May is National Treatment Court Month

National Treatment Court Month is held each May in the United States. It is a national celebration inclusive of all treatment court types: Adult, Family, Juvenile, Impaired Driving, Tribal Healing to Wellness, and Veterans. AllRise recently issued its latest Adult Treatment Court Best Practice Standards, on March 18, 20251. AllRise was founded in 1994 as the National Association of Drug Court Professionals and is a 501©3 non-profit organization2. This blog will explore the recent standards related to drug and alcohol testing.

Adult Treatment Court Best Practice Standards¹

Discussion

All Rise’s Adult Treatment Court Best Practice Standards represent decades of research on treatment courts, criminology, and behavioral health. The standards distill this research into actionable best practices, providing a comprehensive blueprint to enhance outcomes across all treatment court models.

The latest version includes the following revisions:

• Newly revised standard on drug and alcohol testing
• Includes the new standard on community supervision
• Removes the numbering format; standards will be referred to by their titles rather than by numbers
• Temporarily omits the commentary and references, which are being revised for clarity and ease of use; revised commentary and references will be added as they become available
• Reorders the standards as follows to better support practical implementation:
  • Target Population
  • Roles and Responsibilities of the Judge
  • Multidisciplinary Team
  • Substance Use, Mental Health, and Trauma Treatment and Recovery Management
  • Complementary Services and Recovery Capital
  • Community Supervision
  • Incentives, Sanctions, and Service Adjustments
  • Drug and Alcohol Testing
  • Program Evaluation, Monitoring, and Improvement

Revised Standard on Drug and Alcohol Testing¹

Drug and alcohol testing within a drug court program provides an accurate, timely, and comprehensive assessment of substance use throughout participants’ enrollment in treatment court. The following provisions will be summarized:

Forensic and Clinical Testing

Treatment court participants with substance use disorders undergo drug and alcohol testing for unauthorized substance use.

Forensic testing is conducted by or at the direction of justice system professionals, such as community supervision officers or court case managers, and is used to help gauge participant compliance with court requirements. Forensic test results are shared with the rest of the treatment court team and may be used to inform the delivery of incentives, sanctions, and/or service adjustments to promote treatment goals and behavioral change. Treatment courts avoid relying on treatment agencies to conduct forensic testing, as this practice risks interfering with the therapeutic alliance between treatment provider and client, raises ethical concerns for treatment professionals, and requires legal chain-of-custody protection. If a treatment court must rely on a treatment agency to conduct forensic testing, such testing is conducted by dedicated and properly trained staff, not by participants’ counselors, and all legally required chain-of-custody procedures are followed.

Clinical testing, if used, is conducted at the discretion of treatment professionals and is used solely as a therapeutic tool to assess participants’ clinical needs and guide treatment modifications. Participants may also undergo clinical drug and alcohol testing if deemed appropriate by the participant’s treatment provider. Decisions about clinical testing frequency and methods are left to the professional judgment of the participant’s treatment provider, and treatment providers exercise caution, consistent with their professional guidelines, when sharing clinical test results with the rest of the treatment court team.

Specimen Options

Treatment courts use urine testing for forensic abstinence monitoring in most cases because urine offers many advantages: cost, detection window, on-site and laboratory testing options, established forensic standards, and the wide variety of substances that can be detected versus other specimen options. When there are compelling case-specific reasons, treatment courts may use other test specimens, such as sweat, oral fluids, or hair, and modify their testing protocols to account for differences in detection windows and the range of substances detected.

Frequency of Testing

Forensic drug and alcohol testing is conducted frequently enough to ensure that unauthorized substance use is detected quickly and reliably. Urine testing, the most common methodology used in treatment courts and probation programs, is administered at least twice per week until participants have achieved early remission of their substance use disorder and are reliably engaged in recovery management activities and preparing for graduation. Tests that have short detection windows, such as breathalyzers or oral fluid tests, are used primarily when recent substance use is suspected or when substance use is more likely to occur, such as during weekends or holidays. Tests that are designed to measure substance use over extended periods of time, such as sweat patches or continuous alcohol monitoring, offer alternative abstinence monitoring strategies.

Random Testing

The schedule of forensic drug and alcohol testing is random and unpredictable. The probability of being tested on weekends and holidays is the same as on other days. Participants are required to produce a test specimen as soon as practicable after being notified that a test has been scheduled. Urine specimens are delivered no more than 8 hours after the participant is notified that a urine test has been scheduled. For tests with short detection windows, such as oral fluid tests, specimens are delivered no more than 4 hours after the participant is notified that a test has been scheduled.

Duration of Testing

Forensic drug and alcohol testing is conducted throughout the participant’s enrollment in the treatment court program to detect substance use. The frequency of testing may be decreased after a participant has achieved early remission of their substance use disorder and is reliably engaged in recovery management activities and preparing for graduation.

Breadth of Testing

Forensic test specimens are examined for all unauthorized substances that treatment court participants might be using. Randomly selected specimens are tested periodically for a broader range of substances to detect new substances that might be emerging in the treatment court population.

Specimen Collection

Forensic collection of urine specimens is observed by specimen collection personnel who have been trained to prevent tampering and substitution to control the production of fraudulent specimens. However, collection personnel exercise sensitivity to the invasive nature of observed urine testing and use trauma-informed collection practices in cases where there are significant concerns about the possibility of retraumatization. Trauma-informed approaches may include adapted observation techniques, unobserved collection with precautions (like searching participant’s clothing for chemical adulterants or fraudulent samples), increased dialogue with the participant, providing more time to produce the specimen, or alternative specimen collection where appropriate. Absent unusual circumstances, participants are not permitted to undergo drug or alcohol testing by an outside entity that is not approved by the treatment court. When testing specimens, whether urine or an alternative specimen type, treatment courts follow the specific testing protocols set by the test manufacturer

Valid Specimens

Forensic test specimens are examined routinely for evidence of dilution and adulteration. All urine samples should be analyzed for creatinine concentration to detect potential tampering by dilution. Post collection urine temperatures are also monitored at the collection site.

Testing Methodologies

The treatment court uses scientifically valid and reliable testing procedures for all forensic drug and alcohol testing and establishes a legally appropriate chain of custody for each specimen. If a participant denies substance use in response to a positive screening test, a portion of the same specimen is subjected to confirmatory analysis using either gas chromatography/mass spectrometry (GC/MS) or liquid chromatography/tandem mass spectrometry (LC/MS/MS).

Result Evaluation

Drug and alcohol test results are typically reported simply as positive or negative. Treatment courts do not attempt to engage in quantitative analysis of drug tests or draw conclusions from drug concentrations in urine samples. Treatment courts do not attempt to evaluate results that fall below the cutoff threshold for the testing method used. The treatment court team receives sufficient training to understand the complexities associated with the interpretation of testing results and to be aware of the significant consequences that the misapplication or misinterpretation of results can have for therapeutic outcomes.

Result Availability

Test results, including the results of any confirmation testing, are available to the treatment court within 48 hours of sample collection to maximize the effectiveness of any responses that might be delivered, including appropriate service adjustments, incentives, or sanctions.

Participant Contract

Upon entering the treatment court, participants receive a clear and comprehensive explanation of their rights and responsibilities related to drug and alcohol testing. This information is described in a participant contract or handbook and reviewed periodically with participants to ensure that they remain cognizant of their obligations and potential consequences for noncompliance.

Conclusion¹

The Adult Treatment Court Best Practice Standards represent over two decades of research on treatment courts, criminology, and behavioral health. The standards distill this research into actionable best practices, providing a comprehensive blueprint to enhance outcomes across all treatment court models. As a dynamic and evolving resource, the standards are periodically updated to incorporate the latest research, address emerging issues, and add new insights. All Rise maintains a rigorous peer review process involving treatment court practitioners, researchers, and other subject-matter experts. The commentary and references continue to be revised to be more user-friendly and to support practical implementation and will be added as they become available. All Rise is committed to ensuring that these standards are achievable and measurable. Therefore, we offer an array of companion resources, including in-depth commentary on each standard, practice guides, toolkits, and other publications, in-person and online training, and real-time support. For a list of standards-based resources, visit AllRise.org.

DTPM Solutions

DTPM’s mission is to help fight alcohol and drug use and dependency. We offer alcohol and drug testing solutions to a variety of testing facilities such as drug courts, treatment centers, physician office labs, reference labs and more. General testing supplies such as gloves and lint-free wipes are also available. Contact us today to learn how DTPM can help you in this war against drug and alcohol use in the United States.