Quick Reference for Substance-Related Disorders

Evidence of escalating use (frequency), tolerance (how many drinks before intoxicated), habituation, or physiologic dependence (presence of withdrawal signs or symptoms when abstaining)

Attempts to cut back on use or abstain; remorse after use; consumption of more alcohol or drug than intended on more than one occasion; setting up conditions to attempt to limit use (e.g., “I’m only drinking beer” or “I’m only using on weekends”)

Cravings or a subjective sense of compulsion to use; planning social occasions to use

As a result of substance abuse, loss of or damage to health (including mental health—depression that doesn’t seem to get better); loss of or damage to family relationships, social relationships; damage to education or career, finances, or religious practice; family or employer concerns; or legal problems related to use (divorce, loss of child custody, driving under the influence, public intoxication, domestic abuse)

Minimization of use, justification or rationalization of use, inability to acknowledge the consequences of use, euphoric recall (i.e., remembering only the pleasant aspects of abusing a substance), suppression or repression of painful affect, enabling behaviors among social support network, cognitive impairments, including memory distortions (e.g., blackouts)

The survey is useful as a quick screen for the presence of major categories of drugs of abuse. The Drug Abuse Survey is a urine test for alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, opiates, phencyclidine, and tetrahydrocannabinol (THC) by class, with an immunoassay or thin-layer chromatography procedure. Results are presumptive because no confirmation is done. The false-positive rate for the screen is estimated to be 3% (i.e., of every 100 samples tested, three of them will have false-positive results for one of the drugs in the test group), whereas the false-negative rate for this screen is estimated to be low in the absence of adulterants. Thus, this test has a high true-negative rate. This test requires a random urine sample of at least 30 mL.

This is a urine test for the same drugs covered by the Drug Abuse Survey, but this assay uses gas chromatography–mass spectrometry (GC-MS) to confirm the results of the screening assay. This quantitative test is more accurate and sensitive and more expensive than the Drug Abuse Survey. The GC-MS may be used to test body fluids other than urine. This assay is recommended for employee screening programs or situations in which accuracy is paramount. Specimens should be collected under observation for greater reliability. Some states require that specimens collected for employee screening or forensic purposes be accompanied by documentation showing the chain of custody for each specimen. Substitute urine samples may produce false-negative results, and laboratory mix-ups can produce false-positive results. The GC-MS is considered the standard for testing for drug abuse and has a virtual 0% false-positive rate.