Testing and Toxicology; Treatment Courts
Remember the specification from the syllabus and the feedback from previous grading rubrics on these discussions.
For this discussion board we are going to focus on the ethical dilemmas (social work as social control, empowerment) associated with court ordered treatment and mandatory drug testing. We will look at monitoring as a reality check to client self report.
A common dilemma looks something like this: We know that testing (urine, breath, trans-dermal) is random and unpredictable; the treatment court participants know this too and have literally signed a contract agreeing to it.
See this test result on one of your clients, Josie: Conley_Positive Monitoring Bracelet Readout with note.pdf download
IR Voltage: proxy for how close to the skin the bracelet is. This may also reflect impaired ability of the device to measure temperature
TAC: Transdermal Alcohol, Continuous monitoring
She is appearing in drug court with all her fellow participants in two days. One by one they will stand at a podium in court facing the judge. Their fellows will be in the galley to the left and the court team will be at a table on their right: prosecutor, defense, probation officer, you (the treatment provider), and their peer recovery support specialist. As with all the participants in court that day, the judge will ask Josie how her week has gone and if there is anything Josie would like to tell her what has gone well, what has not.
Prior to the court meeting the court team will have met and staffed (discussed, processed developments etc.) each client. Staffing usually takes just a few minutes per case of all is going well, a little longer if not. As the treatment provider, you have Josie’s consent to discuss her progress in treatment with the court the whole team. So the team, and the judge will pretty much what you know – or at least what you choose to tell them.
Here is the rest of the scenario. Three days prior to court, the probation officer sends you over the “Alert Details” indicating a test that was either tampered with or was positive for alcohol. Either way it is a violation of Josies contract with the court all team members will have received the report.
The day after the report comes to you, and a day before the team and court meet, you meet with Josie. At first she says she cant remember if she was tested but then says Oh ya, that. You ask if she is aware the test was positive, and she is ambiguous. Might of could have been maybe she replies. She complains that it is disgusting that the probation officer actually watches her take a pee. You reply, sounds embarrassing and she gets a bit challenging. “Have you ever had to have someone watch you pee a couple of times a week?”
Discussion question: How do you answer her?
After this, you circle back to the test result and this statement comes out of her.
My boyfriend Frank, you know he doesn’t like it that I don’t drink anymore. He says I’m no fun by which he usually means sex. He gets angry when I tell him I dont want anything to drink. And when he gets really angry he can get really scary because he hasnt hit me in a long time, since the protection order thing last year, remember, and the kid thing, but I know he can, especially if he gets angry about enough stuff. So I just shut him up a few days ago had a few and got it on cause if there is any, and I mean Any more trouble in that house Child Protective Services is coming for those kids again so ya, it was positive and I am Not telling all that whole tale of woe to the judge.
Discussion question: How much of this, exactly what, do you share with the Drug Court Team?
What will you encourage Josie to tell the judge in court with everyone?
Do you tell Josie how much of what she shared, you will share with the team? (Read this question carefully).
Who has the final say on who gets to know what, you or her?
Back to court: It is Josies turn in front of the judge. She tells the judge I had a little slip but I am good now, its not gonna happen again, I worked on it with the counselor and she smiles sideways at you. The judge asks her How are things with your boyfriend? and Josie gives you a nervous sideways glance with just her eyes and says Frank is doing good, hes working. The judge turns to you and says So things are good with her and Frank?
More Discussion questions:
What do you say to the judge?
Do you ask for 5 minutes in a side office with the client to help her with her honesty?
Do you stay mute because if you collaborate with her denials now in court it will build trust which you can work with later in dealing with her abuse issues?
Do you speak right out in court about what you know to be honest?
Add additional options not mentioned here for discussion; write for as long as you like.
https://youtu.be/0YiUJ5bu3P0
Read: Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2018). The ASAM principles of addiction medicine (6th ed.). Wolters Kluwer Health.
Chapter 119: Practical Considerations in Drug Testing
Read the entire chapter, except :Biomarkers of Alcohol Consumption” and the “Role of the Medical Review Officer.” this chapter will provide you with a very solid foundation for understanding testing process and interpretation.
Chapter 120: Reducing Substance Use in Criminal Justice Populations
Read the entire chapter, including the insets.
https://www.youtube.com/watch?v=M6Enu3aS0ic&t=7s
https://youtu.be/hPPz8moTgVQ
https://www.pharmacytimes.com/view/parent-customer-education-and-pharmacist-knowledge