
have not been paid for by health insurance plans;
as a result, there are few incentives for health
professionals to make them a priority in the care
of their patients. To close the gap in needed
services, specific barriers in addition to
insufficient funding must be addressed,
including insufficient training of health care and
other professionals and a lack of specialty care
providers; competing priorities and insufficient
resources; and inadequate screening tools.^200Insufficient Training ....................................................................................................
Many physicians and other health professionals
do not screen their patients for risky use of
addictive substances, provide early interventions
or treat or refer for specialty care, or they do so
inadequately because they simply have not been
properly trained.† Education about risky use and
the disease of addiction, their impact on a
patient’s health and other medical conditions,
and how to implement screening, interventions
and treatment is not sufficiently integrated into
medical education or residency training
programs.^201 Among those programs that do
address substance use and addiction, many have
shortcomings in the curriculum such as
insufficient instruction, limited number of* The Constitutionality of these policies is being
tested in the courts.
† See Chapters IX and X.