IS DRUG TESTING THE ANSWER?
A WORK IN PROGRESS
May 2003
4th International Conference on Drugs & Young
People, Wellington, New Zealand
ANN-MARIE
STAPP
MA app. Social Work
PG Cert. Health Sciences (Alcohol and Drug Endorsed)
M.A.N.Z.A.S.W
ABSTRACT
IS DRUG TESTING THE ANSWER?
The
decision of management structures in secondary schools (and in Alcohol and Drug
Treatment environments) to drug test a youth, seems to be based on concerns
about levels of harm that a student is creating for themselves, other students,
their families and their school community. These systems argue that this is
about a policy of identifying barriers to learning and removing those barriers.
While most people would be in agreement with this policy, how to achieve the
goal in practice is a little more controversial.
It
seems that more secondary schools are adopting procedures used by employers
concerned about Occupational Safety and Health issues, without due
consideration to the dilemmas of transporting interventions from adult work
places to youth learning environments.
When
I am requested to provide a drug testing service to check students drug levels,
I do not believe I am providing this in the context of an assessment for this
young person. It raises the issue of legal/procedural/punishment ideas clashing
with practices of the health environment.
Students
experience testing as punishment and catching a student in the hope that this
would motivate them to change the behaviour has a dodgy success rate. Putting
on my behaviourist hat, history would tell us that creating fear and utilising
punishment creates further fear and tends to push us mere mortals into the
realm of denial and becoming more sneaky about the frowned upon behaviour. Now
putting on my Social Work systems analyst hat, picking off an individual
without addressing the context in which the behaviour is occurring, blames the
individual.
So
putting both hats on together, the question for me is how to we support and
encourage an individual to take responsibility for their own drug use and how
they behave towards others plus assist the systems (family, school) around the
individual to change in its response to that individual.
This
15-minute presentation invites clinicians to consider the ethics of “To test or
not to test” and allows 10 minutes for questions and discussion. It updates the
ongoing work presented at
the
2nd and 3rd international conferences on Drugs and Young
People in 2001 and 2002.
Ann-Marie
Stapp
Also Presented at:
Guidance Counsellors Regional (Wellington/Hutt/Porirua) Training - May 2000
Case Management Article for University paper - June 2000
Cutting Edge Alcohol and Drug Conference –
Rotorua -
Aug 2000
Hutt Youth Mental Health Network meeting - Sep
2000
2nd
International Drugs and Youth Conference – MELBOURNE -May 2001
AUSTRALIAN DRUG FOUNDATION
POSITION
PAPER JUNE 2000
DRUG
TESTING SECONDARY SCHOOL STUDENTS
“The
ADF do not believe drug testing is
the answer to managing drugs in schools
and
urges caution for those schools
considering
adopting drug testing”
IS DRUG TESTING THE ANSWER?
INTRODUCTION
The answer of course to the question of whether
drug testing is the answer lies entirely in understanding the original
question.
If the original question is something like:
Does this person take an illegal substance?
or have they taken one recently? Then a drug
test may give you that answer. It also may not.
However, if your question is a little more
complex, like:
Has this person also taken a legal substance
such as alcohol?
or is their any impairment and what degree is
that impairment as a result of taking a substance, then drug testing falls
short of even beginning to be an answer.
In my position as a Youth Clinician with
Hinetitama, Alcohol and Drug Services, Hutt Valley District Health Board, I
provide an assessment and treatment service for secondary school students whom
Boards of Trustees and/or Guidance Counsellors deem to need assistance. The
role involves determining what services our treatment team is able to provide
and determining what is treatment and when it is actually needed? This is, in essence, about building external
partnerships between secondary schools and treatment providers and building
internal relationships between school management systems, BOT representatives
and guidance teams.
What has become highlighted in the course of my
practice, is the different understandings between school management systems,
guidance staff, families, treatment providers and the students themselves as to
what is appropriate, useful, ethical and/or legal treatment. The heart of the
matter seems to lay in the debate of defining harm and whether it is possible
for legal implications of illicit drug use to be supplemented by a
health/treatment perspective or vice versa.
In my opinion, what has occurred is that
schools have become involved in a parallel process with the drug using
students. One of the behaviours attached
to drug use is the behaviour of the PIG, Problem of Immediate Gratification.
(In laypersons terms – “I want it now and I will have it now and it doesn’t
matter how I get that). The danger faced by schools is to see a problem and rather
than having a planned response, react with “I want this fixed and fixed now”.
Ironically, reinforcing the behaviour that is being challenged in the student.
Schools are concerned that students are unable to say ‘No” to drug use, however
schools are unable to hear a “no” to drug testing. The parallel process
continues in that schools remain pre-contemplative about changing their
responses to the issues, in the same way students remain pre-contemplative
about changing their drug use. The last irony is that schools, who adopt “quick
fix” policies and procedures to address illicit drug use by students, are in
turn acting illegally, and I believe unethically.
DISCUSSION
The decision of some management structures in
schools to drug test a student seems to be based on concerns about levels of
harm that a student is creating for themselves, other students, their families
and their school community. It seems also that school environments have a
policy of identifying barriers to learning and removing those barriers. While
most people would be in agreement with this policy, how to achieve the goal in
practice is a little more controversial.
There are some lawyers who are becoming quite
vocal about youth’s rights to privacy and raising questions about the legalities
of requesting drug-testing information, in the same way questions are raised
about drug testing in the work place.
The major legal opinion available on this issue would suggest that to
request drug testing is an infringement of students rights under the New
Zealand Bill Of Rights Act 1990, the Privacy Act 1993, and UN Convention on the
Rights of the Child. Drug testing is illegal in all but most extreme
circumstances. These being defined as serious and widespread problem of drug
use in the school. Limited testing may be reasonable if it is suspected the
student’s use of the drug is interfering with learning. Random testing is
considered an infringement but testing can happen if a student admits to drug
use and the test is considered a condition of re-entry to school. (Eddington: 1997).
As I am not a lawyer, or teacher or a manager
of a school, but a Youth Alcohol and Drug Clinician, I am faced with different
ethics regards this issue. My response to the issue of testing if a student
admits to use and is therefore suspended and needs a test to get back into
school, is simply, if the student has admitted use then what more do you want
the tests to show?
Ethically, when I am requested to provide a
drug testing service to check student’s drug levels, I do not believe I am
being asked to provide this in the context of an assessment for this young
person. Our service may use drug testing for medical reasons to check client’s
levels of opioids in order to adjust treatment medication accordingly but we don’t
do this for cannabis reduction.
I do not want Hinetitama to be the test case in
court as to whether taking a urine sample is a breach of the seizure clause
under Section 21 of the Bill of Rights whereby people are deemed to have
freedom against unreasonable search and seizure. (Eddington: 1997)
While the purpose of drug testing is argued to
be about removing the barriers to learning, some students experience this as
being “snapped”. It is therefore, in my view, in practice, also about catching
a student in the hope that this would motivate them to change their behaviour.
Putting on my behaviourist hat, history would tell us that creating fear and
utilising punishment creates further fear and tends to push us mere mortals
into the realm of denial and becoming more sneaky about the frowned upon
behaviour. Now putting on my Social Work systems analyst hat, picking off an
individual without addressing the context in which the behaviour is occurring,
blames the individual.
So
putting both hats on together, the real question for me is how do we support
and encourage an individual to take responsibility for their own drug use and
how they behave towards others, plus assist the systems (family, school) around
the individual to change in its response to that individual?
In
the light of these critical questions, these are my further thoughts:
·
Students do not have to
necessarily be caught smoking marijuana but suspected of this. This is a
difficult assessment to make given many of the symptoms of being stoned are
also symptoms of depression, distress, abuse and even dissatisfaction in
school. Considering drug abuse as an option for a student experiencing
difficulties in other areas, is good practice, however I find inviting the
student to talk about their drug use rather than risking driving the behaviour
underground usually bears more fruit.
·
The result of drug testing
is health information and is owned by the student and it is their right to
refuse access to this information. Giving a choice about providing the information
or there being consequences is a Clayton’s choice. (The ____________ you are
having when you aren’t having one).
·
Testing can produce false
negatives.
·
Some would suggest that the
gain from drug testing belong solely to the money made by the drug test
companies.
·
It is an expensive method to
use in an attempt to prove drugs are being used when in most cases we know they
are as the student has been caught or they are open about the using. It is also
use of the health dollar for a non-treatment purpose. Consider the cost-benefit
ratio.
·
It is not occurring in the
context of a brief intervention or comprehensive assessment (either by Guidance Counsellors or Health
Professionals) so that an opinion can be formed about family context, treatment
issues, diagnosis, prognosis and intervention options.
·
Relying on a drug test to
show improvement implies that a student may not get back to school until
providing a clear urine which can take up to 8 weeks. The student misses out on
a lot of learning in this time and is denied the right to access education.
·
If a student decides to give
up marijuana there are some detox issues that include a bio/medical phase,
psycho/social phase and social phase that has particular interventions.
(Lundqvast 1993). It is dangerous to simply tell a student to stop using
without the support of the structured school environment and some health
intervention.
·
People use drugs for various
reasons – some of them being survival of untenable living situations and past
experiences of abuse. To remove that survival mechanism, one must have others
to replace it.
·
If the school was able to
identify the students who use together, it would be useful to work with that
group as a whole to assist in some pretreament intervention around motivation
to change and a student (or students) becoming more contemplative about their
drug use.
·
Drug testing does not give a
picture of the pattern of use – when started, how often, heavy periods of use,
attempts to give up (dyscontrol), relapse precipitators, family history
(genetic predisposition), longest abstinence, current use, lost activities
(salience), motivating factors for use and stopping, tolerance and withdrawal
factors, the difference between use, abuse and dependence (pleasure compulsion
– biological factors).
·
A drug test will only show
if THC has been used in the last 45 days, therefore only confirming recent drug
use (Hall et al 1998) – and schools are interested in use at school, not
necessarily weekend use. So how does the school differentiate between those
suspected of using at school, who have a positive drug test and those who are
using in the weekend only and show a positive drug test? This issue splits a
school community and has the potential to create a further drug using culture
of “not getting caught” and who is a “snapped user” and an “unsnapped” one.
·
With particular reference to
the physiological component of drug dependence, the issue of tolerance clouds a
drug result. People with a high tolerance eliminate drugs quicker than
occasional users. One of the ironies of the drug field. E.g. chronic users have
tested negative after a weeklong binge. (Gombos 1999).
·
Drug using is only one
factor in school absenteeism and decreased learning opportunity. Where is the
measure of which factor weighs the heaviest?
·
How is the school measuring
the level of harm that cannabis use is causing?
·
Drug testing ignores the
issue of alcohol use in NZ, which costs the NZ economy $57 million per year
-$41 million in reduced productivity and $16 million in absenteeism. The NZ
population is 3.4 million and average alcohol consumption per annum is 9.7
litres of absolute alcohol for 15 years and over. (Jones et al 1995).
·
Drug testing does not
account for drug experimentation and ignores diagnostic differential.
·
Requesting drug testing has
had some implications in employment courts because of lacks of checks and
balances and may have implications in Human Rights Law around privacy issues.
·
It seems that more secondary
schools are adopting procedures used by employers concerned about Occupational
Safety and Health issues, without due consideration to the dilemmas of
transporting interventions from adult work places to youth learning
environments.
·
Drug testing does not
measure mental and physical impairments.
·
Drug testing discourages an
environment where drug users can identify themselves and what they need for
assistance.
·
What assistance to we
provide to families to respond to their drug using child
·
What about the drug using
family?
·
What training do we give
teaching staff to deal with drug using disclosures?
·
What role does the guidance
staff have in assisting a drug using student?
·
What are the cultural
implications for asking students to agree with semi-invasive body procedure?
·
Schools state that parents
are asking for drug free school communities. Targeting students at the
exclusion of teaching staff does not address the community as a whole. We are
asking students to do what adults have a choice not to do. If we use the same
argument about barriers to learning, then the harm experienced by the staff
from substance abuse would be a barrier in being able to teach effectively. Are
staff therefore drug tested? Or alternatively supported to address their
difficulties?
·
We live in a country, and
work in a field that expects us to understand the Treaty of Waitangi. To
practice partnership, in our relationships with each other as agencies and in
our relationships with our young people. Declaring a war on drugs and using
methods such as drug testing out of context of full assessment, is harmful,
polarising and an antithesis to what the Treaty is asking of us.
CONCLUSIONS
By asking the question is drug testing the
answer, we are attempting to simplify a complex issue, which results in more
questions.
This paper supports the notion of schools
utilising all existing services ranging from education to brief intervention to
fuller assistance from specialist services. It is asking for the developing of
real partnerships with the people who most need our services.
It
supports the idea that the people who provide the services talk to each
other. In working collaboratively on
providing the continuum of services we move away from the need to focus on
punishment for use of illicit drugs. We move towards provision of assessment
and assistance in both public health and treatment contexts.
There
is no reason to respond to any alcohol and drug related issue in the secondary
school environment by ignoring it, or leaning towards a one-off intervention
involving a drug test or a policy that only considers legal implications for
schools.
Whatever
the intervention, education, brief or specialised, it is clear from the
literature, and the services available, that the current opportunities for such
delivery does exist. As Zimmerman et al 1998, sum up:
“It is collaboration among managed care organisation,
schools and public health agencies that are increasingly critical to adequately
address the health needs of youth and to increase access to effective
services”.
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