Child & Family Investigator Colorado

Child & FamilyInvestigatorColorado

Substance Abuse

Substance Abuse

• CJD 04-08 Standard 13

• CFIs no longer “routinely” conduct testing

• Make recommendations to court for testing

and/or evaluation if appropriate

• Done by CFI only if sole issue of appointment,

and if qualified

Substance Abuse

• An enormous problem

• More than one in 10 in US live with

dependent or abusing parents

• Profound effects on the children

Effects on Parenting

• The effects of Substance Abuse on Parenting

• Parent unavailable to child

• Parent disappears

• Parent wastes the resources of the family

• Unstable housing, community and schools

• Criminal activity, child endangerment

• Child more likely to abuse

What the Child experiences

• Broken promises

• Inconsistency and unpredictability

• Shame and humiliation

• Tension and fear

• Paralyzing guilt and an unwarranted sense of responsibility

• Anger and hurt

• Loneliness and isolation

• Lying as a way of life

• Feeling Responsible and obligated

CHARACTERISTICS OF AN ADDICTIONCHARACTERISTICS OF AN ADDICTION

DENIALDENIAL IMPULSIVITY-SENSE OF IMMEDIACYIMPULSIVITY-SENSE OF IMMEDIACY COMPULSION TO USECOMPULSION TO USE LOSS OF CONTROLLOSS OF CONTROL TOLERANCETOLERANCE WITHDRAWAL OF USE (OR WITHDRAWAL OF USE (OR

BEHAVIOR) LEADS TO DISCOMFORTBEHAVIOR) LEADS TO DISCOMFORT PROGRESSION OVER TIMEPROGRESSION OVER TIME

OTHER ADDICTIONS: ItOTHER ADDICTIONS: It’’s not just s not just about drugsabout drugs

InternetInternet PornographyPornography SexualSexual GamblingGambling ShoppingShopping ““PositivePositive”” Addictions (i.e. exercise) Addictions (i.e. exercise)

UNDERSTANDING SUBSTANCE UNDERSTANDING SUBSTANCE ABUSE AND DEPENDENCE:ABUSE AND DEPENDENCE:

DSM IV DIAGNOSISDSM IV DIAGNOSIS CONTINUUM OF USE MODELCONTINUUM OF USE MODEL

-NO USE/NON-PROBLEM, -NO USE/NON-PROBLEM, SOCIAL/RECREATIONAL USE, SOCIAL/RECREATIONAL USE,

MISUSE,MISUSE,EPISODIC ABUSE, ABUSE, EPISODIC ABUSE, ABUSE,

DEPENDENCEDEPENDENCE CO-OCCURRING M.H. DISORDERS ANDCO-OCCURRING M.H. DISORDERS AND

S.A. DISORDERSS.A. DISORDERS DEFENSE MECHANISMSDEFENSE MECHANISMS IMPACT ON COGNITIVE, PSYCH. & SOCIAL IMPACT ON COGNITIVE, PSYCH. & SOCIAL

SYSTEMS SYSTEMS

CONTINUUM OF USE MODELCONTINUUM OF USE MODEL

Social/RecreationalSocial/Recreational Heavy Drinking/Problem Drinker Heavy Drinking/Problem Drinker MisuseMisuse Sustained vs. Periodic UseSustained vs. Periodic Use Abuse (Heavy Episodic Binging-5+ Abuse (Heavy Episodic Binging-5+

drinks)drinks) Dependence Dependence

(Psychological/Physiological)(Psychological/Physiological) Addiction/Addictive Behaviors Addiction/Addictive Behaviors

ADDICTION AS AN ATTACHMENT ADDICTION AS AN ATTACHMENT DISORDERDISORDER

A DISORDER IN SELF-REGULATIONA DISORDER IN SELF-REGULATION

DYSFUNCTIONAL ATTACHMENT STYLESDYSFUNCTIONAL ATTACHMENT STYLES

PADS VS. DAPS (PEOPLE ARE DRUG PADS VS. DAPS (PEOPLE ARE DRUG SUBSTITUTES vs. DRUGS ARE PEOPLE SUBSTITUTES vs. DRUGS ARE PEOPLE SUBSTITUTES)SUBSTITUTES)

THOSE DEPENDENT ON ADDICTIVE SUBSTANCESTHOSE DEPENDENT ON ADDICTIVE SUBSTANCES CANNOT REGULATE THEIR EMOTIONS, HAVE PROBLEMSCANNOT REGULATE THEIR EMOTIONS, HAVE PROBLEMS

WITH SELF-CARE, SELF-ESTEEM AND INTERPERSONALWITH SELF-CARE, SELF-ESTEEM AND INTERPERSONALRELATIONSHIPSRELATIONSHIPS

THE POPULATIONTHE POPULATION

PRE/POST DIVORCE – USUALLY HIGH PRE/POST DIVORCE – USUALLY HIGH CONFLICTCONFLICT

OVERREACTION AROUND SUBSTANCE OVERREACTION AROUND SUBSTANCE ABUSE/ ABUSE/ DEPENDENCEDEPENDENCE

TENDENCY FOR ONE PARTY TO EMBELLISH TENDENCY FOR ONE PARTY TO EMBELLISH AND AND THE OTHER TO MINIMIZETHE OTHER TO MINIMIZE

OFTEN DUAL-DIAGNOSIS ISSUES, TRAUMA…OFTEN DUAL-DIAGNOSIS ISSUES, TRAUMA… THERE MAY BE CRIMINAL AND CIVIL LEGAL THERE MAY BE CRIMINAL AND CIVIL LEGAL

ISSUES AT STAKEISSUES AT STAKE GENERALLY, THIS IS A RESISTIVE GENERALLY, THIS IS A RESISTIVE

POPULATIONPOPULATION

GOALS OF A SUBSTANCE USE GOALS OF A SUBSTANCE USE EVALUATIONEVALUATION

To understand theTo understand the role that a substance plays role that a substance plays in a personin a person’’s life/level of involvement with s life/level of involvement with the substancethe substance

To determineTo determine how the substance use impacts how the substance use impacts the personthe person’’s functionings functioning Cognitive: executive functioning, judgment, Cognitive: executive functioning, judgment,

decision-decision- making, tracking/monitoring, problem making, tracking/monitoring, problem solving, memory,solving, memory,

Psychological: mood, feelings, emotional regulation Psychological: mood, feelings, emotional regulation Social/Legal/OccupationalSocial/Legal/Occupational Medical/PhysicalMedical/Physical

To offerTo offer recommendations that can be recommendations that can be implemented into a parenting planimplemented into a parenting plan

To provide aTo provide a piece of the puzzlepiece of the puzzle for a larger for a larger evaluationevaluation

THE TRUTH IS RARELY PURETHE TRUTH IS RARELY PURE

AND NEVER SIMPLEAND NEVER SIMPLE

OSCAR WILDEOSCAR WILDE

COMPONENTS OF A GOOD EVALUATIONCOMPONENTS OF A GOOD EVALUATION

Overview of the Assessment ProcessOverview of the Assessment Process Developing rapport during the Developing rapport during the

evaluation to reduce defensiveness and evaluation to reduce defensiveness and anxietyanxiety

Use of Assessment ToolsUse of Assessment Tools Brief Mental Status/Cognitive ScreeningBrief Mental Status/Cognitive Screening InstrumentsInstruments ( (AUI, SASSI-3, SUDDS-IVAUI, SASSI-3, SUDDS-IV)) Drug Testing/MonitoringDrug Testing/Monitoring

HistoryHistory Family of Origin: Hx of M.H., S.A., Trauma, Family of Origin: Hx of M.H., S.A., Trauma,

Abuse..Abuse.. Relationship History Relationship History Substance Use: Current and PastSubstance Use: Current and Past

COMPONENTS OF A GOOD EVALUATIONCOMPONENTS OF A GOOD EVALUATION

Use ofUse of Collateral Sources: spouse, family Collateral Sources: spouse, family members, custody evaluator, members, custody evaluator, psychotherapists, treatment programs, family psychotherapists, treatment programs, family doctors, criminal records/motor vehicle doctors, criminal records/motor vehicle records/COPDMPrecords/COPDMP

Assessment of MotivationAssessment of Motivation Presentation/DemeanorPresentation/Demeanor Stages of ChangeStages of Change

Interpretation/Integration Interpretation/Integration - Cross-checking data- Cross-checking data- Preponderance/concurrence of evidence - Preponderance/concurrence of evidence

Report/RecommendationsReport/Recommendations

WHAT GETS US INTO TROUBLEWHAT GETS US INTO TROUBLE

IS NOT WHAT WE DONIS NOT WHAT WE DON’’T KNOW,T KNOW,

ITIT’’S WHAT WE KNOW FOR SURES WHAT WE KNOW FOR SURE

THAT JUST AINT SO!THAT JUST AINT SO!

MARK TWAINMARK TWAIN

KEY CONSIDERATIONSKEY CONSIDERATIONS

Is the concern a current problem Is the concern a current problem (within the past 12 months)?(within the past 12 months)?

How much of a factor is the stress How much of a factor is the stress of the divorce?of the divorce?

Has use occurred during Has use occurred during parenting time/Does use impact parenting time/Does use impact parenting?parenting?

Documented history vs. Documented history vs. ““He said, He said, She saidShe said””??

KEY CONSIDERATIONSKEY CONSIDERATIONS

Past substance use and mental Past substance use and mental health treatment history/records?health treatment history/records?

Is concern based on single or Is concern based on single or multiple episodes?multiple episodes?

Meaning of allegations in the Meaning of allegations in the context of the divorce dynamics.context of the divorce dynamics.

Are there concerns about the Are there concerns about the credibility of the credibility of the accuser/allegations?accuser/allegations?

IMPLICATIONS FOR PARENTING PLANSIMPLICATIONS FOR PARENTING PLANS

Overall concern is keeping children safeOverall concern is keeping children safe

Do there need to be restrictions on Do there need to be restrictions on parenting time?parenting time?

Do the parents need treatment?Do the parents need treatment?

Do children and/or other family members Do children and/or other family members need treatment or support?need treatment or support?


Is limited substance use OK?Is limited substance use OK?

What defines relapse/How to What defines relapse/How to respond?respond?

Is monitoring necessary?Is monitoring necessary?

IMPLICATIONS FOR PARENTING IMPLICATIONS FOR PARENTING

PLANSPLANS:: MONITORING STRATEGIESMONITORING STRATEGIES What Tests to Use:What Tests to Use:

Breath/Saliva testingBreath/Saliva testing Urine testingUrine testing Blood testingBlood testing Hair testingHair testing Transdermal (Sweat)Transdermal (Sweat)

Frequency of Testing: Random or FixedFrequency of Testing: Random or Fixed Duration of TestingDuration of Testing Response to Missed, Dilute or Positive Response to Missed, Dilute or Positive

TestsTests

Recommendations and Treatment Recommendations and Treatment ResourcesResources

Self-management (no use at times prior to Self-management (no use at times prior to parenting time)parenting time)

Drug Testing/Monitored AntabuseDrug Testing/Monitored Antabuse AA, CA, NA, LifeRingAA, CA, NA, LifeRing Individual, family or group counselingIndividual, family or group counseling Intensive Outpatient Program or Inpatient Intensive Outpatient Program or Inpatient

TxTx Psychiatric Referral for Psychiatric Referral for

consultation/medicationconsultation/medication

DSM-IV criteria

• Substance dependence

• Tolerance of the substance

• Withdrawal

• More amounts, no efforts to control

• Time and resources spent obtaining substance

• Outside activities fall away

• Continued use in spite of significant problems

DSM-IV criteria

• Substance abuse

• Failure to fulfill major obligations

• Physically dangerous situations

• Related legal problems

• Persistent or recurrent social or interpersonal problems

• A person is either dependent or abusing a particular substance, not both at the same time

American Psychiatric Association DSM-5 Development Proposed RevisionProposed Revision

Substance-Use DisorderSubstance-Use Disorder:: A. A maladaptive pattern of substance use leading to A. A maladaptive pattern of substance use leading to

clinically significant impairment or distress, as manifested by clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month 2 (or more) of the following, occurring within a 12-month period: period:

recurrent substance use resulting in a failure to fulfill major recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from substance-related absences, suspensions, or expulsions from school; neglect of children or household) school; neglect of children or household)

recurrent substance use in situations in which it is physically recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) machine when impaired by substance use)

continued substance use despite having persistent or continued substance use despite having persistent or recurrent social or interpersonal problems caused or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical with spouse about consequences of intoxication, physical fights)fights)


tolerance, as defined by either of the following: tolerance, as defined by either of the following: a. a need for markedly increased amounts of the a. a need for markedly increased amounts of the

substance to achieve intoxication or desired effect substance to achieve intoxication or desired effect b. markedly diminished effect with continued use of the b. markedly diminished effect with continued use of the

same amount of the substancesame amount of the substance(Note: Tolerance is not counted for those taking (Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.)antidepressants, ant-anxiety medications or beta-blockers.)

withdrawal, as manifested by either of the following: withdrawal, as manifested by either of the following: a. the characteristic withdrawal syndrome for the a. the characteristic withdrawal syndrome for the

substance (refer to Criteria A and B of the criteria sets for substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances) Withdrawal from the specific substances)

b. the same (or a closely related) substance is taken to b. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptomsrelieve or avoid withdrawal symptoms(Note: Withdrawal is not counted for those taking (Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.)antidepressants, anti-anxiety medications or beta-blockers.)


• amounts or over a longer period than was intended

• a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

• important social, occupational, or recreational activities are given up or reduced because of substance use

• the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

• Craving or a strong desire or urge to use a specific substance


Severity specifiersSeverity specifiers:: Moderate: 2-3 criteria positiveModerate: 2-3 criteria positive Severe: 4 or more criteria positiveSevere: 4 or more criteria positive SpecifySpecify if: if: With Physiological Dependence: evidence of With Physiological Dependence: evidence of

tolerance or withdrawal (i.e., either Item 4 or 5 tolerance or withdrawal (i.e., either Item 4 or 5 is present)is present)

Without Physiological Dependence: no Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., evidence of tolerance or withdrawal (i.e., neither Item 4 nor 5 is present)neither Item 4 nor 5 is present)

Relapse

• Now recognized to be standard piece of the road to recovery

• How will this affect your recommendations?

• How can safety be provided for the child?

A Brain Disorder

• Mesolimbic dopamine system

• Pleasure pathway

• Creates attachment

• Drug use is self-medication

• Behavioral extremes

DBT: Dialectical Behavior Therapy

OVERVIEW:OVERVIEW:

• • DRUG AND ALCOHOL CATEGORIES ANDDRUG AND ALCOHOL CATEGORIES ANDTOXICOLOGYTOXICOLOGY

• • BASICS OF AVAILABLE DRUG TESTING,BASICS OF AVAILABLE DRUG TESTING,SCREENS AND CONFIRMATION TESTSSCREENS AND CONFIRMATION TESTS

• • NEW TECHNOLOGIES NEW TECHNOLOGIES • • MONITORING STRATEGIESMONITORING STRATEGIES

- daily, fixed, periodic or random- daily, fixed, periodic or random-oral/saliva/breath/blood/urine/hair/-oral/saliva/breath/blood/urine/hair/

patchpatch

Substances of Abuse Substances of Abuse

• • AlcoholAlcohol • • Amphetamines/Meth/EcstasyAmphetamines/Meth/Ecstasy

• • BarbituratesBarbiturates • Benzodiazepines• Benzodiazepines• • CannabisCannabis • Cocaine• Cocaine• • HallucinogensHallucinogens • Opiates• Opiates• • Prescription MedicationsPrescription Medications• • Anabolic SteroidsAnabolic Steroids•• Designer Drugs (incense, synthetic THC) Designer Drugs (incense, synthetic THC)

TOXICOLOGY:TOXICOLOGY:

Oral Fluids/Saliva (Strips, Swabs)Oral Fluids/Saliva (Strips, Swabs) Breath (Balloons,Tubes,Breathalyzers, Breath (Balloons,Tubes,Breathalyzers,

Sobrietor, InHome, Soberlink, Sobrietor, InHome, Soberlink, Smart Start)Smart Start)

Blood (MD authorized lab. procedures)Blood (MD authorized lab. procedures) Urine (Screens/Chemical or IA, GC/MS, Urine (Screens/Chemical or IA, GC/MS,

LC/MS/MS)LC/MS/MS) Hair (Head, Axillary, Body)Hair (Head, Axillary, Body) Transdermal (Patch, SCRAM)Transdermal (Patch, SCRAM)

Parent Drug vs MetabolitesParent Drug vs Metabolites

Alcohol (Ethanol)Alcohol (Ethanol) -Ethyl Glucuronide (EtG) -Ethyl Glucuronide (EtG)

-Ethyl Sulfate (EtS)-Ethyl Sulfate (EtS)

•• Cocaine -BenzoylecgonineCocaine -Benzoylecgonine

-Cocaethylene-Cocaethylene

-Norcocaine-Norcocaine

•• Marijuana (THC) -Cannabinoids 50Marijuana (THC) -Cannabinoids 50

Testing Limitations/Problems:Testing Limitations/Problems:

Chain of Custody/Forensic Collection ProcessChain of Custody/Forensic Collection Process

Time Limitations & Elimination RatesTime Limitations & Elimination Rates

Errors and Fallibilities (Immunoassay/Chemical assay vs Errors and Fallibilities (Immunoassay/Chemical assay vs Gas Chromatography/Liquid Chromatography/Mass Gas Chromatography/Liquid Chromatography/Mass Spectometry)Spectometry)

Analysis/Interpretation of Tests (Negatives, False Analysis/Interpretation of Tests (Negatives, False Negatives, Detection LevelsNegatives, Detection Levels))

Chain of Custody and Forensic Collection Chain of Custody and Forensic Collection Process:Process:

Is the testing site licensed,with certified staff (CLIA) Is the testing site licensed,with certified staff (CLIA) that that follow Federally Mandated SAMHSA follow Federally Mandated SAMHSA Guidelines, Guidelines, Procedures and Detection/Cutoff Levels?Procedures and Detection/Cutoff Levels?

•• Do they follow Federal DOT Chain of Do they follow Federal DOT Chain of Custody Guidelines:Custody Guidelines:

-Driver License Identification-Driver License Identification-Same gender observation for -Same gender observation for UAUA’’ss-Labelling/Sealing of Specimen-Labelling/Sealing of Specimen-Transportation and Testing -Transportation and Testing

ProceduresProcedures

Elimination RatesElimination Rates

Alcohol-Alcohol- 0.6-1.0 drinks per hour0.6-1.0 drinks per hour Metabolites EtG and EtS up to 80-84 hoursMetabolites EtG and EtS up to 80-84 hours

Amphetamines-1 to 3 daysAmphetamines-1 to 3 days Methamphetamines-3 to 5 daysMethamphetamines-3 to 5 days Methylenedioxy-methamphetamine Methylenedioxy-methamphetamine

(MDMA-(MDMA- Ecstasy)-3 to 4 daysEcstasy)-3 to 4 days Barbiturates-1 to 3 days (Phenobarbitol Barbiturates-1 to 3 days (Phenobarbitol

L.A.up to 2-3 weeks)L.A.up to 2-3 weeks) Benzodiazepines-range from 2 to 7 daysBenzodiazepines-range from 2 to 7 days

and with long term use up to 4-6 weeksand with long term use up to 4-6 weeks

Elimination RatesElimination Rates

•• Cocaine (metabolite-Benzoylecgonine)-1 to 2 days Cocaine (metabolite-Benzoylecgonine)-1 to 2 days and up to 5 days with serious abuseand up to 5 days with serious abuse

•• Opiates (Heroin,Codeine, Morphine,Oxycodone,Opiates (Heroin,Codeine, Morphine,Oxycodone,Oxycontin, Hydromorphone)-1 to 3 days Oxycontin, Hydromorphone)-1 to 3 days

Methadone-1 to 3 daysMethadone-1 to 3 days•• Marijuana/Cannabis (THC)-varies significantly withMarijuana/Cannabis (THC)-varies significantly with

quality, amount/frequency of use, activity quality, amount/frequency of use, activity level level

(and stores in lipid tissue):(and stores in lipid tissue):-Occasional User-3 to 10 days -Occasional User-3 to 10 days -Recreational/Social User- 5 to 10 days-Recreational/Social User- 5 to 10 days-Daily/Chronic User-30 to 45 days-Daily/Chronic User-30 to 45 days

•• Phencyclidine (PCP)-usually 1 to 2 days (up to 7 to Phencyclidine (PCP)-usually 1 to 2 days (up to 7 to 14 days) 14 days)

Errors,Screening and Confirmation TestsErrors,Screening and Confirmation Tests

Immunoassay or Chemical Assay ScreensImmunoassay or Chemical Assay Screens False positive error rate of 1/200 to 1/400False positive error rate of 1/200 to 1/400 Large cross reactivity with other substances Large cross reactivity with other substances

and other drugsand other drugs

•• Gas Chromatography/Mass Spectometry Gas Chromatography/Mass Spectometry (GC/MS) Confirmation Test (to identify (GC/MS) Confirmation Test (to identify

and and quantify at a higher level)quantify at a higher level)•• Liquid Chromatography/Mass Liquid Chromatography/Mass

Spectometry/Mass Spectometry Spectometry/Mass Spectometry (LC/MS/MS) is the platinum (LC/MS/MS) is the platinum

standard in standard in testing testing

Analysis and Interpretation of TestsAnalysis and Interpretation of Tests

Negative Result does not equal no use!Negative Result does not equal no use!-the use can be under the detection or cutoff-the use can be under the detection or cutofflevel (for IA, GC/MS, or LC/MS/MS) level (for IA, GC/MS, or LC/MS/MS) for for screens or confirmation tests (forscreens or confirmation tests (forsaliva, breath, urine, blood, hair,trans-saliva, breath, urine, blood, hair,trans-dermal, etc.)dermal, etc.)

•• If Positive Result for GC/MS or If Positive Result for GC/MS or LC/MS/MS for UA or Hair tests itLC/MS/MS for UA or Hair tests it’’s s PositivePositive

Oral Fluids/Saliva Toxicology ScreensOral Fluids/Saliva Toxicology Screens

Alcohol and Drug Screens are availableAlcohol and Drug Screens are available Rapid Screening Devices that are inexpensive Rapid Screening Devices that are inexpensive

and and can screen for most substancescan screen for most substances More sensitive to recent oral/nasal use of More sensitive to recent oral/nasal use of

substances substances and is present before and is present before showing up in the urineshowing up in the urine

More false negatives (can dilute/cleanse oralMore false negatives (can dilute/cleanse oral

cavity)cavity)

- False positives from alcohol in mouthwash, - False positives from alcohol in mouthwash, Nyquil,cold medicines,etc. Nyquil,cold medicines,etc.

Saliva Toxicology (Cont.)Saliva Toxicology (Cont.)

Alcohol Qtip Swab Saliva ScreensAlcohol Qtip Swab Saliva Screens can screen up to .15 BAL; thermometer like can screen up to .15 BAL; thermometer like

(expensive- 10 for $130.00)(expensive- 10 for $130.00) Alcohol Screen Saliva Test Strips-at .02 BAL; change Alcohol Screen Saliva Test Strips-at .02 BAL; change

color (inexpensive-24 for $66.00)color (inexpensive-24 for $66.00) BreathScan Alcohol Screening Test-at .02BreathScan Alcohol Screening Test-at .02

BAL; squeeze and break center and then blow into BAL; squeeze and break center and then blow into tube and then changes color (inexpensive-25 for tube and then changes color (inexpensive-25 for

$68.75)$68.75)

•• Oral Fluid Drug Screen Device-tests for Alcohol,Oral Fluid Drug Screen Device-tests for Alcohol,THC, Cocaine, Opiates, Meth & THC, Cocaine, Opiates, Meth & Amphetamines, Benzodiazepines Amphetamines, Benzodiazepines

(inexpensive-25 tests for $375.00)(inexpensive-25 tests for $375.00)

Breath ToxicologyBreath Toxicology Breath Sensors/Breathalyzers for AlcoholBreath Sensors/Breathalyzers for Alcohol

blow into straw or tubeblow into straw or tube can readcan read BAL BAL that is time/date stamped and that is time/date stamped and

can be scrolled up and down and store 500-600can be scrolled up and down and store 500-600readingsreadings

easy to use and portableeasy to use and portable reliable and inexpensive to purchase or leasereliable and inexpensive to purchase or lease

•• Sobrietor for Alcohol; Sobrietor for Alcohol; telephone modemtelephone modembased breathalyzer through BI,Inc.based breathalyzer through BI,Inc.

- reliable and inexpensive also- reliable and inexpensive also

Urine Toxicology Screens and Confirmation Urine Toxicology Screens and Confirmation TestsTests

Tests for most substances of abuseTests for most substances of abuse Usually 5 or 7 panel tests (7 panel adds Usually 5 or 7 panel tests (7 panel adds

Benzodiazepines and Barbs) + Creatinine Level Benzodiazepines and Barbs) + Creatinine Level for dilutionfor dilution

Can include EtG and EtS testsCan include EtG and EtS tests Can include Anabolic Steroids testing (as in Can include Anabolic Steroids testing (as in

hair & hair & blood testing)blood testing) Can request to test for other substances Can request to test for other substances

GC/MS and LC/MS/MS very reliableGC/MS and LC/MS/MS very reliable Negative results can mean under Negative results can mean under

detection or cutoff leveldetection or cutoff level

Urine Toxicology (Cont.)Urine Toxicology (Cont.)

•• Specimen Validity TestsSpecimen Validity Tests Creatinine LevelCreatinine Level Basic Adulteration TestsBasic Adulteration Tests

for odor, color, physical characteristics like for odor, color, physical characteristics like temperature and or abnormal instrument responsetemperature and or abnormal instrument response

• • Masking Attempts with Detox Teas,GoldenMasking Attempts with Detox Teas,GoldenSeal Tea, Lavage,and other agentsSeal Tea, Lavage,and other agents(bleach, drano, etc.)(bleach, drano, etc.)

• • Substitution with clean urine, Wizonators, plastic bags and Substitution with clean urine, Wizonators, plastic bags and tubestubes

Whizzinator (Priceless!) comes complete with fake Whizzinator (Priceless!) comes complete with fake penis,penis,

dried synthetic or clean urine, chemical heater dried synthetic or clean urine, chemical heater packs, packs, thermometer)thermometer)

Urine Toxicology (Cont.)Urine Toxicology (Cont.)

•• False Positives related to Diabetes for alcoholFalse Positives related to Diabetes for alcoholtesting and urinary tract and bacterial testing and urinary tract and bacterial infections for EtG testinginfections for EtG testing

•• EtS testing not effected by Diabetes, urinary tract EtS testing not effected by Diabetes, urinary tract and and

bacterial infectionsbacterial infections 5 or 7 panel-lab test from $15-30.005 or 7 panel-lab test from $15-30.00 EtG and/or EtS tests from $35-65.00EtG and/or EtS tests from $35-65.00 LC/MS/MS tests slightly higher than GC/MSLC/MS/MS tests slightly higher than GC/MS ((www.etg.weebly.com for Dr. Skipper for Dr. Skipper’’s s

information-information- Replaces Replaces www.ethylglucuronide.com site) site)

Hair TestsHair Tests

Very reliable-if positive, no false positivesVery reliable-if positive, no false positives Increased window of detection to 90 daysIncreased window of detection to 90 days Deterrent to drug useDeterrent to drug use Cocaine metabolites detected up to 3 monthsCocaine metabolites detected up to 3 months False Negatives for EtG/Alcohol-bleaching/dyeing hair/shampoo False Negatives for EtG/Alcohol-bleaching/dyeing hair/shampoo

kits kits Does not capture recent drug use of last 1 1/2 to 2 weeksDoes not capture recent drug use of last 1 1/2 to 2 weeks Suggest periodic tests every 10 weeks to not haveSuggest periodic tests every 10 weeks to not have

lacunae orlacunae or gaps in testinggaps in testing

•• Urine Toxicology Screens and Tests for two weeksUrine Toxicology Screens and Tests for two weeks

prior to initial hair test if possibleprior to initial hair test if possible

•• Usually head hair sample will be 1 1/2 inches long Usually head hair sample will be 1 1/2 inches long

and pencil diameter in thickness (150-200 and pencil diameter in thickness (150-200 strands)strands)

Hair Testing (Cont.)Hair Testing (Cont.)

Axillary (armpit) or Body hair testing can detect Axillary (armpit) or Body hair testing can detect prior prior drug use up to 1 yeardrug use up to 1 year

Usually 5 or 7 panel test Usually 5 or 7 panel test Cost from $70-150.00Cost from $70-150.00

• • Limitations:Limitations: Cannot test for AlcoholCannot test for Alcohol Cutoff levels may not capture occasional or Cutoff levels may not capture occasional or

infrequent useinfrequent use Darker hair more susceptible to picking up Darker hair more susceptible to picking up

drug usedrug use

Transdermal Toxicology-Patch ScreeningTransdermal Toxicology-Patch Screening

Fairly ReliableFairly Reliable Increased window of detection to 7 daysIncreased window of detection to 7 days Deterrent to drug useDeterrent to drug use No sample dilution or substitutionNo sample dilution or substitution Parent drug and metabolites-no alcohol testingParent drug and metabolites-no alcohol testing

Unknown sensitivity and specificity toUnknown sensitivity and specificity to environmental exposure or pre-existing drug environmental exposure or pre-existing drug

contaminants on skincontaminants on skin •• Cost approximately $36.00 (AlcoPro or PharmChek Cost approximately $36.00 (AlcoPro or PharmChek

or pharmchem.com at 817.590.2537(or 0571)or pharmchem.com at 817.590.2537(or 0571)

SCRAM-SECURE CONTINUOUS SCRAM-SECURE CONTINUOUS RANDOM ALCOHOL MONITORINGRANDOM ALCOHOL MONITORING

Transdermal alcohol detection via ankle monitor that is downloaded by Transdermal alcohol detection via ankle monitor that is downloaded by land-line telephone modem for readout to service center or downloaded land-line telephone modem for readout to service center or downloaded twice weekly at service center. Positives lead to EtG testing for twice weekly at service center. Positives lead to EtG testing for confirmation.confirmation.

24/7 detection window-Cost is approximately $13-14.00 daily 24/7 detection window-Cost is approximately $13-14.00 daily (Rocky Mountain Offenders Management, 8787 Turnpike Dr.,Westminster, (Rocky Mountain Offenders Management, 8787 Turnpike Dr.,Westminster,

303.443.4277)303.443.4277)

SleepTime MonitoringSleepTime Monitoring•• 24/7 Alcohol and Other Drug Abuse Monitoring System24/7 Alcohol and Other Drug Abuse Monitoring System

•• Wrist actigraphy monitor, FDA cleared medical device used for sleep Wrist actigraphy monitor, FDA cleared medical device used for sleep studies, detects erratic sleep patterns that are reliablestudies, detects erratic sleep patterns that are reliableindicators of alcohol and drug abuse and recommends EtG and other indicators of alcohol and drug abuse and recommends EtG and other urine testing to verify episodes of apparent substance abuseurine testing to verify episodes of apparent substance abuse

•• Downloaded on Monday and Thursdays; Cost $3.50/day + $39.00 per + Downloaded on Monday and Thursdays; Cost $3.50/day + $39.00 per +

drug test (ICCS, 1651 Kendall, Lakewood, 303.232.4002)drug test (ICCS, 1651 Kendall, Lakewood, 303.232.4002)


Overall concern is keeping children safeOverall concern is keeping children safe

Do there need to be restrictions on Do there need to be restrictions on parenting time?parenting time?

Do the parents need treatment?Do the parents need treatment?

Do children and/or other family members Do children and/or other family members need treatment or support?need treatment or support?

What Tests to Use:What Tests to Use:

- - Oral Fluids/Saliva testingOral Fluids/Saliva testing Breath testingBreath testing Urine testingUrine testing Blood testing (Prescription Drugs) and Alcohol-Blood testing (Prescription Drugs) and Alcohol-

Phosphatidylethanol-Peth)Phosphatidylethanol-Peth) Hair testingHair testing Transdermal (Sweat)PatchTransdermal (Sweat)Patch SCRAM (Secure Continuous Random Alcohol SCRAM (Secure Continuous Random Alcohol

Monitoring)Monitoring) SleepTimeSleepTime

Frequency of Testing:Daily, Fixed, Periodic, RandomFrequency of Testing:Daily, Fixed, Periodic, Random

Duration of TestingDuration of Testing

Response to Missed, Dilute or Positive TestsResponse to Missed, Dilute or Positive Tests

Recommendations and Treatment Recommendations and Treatment ResourcesResources

Self-management (no use at times prior toSelf-management (no use at times prior toparenting time)parenting time)

Drug and Alcohol Screens, Testing and Drug and Alcohol Screens, Testing and MonitoringMonitoring

Use of Medications (Use of Medications ( Monitored Antabuse (Disulfiram) and Monitored Antabuse (Disulfiram) and Acomprosate (Campral), Vivitrol and Naltrexone, SuboxoneAcomprosate (Campral), Vivitrol and Naltrexone, Suboxone

AA, CA, NA, LifeRingAA, CA, NA, LifeRingIndividual, family or group counselingIndividual, family or group counselingIntensive Outpatient Program or Inpatient TxIntensive Outpatient Program or Inpatient TxPsychiatric Referral for consultation/psych. Psychiatric Referral for consultation/psych.

medicationsmedications

QUESTIONS AND DISCUSSION:QUESTIONS AND DISCUSSION:

Toxicology Web Links:Toxicology Web Links:www.norchemlab.comwww.omegalabs.netwww.questdiagnostics.comwww.redwoodtoxicology.comwww.usdrugtestinglab.comwww.usdrugtestinglab.com

MEDICAL MARIJUANA ISSUESMEDICAL MARIJUANA ISSUES

Marijuana is illegal under federal lawMarijuana is illegal under federal law Regulation of the industry is on-going and Regulation of the industry is on-going and

evolvingevolving Medical marijuana is a political, legal, Medical marijuana is a political, legal,

health and moral issuehealth and moral issue Do people really qualify or do they just Do people really qualify or do they just

want to get high?want to get high? Should drug abuse be treated as a health Should drug abuse be treated as a health

issue, a legal issue, a moral issue or all?issue, a legal issue, a moral issue or all?


•• What or has anything changed in assessing cannabis use with What or has anything changed in assessing cannabis use with medical marijuana recommendations?medical marijuana recommendations?

•• Right to use in Colorado but not a Right to be Impaired when Right to use in Colorado but not a Right to be Impaired when parenting children!parenting children!

Dosing Issues (Smoking, Vaporizers, Edibles, Tinctures, Oils)Dosing Issues (Smoking, Vaporizers, Edibles, Tinctures, Oils)

Right to Use vs. Impact on Personality Functioning (Impact on Right to Use vs. Impact on Personality Functioning (Impact on Parenting Capacity)Parenting Capacity)

Research-What we know about impact on Executive Research-What we know about impact on Executive

Functioning/Motor SkillsFunctioning/Motor Skills

Marijuana and Tolerance and Adaptation to use?Marijuana and Tolerance and Adaptation to use?


• Previous History of Cannabis Use/Abuse/Dependence? Prior to Card?

• Environmental Concerns, Exposure of Children to smoke (clothes/backpacks), cannabis and edibles unlocked at home (infants/toddlers/pre-schoolers)

• Impact on Emotional and Behavioral Attunement of Parents

with children (Ability of Parent to regulate emotions and reflect on child?)

• Aspirational aspects of having parents not use 12 hours or longer or during

parenting time; Window of Detection Issues (Can this be enforced or monitored?)

• Can we regulate prescriptions? (No control over their dosing)

MEDICAL MARIJUANA ISSUESMEDICAL MARIJUANA ISSUES Is there a documented history of debilitating disorders?Is there a documented history of debilitating disorders?

Is using medicinal cannabis the best practices for the medical issue? Is using medicinal cannabis the best practices for the medical issue?

How is assessment the same or different for pain medications and medical How is assessment the same or different for pain medications and medical marijuana?marijuana?

•• When should a pain specialist be used for pain assessment or when to use an IME When should a pain specialist be used for pain assessment or when to use an IME (Independent Medical Evaluation)? (Independent Medical Evaluation)?

•• Medical Marijuana and CPS (neglect and abuse?)Medical Marijuana and CPS (neglect and abuse?)

•• Medical Marijuana Use and DUIDMedical Marijuana Use and DUID’’s (Children in vehicle)s (Children in vehicle)

•• How do we safeguard children from parents that use cannabis regularly? Can we?How do we safeguard children from parents that use cannabis regularly? Can we?

•• Each case is ideographic and unique, case by case basis.Each case is ideographic and unique, case by case basis.

Documents

Child & Family Investigator Colorado