U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

May 2000

Juvenile Accountability Incentive

Block Grants Program

John J. Wilson, Acting Administrator

Ten Steps for Implementing

a Program of Controlled

Substance Testing of Juveniles

Ann H. Crowe and Linda Sydney

This Bulletin is part of OJJDP’s Juvenile

Accountability Incentive Block Grants

(JAIBG) Best Practices Series. The basic

premise underlying the JAIBG program,

initially funded in fiscal year 1998, is that

young people who violate the law need to be

held accountable for their offenses if society is

to improve the quality of life in the Nation’s

communities. Holding a juvenile offender

“accountable” in the juvenile justice system

means that once the juvenile is determined

to have committed law-violating behavior,

by admission or adjudication, he or she is

held responsible for the act through consequences or sanctions, imposed pursuant to

law, that are proportionate to the offense.

Consequences or sanctions that are applied

swiftly, surely, and consistently, and are

graduated to provide appropriate and effective responses to varying levels of offense

seriousness and offender chronicity, work

best in preventing, controlling, and reducing

further law violations.

In an effort to help States and units of local

government develop programs in the 12 purpose areas established for JAIBG funding,

Bulletins in this series are designed to present

the most up-to-date knowledge to juvenile

justice policymakers, researchers, and practitioners about programs and approaches that

hold juvenile offenders accountable for their

behavior. An indepth description of the

JAIBG program and a list of the 12 program

purpose areas appear in the overview Bulletin

for this series.

Major Steps for Program

Implementation

This Bulletin is a companion to the

JAIBG Bulletin Developing a Policy for

Controlled Substance Testing of Juveniles

(Crowe and Sydney, 2000) and presents a

detailed discussion of a 10-step process,

shown in figure 1, for developing and

implementing a substance-testing program. Although these steps are presented independently, in practice they

are likely to overlap, with final determinations about policies and procedures in

one area contingent on decisions made

at other points during the process.

Step 1: Involve Key

Stakeholders

Several principal roles should be represented in the decisionmaking tasks of

program development. These can be

discussed in three categories:

From the

Administrator

This OJJDP Bulletin offers specific information to assist those

seeking to establish an effective

substance abuse testing program. For example, the advantages and disadvantages of

several testing methods are

described, and sample budgets

for testing programs conducted

in various settings are provided.

Suggested readings and resource organizations are also

included.

The testing approach described

in this Bulletin was recommended in the companion Juvenile Accountability Incentive

Block Grants Best Practices

Bulletin Developing a Policy for

Controlled Substance Abuse Testing

of Juveniles. Written by the same

authors, the latter Bulletin provides an overview of substance

abuse testing, sets forth testing

indicators, and summarizes substance abuse trends.

It is my hope that these Bulletins will serve as a foundation

for building successful substance abuse testing programs.

John J. Wilson

Acting Administrator
2

will affect the organization and staff

of the agency implementing it.

When both managers and staff are

involved, they are more likely to

support the effort. They also can

provide key insights about the operation of the program, other staff

and juveniles’ reactions to it, and

possible problems to avoid.

■ Other juvenile justice system stakeholders who will not be involved

directly with administering the drugtesting program, but whose support

and views on drug testing will be important to the program, should be included in the planning process. These

may consist of law enforcement personnel, judges, prosecuting and defense attorneys, paroling authority

representatives, and court administrators. The appropriate mix of these

representatives will depend on the

agency(ies) implementing drug testing and the other juvenile justice

agencies that might be affected by it.

■ Community representatives also

should be included as appropriate.

For example, substance abuse treatment providers working with youth

should be included. Family and

caregivers are also critically important. Others to consider are personnel from education, social welfare,

and healthcare organizations; technical experts; academicians; parents’ or

citizens’ groups; and delegates from

possible funding sources (e.g., businesses and the faith community).

Step 2: Determine

Program Purpose

It is essential to carefully consider and

clearly articulate the purpose of the

substance-testing program. Without a

clear goal in mind, other decisions will

be more difficult. A purpose statement

should describe briefly:

■ What is to be accomplished by substance testing.

■ How it will be done.

■ Who will be tested.

■ Who is responsible.

■ When testing will occur.

■ How results will be used, including what treatment resources will

be used.

■ What objectives are not to be pursued through the program. (For example, if results of tests are to be

used for case management, and not

for punitive purposes, this should

be stated clearly.)

The purpose statement must coincide

with the agency’s mission. For a balanced approach to juvenile justice,

agencies should incorporate and place

equal emphasis on the following three

elements (Maloney, Romig, and

Armstrong, 1988):

■ Community protection.

■ Accountability of youth.

■ Competency development of youth.

Similar balance in the purposes of

substance testing also is appropriate.

Substance testing can be used for the

following:

■ Assessment and treatment. Substance testing is used to identify

youth whose use of alcohol and

other drugs requires treatment and

to monitor their progress in treatment (Pretrial Services Resource

Center, 1998).

■ Health and safety assessment. This

is particularly important when youth

enter programs directly from the

community (such as in detention or

after furloughs from residential

facilities). If youth have abused substances, they may need medical care

or special supervision to ensure their

own and others’ safety. Some drugs

can cause life-threatening effects;

withdrawal from some drugs also

can be dangerous.

■ Case planning. Results of substance

testing may be used as part of the

■ Agency personnel should include

administrators, managers, and line

personnel of the agency that will be

administering the drug-testing program. Testing programs are most

likely to be developed in detention,

corrections, probation, residential,

and aftercare agencies. Administrators must make important decisions about agency resources, while

managers and line personnel will

implement the program. Input

from all is vital. Any new program

Figure 1: Steps for

Developing a

Substance-Testing

Program

Involve key stakeholders.

Determine program purpose.

Investigate legal issues.

Identify youth to be tested.

Select methodology.

Decide how to use results

and arrange for adequate

and appropriate treatment.

Develop written policies

and procedures.

Obtain funding.

Develop staff.

Evaluate the program.
3

information needed to process youth

through the juvenile justice system.

They may be a factor in determining

whether a youth should be released

from detention and what sanctions

and treatment are needed.

■ Compliance monitoring and supervision. Youth may be ordered by the

court to abstain from using alcohol

or other psychoactive substances.

Substance testing is necessary to enforce these judicial orders. This does

not necessarily mean that youth

must be severely punished if they

use drugs, but it gives juvenile justice personnel information they need

for case management (Mieczkowski

and Lersch, 1997; Pretrial Services

Resource Center, 1998).

■ Epidemiological analysis. Substance

testing helps juvenile justice professionals learn the incidence and

prevalence of substance abuse and

the types of chemicals being abused

in the communities they serve.

The results provide information

for planning and evaluation

(Mieczkowski and Lersch, 1997).

Step 3: Investigate

Legal Issues

Legal issues require research at the

local and State levels. The areas discussed in this Bulletin generally prevail, but they may vary according to

local and State statutes or regulations

and emerging case law. Having the

help of legal counsel in drafting and

reviewing policies is advised.

Authority To Test

Examine the agency’s authority to

test early in the development of drugtesting policies. Authority to test generally comes from one or more of the

following three sources:

■ Statutes. State or local statutes may

mandate, permit, or prohibit practices related to substance testing

of juveniles. Any such legislation

should be cited in the jurisdiction

or agency’s policies and procedures

document. Statutory support for

testing is preferred, as it provides

the maximum legal protection for

agencies and practitioners carrying

out the program.

■ Court or paroling authority orders. Court or paroling authority

orders for adjudicated youth may

direct that the youth submit to substance testing. Courts or paroling

authorities should impose such a

condition where substance testing

could facilitate the rehabilitation of

the youth or where alcohol or other

drug use is related to the youth’s

delinquent behavior. (This provision

does not apply to preadjudicated

youth, whose situation is discussed

later.) Although it is preferred that

courts or paroling authorities impose conditions for substance testing, they should make those orders

flexible enough for the agency or

practitioner to determine the frequency of testing.

■ Agency policy. All agencies conducting substance testing should have

written policies that clearly state the

purpose for testing and identify the

juveniles who will be subject to testing (e.g., all juveniles, those juveniles

with a history of drug use, youth

with court orders for testing).

The testing program is most defensible if all three sources of authority

are in place. In the absence of statutory authority, both court or paroling

authority orders and agency policies

are recommended.

Testing Preadjudicated Youth

Because of their age and status, adjudicated youth’s rights are diminished

in some respects. Being minors, they

cannot vote, drive vehicles, or legally

purchase alcohol or tobacco, and as a

result of their adjudication, they may

lose their freedom or have restrictions

placed upon it. However, until youth

have been adjudicated, they are entitled to all the rights and protections

afforded any youth in the community.

Nonetheless, there is a rationale for conducting testing of preadjudicated youth

in a detention program, as stated by the

American Correctional Association and

Institute for Behavior and Health, Inc.

(ACA/IBH) project (1991a, p. 1):

The issue of constitutionality of

urine collection and testing in

detention facilities hinges on

what use is made of the test results. Test results can be used

with confidence as part of a

case management plan, just like

other information from a medical examination. When an initial health screen reveals evidence of diabetes or a sexually

transmitted disease (STD), the

detention facility is obligated to

devise a plan for treatment.

This principle holds for urine

test results. On the other hand,

if testing is used to file charges

and prosecute, there is a potential for legal challenge.

Agencies should note that statutory

authority still is preferable when considering testing of preadjudicated

youth. Sometimes laws do not specifically authorize drug testing, but authority may be inferred from other laws.

For example, the Code of the District

of Columbia contains the following

three provisions that are interpreted

broadly to allow for urine drug testing of youth in detention (ACA/IBH,

1991b, 1995):

■ Physical examinations of youth are

permitted. Drug testing is considered within the definition of “physical examinations” allowed by this

law (D.C. Code 16–2315).

■ A preliminary determination of the

need for supervision is mandated

(D.C. Superior Court Rules 102 and

103). Because the determination of

illegal drug use generally justifies

the need for supervision, testing to

detect drug use may be viewed as an

essential part of the intake process.
4

■ A determination must be made

about the necessity of detaining a

juvenile for his or her protection or

the protection of others. Substance

abuse is among the factors considered when assessing the need to

keep a youth in detention (D.C.

Superior Court Rule 106).

The District of Columbia Superior

Court determined these statutory and

regulatory provisions were sufficient

to enter into a memorandum of understanding that allows for drug testing

of preadjudicated youth. Jurisdictions

should approach preadjudication

testing cautiously and explore

jurisdiction-specific laws to determine whether present statutes support

preadjudicatory testing (ACA/IBH,

1995).

Voluntary Testing

Where legislation does not support

testing, agencies may elect to make

testing voluntary, especially at the

preadjudication phase. In a voluntary

program, agencies should obtain informed consent from youth (and possibly their parents in some States) before

testing. Informed consent includes

knowledge of the following:

■ Specimen collection process.

■ Use that will be made of test

results.

■ Consequences of testing positive.

■ Confidentiality provisions.

■ Right to legal counsel, if applicable.

This information should be given to

youth orally and in writing. Youth

should then sign a statement confirming that they understand the

information and give their consent to

participate in testing. If the testing

program is voluntary, youth should not

be penalized for refusing to be tested.

Constitutional Issues

Regarding Testing

Challenges to drug testing usually relate to the five constitutional rights

discussed below (Del Carmen and

Sorensen, 1988):

■ Right against unreasonable search

and seizure (fourth amendment).

Urine testing is equivalent to a

search for illicit drugs and includes

invasive procedures to collect body

fluids. To ensure that it meets this

constitutional test, the “search”

must be reasonable and based on a

rational belief that it is necessary.

■ Right to due process (fifth and

fourteenth amendments). Before a

youth is deprived of liberty, certain

procedures must be followed. Tests

must be accurate and meet scientific

standards acceptable to courts. A

second confirmatory test may be

necessary before limiting a youth’s

freedom. Chain-of-custody procedures involving specimens also are

vital. There must be safeguards

against the possibility of tampering

with the specimen or test results, or

they may be invalid for legal use.

(Chain-of-custody procedures are

discussed later.) Specimens from

positive tests should be kept in case

of possible legal challenges.

■ Right to confrontation and crossexamination (fifth amendment).

If the personnel who actually conduct tests are not present to provide testimony, the potential for

challenging results on the basis

of hearsay evidence exists. These

challenges usually have not succeeded, as courts have allowed exceptions to the hearsay rule. The

business records, reliability, and

trustworthiness of a laboratory are

factors a judge might rely upon

when excluding the testimony of

staff member(s) who administered

the test(s) from the hearsay rule.

■ Right to equal protection (fourteenth amendment). Under the

Constitution, individuals cannot be

treated differently unless such treatment is legally justified. In detecting

substance abuse, different treatment

is related to alleged illegal activity

rather than to racial, gender, socioeconomic, or other differences. Drug

screening is reasonably related to

detecting, treating, and preventing

substance use and, therefore, is a

reasonable requirement.

■ Right against self-incrimination

(fifth amendment). Defendants are

protected against self-incrimination

when they give testimony in court.

Urinalysis, however, is a form of

physical evidence (similar to fingerprinting or appearing in a lineup).

Therefore, it is not included in this

constitutional protection. Substance

testing does not require a youth to

confess to drug use.

Challenges to Drug Testing

Substantial case law supports substance testing,1

 but only a few cases

are specifically related to substance

testing of juveniles. Those cases are

summarized briefly:2

■ In re C.J.W., 727 P. 2d 870 (Colo. Ct.

App. 1986). A juvenile failed to

submit to urine testing, which was

a condition of probation, but she

admitted this failure to the probation officer. The court held that

hearsay testimony of the probation

officer was admissible to establish

that the juvenile violated conditions of probation.

■ In re Jimi A., 257 Cal. Rptr. 147 (Cal.

Ct. App. 1989). A juvenile disturbed

1

 For a review of drug-testing case law, refer to Drug

Testing Guidelines and Practices for Juvenile Probation and

Parole Agencies, developed by the American Probation

and Parole Association (APPA) and published by the

U.S. Department of Justice, Office of Justice Programs,

Office of Juvenile Justice and Delinquency Prevention,

1992. Summaries of 62 cases are presented and classified for easy reference in this document.

2

 Some other recent court challenges to drug testing

that are not specific to juvenile offenders include:

Alston v. State, 646 So.2d 184 (Fla. Sup. Nov. 1994);

Bryant v. State, 622 So.2d 620 (Fla. Dist. App. Aug.

1993); Peterson v. State, 623 So.2d 637 (Fla. Dist. App.

Sept. 1993); Stevens v. State, 900 S.W. 2d 348 (Tex. App.

July 1995); United States v. Stephens, 65 F.3d 738 (U.S.

8th Cir. Sept. 1995); Garcia v. State, 661 So.2d 1313 (Fla.

Dist. A.P. Nov. 1995); United States v. Grandlund, 71 F.3d

507 (U.S. 5th Cir. Dec. 1995); Brock v. State, 667 So.2d

1014 (Fla. Dist. A.P. Feb. 1996).
5

the peace and committed a battery

on school property. The defendant

had a history of admitted substance

abuse and had no parental supervision in the evening hours. A condition of probation required the defendant to submit to random drug

testing. The court held this condition

was appropriate, given the youth’s

background of substance abuse and

lack of parental supervision.

■ In the Interest of C.P., 217 (Ga. A.P.

1995 505). A juvenile was adjudicated for violating probation terms

imposed for possessing alcohol.

She appealed, but the court held

that possession of alcohol was a

delinquent act and upheld the

court-ordered probation.

■ ALJ v. State of Wyoming, 836 P. 2d

307 (Wyo. 1992). A youth attended a

party during which he pointed a

gun at others and was adjudicated

for reckless endangerment. He was

placed on 3 years’ probation and

required to submit to random

chemical testing, among other

things. The youth contested this

condition on the grounds that it

violated his right to be free from

unreasonable searches and seizures.

The court ruled that fourth amendment protections that apply to adult

probationers do not necessarily apply to juvenile probationers. They

held it was within the court’s discretion to allow a probation officer

to search a juvenile without reasonably suspecting a probation violation exists. There are differences in

the rights of juveniles at the adjudicatory stage (due process and fair

treatment) and at the dispositional

stage. By statute, Wyoming requires that the court do what is best

for public safety, preservation of

families, and the welfare of the

child. This allows the court to impose conditions for counseling,

treatment, or other programs to rectify the problems contributing to

delinquency. The appellate court

decided these were broad enough

to include chemical testing.

Del Carmen and Sorensen (1988) say

conditions of probation, to be valid,

must be constitutional, clear, reasonable,

and reasonably related to the protection

of society or the rehabilitation of the

individual. They make the following

recommendations for implementing a

drug-testing program:

■ Impose drug screening only when

it is reasonably related to public

safety concerns or the rehabilitation of the individual and in such

cases where the person’s delinquent behavior could be attributed

to drug use.

■ Determine whether a confirmatory

test is required.

■ Ensure that those administering

drug tests are trained and properly

qualified, whether they are agency

staff or employees of a laboratory.

■ Follow strict chain-of-custody procedures, including sealing, labeling, storing, and documenting the

transfer of specimens.

■ Save samples with positive results

until the time for all possible legal

challenges has elapsed.

■ Have clearly written policies and

procedures for drug screening and

for responses to positive findings.

Confidentiality

Programs implementing substance

testing should examine present policies, State and local statutes, and case

law on confidentiality to ensure that

the program complies with them.

Some special considerations apply

when substance abuse services are

provided. Two Federal laws and several Federal regulations affirm these

confidentiality rights (42 U.S.C., § 290

dd-3 and ee-3 and 42 CFR Part 2).

The Federal confidentiality laws

and regulations protect any information about a youth if the youth

has applied for or received any

alcohol or other drug-related

services—including diagnosis,

treatment or referral for treatment—from a covered program.3

The restrictions on disclosure

apply to any information,

whether or not recorded, that

would identify the youth as an

alcohol or other drug user, either

directly or by implication.

(Brooks, 1990, p. iv)

The purpose of the confidentiality laws

preventing disclosure of (written or

oral) information that would identify a

person receiving alcohol or drug treatment is to promote participation in

treatment and related programs. Programs should establish policies and

procedures for confidentiality. Some of

these confidentiality concerns are more

likely to apply to treatment providers

than to juvenile justice agencies; however, juvenile justice personnel must

consider these confidentiality issues

and be aware of the restraints under

which treatment providers must work.

Policies and procedures about confidentiality for drug testing should

address:

■ The youth’s right to privacy.

■ The person(s) to whom and the

circumstances under which information may be released.

■ The type of information that may

and may not be shared.

■ The process and forms for obtaining

permission to release information.4

3

 Covered programs include those that are federally

assisted, both directly and indirectly. Indirect forms of

Federal aid might include tax-exempt status or funding from State or local governments that originated

with the Federal Government (Brooks, 1990).

4

 A sample consent form for release of information and

a statement regarding redisclosure of information may

be found in Legal Issues for Alcohol and Other Drug-Use

Prevention and Treatment Programs Serving High-Risk

Youth, written by M.K. Brooks and published by the

U.S. Department of Health and Human Services

(HHS), Substance Abuse and Mental Health Services

Administration (SAMHSA), Office for Substance

Abuse Prevention, 1990.
6

■ The consequences for unauthorized disclosure of information.

■ The precautions to be taken when

collecting and aggregating data

to ensure the confidentiality of

individual youth.

Step 4: Identify Youth To

Be Tested

Selection of youth to participate in a

substance-testing program will be

based, in part, on the agency and the

purpose for testing. Testing could be

conducted at every point in the juvenile

justice continuum. For example, the

following illustrates options for testing

juveniles:

■ At intake to detention. All youth

could be tested to detect possible

health or safety concerns, to help

in considering (with other factors)

which youth might be released before adjudication with minimal

risk to themselves or the community, and to assist in making case

plans for treatment, supervision,

or placement.

■ During probation supervision. Probation agencies might adopt policies

to test every youth at intake to probation or limit testing to those with

court orders for testing. Testing

should be adjusted to the case situation on an ongoing basis. For example, if a youth tests negative

several times, stopping or diminishing drug testing should be considered. On the other hand, if a

youth who was not previously subject to testing begins showing signs

of substance abuse (e.g., declining

grades, absenteeism, getting in

trouble), initiating testing should be

deliberated.

■ In residential placement. Testing

in a residential facility might be

done when youth are admitted,

when they have been away from

the facility (e.g., furloughs, work

release) and might have had access to psychoactive substances,

and when behavior or evidence

(e.g., discovery of contraband)

suggests they may have used

chemicals.

■ During aftercare or parole. Youth

who have been in placement usually are supervised during their

reintegration into the community.

This may be a time when they are

vulnerable to resuming substance

use, and testing can provide

needed information for personnel

supervising them. Awareness that

testing will occur may also serve as

a deterrent when youth are deciding on drug usage. Many youth

released from placement may

need ongoing substance abuse

treatment and relapse prevention

in the community, and substance

testing provides a method of

monitoring their compliance

and progress.

The JAIBG legislation requires that

States or local units of government

develop a “policy of controlled substance testing for appropriate categories of juveniles within the juvenile justice system.” However, it

leaves the responsibility of determining which groups of youth are

considered “appropriate” for testing

to the States and local agencies. As

John J. Wilson, Deputy Administrator of State and Local Programs for

OJJDP, stated (Mattingly, 1998, p. 14):

We will let the State and local

governments make the determination of what the appropriate categories of juveniles are.

Our research shows that most

drug testing occurs as a result

of local policies and so I expect

that whether there is drug testing at the local level will vary

not only from State to State,

but also within the State. The

determination of who should

be tested will depend, in part,

upon what kind of program

interventions are available or

can be developed for juveniles

who test positive for drug use.

It doesn’t make any programmatic sense to test somebody

for drug use unless you’re going to do something with the

results. So, in part, it will depend upon the capacity of the

State or local government to

use those results in a meaningful way.

Step 5: Select

Methodology

Testing Technology

There are several technologies available to test for substances, and new

ones are emerging rapidly. Developing substance-testing policies requires

making informed choices about the

most accurate, cost-effective, and

practical methodology. Several technologies presently available or in development are summarized in tables

1 through 6.

Technologies for substance testing

have changed rapidly during the past

25 years, and developments are ongoing. Urine testing for alcohol and other

drugs of abuse and breath or saliva

testing for alcohol use are presently

the most practical and cost-effective

methods available for juvenile justice.

Thus, this Bulletin focuses primarily

on urinalysis for illicit drug use. However, new technologies likely will provide more comprehensive and precise

information as they emerge and become more generally used. They also

may be able to detect new drugs of

abuse better and more quickly than

present methods. Thus, reviewing current information about technology development is very important for juvenile justice practitioners involved in

substance testing (Mieczkowski and

Lersch, 1997; Pretrial Services Resource Center, 1998).

Immunoassay tests that detect specific drug metabolites in urine when

they react with antibodies that are
7

formulated to respond to that substance are generally used as the initial

urine test in juvenile justice settings

(Mieczkowski and Lersch, 1997). The

chemical reaction produced between

the antibody and the drug or drug

metabolite in the specimen causes a

change in the test medium and can be

measured to determine the presence

of a drug in the sample. If a change is

noted, it is compared with the change

caused by a known quantity of the

substance (calibrator). This known

quantity of the substance is set as the

cutoff for measuring the presence of

a substance with the test. If the response indicates that the cutoff

amount (or a greater quantity of the

substance) is present, it is a positive

test. If the amount present is lower

than the cutoff (or none is present),

the test is negative (Robinson and

Cargain, 1998).

Immunoassay tests are used only to

measure the presence or absence of

substances (qualitative measure)

and are not accurate for determining the quantity of drug in the

sample. There are several types

of immunoassay tests that vary 

primarily according to the type

of material the manufacturers use

to produce the reaction.

A study reported in 1991 compared

the accuracy and suitability of various technologies for use in the

criminal justice system. The research concluded that “thin-layer

chromatography performed poorly

in identifying the presence of illegal

drugs,” but “no one type of immunoassay is consistently superior in

identifying positive and negative

urine specimens” (Visher

and McFadden, 1991, p. 3).

Chromatography works on the principle that molecules of different substances move at different rates. This

movement creates characteristic patterns that can be differentiated from

each other. In a chromatography test,

concentrated substances are placed

on a surface where they separate

from each other and the molecules

form distinctive patterns or bands.

An early form of this method, thinlayer chromatography (TLC) was

slow and required interpretation

by expert technicians (Crowe and

Schaefer, 1992; Mieczkowski and

Lersch, 1997). Chromatography

methods indicate the quantity of

a substance in the sample.

Gas chromatography/mass spectrometry (GC/MS) uses two testing

procedures. This method is highly

accurate and considered the “gold

standard” in urinalysis methodologies. It also is the most expensive

method because it is an elaborate

and time-consuming procedure.

Therefore, it is only practical for

confirmation of positive results

when this is legally required.

Table 1: Hair Analysis

Summary

Drugs and drug metabolites remain in the hair shaft indefinitely. Thus, testing hair

provides an extended view of a person’s history of using substances. The period

for which substances can be detected depends on the length of hair (Robinson and

Cargain, 1998). It generally costs between $50 and $100 to screen and confirm the

five drug classes through hair testing (Jackson and Borrowman, 1998).

Substances Tested

All types of illicit substances can be tested. However, tests for marijuana have

been inconsistent. Hair analysis also has not been useful in detecting some

opiates, especially codeine (Mieczkowski, 1995; Mieczkowski, 1997).

Benefits

■ Specimen collection is easy and noninvasive.

■ Preservation, storage, and transportation of samples is relatively easy.

■ Drug use history can be detected.

■ The amount of drugs detected can be quantified (but the amount ingested

cannot be quantified).

Disadvantages

■ It takes time for the drug metabolites to enter the hair shaft, so hair analysis

may not detect the most recent drug use.

■ Washing and manipulation of hair (e.g., permanents, coloring) may affect the

concentration of drugs in hair, but sensitive tests still can detect the presence

of substances.

■ Results may be subject to influences related to race, environment, and sex

differences. For instance, hair pigment may alter the amount of a drug absorbed in hair. In some cultures, hair has significant meaning, and cutting it

may cause distress.

■ Hair length affects the period of detection. Shaving may make detection

difficult, although hair from any part of the body may be used for testing.

■ Presently, hair samples must be sent to laboratories for analysis, so it may take

longer for results of tests to be available.

■ There are a limited number of laboratories that can test hair.

■ Hair testing is more expensive than urine testing.

Sources for lists: Jackson and Borrowman, 1998; Mieczkowski, 1995; Mieczkowski and Lersch, 1997;

Pretrial Services Resource Center, 1998; Robinson and Cargain, 1998.
8

Onsite or Offsite Testing

The testing process may be conducted in three ways:

■ By a certified laboratory.

■ By using an onsite instrument

operated by trained personnel.

■ By using onsite noninstrumentbased tests (small kits or handheld

devices) at the point of contact

with the youth.

Several factors should be considered

when selecting the most appropriate

process for a particular jurisdiction

or program. Costs, staff training,

and the time it takes to obtain results

are some of the important areas to

consider.

Laboratory Testing

Using a laboratory to complete the

tests usually requires a contract for

services. This demands excellent

chain-of-custody procedures because

the specimen and the results will

6

 See “Establishing Juvenile Justice Onsite InstrumentBased Drug Testing for Initial Drug Testing” in Drug

Testing Guidelines and Practices for Juvenile Probation and

Parole Agencies for additional information on this type

of testing (APPA, 1992).

5

 See “Contracting for Drug Testing Services” in Drug

Testing Guidelines and Practices for Juvenile Probation and

Parole Agencies for additional details about using laboratory services for testing (APPA, 1992).

leave the juvenile justice agency for

processing. The agency and the laboratory should enter into a written

contract specifying the laboratory’s

testing equipment, staff qualifications, chain-of-custody practices, and

other procedures. The laboratory

should have in place procedures for

quality control to ensure the accuracy,

validity, precision, performance, and

reliability of the tests. Sending specimens to a laboratory will require a

longer time to obtain results, but the

turnaround time should be limited to

72 hours or less (Crowe and Schaefer,

1992).5

 Usually a commercial laboratory service will be used, but in some

communities, there may be a possibility of obtaining services through a

criminal justice or healthcare agency

laboratory. Even if an agency plans to

do initial testing onsite, a laboratory

should be identified and contracted

to perform any necessary confirmatory tests.

Onsite Instrument-Based Testing

Testing instruments can be purchased

or leased for use at an agency for initial

immunoassay tests. These instruments

can test for one drug at a time or for a

group of drugs. Staff who operate these

machines must be trained and must

follow the manufacturer’s suggested

procedures for operation. The instruments must be calibrated regularly as

directed by the manufacturer to ensure

test accuracy. Policies and procedures

should include methods for monitoring

each aspect of the testing process to

ensure quality control. Further, safety

precautions for conducting the tests

should be incorporated in agency policies. Results should be available relatively quickly with this type of testing;

however, sometimes it is more practical

and cost effective to run tests only

when there are enough specimens to

use all of the instrument’s capacity

(Crowe and Schaefer, 1992).6

Onsite Noninstrument-Based Tests

Several manufacturers have developed portable test devices that are

variously called kits, handheld tests,

or point-of-contact tests. These tests

can analyze for a single drug, and

some are available that will detect

several drugs at the same time. They

are suitable for initial testing and provide qualitative results (the drug is

present or not found in the sample).

The cutoff levels for these tests are

set by the manufacturers and usually

are consistent with government and

industry standards. Staff training is

very important when using these devices. Manufacturer’s instructions for

operation should be strictly followed.

An advantage of this method is the

Table 2: Breath Analysis

Summary

Breath analysis is used widely to detect alcohol use. The quantity of alcohol in the

breath an individual exhales is directly related to the quantity of alcohol in the

person’s blood (Milgram, 1990).

Substances Tested

Alcohol.

Benefits

■ The level of alcohol use can be detected.

■ The procedure is noninvasive.

■ Results are displayed immediately.

■ Courts have upheld breath analysis results.

■ Per-test costs are low, although initial purchase of the device is costly.

Disadvantages

■ Only very recent use of alcohol (within a few hours) can be detected.

■ The results do not indicate the frequency or duration of alcohol use.

■ The initial cost of the device is expensive.

■ Only one person (staff) can use the instrument at a time.

Sources for lists: Crowe and Schaefer, 1992; Jackson and Borrowman, 1998.
9

Table 3: Sweat Analysis

Summary

The body constantly discharges waste through sweat. By placing an absorption

pad on the skin, sweat and the components it contains can be collected and analyzed. The patch may be worn for a period of from a few days to about 2 weeks

(Baer and Booher, 1994).

Sweat analysis technologies are still in development and are not used widely. In

the future, patches may be designed to include a microelectronic chip that will

give immediate results and detect the specific date on which particular substances were used (Mieczkowski and Lersch, 1997).

Roughly, costs are $7 for a patch, up to $15 for an initial screening, and up to

$22 for a confirmation test (Jackson and Borrowman, 1998).

Substances Tested

Marijuana, cocaine, amphetamines, barbiturates, opiates, phencyclidine,

benzodiazepines.

Benefits

■ Specimen collection is relatively noninvasive, and the patches are easier to

collect, handle, store, and transport than urine.

■ The period for which drugs may be detected is about 2 weeks (compared with

much shorter periods for most drugs when tested by urinalysis). Sweat analysis also offers the ability to detect drug intake for as long as the youth is wearing the patch.

■ Use of sweat patches allows for more flexibility in scheduling testing, and as it

is worn continuously, it reduces the potential for youth to plan their substance

use to avoid detection.

■ Patches are designed so tampering with them is apparent.

■ Secretion of drugs and/or metabolites through sweat is not affected by

consuming water or other substances.

■ Although sweat analysis costs more than urinalysis, it may be more cost

effective because it can be conducted less often.

Disadvantages

■ It takes time for enough sweat to accumulate for analysis. Therefore, immediate detection of recent substance use is not feasible.

■ There are no proficiency testing programs for administrators. Thus, accuracy

of results may be questioned.

Sources for lists: Baer and Booher, 1994; Jackson and Borrowman, 1998; Mieczkowski and Lersch, 1997.

immediacy of results; tests can be performed while the youth watches. The

tests also can be used outside the

agency, such as on home visits.

However, agencies should consider

and develop protocols for all testing

that include consideration of staff

and youth safety (Crowe and

Schaefer, 1992).7

Accuracy and Validity of Onsite

Drug Testing

To rate the performance of onsite

testing methods, the test results are

compared with the results obtained

when the same specimen is tested

using laboratory instruments, usually GC/MS. When a specimen has a

negative result using the onsite test

device and a negative result in subsequent testing by GC/MS it is considered a true negative. If the “negative” specimen tests positive by GC/

MS, it is considered to be a false

negative. When a specimen has a

positive result by the test device and

a positive result by GC/MS, it is considered a true positive. A specimen

that tests positive with an onsite testing device and subsequently tests

negative by GC/MS is considered

a false positive.

False positives and false negatives are

more likely to occur with specimens

in which the drug concentration is at

or near the cutoff levels. With those

specimens, the varying sensitivities of

the testing methods can produce the

differing results. It is thus more accurate to refer to the testing result as an

unconfirmed positive when the presence of the drug was accurately detected but the quantity was inaccurately determined. The likelihood is

that most specimens in field situations will not have drug concentrations near the cutoff levels. With drug

concentrations noticeably above or

below the cutoff levels, the number

of true positives and true negatives

increases.

Onsite drug testing results can also

be affected by food such as poppy

seeds and foods containing hemp

derivatives and by over-the-counter

products such as some cold medications consumed by the individual being tested. Results can also be

affected by products added to the

urine specimen after urination.

Laboratory testing can detect the

different molecular structure of

cross-reacting agents and can determine if an adulterant has been added

to the specimen in an effort to mask

the test result. Therefore, unless the

person being tested admits to using

drugs after a positive test result,

positive test results should be confirmed by a laboratory test, preferably GC/MS.

7

 See “Establishing Onsite Non-Instrument-Based

Drug Testing” in Drug Testing Guidelines and Practices

for Juvenile Probation and Parole Agencies for additional

information on this type of testing (APPA, 1992).
10

To ensure the greatest accuracy

when using onsite testing devices, it

is advisable to establish protocols for

collection and testing that minimize the

numbers of false positives and false

negatives. Suggested procedures are:

■ Appropriately identify the person

being tested.

■ Observe all specimen collections.

■ Follow appropriate chain-ofcustody procedures.

■ Obtain information from manufacturers of onsite test devices on the

foods or products that may affect

their test results.

■ Require youth to report consumption of any prescribed or over-thecounter medication or use of any

of the identified food products.

■ Prohibit consumption of identified

cross-reacting foods, over-the-counter

medication, or other products.

■ Check urine samples for adulterants.

■ Conduct confirmation testing when

positive test results are disputed.

Determine Which Drugs

To Test For

If possible, initial urine tests should

cover a variety of drugs based on information about the substances most

commonly abused in a particular locality and, if the youth is cooperative,

his or her drug use history. These

tests might identify a combination of

several of the following:

■ Marijuana.

■ Cocaine.

■ Amphetamines.

■ Barbiturates.

■ Opiates.

■ Phencyclidine (PCP).

■ Benzodiazepines.

Depending on the timeframe, it also

might be advisable to test for alcohol

Table 4: Saliva Testing

Summary

Tests of saliva have been used to detect recent drug and alcohol use

(Mieczkowski and Lersch, 1997). The presence of the substances is identified

through a chemical reaction between saliva and the reagents in the test. Various

tests may give either qualitative results (i.e., substance is present) or quantitative

results (i.e., the amount of substance present).

Costs of testing saliva for alcohol are minimal. However, the cost of testing

saliva for other substances is similar to the cost of blood tests, often ranging

from $50 to $200 depending on the type and number of analyses (Jackson and

Borrowman, 1998).

Substances Tested

Alcohol, cocaine, cannabinoids, opiates.

Benefits

■ This method does not pose a privacy issue and is considered noninvasive.

■ Testing is not difficult for the administrator because the specimens are readily

available.

Disadvantages

■ There are no proficiency testing programs to determine the accuracy of this

testing method and the results it produces.

■ Scientists do not yet fully understand the biological functions and attributes of

saliva. Therefore, saliva testing should be used in conjunction with a confirmatory test of urine or blood for illicit substances.

Sources for lists: Jackson and Borrowman, 1998; Mieczkowski, 1997; Mieczkowski and Lersch, 1997.

Table 5: Blood Analysis

Summary

Testing of blood is one of the most accurate methods of detecting substances that

have been ingested. It is most commonly used in medical settings and for forensic

purposes, such as postmortem investigations. It also is frequently used to test for

driving under the influence of psychoactive substances. Costs range from $50 to

$200 (Jackson and Borrowman, 1998).

Substances Tested

Alcohol and all illicit substances.

Benefits

■ Results are accepted by courts for criminal justice purposes.

Disadvantages

■ Invasive procedures are required to collect samples.

■ Specialized training for drawing blood samples is required.

■ Storing and transporting samples requires special procedures.

■ Lack of proficiency testing programs and accreditation of many laboratories

can make results questionable.

Source for lists: Jackson and Borrowman, 1998.
11

use. This would be most appropriate

at times such as detention intake,

return of the youth to a facility after

a furlough or a runaway episode,

and staff visits with youth on probation and parole at home or other

places in the community. Alcohol

does not stay in the system long, and

testing is usually not indicated if the

youth has not had recent access to

alcoholic beverages.

At intake to the program, screening

for multiple drugs gives the most

helpful information for juvenile

justice personnel to use in planning

for the needs of the youth. However, the more drugs included in

the test, the more expensive it becomes. Where funds are very limited, the panel may be restricted to

the most commonly seen drugs,

with the knowledge that others

may be missed.

When youth are tested on an ongoing basis, urinalysis may be limited

to their drug(s) of choice; however,

if possible, a full panel should be

given occasionally to ensure that

youth are not changing drugs to

avoid detection.

Various ordinary household and

other substances are inhaled by

youth for the psychoactive effect

they induce. Testing for inhalants

becomes more complex because each

substance produces different antibodies. Some laboratory tests are

available for the more frequently

abused components of inhalants, but

others require much more sophisticated chemical analysis.

Step 6: Decide How To

Use Results and Arrange

for Adequate and

Appropriate Treatment

Juvenile Justice Response

The use of results of drug testing

should be determined by the agency

mission and the substance-testing program purpose. A response should be

given every time a youth is tested.

When test results are positive for drug

use, referral for assessment and treatment, a system of graduated sanctions,

or both, should be in place. By the

same token, when results are negative,

a supportive response is needed to

reinforce continued abstinence.

A youth’s time perspective is different from that of an adult. Youth are

more likely to be present- than futurefocused and to discount the future

consequences of their present behavior.

Thus, it is important to respond to

youth as soon as possible after they

have been tested so they are more

likely to connect their actions with consequences. Drug Testing Guidelines recommends that juveniles be confronted

with test results within 72 hours after

they are obtained and that the period

for responding should never exceed

7 days (American Probation and Parole

Association [APPA], 1992). With onsite

instrument- or noninstrument-testing

technologies, responses can be given

almost immediately. Responses to

youth also must be appropriate for

their developmental level.

Nonadjudicated youth who test positive upon entering detention should

Table 6: Urine Testing

Summary

Urine testing is presently the most practical and widely used technology for testing for illicit substances among youth in the juvenile justice system.

Costs vary according to the type of tests, onsite or laboratory testing, number of

tests conducted by an agency, and other factors. For onsite instrument-based

tests, the cost is about $1 to $2 per test for each drug tested (not including the

cost of equipment). For onsite noninstrument (handheld) test kits, the cost ranges

from $2 to $5 for each drug tested. For laboratory testing, costs range from $2 to

$20 for each drug tested (Pretrial Services Resource Center, 1998).

Substances Tested

Marijuana, cocaine, amphetamines, barbiturates, opiates, phencyclidine,

benzodiazepines, alcohol.

Benefits

■ It is the most cost-effective methodology presently in common use.

■ It is less invasive than blood testing.

■ Urine tests are very accurate and generally accepted by courts.

■ Results can be available very quickly, especially when using onsite testing

methods.

Disadvantages

■ To be confident of accurate testing, specimen collection should be observed,

which is invasive and sensitive.

■ Requires physical facilities for sample gathering.

■ Has a short window of detection, as drugs or their metabolites stay in the

body a relatively short time. Thus, testing must be conducted frequently to

monitor drug use.

■ Special storage and transportation practices are required.

■ It will not indicate the amount, frequency, or duration of drug use.

Sources for lists: Crowe and Schaefer, 1992; Jackson and Borrowman, 1998.
12

not be punished. A drug test at arrest

or intake to detention should be used

for assessment and diagnosis. Positive

results provide the basis for referring

youth for further assessment and

treatment.

At the time of admission to a juvenile

justice program or facility, all youth

should be told the possible therapeutic, incentive, or punitive responses

that will occur following every test.

Examples of graduated responses that

could be used for positive tests include the following:

■ Participation in drug education

programs.

■ Participation in discussions about

his or her substance abuse behavior.

■ Increased frequency of drug testing.

■ Increased contact with a probation

or parole officer or other staff.

■ Earlier curfew or loss of other

privileges.

■ Community service or other work

assignments.

■ Home or facility restriction.

■ Probation or parole violation determination or facility disciplinary

procedures.

Possible responses to negative results

include the following:

■ Verbal praise.

■ Positive notes to parents.

■ Rewards (e.g., movie tickets, skating passes, fast-food coupons).

■ Privileges and activities (e.g., later

curfews, drug-free parties).

Substance Abuse Treatment

for Juveniles8

Juvenile justice professionals should

be able to recognize the need for

substance abuse assessment or treatment and serve as brokers to obtain

needed services. Juvenile justice and

treatment professionals should establish

collaborative working relationships to

best meet the needs of the youth they

both serve. Interagency agreements

between juvenile justice agencies and

treatment providers are crucial for ensuring appropriate treatment resources

for substance-abusing youth.

Need for Substance Abuse

Treatment for Youth

It is difficult to compare the need for

treatment among youth with the rate

of treatment availability. There is no

national treatment system for adolescents and, therefore, national data

collection and analysis are largely unavailable. However, the 1997 National

Household Survey on Drug Abuse

estimates more than 8.2 percent of

youth ages 12 to 17 need drug abuse

treatment—that is, approximately

1,887,000 of the 23 million adolescents

in the Nation (Substance Abuse and

Mental Health Services Administration [SAMHSA], 1998b). The survey

also estimates 9.5 million persons

need treatment for illicit drug abuse,

but that in any year, only 2.1 million

receive it in a specialized facility. It is

estimated that the current national

treatment system, designed primarily

for adults, can treat 50 percent of persons with the most severe addiction.

In a system able to treat only 50 percent of those most needing treatment,

triage decisions are influenced by

who is the most needy and priority is

often given to adults who are chronically and severely addicted. It is important to note that these data do not

include adolescents and adults needing treatment for alcohol abuse.

More trained clinicians are needed to

provide specialized treatment services,

and more case managers are needed to

coordinate community resources and

monitor issues involving other social

systems, such as treatment, primary

medical and mental health care, education, and family services. There are few

national examples of a system coordinating all services needed to provide a

continuum of treatment services for

youth. Using a systematic program to

identify the number of substance-using

and -abusing youth lays the foundation

for the next step in building a national

system for treating adolescents. Comprehensive programs for drug testing

will document the need for adequate

and appropriate substance abuse treatment for those youth who are identified as needing such services.

Effective Treatment for

Adolescents

Adolescent substance abusers are

more difficult to treat than adult substance abusers. The pressures created

by physical, hormonal, and emotional

changes produce stressors that are

magnified by typical adolescent developmental drives for individuality,

separation, autonomy, and social

acceptance. Lacking life experience,

youth often have difficulty controlling

their impulses or making appropriate

decisions. Chemical dependence intensifies the behavior problems associated with adolescent development

and simultaneously delays emotional

development. Substance-abusing adolescents are frequently members of

dysfunctional families in which there

are no appropriate role models or

support. An estimated 7 million children are growing up with at least

one substance-abusing parent, and

approximately 38 percent of all

child abuse cases have parental substance abuse as a factor. These multiple disorders—mental, medical,

and developmental—interfere with

the progress and effectiveness of

treatment. For that reason, the most

8

 Most of this section was contributed by Roberta

Messalle, Office of Evaluation, Scientific Analysis

and Synthesis, Center for Substance Abuse Treatment

(CSAT). It was developed from material presented in

CSAT publications. References used include Screening

and Assessment of Alcohol and Other Drug Abusing Adolescents, HHS Publication No. (SMA) 95–3058, SAMHSA,

1995; Guidelines for the Treatment of Alcohol and Other Drug

Abusing Adolescents, HHS Publication No. (SMA) 93–

2010, SAMHSA, 1993; and Treatment for Alcohol and Other

Drug Abuse: Opportunities for Coordination, HHS Publication No. (SMA) 94–2075, SAMHSA, 1994.
13

successful treatment for any adolescent is based on an assessment of

each contributing factor and is designed for that individual.

Treatment begins with a diagnosis.

Substance abuse is a disease of the

brain that is expressed in behavioral

ways and occurs in a social context

(Bigelow, 1995). Unlike other health

conditions, substance abuse is highly

individualized and complex, grounded

in each individual’s biological and psychological makeup, and influenced by

each individual’s unique experiences of

social development and functioning.

However, like all other health disorders,

effective treatment for substance abuse

begins with a trained professional’s

careful diagnosis of the causes and

symptoms of the condition.

Other components of an effective

treatment strategy. Effective treatment for substance abuse includes

the following elements:

■ Screening—a quick gathering and

sorting of preliminary information

used to determine if a person has

substance abuse problems, mental

health disorders, or infectious diseases and to ascertain if a clinical

assessment is needed.

■ Drug testing—part of a structure for

holding participants accountable

while also allowing a flexible but

finite response to substance abuse.

■ Intake and assessment—an

indepth collection of detailed information concerning, but not limited to, a youth’s substance abuse

and treatment history, current

conditions, emotional and physical health, family status, social

roles, victimization, education,

and criminal history.

■ Patient-oriented treatment plan—

a course of action developed by a

licensed substance abuse counselor

or mental health professional that

includes various milestones for

evaluating the progress and success

of the treatment. The treatment

includes a case management

plan that oversees the following

elements:

■ Planning for treatment, establishing agency coordination,

and implementing reporting

procedures.

■ Brokering treatment and other

services to ensure continuity as

the client progresses through

treatment and program

completion.

■ Monitoring and reporting the

client’s progress using a schedule that ensures reporting back

to the referral source on a frequent and consistent basis.

■ Supporting the client by identifying problems.

■ Advocating for the client with

legal, treatment, social service,

medical, and mental health

systems.

■ Monitoring through urinalysis,

breath analysis, or chemical

testing for relapse to substance

abuse.

■ Protecting the confidentiality of

a client’s treatment records,

consistent with Federal and

State regulations regarding the

right to privacy.

Treatment modalities and components. A continuum of treatment options should be available to provide

the services most appropriate to the

treatment needs of each youth and

family. Detoxification is not a treatment modality, but it may be a necessary first step in the treatment process. Detoxification provides medical

and supportive services needed to alleviate the short-term symptoms of

physical withdrawal from chemical

dependence, including physical discomfort, cravings, and mood changes

(Institute of Medicine, 1990; Office of

National Drug Control Policy, 1990).

Once symptoms of craving and withdrawal are controlled, treatment can

begin. Available modalities should

include:

■ Substance abuse education and

drug testing for persons assessed

as having no history of abuse or

dependence and therefore having

no withdrawal symptoms.

■ Weekly outpatient treatment including pharmacological interventions (e.g., naltrexone, methadone);

treatment includes group therapy

and help building life, cognitive,

and anger-management skills.

■ Intensive outpatient treatment for

persons abusing substances and

having additional problems requiring structured therapy and weekly

outpatient treatment, including

pharmacological interventions.

■ Intensive residential treatment for

persons experiencing acute intoxication and withdrawal, having

medical or psychiatric disorders,

or needing assistance to provide

for their immediate needs. This

usually is hospital-based treatment

that requires short- or long-term

residential services. It also may

include therapeutic communities,

a more behaviorally based intervention usually targeting fairly

hardcore drug abusers.

In addition to these treatment approaches, self-help or 12-step programs

may also be beneficial. These organizations involve mutual help among peers

experiencing similar problems. Alcoholics Anonymous (AA) was the first

and is the best known of these programs, but many others exist. Members of AA believe (as do many others,

including the National Institute on

Drug Abuse) that addiction is a disease

that can never be cured; however, they

maintain that the progression of the

disease can be arrested and describe

those in remission as recovering alcoholics (Doweiko, 1990). If used with

adolescents, these programs need to

be tailored to meet their specific developmental needs.
14

Patient-oriented treatment components. Treatment should be designed

to respond to each patient’s specific

configuration of causes with an array

of “wraparound” services. For example, several of the following services may be needed by youth:

■ Counseling involving and

strengthening the family unit.

■ Preventive and primary health

care and health education.

■ Mental health services for cooccurring substance abuse and

mental health disorders.

■ Specialized treatment for girls

(addressing, for example, victimization issues, pregnancy, and

childcare).

■ Remedial assistance for educational deficits or disabilities.

■ Group counseling interventions.

■ Treatment that is sensitive to racial, ethnic, cultural, and social

minority issues.

■ Employment training or counseling.

■ Practical life skills including refusal and avoidance skills and independent living skills training.

■ Housing for the homeless or those

needing a drug-free environment.

■ Liaison with other social service

agencies or support groups (e.g.,

victim support, assistance for

HIV/AIDS patients).

■ Cognitive skill development for

managing stress, anger, violence,

and antisocial behaviors.

Medical interventions. The diagnostic

assessment may show the need for

other medical care, which is provided

onsite or through arrangements with

other healthcare facilities, such as

pharmacotherapeutic interventions

(medications) to block cravings associated with addictions or treat underlying psychiatric disorders and primary

health care to treat any physical health

problems, including HIV/AIDS.

Relapse prevention methods. Substance abuse and addiction are

chronic disorders that are prone to

recur. Effective treatment includes

special counseling to prevent or

limit relapse and creates a structure

of incentives and sanctions that respond to episodes of relapse.

Special Concerns About

Treatment for Youth

Adolescents are in a stage of intense

physical, hormonal, and developmental change that presents challenges

to the effectiveness of treatment for

substance abuse. Just as services must

be specialized for them, there are several pitfalls to avoid when planning a

treatment program for adolescents,

including the following:

■ Limiting assessment to substance

abuse alone and thus excluding

the diagnosis of contributing disorders that may complicate or interfere with treatment.

■ Standardizing treatment and not

considering adolescent developmental stages; the specific needs

created by the age, gender, ethnicity of the youth; or co-occurring

disorders of the adolescent substance abuser.

■ Using adult criteria for treatment

services that do not consider the

psychological and clinical needs

created by the developmental

stages of adolescents.

■ Ignoring evidence that familyfocused services for adolescents

have more successful outcomes

than those that focus only on individual youth. This does not negate that family management

skills may have contributed to the

adolescent’s addictive disorder

and that possible solutions could

strengthen the family unit.

Step 7: Develop Written

Policies and Procedures9

Policies help to formulate a course of

action that determines the way specific decisions are made. There are

several key issues that must be addressed by substance-testing policies and procedures.

Scheduled and Random

Testing

Some agencies may schedule testing

of youth at specific points in the

system’s process:

■ At intake to detention.

■ Following any furlough from a

residential placement.

■ At intake to probation.

However, for ongoing substance testing, random specimen collection is

recommended. Random or unscheduled testing reduces the possibility

that youth will attempt to schedule

their drug use to avoid detection.

Frequency of Testing

Youth should be tested randomly and

frequently enough to detect and deter

illicit drug use. Agency resources

and a youth’s drug(s) of choice will

influence how often testing occurs.

Some drugs typically remain in the

9

 This section highlights some of the important areas

to consider in developing policies and procedures for

substance testing. For more details on these and other

policy issues, consult Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies, published

by the U.S. Department of Justice, Office of Justice

Programs, Office of Juvenile Justice and Delinquency

Prevention (APPA, 1992). Suggested forms to use with

a substance abuse testing program may be found in

Drug Identification and Testing in the Juvenile Justice

System (Crowe, 1998) and Drug Testing Guidelines and

Practices for Juvenile Probation and Parole Agencies

(APPA, 1992). References used to develop this section

include American Probation and Parole Association

(1992), Drug Testing Guidelines and Practices for Juvenile

Probation and Parole Agencies, Washington, DC: U S.

Department of Justice, Office of Justice Programs,

Office of Juvenile Justice and Delinquency Prevention;

and Crowe, A.H., and Schaefer, P.J. (1992), Identifying

and Intervening with Drug-Involved Youth, Lexington,

KY: American Probation and Parole Association.
15

concentration of creatinine, a substance eliminated from the body in

urine. Many current drug-testing

technologies can measure creatinine

and detect youth’s attempts to dilute

specimens by drinking fluids. Similarly, some tests check for specific

gravity by measuring the concentration of solid particles in urine to ensure youth have not diluted or adulterated a specimen (Elbert, 1997).

Additional precautions may be taken

to prevent youth from switching or

adulterating samples:

■ Have youth take off jackets, empty

pockets, and leave purses outside

the collection area.

■ Place a blueing agent in the toilet

to avoid substitution of toilet water

for the specimen.

■ Use pH paper to measure the pH

level or a temperature strip to record

the temperature of the specimen.

(The temperature should be measured within 4 minutes of urination.)

■ Keep soap and other chemicals

outside the collection area.

■ Allow only one observer and one juvenile to be in the collection area at a

time, and prohibit youthful offenders

from participating in the collection of

another youth’s sample or having

access to testing equipment, supplies,

storage facilities, or documentation.

Chain of Custody

All possible steps should be taken to

ensure the integrity of youth’s drug test

results. Chain of custody means procedures are used to document that the

specimen collected is that of the intended youth and the specimen, testing

procedures, and results of the tests are

handled properly throughout the process. In addition to the specimen collection procedures already discussed, the

following elements of chain-of-custody

procedures are needed:

■ Handling. There should be a record

of the whereabouts and names of

Table 7: Approximate Duration of Detectability of Selected Drugs

in Urine

Drug Duration of Detectability*

Amphetamine 48 hours

Methamphetamine 48 hours

Barbiturates

Short acting 24 hours

Intermediate acting 48–72 hours

Long acting 7 days or more

Benzodiazepines 3 days (therapeutic dose)

Cocaine metabolites 2–3 days

Methadone 3 days (approximate)

Codeine/Morphine 48 hours

Propoxyphene/Norpropoxyphene 6–48 hours

Cannabinoids (marijuana)

Single use 3 days

Moderate use (4 times weekly) 4 days

Heavy use (daily) 10 days

Chronic heavy use 21–27 days

Phencyclidine (PCP) 8 days (approximate)

* These are general guidelines only. Interpretation of the duration of detectability must take into

account many variables, such as drug metabolism and half-life; the youth’s physical condition, fluid

balance, and state of hydration; route of administration; and frequency of ingestion.

Source: Council on Scientific Affairs. 1987. Scientific issues in drug testing. Journal of the American Medical

Association 257(22):3112.

system longer than others. Table 7

indicates the approximate duration of

detectability of selected drugs. As the

table shows, a youth using marijuana

might be tested less frequently than

one who is using amphetamines.

Specimen Collection

If the person collecting specimens

does not personally know each youth

being tested, a process for identification of youth should be implemented

to ensure the sample is from the appropriate individual. Urine collection

should be observed by juvenile justice

personnel to avoid the possibility of

youth switching or adulterating

specimens. The collection facility

should have both a sink and toilet and

should afford privacy for the youth

and staff involved in the collection

process from other youth, staff, or the

public. Youth should be instructed to

wash their hands and then void into

the collection cup within the view of

the attending staff member, who

should be of the same gender as the

youth. The youth also should seal

the cup and verify on the attached

paperwork that the specimen is theirs.

Youth may consume enough liquid to

dilute the sample sufficiently to influence test results. Therefore, if enough

of the drug has already been excreted

so the level is at or near the cutoff,

dilution could be effective in rendering the test negative. Similarly, youth

could add something to the voided

specimen that would dilute or change

its chemical composition so the test

will be inaccurate. The amount of

liquid a youth drinks affects the
16

persons handling the urine specimen and test results at all times.

■ Storage. Urine specimens should be

refrigerated immediately after they

are collected or, if tested immediately, right after they are tested. After testing, negative specimens may

be discarded, but positive samples

should be frozen until all relevant

court proceedings are completed.

■ Transportation. Packaging and

transportation procedures should

include secure sealing and identification and should safeguard against

tampering or the possibility of misidentification of specimens.

■ Testing. Agency staff or laboratory

personnel testing specimens must

properly document all steps taken

to analyze the specimen.

■ Results. Forms and logs should

be completed to document the instrumentation used, drugs tested

for, test results, and cutoff level of

each test.

Confirmation Tests

If an initial test is positive, it may be

necessary to perform a confirmation

test, especially if serious sanctions

will be applied or if the results will be

used in court. It may not be necessary

to perform confirmation tests if results

are being used solely for case management and treatment purposes.

Both costs of testing and legal issues

are considerations when determining

whether to perform confirmation

tests. Three types of confirmation

are possible:

■ Admission statement. A youth

signs a statement acknowledging

drug use.

■ Second test using the same methodology. A specimen is tested a

second time with the same test

method. This is not recommended

if sanctions for a positive test will

result in loss of liberty.

■ Second test using a different

methodology. The second test

methodology used must have an

accuracy rate that is at least as high

as the initial screening instrument,

and the cutoff level must be the

same or lower. High performance

liquid chromatography (HPLC)

and GC may be used for confirmation tests. However, GC/MS is the

most specific and most sensitive

method of urinalysis.

Cutoff Levels

The cutoff level is the amount of drug

or metabolite that must remain in the

specimen for a test to show a positive

result. Thus, a positive test means a

youth has an amount of the substance

in his or her system that exceeds the

cutoff level. Negative results indicate

the youth either has none of the drug

in his or her system or its concentration is below the cutoff level. The Division of Workplace Programs, Center

for Substance Abuse Prevention, recommends the cutoff levels in table 8

for initial and confirmation tests for

cannabinoids, cocaine, opiates, amphetamines, and methamphetamines.

Cutoff levels for benzodiazepines,

barbiturates, and methadone are consistent with recommendations by the

scientific community.

If the results of drug tests are challenged, cutoff levels that are consistent

with those recommended by the U.S.

Department of Health and Human Services guidelines (SAMHSA, 1998a) are

more likely to be accepted by courts.

Health and Safety

According to the Occupational

Safety and Health Administration

(OSHA) of the U.S. Department of

Labor (Clark, 1993), employers must

make a determination about jobs

that involve an occupational risk of

exposure to bloodborne pathogens

such as HIV and hepatitis. Bloodborne pathogens are most likely to

be transmitted from an infected to a

noninfected person through bloodto-blood or sexual contact. When

there is a risk of exposure to blood or

semen, vaginal secretions, and other

body fluids containing visible blood,

universal precautions should be

used to minimize the risk; however,

“universal precautions do not apply

to feces, nasal secretions, sputum,

Table 8: Recommended Cutoff Levels

Drug Initial Tests Confirmation Tests

Cannabinoids* 50 ng/ml 15 ng/ml

Cocaine* 300 ng/ml 150 ng/ml

Opiates* 2,000 ng/ml 2,000 ng/ml

Amphetamine/Methamphetamine* 1,000 ng/ml 500 ng/ml

PCP* 25 ng/ml 25 ng/ml

Benzodiazepines** 300 ng/ml 250 ng/ml

Barbiturates** 300 ng/ml 250 ng/ml

Methadone** 300 ng/ml 250 ng/ml

* U.S. Department of Health and Human Services Mandatory Guidelines for Testing Levels.

** Cutoff levels for these drugs are not included in the HHS guidelines because they may be legally

prescribed. The cutoff levels cited are those recommended by the scientific community.

Sources: Substance Abuse and Mental Health Services Administration (1998), Mandatory Guidelines for

Federal Workplace Drug Testing Programs, Washington, DC: U.S. Department of Health and Human Services,

Substance Abuse and Mental Health Services Administration; American Probation and Parole Association

(1992), Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies, Washington, DC: U.S.

Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
17

sweat, tears, urine and vomitus unless they contain visible blood” [emphasis added] (Update, 1988). Several

problems may cause blood in the

urine, but the most common are kidney and urinary tract diseases. For

girls, menstrual blood also may become mixed with urine. Any urine

containing visible blood should be

discarded, and if the cause could be

anything other than menstruation,

the youth should be referred for

medical care. However, if no visible

blood is present in the urine sample,

the risk of infection from bloodborne

pathogens, even if one comes in direct contact with urine, is considered

negligible. No cases of HIV transmission through laboratory contact with

urine have been reported.

For general health and sanitation,

however, personnel should take

standard precautions to protect

themselves from possible contact

with urine. Because accidental spills

and splashes can be hazardous, it

should be standard procedure for

staff to wear rubber gloves, lab

coats, and goggles, as procedures require, when conducting urine testing.

Specimens also should be protected.

Smoking, eating, or drinking should be

prohibited in the area where specimens

are stored or handled. No food should

be stored in the same refrigerator with

specimens.

Because of the strong association between injection drug use and HIV

transmission, youth who have injected

drugs may need guidance and assistance in being tested for HIV. Health

and safety procedures also should be

developed for working with youth.

Personnel should be able to identify

possible withdrawal symptoms or side

effects of substance abuse that might

endanger a youth’s health and safety.

Erratic behavior that could endanger

the youth or others may be provoked

by some substances. Some youth may

also become upset when positive results are revealed. There should be a

crisis intervention protocol so staff

know how to intervene appropriately

in emergencies.

Interventions

Besides the policies and procedures

needed for the actual testing process,

guidelines should be in place for interventions, including appropriate

responses to both positive and negative test results.

Rewards and Sanctions

The general purpose and approach to

responding to youth should be incorporated in policy documents, including

the requirement that youth receive an

appropriate response for every drug test

result. Listing suggested graduated

sanctions can be helpful in assisting

staff working with youth to select appropriate responses, but these should

allow enough flexibility to make them

suitable to the particular circumstances

of individual youth.

If testing is voluntary, it is not appropriate to punish or otherwise intervene with youth who refuse to give a

specimen. In a voluntary testing program, youth probably would refuse

rather than attempt to adulterate or

dilute a specimen. However, where

testing is mandatory, some youth

may attempt to refuse or to provide

an adulterated or diluted sample,

and policies should be designed for

responding to these situations. For

youth who are required to submit to

drug testing because of probation

or paroling authority orders or program rules, a refusal to provide a

specimen (either by failure to report

for collection or by being unable to

provide a specimen) may be considered a violation of program rules or

probation and paroling authority

conditions. However, if a youth is

unable to provide a specimen at the

appointed collection time, he or she

should be given a reasonable amount

of time (and liquids) to allow for

specimen production.

If it is evident that a youth has

switched samples or diluted or adulterated the specimen, policies should

be in place for responding to the situation. Sometimes such attempts are

addressed as if results would have

been positive if the person’s own

urine or an uncontaminated or undiluted specimen had been available.

Referrals for Substance Abuse

Assessment and Treatment

Policy documents should include

procedures to be used when youth

require referral to other service providers for substance abuse assessment

and treatment. Interagency agreements

should be developed between juvenile

justice agencies and substance abuse

treatment providers that spell out these

processes, the requirements of practitioners in each agency, and any special concerns of the youth and family/

caregivers.

Support of and Cooperation

With the Treatment Process

The policies and procedures document

should describe interagency agreements

between juvenile justice agencies and

treatment providers. Policies should

underscore the expectation that juvenile justice staff and treatment providers will work in concert toward the

treatment and best interests of the

youth. In addition, procedures should

stipulate that youth be informed about

the treatment process. Some programs

develop a written agreement for youth

to sign regarding their role in, responsibilities toward, and understanding

of the treatment process. Important

information to incorporate in discussions or written agreements with youth

include the following (Aukerman and

McGarry, 1994):

■ A description of the treatment

program.

■ Types of misconduct and their

consequences.
18

■ Information that will be shared between the treatment and juvenile

justice agencies.

■ Criteria for successful completion

of treatment.

■ Results that can and cannot be

achieved through treatment.

■ Demands of treatment and recovery.

■ Description of the typical recovery

process and information about

relapse.

Step 8: Obtain Funding

Costs

A paramount concern for agency administrators and others who must

worry about budgets is the cost of drug

testing. There are several important

factors to consider. This document

provides information for estimating

program costs. However, as each

agency or program is different, tests

diverse numbers of youth, and perhaps needs to test for different classes

of drugs, cost factors must be adjusted

for each locality. (Three examples of

costs for substance testing in different

types of juvenile justice agencies appear on pages 18 to 20.)

Several types of costs accrue to an

agency or jurisdiction and should be

considered in program planning

(Crowe and Schaefer, 1992; Pretrial

Services Resource Center, 1989,

1998), including:

■ Costs that are constant regardless

of methodology used, such as:

■ Supplies for collecting specimens (e.g., collection cups, rubber gloves, chain-of-custody

forms).

■ Space and equipment required

(e.g., a toilet and sink with running water for specimen collection; secure refrigerator and

freezer space for storing specimens; if testing is onsite, a secure room for storing testing

equipment and analyzing

specimens that includes a sink

with running water to dispose

of negative specimens; a trash

receptacle for disposing of used

testing supplies).

■ Utility costs for additional

water used.

■ Personnel time for collecting

specimens and completing necessary paperwork for chain-ofcustody procedures.

■ Trainer costs, staff time, and

materials for general training of

staff in substance-testing policies and procedures.

■ Costs that vary by methodology

selected, including:

■ Costs per test for onsite instrumentbased testing. Testing a specimen for a single drug with

these instruments presently

costs about $1 per test for the

reagents required (Pretrial

Example 1: Small Detention Center

The Eastview Detention Center admits approximately 500 youth each year. It

is the policy of the center to drug test each youth at admission as part of the

physical examination. Only marijuana and cocaine tests are used. There are

10 staff members, and all must know how to collect specimens and administer the onsite test kits. No confirmation tests are required because results

are used only for assessment purposes and referral for services.

Startup Costs

The youth restrooms will be used, and the nurse’s office has running water

and room to securely store specimens and test supplies.

Refrigerator $500

Staff training (2 [8-hour] days x 10 staff @ $8/hour) $1,280

Trainer for 1 day (Training provided by the test

manufacturer on the second day.) $350

Substitute staff while others in training $1,024

Personal computer, software, and training to use it $3,000

Other miscellaneous expenses (e.g., trash receptacle, gloves) $100

Total Startup Costs $6,254

Ongoing Costs (estimated for 1 year)*

Number of youth tested at admission 500

Number of tests administered to each youth 1

Number of drugs tested for 2

Total tests 500

Cost per test (two drugs/test) x $6

Total cost for tests $3,000

Supplies, forms, etc. @ $.50/youth $250

Staff time @ 15 minutes/youth @ average salary of $8/hour $1,000

Additional utilities Negligible

Yearly Cost $4,250

* Estimated costs per test were taken from Pretrial Drug Testing: Overview of Issues and Practices

(Pretrial Services Resource Center, 1998).
19

Services Resource Center, 1998).

In addition, there is the initial

cost for purchasing the instrument or ongoing costs for leasing it (these costs often are

negotiable and may be lower if

the program purchases a certain volume of testing supplies

from the manufacturer). Further, it probably will be prudent to purchase a maintenance

contract for the machine. Electrical renovations may be

required for its proper use, and

higher electric utility bills are

possible. Additional training

and staff time for the operator(s) of the machine also

must be considered.

■ Costs per test for onsite noninstrument-based testing (kits). Prices

currently range from about

$2.50 to $4.50 per individual test

according to Pretrial Services

Resource Center (1998). These

usually are less expensive when

purchased in larger quantities,

but they may have a limited

shelf-life. Thus, an agency

should purchase only the number of tests that reasonably can

be used before the expiration

date. Costs will be greater for

devices that test for multiple

drugs or when several single

drug tests are used to detect

multiple drugs.

■ Costs per test for laboratory testing. These costs may vary

markedly depending on the

volume of testing, the drugs

tested for, and the laboratory

used. According to Pretrial Services Resource Center (1998),

the costs can range from about

$2 or $3 to $20 for each drug

tested. In addition, there are

costs for shipping specimens

to the laboratory.

■ Costs per test for confirmatory

testing (usually by a laboratory).

Regardless of the initial testing

Example 2: Medium Residential Facility

Youthville is a residential treatment program for 35 juveniles. The total

number of youth served each year is about 90. The facility’s policy is to test

each youth at admission and again, randomly, following off-grounds activities,

such as home visits, recreation, or work details. Staff estimate that each of

the youth will make eight off-grounds trips each, and staff expect to test

the youth about half of the time. Three tests—for marijuana, cocaine, and

methamphetamines—will be conducted on each specimen. There are 15 staff

members who will collect specimens, when needed, and must be trained.

A laboratory will conduct tests and perform confirmations on positive

tests. A supervisor and clerical staff member will have responsibility for

shipping specimens and receiving and filing results.

Startup Costs

No remodeling or additional space is needed.

Refrigerator $500

Staff training (1 [8-hour] day x 16 staff @ $9/hour) $1,152

Trainer for 1 day $350

Substitute staff while others in training $504

Computer system not needed because the laboratory

will keep records of the testing and can furnish

information on numbers tested, results, etc.

Other miscellaneous expenses (e.g., trash receptacle, gloves) $100

Total Startup Costs $2,606

Ongoing Costs (estimated for 1 year)*

Number of youth tested at admission 90

Number of tests administered to each youth 1

Number of drugs tested for 3

Total admission tests 90

Cost per test (three drugs/test) x $10

Total cost for admission tests $900

Number of youth tested randomly 90

Number of tests administered to each youth

(after 50% of eight off-ground trips) 4

Number of drugs tested for 3

Total random tests 360

Cost per test (three drugs/test) x $10

Total cost for random tests $3,600

Total cost for all tests $4,500

Supplies, forms, etc., will be provided by laboratory.

Staff time @ 15 minutes/youth @ average salary of $9/hour $1,013

Additional utilities Negligible

Yearly Cost $5,513

* Estimated costs per test were taken from Pretrial Drug Testing: Overview of Issues and Practices

(Pretrial Services Resource Center, 1998).
20

Example 3: Large Juvenile Probation Department

The Springfield Probation Department has approximately 1,000 youth on its caseload at any time. Five hundred of those

are newly adjudicated cases each year. All youth will be tested for five drugs at intake. Based on history, the department

estimates that approximately one-half of the youth use drugs on an ongoing basis. Marijuana and cocaine are the major

drugs used, but methamphetamines are a problem occasionally. Tests will be administered randomly three times a month.

The department has 30 probation officers who will be required to collect specimens. An onsite instrument will be used

for testing, and two officers will be specially trained to use it. Five administrators also will attend training. Confirmation

tests will be used for any youth—estimated at about 10 percent—who will go back to court for possible revocation after

several consecutive positive tests.

Startup Costs

No remodeling is necessary, and there is sufficient space to store tests and operate testing equipment.

Refrigerator $500

Staff training (1 [8-hour] day x 35 staff @ $12/hour) $3,360

Trainer for 2 days (Training provided in two sessions each for half the staff; no substitute staff needed.

Training on use of instrument provided by manufacturer.) $700

Personal computer, software, and training to use it $3,000

Other miscellaneous expenses (e.g., trash receptacle, gloves, safety goggles) $200

Total Startup Costs $7,760

Ongoing Costs (estimated for 1 year)*

Number of youth tested at admission 500

Number of tests administered to each youth 1

Number of drugs tested for 5

Total admission tests 500

Cost per test (five drugs/test) x $5

Total cost for admission tests $2,500

Number of youth tested randomly (50% of 1,000-youth caseload) 500

Number of tests administered to each youth (three tests/month) 36

Number of drugs tested for 2

Total random tests 18,000

Cost per test (two drugs/test) x $2

Total cost for random tests $36,000

Total cost for all tests $38,500

Supplies, forms, etc. @ $.35/test (18,500 tests [admission and random] x $.35/test) $6,475

Confirmation tests at laboratory for 10% of randomly tested youth (50 tests x $20/test) $1,000

Staff time @ 15 minutes each for 18,500 tests [admission and random] @ average salary of $12/hour $55,500

Staff to operate instrument @ 3 minutes each for 38,500 drugs tested @ $12/hour $23,100

Maintenance contract on instrument $750

Additional utilities @ $50/month $600

Yearly Cost $125,925

* Estimated costs per test were taken from Pretrial Drug Testing: Overview of Issues and Practices (Pretrial Services Resource Center, 1998).
21

the JAIBG legislation states: “Funds

received under this program may

be expended for such purpose [i.e.,

substance testing].” Some States or

localities have drug seizure programs where money and property

related to drug trafficking are confiscated. These funds often can be

used for combating drug use and

might be available for a juvenile

substance-testing program.

■ Agency collaboration. For example, agencies can share space,

pool supplies, and engage in interagency training and staffing to

defray the costs of implementing

the program.

■ Resource sharing. It may be possible to obtain donations of needed

items, such as refrigerators, rubber

gloves, testing supplies, and possibly even test equipment in exchange

for public recognition by the agency.

■ Fundraising. Businesses, organizations, churches, and other community entities interested in fighting

crime, protecting the community,

and helping youth could provide

funding for the program.

■ User fees. This is not as realistic with

youth as it is with adults, because

youth seldom have steady income;

however, youth might be required

to provide community service or

engage in other work activities in

exchange for testing.

Step 9: Develop Staff

Staff involvement and cooperation

are vital for implementing any program change. Staff roles, attitudes,

and comfort in performing their jobs

may be affected by developing a substance-testing program.

Staff resistance to implementing a

substance-testing program often is related to program expectations, such as:

■ Additional paperwork to comply

with rigorous chain-of-custody

procedures and program evaluation.

method selected, it may be

necessary to budget for some

confirmatory tests. The

amount required may depend

on the program’s policies.

Some policies require confirmation of all positives, others

require confirmation only if

results will be used for legal

purposes, and some confirm

only if the youth contests the

findings. In some cases, youth

are required to pay for confirmatory tests that also show a

positive result, while the

agency pays if the confirmation test is negative.

■ Costs for a substance-testing information system. Keeping accurate information about each youth

and the entire testing program is

vital. Records can be kept by

hand, but unless the population of

youth to be tested is quite small,

record keeping on computers is

likely to save time and yield more

accurate and accessible results.

Costs associated with this may

include software, programming

time, hardware, and data entry

time.

■ Costs for responding to tested

youth. As stated previously, there

should be a response given for

each and every test administered.

Much of the time, a verbal response praising youth for a negative test or counseling and admonishing them for a positive

test will be the primary response.

However, some programs may

want to include rewards for ongoing negative tests and graduated

sanctions for ongoing positive

tests. Rewards could include the

cost-saving measures of decreasing the frequency of testing and

limiting visits by community supervision personnel. On the other

hand, sanctions such as increased

testing and supervision or the

need for referrals to treatment or

other programs may increase the

financial cost to the juvenile justice

agency.

Variable factors that must be considered to determine costs for substance

testing include:

■ The number of youth to be tested.

■ The number of personnel to be

trained.

■ The frequency of testing.

Cost Savings

One way of minimizing costs is to test

youth only as needed. In programs of

ongoing testing, after several negative

tests, the frequency of testing may be

reduced or testing may be stopped

altogether. Decisions about testing

also may be related to the youth’s behavior, peer associations, and history

of drug use and to the nature of the

offense committed. If testing is random, it can be done somewhat less

frequently. Youth also may be encouraged to admit illicit drug use rather

than undergo testing.

Using volunteers or student interns

within the agency may be another

cost-saving device. Only trained personnel should conduct drug testing,

but volunteers or interns may be able

to assist with other time-consuming

tasks that free some of the juvenile

justice professionals’ time.

Never economize by collecting specimens but not testing them. This can

seriously jeopardize the integrity of the

testing program. If youth know they

should be testing positive but do not

receive feedback on the test results,

they are more likely to take chances

using drugs.

Sources of Funding

There are a variety of avenues and

creative strategies for obtaining funds

for a testing program, including:

■ Federal, State, and local grants and

funding programs. For example,
22

■ Observed specimen collection.

■ Confrontation of drug-involved

youth.

■ Additional work in managing

cases when youth need treatment

and other services.

Staff enthusiasm may increase with

program benefits, such as:

■ More accurate information about

youth to assist in case management

and intervention.

■ Drug-testing results to help overcome youth’s denial of drug use.

■ Data collected from a drug-testing

program to document the need for

additional treatment resources.

Staff Empowerment

Staff involvement in the program planning and development process is recommended. Staff at all levels are stakeholders in the program and should be

included in the process. In addition,

agency administrators can facilitate effective teamwork and staff cohesion by:

■ Working with staff to set clear objectives and achievable goals for

the program.

■ Establishing effective procedures

for conducting the program.

■ Maintaining constructive communication among team members.

■ Allowing the team latitude to

solve problems and grow with

their responsibilities.

■ Providing training programs to

help members perform their duties

proficiently.

■ Recognizing and rewarding excellent job performance and allowing

the team to share in the success of

the program.

Staff Responsibilities

A substance-testing coordinator should

be designated to oversee the program.

Depending on the size of the program,

this may or may not be a full-time

responsibility. Responsibilities of the

coordinator include, but are not limited

to, the following:

■ Assisting in development of policies

and procedures for the program.

■ Handling contract negotiations

and renewals for program instruments and supplies, and recommending and implementing

changes when needed.

■ Acting as a liaison between contracting agencies, ensuring that

contract obligations are fulfilled,

and seeing that rendered services

are satisfactory.

■ Taking steps to solve problems.

■ Coordinating training opportunities

for staff.

■ Making budgetary decisions in

compliance with agency policy.

■ Monitoring legal issues, such as

court challenges and requirements

for testifying.

■ Assisting in evaluating the program design and implementation

and analyzing results regarding

the substance-testing program.

Staff of the program will have an array

of responsibilities. The primary ones

include the following:

■ Advising youth of the testing program and the procedures that will

be taken.

■ Collecting specimens.

■ Following all chain-of-custody

procedures.

■ Operating instruments, using test

kits, or sending specimens to

laboratories.

■ Complying with all procedures to

maintain quality control.

■ Communicating results to youth and

handling results properly within the

agency (e.g., filing, entering in log).

■ Testifying in court, if necessary.

■ Completing all program evaluation

procedures.

Staff Training

To successfully implement a testing

program, staff will need to participate

in training to acquire an array of information and skills. Training content

should include:

■ Information about adolescent

drug use.

■ Effects of various drugs on youth.

■ Program purpose and agency

mission.

■ Discussion of legal issues.

■ Testing methodology and how it

works.

■ Use that will be made of results.

■ Program policies and procedures,

such as scheduled or random testing,

frequency of testing, observed specimen collection, chain-of-custody

procedures, confirmation of positive

results, cutoff levels, and health and

safety requirements.

■ Intervention strategies, including

graduated sanctions and rewards.

■ Conflict management.

■ Program evaluation procedures.

Step 10: Evaluate the

Program

Although it is the last topic in the program development process, program

evaluation is essential and occurs

throughout program implementation.

What To Evaluate

Both process and outcome evaluation

measures are vital. Process evaluation

examines the implementation of the

program, while outcome evaluation

focuses on the impact of the program.

For example, questions that might be

answered through a process evaluation include:
23

■ Are the intended youth being tested

at the appropriate frequency?

■ Are staff correctly following chainof-custody procedures?

■ How is drug testing affecting the

staff?

Questions that might be answered

through outcome evaluation include:

■ How many youth are using drugs,

and what kinds of substances are

they using?

■ Are youth who test positive receiving needed assessment and treatment services?

■ Are tested youth abstaining from

using drugs?

■ Is recidivism reduced for youth

who are tested?

Many other important process and

outcome questions can be answered

through evaluation. The specific areas

to be measured should correspond

with the agency mission and the purpose and goals of the testing program.

When To Evaluate

Evaluation should be built into the

testing program and should begin

when the program begins. It is helpful if baseline data can be collected

against which later findings can be

compared.

Data Collection

The purpose of the program determines the data to be collected. Data

can be collected through traditional

paper forms and filing systems, or

they can be entered, stored, and

retrieved using computers. Selection

of a method will depend, in part, on

the availability of technology, the

amount of data to be collected, and

the expertise and time required by

staff to use the method. Whichever

method is selected, it is vital that a

systematic process be established for

collecting and using the data. Some of

the types of data that should be collected on individual youth include

the following:

■ General identifying information

about the youth (e.g., name, age,

legal status).

■ Substance use history (e.g., types,

amount, and frequency of drugs

used).

■ Treatment history and current

status (e.g., types of treatment

received, attendance at present

treatment program).

■ Drug-testing results (e.g., dates

tested, types of drugs tested for,

results).

■ Responses given to drug-testing

results.

Evaluation Findings

Collected data can be used in several ways. This information may be

used to track the services provided

and the progress of an individual

youth. Data such as those listed

above can be used to show trends

in drug use and youth responses to

treatment and juvenile justice interventions. This is useful in assessing

the effectiveness of the current case

plan and modifying it if necessary.

Aggregate data also can be used to

assess the drug-testing program.

For example, cumulative data can

reveal trends in drug use among

youth over time, the effectiveness

of treatment services and case

plans, and any problems in program implementation.

Evaluation results should be used

to make ongoing decisions about

program operations. Evaluation

findings can help to answer these

questions:

■ Are program goals appropriate?

■ Are the program’s processes adequate and are they being implemented accurately?

■ What are the outcomes?

■ Are the outcomes found through

the evaluation consistent with the

program goals?

■ Are there any unintended

outcomes?

■ Is the cost of the program appropriate for the results received?

■ Are the data collected appropriate

and adequate for effective evaluation and decisionmaking?

■ Are the findings consistent with

local community data?

A management information system is necessary for evaluating a

substance-testing program. The

system may be either manual or automated, but it should be capable of

providing information about the effectiveness of the program. It should

be easy to use, and results should be

easily retrievable. The agency should

establish standard procedures for

staff responsibilities and operation

of the management information system. Confidentiality must also be

considered in designing the input,

storage, and retrieval of information.

Conclusion

The 10 steps outlined in this Bulletin

are important because they can help

agencies reach the ultimate goal of a

substance-testing program—helping

youth to stop using substances of

abuse. The consequences of juveniles’

use of mood-altering substances can

be dire. Substance abuse and delinquency are closely associated. Further, substance abuse can strain the

user’s peer and family relationships,

damage his or her physical and emotional health, and even lead to death

by overdose, suicide, or drug-related

homicide. Creating an effective

substance-testing program will

allow agencies to prevent some of

these tragic consequences as they

accomplish the following:
24

■ Identify youth needing treatment

and other interventions for substance abuse.

■ Deter youth’s use of alcohol and

other drugs.

■ Screen for substances that may lead

to health and safety problems for

the youth and others.

■ Assist agency staff in making appropriate case plans and supervising

and monitoring youth’s compliance

with court orders or program rules.

Without effective testing, youth involved with alcohol and other

drugs may not be discovered and

opportunities for intervention may

be lost.

References

American Correctional Association/

Institute for Behavior and Health, Inc.

(ACA/IBH). 1991a. Drug Testing in

Juvenile Detention Centers: Current

Practice and Future Directions. Literature Review, Prototype Drug Testing

Program, and Sample Policies and

Procedures. Laurel, MD: American

Correctional Association.

American Correctional Association/

Institute for Behavior and Health, Inc.

(ACA/IBH). 1991b. Drug Testing of

Juvenile Detainees. Monograph.

Laurel, MD: American Correctional

Association.

American Correctional Association/

Institute for Behavior and Health, Inc.

(ACA/IBH). 1995. Testing Juvenile Detainees for Illegal Drug Use. Final Report. Laurel, MD: American Correctional Association.

American Probation and Parole Association (APPA). 1992. Drug Testing

Guidelines and Practices for Juvenile

Probation and Parole Agencies. Washington, DC: U.S. Department of

Justice, Office of Justice Programs,

Office of Juvenile Justice and Delinquency Prevention.

Aukerman, R.B., and McGarry, P.

1994. Combining Substance Abuse

Treatment With Intermediate Sanctions

for Adults in the Criminal Justice System. Treatment Improvement Protocol Series #12. Rockville, MD: U.S.

Department of Health and Human

Services, Substance Abuse and Mental Health Services Administration,

Center for Substance Abuse Treatment.

Baer, J.D., and Booher, J. 1994. The

patch: A new alternative for drug

testing in the criminal justice system.

Federal Probation 58(2):29–33.

Bigelow, G.E. 1995. President’s comments: Behavior science is fundamental to drug abuse research and treatment. In Problems of Drug Dependence

1994: Proceedings of the 56th Annual Scientific Meeting. The College on Problems of Drug Dependence, Inc. Volume I. NIDA Research Monograph

152. Rockville, MD: U.S. Department

of Health and Human Services, National Institute on Drug Abuse.

Brooks, M.K. 1990. Legal Issues for Alcohol and Other Drug-Use Prevention

and Treatment Programs Serving HighRisk Youth. OSAP Technical Report–2.

Rockville, MD: U.S. Department of

Health and Human Services, Alcohol,

Drug Abuse, and Mental Health Administration, Office for Substance

Abuse Prevention.

Clark, R.A. 1993. OSHA Standard on

Occupational Exposure to Bloodborne

Pathogens. OSHA Standards and

Compliance Letters. Washington,

DC: U.S. Department of Labor,

Occupational Safety and Health

Administration.

Council on Scientific Affairs. 1987.

Scientific issues in drug testing. Journal of the American Medical Association

257(22):3112.

Crowe, A.H. 1998. Drug Identification and Testing in the Juvenile Justice

System. Summary. Washington, DC:

U.S. Department of Justice, Office

of Justice Programs, Office of

Juvenile Justice and Delinquency

Prevention.

Crowe, A.H., and Schaefer, P.J.

1992. Identifying and Intervening with

Drug-Involved Youth. Lexington, KY:

American Probation and Parole

Association.

Crowe, A.H., and Sydney, L. 2000.

Developing a Policy for Controlled Substance Testing of Juveniles. Bulletin.

Washington, DC: U.S. Department

of Justice, Office of Justice Programs,

Office of Juvenile Justice and Delinquency Prevention.

Del Carmen, R.V., and Sorensen, J.R.

1988. Legal issues in drug testing

probationers and parolees. Federal

Probation 52:19–27.

Doweiko, H.E. 1990. Concepts of Chemical Dependency. Pacific Grove, CA:

Brooks/Cole Publishing Company.

Elbert, M.J. 1997. The use of creatinine

and specific gravity measurement to

combat urine test dilution. Federal

Probation 61(4):3–10.

Institute of Medicine. 1990. Treating

Drug Problems. Volume I. Washington,

DC: National Academy Press.

Jackson, K., and Borrowman, S. 1998.

Technology for drug testing. Audio

Teleconference. Lexington, KY: American Probation and Parole Association.

Maloney, D., Romig, D., and Armstrong,

T. 1988. Juvenile probation: The balanced approach. Juvenile and Family

Court Journal 39(3).

Mattingly, M. 1998. OJJDP Deputy

Administrator John Wilson highlights

agency positions. Juvenile Justice Update

4(2):1, 12–15.

Mieczkowski, T. 1995. Hair Analysis

as a Drug Detector. NIJ Research in

Brief. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice.
25

Mieczkowski, T. 1997. Hair Assays and

Urinalysis Results for Juvenile Drug Offenders. Research Preview. Washington,

DC: U.S. Department of Justice, Office

of Justice Programs, National Institute

of Justice.

Mieczkowski, T., and Lersch, K. 1997.

Drug testing in criminal justice: Evolving uses, emerging technologies. National Institute of Justice Journal 234:9–15.

Milgram, G.G. 1990. The Facts About

Drinking. New York, NY: Consumers

Union.

Office of National Drug Control Policy.

1990. Understanding Drug Treatment.

White Paper. Washington, DC: Office

of National Drug Control Policy.

Pretrial Services Resource Center.

1989. Estimating the Costs of Drug Testing for a Pretrial Services Program.

Washington, DC: U.S. Department

of Justice, Office of Justice Programs,

Bureau of Justice Assistance.

Pretrial Services Resource Center. 1998.

Pretrial Drug Testing: Overview of Issues

and Practices. Washington, DC: Pretrial

Services Resource Center.

Robinson, J.J., and Cargain, M.J. 1998.

Criminal justice drug testing: Burgeoning technology in applications for the

future. Journal of Offender Monitoring

11(4):21–23.

Substance Abuse and Mental Health

Services Administration (SAMHSA).

1998a. Mandatory Guidelines for Federal Workplace Drug Testing Programs.

Washington, DC: U.S. Department of

Health and Human Services, Office

of Applied Studies, Substance

Abuse and Mental Health Services

Administration.

Substance Abuse and Mental Health

Services Administration (SAMHSA).

1998b. Preliminary Results From the

1997 National Household Survey on

Drug Abuse. Rockville, MD: U.S. Department of Health and Human

Services, Office of Applied Studies,

Substance Abuse and Mental Health

Services Administration.

Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis b virus,

and other bloodborne pathogens in

health care settings. 1988 (June 24).

Morbidity and Mortality Weekly Report

37(24):377–382, 387–388.

Visher, C., and McFadden, K. 1991. A

Comparison of Urinalysis Technologies

for Drug Testing in Criminal Justice. Research in Action. Washington, DC: U.S.

Department of Justice, Office of Justice

Programs, National Institute of Justice.

For Further Information

Suggested Readings

Drug Testing

The following publications offer additional information on drug testing

strategies and procedures.

American Probation and Parole Association. 1992. Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies. Washington,

DC: U.S. Department of Justice, Office of Justice Programs, Office of

Juvenile Justice and Delinquency

Prevention.

Crowe, A.H. 1998. Drug Identification

and Testing in the Juvenile Justice System

Summary. Washington, DC: U.S. Department of Justice, Office of Justice

Programs, Office of Juvenile Justice

and Delinquency Prevention.

Crowe, A.H., and Schaefer, P. J. 1992.

Identifying and Intervening with DrugInvolved Youth. Lexington, KY: American Probation and Parole Association.

Del Carmen, R.V., and Sorensen, J.R.

1988. Legal issues in drug testing

probationers and parolees. Federal

Probation 52:19–27.

Mieczkowski, T. 1997. Hair Assays and

Urinalysis Results for Juvenile Drug Offenders. Research Preview. Washington, DC: U.S. Department of Justice,

Office of Justice Programs, National

Institute of Justice.

Pretrial Services Resource Center. 1998.

Pretrial Drug Testing: Overview of Issues

and Practices. Washington, DC: Pretrial

Services Resource Center.

Robinson, J.J., and Cargain, M.J. 1998.

Criminal justice drug testing: Burgeoning technology in applications for the

future. Journal of Offender Monitoring

11(4):21–23.

Substance Abuse Treatment

The Center for Substance Abuse Treatment publishes numerous protocols

and technical assistance materials on

substance abuse treatment. All are free

of charge and available from:

National Clearinghouse for Alcohol

and Drug Information (NCADI)

P.O. Box 2345

Rockville, MD 20857–2345

800–729–6686

The following publications may be ordered from NCADI by title and number:

Assessment and Treatment of Patients

with Coexisting Mental Illness and Alcohol and Other Drug Abuse (BKD134)

Combining Alcohol and Other Drug

Abuse Treatment with Diversion for Juveniles in the Justice System (BKD169)

Comprehensive Case Management for

Substance Abuse Treatment (BKD251)

Detoxification from Alcohol and Other

Drugs (BKD172)

Juvenile Justice Treatment Planning

Chart (PHD 598)

Guidelines for the Treatment of Alcohol

and Other Drug Abusing Adolescents

(BKD109)

Principles of Drug Addiction Treatment:

A Research-Based Guide (BKD347)
26

The Role and Current Status of Patient

Placement Criteria in the Treatment

of Substance Use Disorders (BKD161)

Screening and Assessment of Alcohol

and Other Drug Abusing Adolescents

(BKD108)

Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse

and Infectious Diseases (BKD143)

Substance Abuse Treatment Planning

Guide and Checklist for Treatment-Based

Drug Courts (SMA 97–3136)

Organizations

American Correctional Association

4380 Forbes Boulevard

Lanham, MD 20706–4322

301–918–1800

301–918–1900 (fax)

American Probation and Parole

Association

Juvenile Drug Testing Project

P.O. Box 11910

Lexington, KY 40578–1910

606–244–8192

606–244–8001 (fax)

Center for Substance Abuse

Treatment

Substance Abuse and Mental Health

Services Administration

5600 Fishers Lane, Rockwall II

Rockville, MD 20857

301–443–2467

301–443–3543 (fax)

Centers for Disease Control

and Prevention

U.S. Department of Health

and Human Services

1600 Clifton Road NE.

Atlanta, GA 30333

770–488–5292

Drug Courts Program Office

U.S. Department of Justice

Office of Justice Programs

810 Seventh Street NW.

Washington, DC 20531

202–616–5001

202–514–6452 (fax)

Drug Information Hotline

800–662–4357

Juvenile Justice Clearinghouse

800–638–8736

Legal Action Center

153 Waverly Place, Eighth Floor

New York, NY 10014

212–243–1313

National Association of Drug

Court Professionals

901 North Pitt Street, Suite 300

Alexandria, VA 22314

703–706–0576

703–706–0565 (fax)

National Association of

State Alcohol and Drug

Abuse Directors

444 North Capitol Street NW.

Suite 642

Washington, DC 20001

202–783–6868

National Center for

Juvenile Justice

701 Forbes Avenue

Pittsburgh, PA 15219–3000

412–227–6950

412–227–6955 (fax)

National Center on

Addiction and Substance Abuse

152 West 57th Street

New York, NY 10019

212–841–5200

212–956–8020 (fax)

National Clearinghouse for Alcohol

and Drug Information

P.O. Box 2345

Rockville, MD 20847–2345

800–729–6686

301–468–6433 (fax)

National Institute on Alcohol Abuse

and Alcoholism

6000 Executive Boulevard, Wilco

Building

Bethesda, MD 20892–7003

301–443–3860

National Institute on Drug Abuse

National Institutes of Health

6001 Executive Boulevard,

Room 5213

Bethesda, MD 20892

301–443–1124

National Juvenile Detention

Association

Eastern Kentucky University

217 Perkins Building

Richmond, KY 40475–3127

606–622–6264

National Treatment Accountability

for Safer Communities

1911 North Fort Meyer Drive,

Suite 900

Arlington, VA 22209

703–522–7212

703–741–7698 (fax)

Office of Justice Programs

Drug Court Clearinghouse

and Technical Assistance Project

American University

Brandywine 660

4400 Massachusetts Avenue NW.

Washington, DC 20016–8159

202–885–2875

202–885–2885 (fax)

Office of Juvenile Justice and

Delinquency Prevention

U.S. Department of Justice

Office of Justice Programs

810 Seventh Street NW.

Washington, DC 20531

202–307–5911

Pretrial Services Agency

District of Columbia

Superior Court

400 F Street NW.,

Suite 310

Washington, DC 20001

202–727–2911

202–727–9852 (fax)
27

Acknowledgments

Ann H. Crowe and Linda Sydney

are Research Associates at the

American Probation and Parole

Association.

Points of view or opinions expressed in this

document are those of the authors and do

not necessarily represent the official position

or policies of OJJDP or the U.S. Department

of Justice.

The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes

the Bureau of Justice Assistance, the Bureau

of Justice Statistics, the National Institute of

Justice, and the Office for Victims of Crime.

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