Contingency management, a behavioral therapy used for treating substance abuse, encourages behavioral changes like abstinence from alcohol and drugs by providing stimulus like control and positive reinforcement to meet the treatment goals. To reinforce abstinence from addictive substances, various drug-screening procedures are used and the goal is to detect all the instances of target drug. Therefore, under the provisions of the contingency management therapy for addiction treatment, the clinician monitors substance use for two to three times every week through urine test.

When individuals submit a negative urine sample for the targeted drug, they receive reinforcers like prizes or vouchers. On the contrary, the submission of the positive sample results in the deprivation of any kind of reinforcement or infliction of punishment. Reinforcing drug abstinence is a straightforward procedure that can be introduced at the treatment centers or clinics. Most treatment centers and clinics screen urine samples as a part of the standard treatment.

If the urine samples are sent to the laboratories located outside the treatment facilities for screening, then it can hinder the application of contingency management therapy procedures due to the delay in obtaining the outcomes. Therefore, it is necessary to have onsite test kits at the treatment centers.  These kits are capable of providing immediate results in mere two to five minutes. At the same time, separate tests can be conducted to help the medical practitioner in specifically screening any substance like methamphetamine, cocaine, marijuana and heroin. The submission of urine samples must be observed by a staff member to ensure the validity of samples.

Frequency of urine test

The frequency of urine test used as a part of the monitoring strategy depends on the substance abused by patients. The testing schedule must coincide directly with the test’s ability to detect the presence of the target drug. Some drugs can be detected in short intervals, whereas many take time. For alcohol and nicotine testing, one needs to conduct drug testing two to three times per day.

While drug testing is conducted thrice a week in the case of chronic marijuana users, it is sufficient to conduct test once a week for the normal marijuana users as it stays in the body for a longer time compared to other drugs. For cocaine, opioids and other stimulants, it is optimal to conduct urine test three times a week due to the scope of detection over 48 to 72 hours.

In order to reinforce the initial abstinence tendencies, the quantitative analyses of reduction in metabolites can be conducted. Alternately, patients can be reinforced for attendance in the first three weeks. Generally, the urine samples of patients start displaying negative readings within three to four weeks. Therefore, reinforcement is contingent upon the negative readings.

If the urine test is negative, then a reward is given to the concerned patient. The reward can be a voucher or cash that allows an individual to buy a product or enjoy a service. Usually, the rewards start getting bigger with the increase in drug-free tests. If the rewards get bigger and more frequent, it becomes a motivating factor for patients.

Key steps involved urine testing

The urine tests help clinicians in keeping tabs over the chances of relapse or cravings among their patients. They play a pivotal role in assisting patients in remaining clean and sober despite all odds. The presence of the drugs in the urine samples is crucial for making clinical treatment decisions. The following are the steps for performing urinalysis during contingency management therapy:

• Obtaining the urine sample: An individual can give a urine sample in a sample cup. It is important for people to leave coats or bags aside to prevent the submission of wrong urine samples. A staff member of the treatment or diagnostic facility must escort the person to the bathroom and can wait outside if required.
• Avoiding tampered or adulterated samples: The urine sample must be stored at the correct temperature. Moreover, the limit of urine samples shared should also be checked to avoid the chances of handing over wrong urine samples or diluting urine with water. The time from urination to the measurement of temperature must not exceed more than 4 minutes. If the temperature of the specimen is outside the range of 90 to 100°F, then chances are that the donor may have substituted or altered the specimen.
• Setting up the urinalysis machine: The urinalysis machine is plugged into the computer and logged in with the profile of general use. The tag is inserted and selected to read it into the urinalysis machine. After inserting the calibration cassette into the urinalysis machine, the results are saved. After this, the calibration cassette is removed and holder cassette is inserted for testing the required substance.
• Analyzing the urine sample: The pipette is filled with 1 ml of urine and then released into the dilution tube. The required stimulant test device is placed into the holder cassette in the urinalysis machine drawer. The C and T mark must match the C and T mark on the side of the cassette. Some of the diluted urine is drawn with the help of the pipette and three drops are released into the specimen. The drawer is closed and clicked on the analysis tab.
• Determining the outcome: After analyzing the result, clinicians take the decision whether the participant has passed the test or not. All materials like urinalysis cassettes and urine sample must be put in the clinical waste bag. The urine sample can also be disposed in the bathroom and materials be placed in the clinical waste bag.

Constant vigilance necessary to avoid relapse

One of the harshest truth of any treatment is the increased chances of a relapse. As highlighted by studies, patients run the risk of relapsing to the drug of their choice or other substances during the course of their treatment. Therefore, it becomes necessary to constantly monitor their drug-seeking behavior through urine tests.

If you or your loved one is addicted to any type of substance, contact Sovereign Health of California for help. Our state-of-the-art-art addiction treatment centers can assist you by providing holistic treatment and adequate support. Call at our 24/7 helpline number or chat online with our representatives to access more information on various treatment programs.