Substance abuse is often used as a weapon in family court, even when there isn’t a significant problem. Courts have several ways of handling this issue, and each method can have long-term implications.
In this episode of Children First Family Law, Krista explores how family courts determine whether a parent is safe with a child. She outlines her experiences with families dealing with these scenarios, implementing advice and expertise from psychologist and attorney Dr. Stephanie Tabashneck. Two previous podcast episodes, with guests Cheryl and Mike, explore both parenting sides of this situation.
Krista offers an outline of the tools the court can use to evaluate a substance abuse issue and any additional risk factors. You’ll also hear the 10 factors the DSM-5 defines substance abuse. Together, these tools help attorneys and courts form parenting time recommendations.
Substance abuse in a divorce scenario can be complicated. This episode is a guide for navigating substance abuse while keeping children’s best interests at the forefront.
In this episode, you will hear:
- Substance abuse—primarily alcohol—is a chronic issue in family court, requiring assessments of handling approaches, their implications, and parental safety.
- Krista’s experiences working with families in these situations and the expert advice she receives from attorney and psychologist Dr. Stephanie Tabashneck
- The tools used by courts when a child’s safety is an immediate concern
- Why courts are sometimes hesitant to restrict legal substance use entirely
- Direct testing methods like Soberlink or BACtrack, urine analysis, hair follicle, and nail testing
- Substance Use Evaluation (SUE) involves an in-depth assessment conducted by a highly qualified professional with a strong background in addiction counseling, psychology, social work, or a related field.
- Psychological testing in conjunction with a Substance Use Evaluation
- A sample of questions you can expect from a Substance Use Evaluator (SUE) and the background information included
- Substance Abuse Subtle Screening Inventory (SASSI) evaluations and its insight into a person’s potential proclivity for substance abuse
- DSM-5’s definition of substance abuse and substance abuse disorders and the required criteria
- The 10 factors used to diagnose a substance abuse disorder according to the DSM-5
- Dimensions to evaluate for level of care decisions and what to look for in the evaluator’s report
- Recommendations following a Substance Use Evaluation (SUE) based on the results and when these evaluations are needed
Resources from this Episode
www.childrenfirstfamilylaw.com
Soberlink Remote Alcohol Monitoring | Improving Lives
BACtrack | The Leader in Breathalyzers
Adult SASSI-4 | The SASSI Institute
Alcohol Use Disorders Identification Test (AUDIT)
Michigan Alcohol Screening Test (MAST)
5280 Drug Testing – 5280 Drug Testing, Greenwood Village, CO
Drug Testing – Precise Monitoring
ASAM – American Society of Addiction Medicine
SAMHSA – Substance Abuse and Mental Health Services Administration
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5).
American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) defines a Substance Use Disorder based on using the criteria below. If, in the previous 12 months, an individual was identified as meeting 2-3 of the criteria they would have a mild disorder; meeting 4-5 criteria would equal a moderate disorder; and meeting 6 or more criteria would indicate a severe disorder. If the individual had previously met the criteria for a Substance Use Disorder, and none of the criteria have been met in the last three months, but less than 12 months, the diagnosis would be considered “In Early Remission.” If the individual had previously met the criteria for a Substance Use Disorder, and none of the criteria have been met in the previous 12 months, the diagnosis would be considered “In Sustained Remission.”
- Substance is often taken in larger amounts over longer time period than was intended
- Persistent desire or unsuccessful efforts to cut down or control substance use
- Great deal of time spent in activities necessary to obtain, use, or recover from its effects
- Craving, or a strong desire or urge to use the substance
- Recurrent use resulting in failure to fulfill major role obligations at work, school, or home
- Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance use
- Important social, occupational, or recreational activities are given up or reduced
- Recurrent use in physically hazardous situations
- Continued use despite knowledge of having a persistent recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use
- Tolerance as defined by:
- A need for markedly increased amounts to achieve intoxication or desired effect
- A markedly diminished effect with continued use of the same amount of substance
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for the substance
- The substance, or a closely related substance is taken to relieve or avoid withdrawal symptoms
All states have different laws; be sure you are checking out your state laws specifically surrounding divorce. Krista is a licensed attorney in Colorado and Wyoming but is not providing through this podcast legal advice. Please be sure to seek independent legal counsel in your area for your specific situation.
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Alcohol, Drugs & Other Addictions in Child Custody: The Traditional Approach Podcast Transcript
Krista Nash 00:00
Generally you should see in a good report what limitations there are on the evaluation you know. So, for example, situational stress should usually be indicated, because there’s certainly stress around the legal case, the agendas of the different parties involved, reliability, questions about self reporting, collateral contacts. Maybe the weaponization of this process by the other parent can be a big thing, and defensiveness and just the whole stress of being in a legal situation, and you know the fact that sometimes there aren’t professional resources to speak to, or professional references, or there aren’t people that are participating at the level that they showed or that they could to get a good report, sometimes there’s treatment records that are unavailable, things like that.
Intro/Outro 00:39
Welcome to the Children First Family Law podcast. Our host, Christa Nash is an attorney mediator, a parenting coordinator and child advocate with a heart to facilitate conversations about how to help children flourish amidst the broken area of family law. As a child advocate in demand for her expertise throughout Colorado and as a speaker on these issues at a national level, Krista is passionate about facilitating and creatively finding solutions to approach family law matters in a way that truly focuses on the best interests of kids. Please remember, this podcast is provided to you for information purposes only. No one on this podcast is representing you or giving you legal advice as always. Please enjoy this episode and be sure to like, subscribe and share the podcast with others you think would benefit from this content.
Krista Nash 01:27
Hi everyone. Welcome to today’s episode of the podcast. Today you’re stuck with me. I’m going to be doing what I think is going to end up being a two part episode to give an overview and insight into addiction and how we handle addiction in family cases, in family courts. This is a very complicated area, and I’ve been trying to distill it down as I’ve thought about bringing you some overarching information about this, so you can start whether you’re a family member going through this, a parent, or you are a professional involved in working in cases that have these dynamics. There is really a lot to think about. And so I think we’ll see how this goes today, but I’m thinking it’s going to end up being too stay tuned, and we’ll see at the end how long this takes me to get through. Also, you know, if you’re watching me on video, you’re going to see that I’m relying on some notes, because I have a lot of details I need to get into, basically in terms of definitions and things like that. And so I just want to make sure that I get it right. So I am coming to youoday, from an off site setting as well. So if you’re watching online on YouTube, you can see that I’m in a sort of cabin area. So from time to time, I try to get away from this hard work of the cases and get to a place where I can actually think a little bit and reflect a little bit. So that’s where I am today as I record this. All right, so let’s get into it. I think that the first thing you need to know, and hopefully, if you’ve been following the podcast, you will have listened to or watched the two episodes that will have already released, one from a woman named Cheryl and another from a man named Mike, both of whom tell their stories from really different sides of the case in their each of their situations in terms of how alcohol use, specifically, but also drug use and things like that have affected their families and the dynamics in their individual cases. This is a very chronic situation in family courts, that we have cases that have issues of addiction or allegations of addiction, or allegations just of misuse. So that can be a variety of things, but usually it’s alcohol. Sometimes, I mean, I practice large in Colorado, we have a lot of marijuana use that’s become more common nationwide and internationally as well. Sometimes it’s other drugs, but certainly the most common one is alcohol. Although I would say that the principles that I’m sharing with you today really do apply to a lot of different types of addictive behaviors. So I’ll give you a few ways that these cases come in. First of all, we have cases that are pre decree, which is, you’re going through your family situation, whether you’re married or not, and you recognize that there’s a problem with the other person and maybe with yourself. But oftentimes I’m getting calls from people who are themselves seeing addiction problems in the CO parent. And so they’ll make phone calls to lawyers, or they’ll start looking around on the internet and say, Wow, what should I do about this. And so go back and listen to the podcast with Cheryl to hear how some attorneys approach that in terms of ensuring that evidence is created so that you have it’s not just a, he said, she said, situation, but it is an actual provable, really, or at least as provable as possible, to show that there really is a concern, because otherwise it becomes very hard to do anything about if it’s just two parents throwing allegations at one another, or one parent throwing allegations at the other. So that can come in the form of criminal activity, such as being, you know, getting a DUI, or something like that. It can come in the form sometimes couples with domestic. Violence claims. Sometimes it is video or audio recordings of things that have occurred in the family. There can be a whole bunch of different ways. It could be ER visits, photographs, although photographs aren’t as helpful, it really it’s more helpful to see things within context. So I’d send you back to the episode with Cheryl to learn about ways to think about that if that’s your situation. Other times we get calls from the person who is the one who is abusing or misusing, I guess is a better way to say it substances. And so in those situations, you can go listen to the podcast with Mike and hear about my approach, at least in terms of how to really try to change that narrative so that you can parent your children if you have been accused or you do actually have a drinking or drug problem, I would refer you back to those two situations. These dynamics are always very, very heartbreaking and difficult, and a lot of times they’re things that might not have been that extreme or even pointed out as a serious problem before you got into this divorce dynamic or allocation of parental responsibilities, dynamic, people get frustrated that the microscope is on them more under the bright lights of the court situation, and that’s true. So it is accurate that if you have a problem with this area in your life, you should be taking that very seriously if you’re heading into or are already in a court situation. So it comes, like I was saying, in two ways. First, we have a pre decree situation where we haven’t allocated parenting responsibilities yet or parenting time, but we are starting down that path, and the alcohol or addictive behavior or misuse of substances comes in at the very beginning of the case. That is a frequent situation, and it can come in a variety of ways, depending on your state and your state laws. In Colorado, sometimes we’ll have people come in with protective order requests. Sometimes there will be, protective order requests already done in the civil outside of the family court system. Those tend to get combined, essentially, with a family law divorce case, if it has started in just a regular civil protective order situation, you have to have really a very serious concern about the safety of you or the children if you’re going to go that route. And there are a whole lot of different implications you need to think about if you’re trying to get protection orders. I should make a note here. That’s another podcast that we should do separately, because it’s an area in itself, things you need to think about around that. Other times we will see restrictions filed which are basically imminent risk of mental, psychological, physical threat to or risk to the child. And parents will come in and try to seek a restriction on one or the other person. And sometimes that can be about substance use or misuse. So also, though, a lot of times, this narrative about sobriety or in sobriety or misuse or abuse of substances comes in throughout the case. So it can be something that colors the case long after the divorce occurs. So we may have a decree that issues parenting time for one or both, you know, for both parents, basically, and then we have ongoing problems like this, and so parents will come back to court with new or emerging or additional concerns that maybe didn’t get handled in the way they think was safe initially, or that has turned out to not be safe enough for the kids in that parent’s view. So sometimes I will get appointed as a child’s legal representative on cases involving substance use years and years into a case. So a lot of states use the calendar year as the way that we determine the case dates are the case number, basically. So if a case starts in 2024 it will be 24 in Colorado domestic relations, so Dr, 24 Dr, and then the case number. That’s true in a lot of states, and so I’ll get appointed on cases that started long, long ago, like cases that start with a 12 for 2012 or even earlier than that, where we have basically ongoing concerns about kids and ongoing concerns about safety based on even new or long time use of substances. Now the way that we do this, we have to decide in the courts or amongst just the parties, what are we going to do about this? There are several wonderful things that allow us to be able to check on how parents are using substances, or be able to test for them. So in some ways, it’s a little bit easier of a situation than, say, somebody who comes in and just says, Oh, my spouse is a narcissist, okay, that’s harder to test for. That’s a diagnosis. Is there a treatment for that? Yes, maybe. But alcohol and substances, at least, we have a great big body of work that we have the ability to really see if a parent is safe with a child, and we do that through a great variety of different experts and testing mechanisms that allow us to check on this. And you’ll hear those things discussed also in those two podcasts with Cheryl and Mike, because we used a lot of those in Mike’s case and Cheryl had used a lot of those in her case as well. So those are breath locks. Those are tests you can get at labs, nail tests, hair follicle tests, ongoing sobriety testing, things like that, that help us know whether or not kids are safe in the moment and whether a parent is exhibiting use by basically being able to test them for those things. So that’s really important, that we have tools, at least, to do that. The other thing I want you to think about is that we have to carefully understand and navigate what those tools are, and so it’s important, if you’re in this kind of situation, that we understand the different array of tools and the different array of experts to look at and understand what the courts are currently doing. Now that said, though, I want you to listen well into this episode. If this is an area in which you practice, or an area in which you are having a problem in your own family, because there are a lot of new ways to think about this situation and these situations that courts and lawyers are not very good at considering right now. And so probably my second episode on this, where I’m speaking to you about these issues, is going to be more focused on the new ways we’re thinking about this, and the very important, nuanced approach that needs to be taken, that is generally not taken by our courts today. So lots of new and emerging research I’m going to have guests on, and we’ll be talking about that in depth, but I first want you to understand the way that the courts are generally approaching this topic, and it’s not necessarily the right way to approach it, but it is how it is generally approached right now. So be sure to listen to the end of this if this is your area of working in, and there’s a shocking number of lawyers who don’t understand these things as well. So if you’re an attorney and you’re listening to this, I would really encourage you to listen through because you will really get a lot of insight that I find is not possessed by a lot of attorneys or judges sometimes. And so this will give you a lot of information about where we are now and then the next episode, and I’ll touch on it at the end of this one will be about what that means for us moving forward in terms of new research, newer trends in this better ways to help kids when they’re in these situations. Okay, so for those of you who have been, for example, involved, we have a great big conference every year in Colorado called the Family Law Institute. And a lot of where my thoughts have gone on this have been informed by Dr. Stephanie Tabashneck
, who is a really world class researcher. She’s a lawyer and psychologist who has been kind enough to speak with me on background for this podcast, and we have been having some dialog, and she’s been providing me some papers and research that she’s been doing, work that she has done. She, also at the Family Law Institute, was one of our keynote speakers. So those of you who were there in 2024 will remember her. She’s written an important resource about substance use and how to think about it, that I will include as a resource here at the end of this episode, and on my resources, on the show notes and on my website. So if you think you know all you need to know on addiction and substance use and substance misuse and Family Court, please do yourself a favor and really try to take this all very seriously, because there are a lot of dynamics that we aren’t thinking about enough in family courts, and that professional is really world class in helping us understand that, and has been generous enough to provide me a lot of information to help me think about this, and continues to provide a lot of resources for professionals and for families in this area. I will say she won’t become a podcast guest because she doesn’t do that. She doesn’t do podcasts for a variety of reasons in her own work and the roles that she takes. But I want you to know that we do have her resources in terms of and she gave me permission to tell you that she’s been providing background information for me, including some work with me, directly with her, so that I can better understand how to bring this important topic to you. Also, I do have an unfortunate amount of experience in this area, based on some clients, who they know, who they are, who have given me years of experience in working in this area. I also have been a child and family investigator, as many of you know, many of those cases also have substance use evaluators involved in the cases, and so I’ve worked with substance use evaluators in that context for many years. Also as a child’s legal representative, I am tasked with coming up with some solutions to help families. So I’ve got a lot of experience working with experts across Colorado and beyond in terms of helping families understand how to navigate and approach this. And I have several cases where I have been the attorney for many years for the parent who is trying to protect their child from the person who is abusing substances or misusing substances. And I’ve had to navigate a lot of different experts in that work. So I’ve had internal case experts who have helped us navigate those things and those important decisions about how to handle those cases, and I’ve had the ability to work with experts who have been the ones who have advised my clients over the years, as well as having substance use. Evaluators and Parental Responsibilities Evaluators, custody evaluators, involved in navigating how we intersect those drug and alcohol tests and the approach of protecting children with what that means as we go through a case for years. So all of that I’m bringing to you, as I share with you, the way that courts are doing this and the way we need to think about this moving forward.
Okay, so with all of that, let me get into the main tools that we have. Okay, so at some point the question of testing arises, depending on the level of misuse and addictive behavior that we are facing. And so let me go through what those general options are. Okay, so first of all, if we have an immediate need for a child’s safety we generally start using, and especially if it’s alcohol, we will generally start using testing for the alcohol use in real time. Okay, those different options that we use are, for example, I’ll just give you two of them that are the leading ones that we use in Colorado. One of them is and I think this is true nationally as well. So for breathalyzers, there are two main brands that we use, at least in Colorado and I think nationally, and those are Sober Link and BACtrack, capital B, capital A, capital C, track, T, R, A, C, K, which is to look for blood alcohol content. And they are very sophisticated breathalyzers. You can find more information on those online, but basically they allow for real time protection of kids, because you pick one or two people basically who are going to receive that real time information back in terms of whether or not it’s like a green light, yellow light or a red light, for example, that gives you what that blood alcohol content is, there’s usually different provisions that we do to say that if you have a positive and you have a few minutes to retake your test, basically because every once in a while there’s a false positive, although that’s not very common. And so, you know, there’s things like mouthwash or things like that can set that off. And so we go ahead and allow for a secondary test, there are different suggestions about how frequently people have to do that testing. I think it’s better to use now, I’ll say with the caveat, I’m not a substance use expert myself, but in working with them, I think that I’ve seen best practice be that we do sober testing on these breathalyzers very frequently. So you’ll see on the websites that there are different programs you can buy or different packages that don’t allow for as many tests. I don’t suggest those. I suggest the ones that allow for unlimited testing. And that’s because, really, you’re trying to show that there is no drinking going on from, you know, test to test. And so we want to be sure if we’re really trying to track for no drinking at all, then we want to test very frequently. You also want to consider what someone’s drinking patterns usually are. So we want to note, for example, if someone’s drinking usually at night, which is, I think, more common for most people. It’s not 100% true, but it’s more common. We want to make sure that we limit the gaps in testing overnight as much as possible, still recognizing people need to work and sleep and get sleep so that they can work. So generally, I’ve seen people do really all over the map, but generally, I’d say about it every four hour testing time. So maybe that’s at 6am, 10am, 2pm, 6pm and then 10 or 11pm right before bed, and then again, 6am in the morning, and doing so around the clock. Now you can see how this can be, what I would say, sort of draconian, which my next podcast about things to think about that are a little different than this sort of cat and mouse game all the time about trying to catch whether somebody’s drinking or not and whether that’s the right approach is what we will talk about as we move forward, but that is what we do right now, most of the time, because most of the time we’re trying to say, you can’t drink at all. Okay, if you have had a problem, we’re not going to let you drink at all. Now, some judges don’t want to go that far, and they’re like, look, these substances are legal. I mean, of course, if they’re illegal, we have a bigger problem and or different problem, at least, and so I don’t think there’s any judge anywhere that would say, Oh, it’s a fine to go do meth, or it’s fine to use heroin or any of these kinds of things. But if we’re talking in places where marijuana is legal or where alcohol is legal, especially with a lot of states and countries having I think maybe it’s almost universal that there’s a lot of celebratory positive things associated with alcohol, at least. And there’s certainly an advertising industry that fosters this idea that alcohol is fun and good and socially acceptable, which is a whole nother topic, because I think there’s a pretty solid argument that’s very dangerous and maybe the wrong thing. And there are, frankly, some countries that are leaning more sober in terms of why do we need alcohol so much as something that we are all using so frequently, if it really does cause a lot of injury, and it’s so easy for it to cause injury for so many people, it might be interesting for me to have a police officer on remember talking to one one time who said that some massive percentage of the crimes that this police officer has been involved in over the years involve alcohol.
Certainly, a lot of domestic violence is associated with the use of alcohol. And there’s just, I suppose, a very solid argument that maybe we should all be questioning, societally, how smart it is for us to be using that so much. But in any case, judges are like, okay, it’s legal. Should I really? They wrestle a lot about, should I really be denying a parent’s ability to drink at all? Or do we only want a parent to not be able to drink on the his or her parenting time? So that’s another dynamic that we work with. And certainly the most important thing is that the parent doesn’t abuse or misuse alcohol or another substance during parenting time that I think we can all be, we can all agree, is true and fair. The question is, you know, what is misusing it? And for each person, you know, maybe one person can have a glass of wine and or a beer and the other really can’t, or it leads to a slippery slope. It’s also true that kids who have been around substance use and misuse, especially substance misuse, often have what I call spidey senses. I took that from a kid who used that language himself as to being triggered by the use of alcohol. I would encourage you to go back to use of substances. I’d encourage you to go back and listen to the podcast I did with Judge Robert Lung, who spoke about that very eloquently, and why even a non alcoholic drink would trigger a child potentially, and so he in his courtroom had made some very serious orders around not being able to drink at all, even non alcoholic drinks, for that reason, because of the way it affects children in a lot of these cases. So there’s a wide variety, though, of provisions that we do about whether it is no drinking at all, no marijuana at all, no or whether it’s a little bit, or whether it’s during just parenting time, or some level of time prior to parenting time, etc. So those are real time tests, okay? Sober Link k and BACtrack give you an immediate response that can go to the other parent, which a lot of our orders say must go to the other parent, and it will let you know whether or not there is a positive test, and then plans can have action items around them about what happens if there’s a positive test.
Now I will say again listening to the next episode, because it will talk about how maybe some of our ways that we approach this have become an overreaction, and we need to consider that, because we need to think about the attachment of children, and what we’re doing to children when we just cut off parenting time immediately when there’s any kind of positive test, which is sometimes what we do. The next kind of testing that we can do is testing that takes longer to get back. So that would be UAS. So that’s like Urine Analysis Tests, hair follicle testing, nail testing and then other testing. For example, there’s a test that many people don’t know about, that many Substance Use Evaluators use in at least my area and those that’s called blood spot path tests or PEth tests. That’s capital P, capital E, lower case th, PEth tests. This is something I’m going to have a sobriety expert talk about because, and we’ll do that upcoming here on the podcast, but I will give you just a very cursory understanding of it, and it basically involves being able to look back over about a month, 28 days or so, and look at the whether or not a parent has been binge drinking or not, based essentially on some information about the half life of alcohol and it being left in your system. So that’s about as far as I’m going to go, because this is very “techy/science/alcohol/expert” area in which I’m treading at this moment. But I want you to know that blood spot PEth tests are something that get ordered a lot in the cases in which I participate, and they can show whether somebody has been binge drinking over the course of the last month. This can be very, very helpful, especially when allegations are first brought, because it’s fair to say, if somebody calls me and says I’m getting accused of over drinking, I can say, well, go get me a PEth test today and have that PEth test sent to directly to me, not through you again. This is because, you know, people who misuse substances sometimes lie and hide and cheat and do things like that. Go listen to Mike’s podcast on that because he had become the master of that at the time. And so it’s certainly within reason to think that somebody who is misusing substances would doctor a PDF that was sent directly to that person before it would get sent to an attorney or to a parent to show that they’re drinking or not drinking. So it’s not that hard to open a PDF and in an application and change the numbers and change the positives to negatives and things like that. So we want to make sure that those are getting delivered directly from that center to a professional or to the other parent, and we want to go to a reputable center for this work. This is true of any testing that you go to a center for or go to a facility for, UAS, hair follicle testing, nail testing. There are a lot of places that can be bribed and you don’t want to go. Of those places because they don’t have any veracity or truth to them, they get questioned a lot. So in Colorado, I suggest that people go at least to two different facilities that I think are generally considered reputable. Precise Monitoring is one of them, and 5280 Drug Testing is another. And those are ones that I have learned from Substance Use Evaluators to be more reliable than others. If you go to some sketchy kind of place, there’s many other than just those two. But just know that if you go to some place that seems sketchy or really inexpensive or something like that, then you’re probably getting what you’re paying for. And you need to be really careful that you know the work you’re doing to go get that test is going to actually show something, and if it’s got a lot of questions about whether it can be faked, whether they’ll, for example, allow fake urine. And I mean, I’ve had cases where you’d be really surprised, and I’ll have our substance experts talk about this more when they come on. But for example, people can buy urine on the internet and or they can get urine from other people. There was one I did where the test showed, I think, was like horse urine or something; was what this person snuck into the center. And so when we got the results, it said it was horse urine and just crazy stuff like that. There’s all sorts of faking that goes on because people are so attached to their substances that they’ll go to those kind of limits. And there are places that allow them to do so. For example, urine tests need to be observed. That’s a really important part of it. You can’t just have them unobserved. I know that sounds a little bit gross. That means, yes, someone is watching that person urinate, so that they know it’s coming from their body and not from their backpack and whatever they bought on the internet or got down the street. But it’s very important that those tests are observed. So there’s a lot of nuances about how to get an appropriate test. Now the other problem with those is that UAS, hair follicles, nail tests, PEth tests, all these other tests, they don’t come back immediately, so they don’t provide immediate information for us to protect children. And that’s where it gets tricky with drug testing, and also with anything that isn’t real time, we really have trouble knowing. So if your problem is doing some drug that we can’t test through just a breathalyzer, which is most drugs, then you’re going to see tighter, probably more restrictive provisions around parenting that are based on clean tests being promoted. And it’s probably a slower path back to parenting alcohol, though, which fortunately or unfortunately is the most common one misused. We can really test for and we can test real time, which is great. That means we should be able to have less restrictive parenting time that is still safe for children, because we have very good testing that is available that is real time.
Now the third kind of testing that we can do is psychological testing combined with looking at substance use, because there is a great deal of like co-presentation. I’m sure that’s not the right word. I’m thinking of something else, but where they’re presenting at the same time. So many times, people who have substance uses have a simultaneous problem with mental health or something psychological that is contributing to their substance misuse, and so sometimes psychological testing can be very helpful, and I have had great success lately in working with psychologists who are falling short of doing full on custody evaluations, because we don’t really need that, especially if we have a Child’s Legal Representative on board who can make that bridge between the assessment of experts on substances or psychology mental health into the parenting time realm, that’s what a good CLR can do. But we do need some more help to understand whether the substance uses or to what extent those substance uses are co-presenting with psychology issues, and so that can be a much less expensive way to go, at that than getting this big, huge, very expensive PR case in Colorado psychological testing that involves also a parenting evaluation. But that’s one thing that we do consider sometimes, and when we have somebody who really has, for example, I had somebody who had a lot of sexual abuse trauma in her life, and a lot of acting out sexually in a way that was really disruptive to herself and dangerous to the kids, very sad situation, and a lot of alcohol abuse misuse that was really seriously impacting the whole family dynamic. And we were in a pre decree case, so the divorce had not gone through yet, and the kids were little, and we really needed to be sure that we weren’t trying to break those attachments as much as possible. We didn’t want gaps, but we really needed some serious fast help. We were able to get that kind of care very quickly from a psychologist who could look at substance use in combination with psychological testing, and within just a few weeks provide a report that gave us some really serious solutions, way faster than would happen in many, many cases. Also, we were able to institute immediately that sobriety testing and both PEth testing and the Sober Link testing, and we were able to. Do this faster and get really back on track, in a way that got these kids their mother much faster than any of the other solutions we would have used.
Lastly, I would say that we can use a Substance Use Evaluation, which is the more extensive use of a of an expert who can come in, and I’m going to spend a lot of time right now, talking through what that looks like, so that you understand what a Substance Use Evaluation is and kind of what the output of that is in Colorado, at least. You know, there’s, again, you can get these drive-by kind of substance use, and I’ll say mental health evaluations. I call them drive-bys because the ones you don’t want to rely on are the ones that are only based on self reporting. Okay, you can imagine the court says, or the other parent or the other attorney says, I need this person to go get a Substance Use Evaluation, or I need this person to go get a mental health evaluation, or both, and that party, or that party’s attorney will say, yeah, just go get one. Go get one wherever you want. Okay, this is a very poor way to go about this, because they have almost no usefulness if it is only based on that party, the person who has the problem allegedly providing feedback as to what the problem is, okay. You can imagine why, because it’s not extensive enough. And so people who do that are wasting a lot of time, and they’re wasting money. They’re usually very inexpensive. They’re usually only based on a couple hours of work. You know, somebody will go in and say, you know, my ex is being a jerk. I get accused of this abuse or this kind of a misuse of substances, and I’m getting told to do a mental health evaluation and Substance Use Evaluation or both. You know, both are one or the other, and they’ll set an appointment for the person, and the person will come in and do an hour or two with the provider. Even if that person is a mental health professional, it’s still going to result in a couple page, few page document that says, I interviewed this person on this day. Maybe I did, or maybe I didn’t, look at medical records, but based on this history, I can say this, that the person has it under control, or the person should I don’t know. There could be a variety of recommendations in it, but ultimately it will show that there is only one person providing that information, or people that are only aligned with that one person. Okay, you can understand how that isn’t very helpful.
Okay, so when I get on a case and I have those sorts of reports, I’ll say this is not sufficient, and I will go to the court and say, ‘We need a much better, more solid substance use evaluation or mental health evaluation or both’. Now we want to make sure that when you go to somebody who claims to be a Substance Use Evaluator, the person really should have some background in both mental health or social work. Okay, so could be a therapeutic background, could be a social work background, and that they are a licensed addiction counselor and have that kind of training, you’re often going to see different labels by their name, of kind of what their background is, and it’s usually something involving certified addiction counseling. Just trying to look back here at one that I have in front of me to see exactly what those terms are. But there’s different levels of those. So there’s like, and I’ll have the substance use. People talk about this when they come on, but it’s just important that you understand that these people are recognized as addictions counselors, and that’s going to come with certain letters behind their name.
Okay. There’s also different phrases, such as, like different certifications, like being an addiction counselor with different organizations, and those are things you should look at as well. So you’re looking for people that have, you know, a strong resume in addiction work, and have enough experience. And I would suggest you find people who’ve also been doing work that’s informed by the court, so they’ve testified before, they’ve written expert reports for before in family courts. And those are the best people to go get to evaluate either your co parent or yourself, and so that person then comes in, and usually it’s a few $1,000 now I will say one big hole we have is getting people who can do this, who can do it under Medicaid or for a lot less money, because that is just a problem in and of itself. We end up with a sort of dual system where people who have the money can get more help than people who don’t. So that’s a whole nother problem. But if you’re looking for the very best practices, you want to go get somebody who would be a good way to spend your funds. Is it versus on lawyers, for example, or, you know, basically going in and making sure that you’re getting extensive substance use evaluators you can and so that person will say, these are the things that I’m being asked to address. And generally this is ordered by the court, or it’s agreed upon by the parents and their attorneys. they have attorneys, and usually it becomes a stipulation that a court ordered Substance Use Evaluator is being appointed, and we are agreeing that this person is going to answer the following questions. And so let me give you some examples, reading from one that I’ve got that, you know, won’t get into details on, but it’ll just give you some good insight.
So for First of all, has the parent experienced an alcohol or drug problem? If so, what’s the extent of that problem?
Is that alcohol or drug problem negatively impacting that parent’s functioning in some way?
If that parent does have a current or recent alcohol or drug problem; what should be the treatment and monitoring recommendations to assist with safety, recovery and sobriety?
What would be the recommendations if that parent failed to follow through with any of the initial recommendations?
Then that Substance Use Evaluator who’s doing a really good job will go into a variety of paths to get information, including getting demographic information, getting historical use of substances from that person and from the co parent, to understand what both of those people have observed. Also, a psychosocial history should be completed. There should be different testing done. So, for example, people that I have used as Substance Use Evaluators will do things called the Substance Abuse Subtle Screening Inventory, (SASSI) They also will run other tests, substance use disorders, diagnostic, schedule five, again, SUDDS5, they’ll do interviews and data checks, including several hours of interviews with the individual, few hours of interviews with the spouse or partner, interviews with professional references, a review of written references, a review of background checks and court checks, and a review of materials submitted by parties. They’ll also submit that person who has the concern, the person we’re concerned about. To a variety of testing, including, for example, the PEth tests I discussed, if it’s an alcohol problem, other testing, if it’s different problem, then there’s other tests that can be used. For example, Alcohol Use Disorders Identification Test (AUDIT) and the Cannabis Use Disorder Identification Test (CUDIT). There’s a variety of other tests, for example, the Michigan Alcohol Screening Test (MAST) and the Drug Abuse Screening Test (DAST-10).
Now I think it’s also important to understand that, as we go through this that it is confidential. So for example, in Substance Use Evaluations that I see, I often see a footnote that says that the information that is being included in this and that have been disclosed from records are protected by the Federal Confidentiality Rules and prohibit anybody who receives this report from making any disclosure of this information unless it’s expressly allowed by written consent of the person to whom it pertains, or as otherwise permitted by 42 CFR Part Two, that’s again, CFR is the Federal Rules of Confidentiality, and the footnote says a general authorization for the release of medical or other information is not sufficient for this purpose to give that authority and that the Federal Rules restrict any of this information to use to criminally investigate or prosecute any alcohol or drug abuse patient. Okay, so I think that’s really important to note that it is to your benefit to understand that, you know, people are afraid, oh, I don’t want this used against me. I don’t want these things coming after me or people to prosecute me based on this. And so I just want to give you that caveat at this point that’s important for you to understand as well. The people then go through these Substance Use Evaluators go through family, interpersonal and economic background in their reports. Okay, they talk about the history and use, for example, of alcohol as self reported and reported by others. So for example, you’ll be asked, you know, when asked if he or she believed he has a let’s just say he for this situation, when asked if he believed he has a drug or alcohol problem, here’s what he said when asked if he believed family members or friends think he has or has had an alcohol or drug problem, here is what he said when asked if friends or family members have expressed concern about alcohol or drug use, and then the response when asked if family members or friends have ever had concerns about his behavior when drinking or using drugs. And then the response when asked if he’s ever had any relationship or friendship problems due to alcohol or drug use. And then the response when asked if his alcohol or drug use has interfered with his parenting or relationship with his children, and then the response, and then when asked if friends or family members have ever asked him to stop drinking or using drugs, and then the response. Then often, they’ll go into those tests that I told you about, and they will review whether the test answers, which have some similar questions indicate truth or denial or an indication of authenticity in those responses and things like that, so the test can show those things, and the reports often go into those then those same questions get asked. Essentially similar questions get asked of the spouse or partner, and then those answers are provided. We then can look at a review of the impact on education and work and impact from either the reporting of either the parent who has supposedly the problem, or the other parent, or from other references, and so that you’ll see that they’re trying to weave together sort of this psychosocial history that they’ve received all of the collateral information. Have received from others and what that relates to the answers that the parent gave or the CO parent gave. They’ll talk about medical and psychological status and impact from substances, you know. So have you felt depression when we talk about mental health issues, you know? Have you had counseling for mental health issues? Have you had taken medication for mental health issues? Have you had suicidal or homicidal ideation or actions. Have you had emotional problems that you think are caused by or related to alcohol or drug use? And then the spouse is asked the same thing, plus some other questions about anger, emotions, suicide, medical conditions and so on. Then oftentimes these reports will go into legal impact. So have you had civil criminal violence, driving issues, any sort of current legal charges, traffic violations, charges that have been dropped, charges that have been pled down, anything involving drug or alcohol at all? Have you had any jail or prison time? Have you had probation or parole violations? And all of that gets asked of both parents as well, generally. Then we look at the use of substances and treatment history. So what substances have you used, for example, have you used nicotine? Have you used vape? Have you used alcohol? Have you used marijuana? Have you dabbled in any other drugs? What age did you start these things? And this will also combine your interviews and interviews with other people. Have you had any prescription drug misuse? Have you needed more alcohol or drugs to have the same level of impact on yourself? Have you ever been to detox? Have you ever been in treatment, any of those things, and then they go into the various types of different types of substances and the history of use of all of those things. Then they do all this testing.
Okay, so they use standardized testing instruments, and let me just read this to you. Out of a sample report, standardized testing instruments were used to generate hypotheses about the individual’s level of substance use. These standardized testing instruments do not provide definitive information about a person’s substance use. They generate hypotheses that require further exploration. Then they go into this SASSIy test. I hope I’m saying that right. SASSI the Substance Abuse Subtle Screeningnventory, and they talk about what that means. And I’ll put these things in my show notes and on my website so you can go back and look at this. But it basically says it’s a reliable, valid, brief and easily administered screening measure that helps identify individuals who have a high probability of having a substance use disorder.The screening tool has valid items that ask the person to report the frequency of common consequences of substance dependence. So it’s about attitudes, values and beliefs. And there’s subtle items that do not address substance misuse in a direct or apparent manner. The intent is to be able to identify some substance dependent individuals who may be unable or unwilling to directly acknowledge substance related behavior. Scores above the 85th percentile and below the 15th percentile can be considered significant. And so this is about defensiveness and things like that. And so they’re looking like, are you defensive? Are you sort of faking your answers, things like that, whether the individual is willing to acknowledge specific problems they’ve had in their life related to alcohol or drug use, and whether they’re acknowledging negative consequences that they or others may have experienced due to their use, also asking about family systems and the way that family systems are affected. And really we’re looking for defensiveness, so defensiveness would give us some reason to not believe or to question the person’s answers that they’re giving to the evaluator. Okay, so that is what that test does, and it sort of also gives some insight into like risk of impulse control problems and judgment and things like that.
Then we get into this, SUDDS5 the Substance Use Disorder Diagnostic Scale 5. Again, this is described as “valid and reliable, structured interview that provides for a detailed assessment of substance use disorders in accordance with the diagnostic and statistical manual of mental disorders of the fifth edition, the DSM 5”. So the DSM-5 is that book we hear cited kind of a lot about kind of, what are the disorders, and how do we define what disorders look like? So the Substance Use Disorder Diagnostic Schedule provides for both a lifetime and current review of problems, behaviors and issues related to substance use and substance use disorders, with the time frame for current problems being in the previous 12 months in accordance with the DSM-5 diagnostic criteria. And then they’ll specify what criteria are met for alcohol disorder, alcohol use disorder, and going through the number of criteria in the last 12 months. Okay, and so this will explain, and I’ll get into those DSM-5 criteria here in a minute.
Then we talked through, for example, thisAUDIT (Alcohol Use Disorders Identification Tes. This is described as a reliable and valid, standardized self report screening instrument that emphasizes the identification of hazardous drinking rather than long term dependence and adverse drinking consequences. It can be easily faced. Act as to appear that there are no current alcohol problems. It asks 10 questions about recent alcohol use, alcohol dependent systems and alcohol related problems, and focuses primarily on symptoms occurring during the recent past, rather than ever, like ever in one’s life, a score of eight or more generally indicates current alcohol use disorders as well as higher risk of future harm. Okay? And so this is where people, like will look the Substance Use Evaluator in the eye and say, Yeah, I haven’t drank at all, or just kind of it can lie pretty easily on this one, the cannabis use disorders identification test, revised, which is CUDIT (Cannabis Use Disorder Identification Test), is described as a reliable and valid standardized test instrument that provides a qualitative measure of the severity of cannabis use disorders over the last six months. Again, it’s a self report instrument and can be easily faked as to minimize the problem. A score of eight or more is considered to be highly predictive of a DSM-5 diagnosis cannabis use disorder, and so that’s the one we use. Now, if we have other concerns about other types, there’s other testing we can do for other different drugs, but these are the big ones. So those are the ones I’m explaining here today.
Okay, the MAST (Michigan Alcohol Screening Test) is described as a reliable and valid questionnaire designed to provide a rapid and effective screening for lifetime alcohol related problems and alcoholism. It asks 24 questions about the consequences of the individual’s alcohol use and their perception of their use, a score of five or more generally indicates the individual is a problem, drinker or alcoholic. Then the Substance Use Evaluator would go into what the scores are on that.
Then we have the DAST (Drug Abuse Screening Test), described as a reliable and valid questionnaire designed to provide a quantitative report of an individual’s perception of the extent of their problems related to drug use and abuse. It is a self report instrument, so can be easily faked, and it asks 20 questions about the consequences of the individual’s drug use and their perception of their use. A score of six or more may indicate the individual meets the DSM-5 five criteria for a substance use disorder. A low score does not necessarily mean the individual does not meet the criteria, but the score must be considered in the context of the larger evaluation.
Then in the Substance Use Evaluations I’ve seen, we then get results of drug testing. And so, for example, we’ll talk about PEth testing, or the various things. And here I’ll give you, since it’s in this draft report that I’m looking at, I will give you the sample report. I will tell you a little bit more about the PEth testing. This is described as a blood test that looks for direct alcohol biomarkers in the blood. Testing for the biomarker going back between 21 and 28 days, the test is reliable for detecting chronic or binge drinking over the testing period. A PEth test with a specific result is considered to be an indication of purposeful alcohol ingestion, and I would just put kind of as a footnote in a binge-like way. Okay? And then there’s a citation to the Journal of Forensic Science that basically says that there’s consensus among labs in the United States that the level of 20 ng dash ml threshold has been established by consensus, and while reasonable, it’s a little bit still of an arbitrary threshold. But regarding negative PEth testing, the Journal of Forensic Sciences notes that given the large individual differences in how much alcohol is necessary to create a specific amount of PEth, it is difficult to provide a specific benchmark for how many drinks it takes to create a PEth of 20, and then we look at the different results. And so this would get us into a huge debate about, you know, the efficacy of the PEth testing. It’s meant for somebody who’s got more experience in this than I do to describe to you. But you know, there’s only so many things we can do. There’s holes we can poke in all of these things, but PEth testing has been one of the things that we do to really try to protect children. So it is something that you should understand if you’re working in this area or you have the situation in your family.
Okay, so then we go through, you know, if the person’s on SoberLlink testing, we look at when they tested, when the device is activated, how many tests they have, how many were compliant, how many were missed, how many were non compliant, and so on and so forth. And I might have somebody from Sober Link, or one of these places come on and talk even more specifics about kind of how that testing works, because it really is something that a lot of people need to understand a lot more. We won’t get into that in more detail here. Now, going back to the DSM-5, you need to understand the diagnosis factors so that American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders fifth edition. So the DSM-5 is a reference handbook of mental disorders, and in the book, each disorder has a specific set of criteria outlined that can assist in providing consistent, reliable mental health diagnoses, as well as giving mental health and medical practitioners a common language, and so I’m going to go through what the criteria are for the diagnosis of a substance use disorder. And essentially, if in the previous 12 months an individual was identified as meeting two to three of the criteria, they would have a mild disorder. Meeting four to five of the criteria would be a moderate disorder, and meeting six or more would indicate a severe disorder. If the individual had previously met the criteria for a substance use disorder, and none of the criteria have been met in the last three months, but less than the previous 12 months, the diagnosis would be considered in early remission. If the individual had previously met the criteria for a substance use disorder, but none of the criteria have been met in the previous 12 months, the diagnosis would be considered in sustained remission. Alright?
So here are those criteria. Okay? One, the substance is often taken in larger amounts over a longer time period than was intended. Two, there’s a persistent desire or unsuccessful efforts to cut down or control substance use. Third, a great deal of time is spent in activities necessary to obtain use or recover from its effects. Fourth, craving, or a strong desire or urge to use the substance. Fifth, recurrent use resulting in failure to fulfill major role obligations, at work, school or home. Six, continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance use. Seven, important social, occupational or recreational activities are given up or reduced. Eight, recurrent use in physically hazardous situations. Nine, continued use despite knowledge of having a persistent, recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use. Ten, tolerance as defined by and then there’s two parts to it, a a need for markedly increased amounts to achieve intoxication or desired effect be a markedly diminished effect With continued use of the same amount of substance Eleven,withdrawal as manifested by either of the following, again, two parts A, the characteristic withdrawal syndrome for the substance B, the substance, or closely related substance, is taken to relieve or avoid withdrawal symptoms.
Okay, I’ll drop those things into the show notes as well, and put that link on my website, so you can find that in my resources. And so then the Substance Use Evaluator would go through and determine which ones this person is being evaluated responded affirmatively to regarding an alcohol use disorder, and look at the various tests that probe the ones I just talked about. All these different tests probe different parts of that. And so they’re trying to by doing these multitude of tests and getting self reporting, trying to understand and get to the right answers about whether or not there is an alcohol use disorder, whether or not somebody is lying about it or not. Okay? And this involves even sometimes looking at personal references.
All right, so now there is also something called the American Society of Addiction Medicine as ASAM, placement criteria that has been developed to assist in providing objective criteria along multiple dimensions to help match individuals to an appropriate level of care regarding substance use treatment that was revised in late 2023 so the ASAM placement criteria defines treatment as a continuum over four levels of care, with the understanding that within each level of care there’s a range of intensity of services that may be provided. In addition, we should note that the most appropriate level of care would be the least intensive level that meets the treatment objectives and provides safety and security for the individual. And you know, obviously our ultimate goal for the children, right? The criteria are supposed to be a general guide to help make appropriate level of care decisions, and they should be used in combination with objective data, clinical data and professional interpretation to help define the appropriate level of treatment, and those levels of care include outpatient treatment, intensive outpatient residential treatment and medically managed, intensive inpatient treatment, substance use. Evaluators then would often talk about how that in making these level of care decisions, an individual should be examined with consideration to each dimension independently, as well as considering interactions between the dimensions. And therefore, we often then find we get a brief explanation for different assessment dimensions that need to be evaluated in making placement decisions, along with the sixth dimension, which is more centered on the individual and the individual’s considerations. And so those various things that we consider, okay, these are the different dimensions that are considered. And again, I’m sorry this is also complicated, but if you’re with me this far, I know you’re very interested in, very engaged in what you need to do to either help yourself or help your loved one, or to understand. In this better as a professional. So I’m going to keep plowing through this, and I’m just going to remind you again to please listen to this through to the end, but also listen to my next episode, which will be about a whole other set of things we need to think about regarding this complicated area of substance misuse and what we do to protect children.
Okay, so going back, we’re going to talk about now each dimension that we need to think about when we’re looking at level of care decisions. So the first dimension is intoxication, withdrawal and addiction medications. Okay, so that involves current signs of withdrawal, current intoxication, risks of severe withdrawal symptoms or seizures, previous withdrawal issues and the need for addiction medications. Okay, that’s the first dimension. The second dimension is biomedical conditions, physical illnesses or medical issues other than withdrawal issues that may need treatment create risk or complicate treatment. Relationship between medical issues and substance abuse, okay. The third dimension is psychiatric or cognitive conditions, current mental health conditions, trauma related concerns, cognitive conditions, developmental disorders and substance use related mental health concerns. The fourth dimension is substance use related risks, history and recent substance use consequences of use, exposure and awareness to triggers, access to substances and coping skills and five, recovery environment, interactions, current environment, including safety, daily living and interpersonal skills and current supports. And then six, as I mentioned, is individual, person centered considerations. And this is used more in a clinical setting, and it’s used really for shared decision making, by helping the people making these decisions to be more involved in evaluating barriers to care, patient preferences and a patient’s beliefs. All right, so then we look at the severity rating in the ASAM criteria, and we determine the substance use evaluator determines which category the person’s in and therefore what level of care is necessary. And there’s usually an analysis done between those dimensions and what we need to do, you know, what is specific to this person? Okay? And they go through each of those dimensions and talk about this specific person. Generally, you should see in a good report what limitations there are on the evaluation, you know. So, for example, situational stress should usually be indicated, because there’s certainly stress around the legal case, the agendas of the different parties involved, reliability, questions about self reporting, collateral contacts. Maybe the weaponization of this process by the other parent can be a big thing, and defensiveness and just the whole stress of being in a legal situation, and you know the fact that sometimes there aren’t professional resources to speak to, or professional references, or there aren’t people that are participating at the level that they showed or that they could to get a good report. Sometimes there’s treatment records that are unavailable, things like that. Okay? And then we really should get to summary and conclusions, you know, is the person open? Was the person cooperative? How did the other parents seem, did that parent seem to be, you know, again, trying to weaponize this? Was it being used in a way that seemed to be reasonable by the other parent? What are the conflicts that we’re seeing between the different self reporting that’s going on? How did the standardized testing go? Etc? And then, you know what? Basically, by looking at, how is this issue affecting this person and affecting this parent, and what are the things that the substance use evaluator thinks that we should do as a result? I think it’s important that when we’re talking about alcohol use disorder, it is true that most good Substance Use Evaluators will indicate that it’s very difficult to give definitive prognosis with this because it is so complicated, but taking into consideration the course of the disorder, the severity of it, the individuals insight, their willingness and openness to change, can give us some insight into this. And so there’s usually some ability of the Substance Use Evaluator to engage in that kind of conversation, to explain what that person thinks is the prognosis, basically, even though it’s not definitive, and then we look at other concerns about especially if there’s children involved, we want to really understand how this affects children, and I’m going to wait to talk through that in a good report. You’re going to see some definitions and some analysis of what this means to children. I’m going to do that in my next episode, as I talked about new ways we’re thinking about this, but I will say that it’s important that good substance use evaluations include that kind of information. So I’ll get into that into my next episode, but I do want to also include that good Substance Use Evaluation should include specific recommendations, and those recommendations generally include some level of abstinence or serious, you know, taking very seriously, careful use, depending on it. But I usually see in Substance Use Evaluations, lately, we have had a focus on abstinence and therefore a focus on testing.
Okay, now we’re going to talk in my next episode. About, again, how kind of newer research is looking into what some new ways of thinking about this are. But usually we see abstinence and testing to prove the abstinence, and usually they’re looking for some depending on the problem severity. They’re looking at what that time frame should be. So for example, I often see, you know, six months of totally clean PEth tests, and if anytime any screens are late or positive, that time frame should start over, and that negative path testing should be provided, potentially even up to one year, even for fairly mild use. I’m seeing that even if it’s not an extreme, severe, mild to moderate would garner that kind of recommendation generally, then we usually see recommendations for individual therapy with a licensed addictions therapist, either a CAC three or a licensed addiction counselor, an lac a minimum of one time per week for at least three months, is what I often see. And after that, therapist recommended sessions can be reduced per the therapist recommendations, basically it would be reduced potentially to every other week or every third week, as appropriate, and it should go on for at least one time per month for a minimum of a year. Is what I often see again. This is just in my practice what I’m seeing. There’s lots of variety here, but I want to give you all an example of what I’m seeing fairly regularly. Next if this person is determined to have relapsed with respect to alcohol or drugs, that person should be required to enroll in and successfully complete an intensive outpatient program that’s IOP, meeting a minimum of three times per week for a minimum of eight weeks, followed by an aftercare program, as recommended by the treatment program. Determination of relapse may require feedback and gathering information from the Substance Abuse Counselor, the opposing parent, testing results and other sources of information. So this will be a huge jump off point for my next episode, because this idea of relapse and when someone’s relapsed is a big piece and kind of what we do if, quote, relapse occurs, is a big piece of how research has been changing pretty significantly, moving forward regarding what we know about attachment needs of children. So I will get into that into our next episode. And then also, I often see that the parents should attend Alcoholics Anonymous or Narcotics Anonymous or a comparable support group a minimum of X number of times weekly, like sometimes I see twice weekly maintaining and continuing to work with a sponsor and working the 12 steps in the hopes of learning how to build a sober support network. Sometimes we see different resources, other than AA or Narcotics Anonymous, but they’re usually some kind of support group like that. And then often we see that a copy of this report should be provided to the person’s therapist and the primary care physician and the IOP staff if that person has to go to a treatment. And then sometimes we see actually recommendations. If we have a more severe presentation of this, so somebody that’s found to be in a more severe diagnostic category, we’ll see that the person is recommended to go to inpatient rehab, even right away. Okay, so that would be another piece of it.
Now, what we don’t see in a straight up Substance Use Evaluation. What that means;hese people are not generally allowed to make parenting time recommendations, because they’re not child experts, even though they know a lot about it generally, because we deal with a lot of situations, with a lot of kids and a lot of families. But they don’t make that bridge into parenting time recommendations like a Child and Family Investigator (CFI) n Colorado, or a Parental Responsibilities Evaluator (PRE). These are custody evaluators would need to take that SUEreport and incorporate it into what the recommendations would be. Or a Child’s Legal Representative (CLR) can do that. So if we go so far as to have a Substance Use Evaluation in a case i then, as the CLR would take, or the best interest attorney, it’s known as in many states, would take this kind of report and these recommendations and use it in the work of determining what that parenting time should look like.
Now, do we need to go as far as a Substance Use Evaluation? I don’t know. I mean, if somebody is acknowledging that they have a problem or have had a problem, then having somebody write this up isn’t necessarily that helpful for us, right? Because I can pretty easily take these types of ideas and turn them into something that I would then bring to a case and say, Hey, we need to do some sobriety testing, and we need to do these sorts of things. And I can determine that kind of thing without necessarily a Substance Use Evaluation, or if I have evidence that proves that there’s sobriety problems. For example, we can usually jump to this without a Substance Use Evaluation. Oftentimes we need the Substance Use Evaluation when we have attorneys who are denying the extent of a problem for a parent, or we have a parent flat out denying that there was any problem. So for example, the Cheryl podcast is an example of that which you can go back and listen to, because in that case, we had a parent claiming there was no problem at all, and therefore needed a Substance Use Evaluation to be entertained by Cheryl, as guided by her attorney, to be able to go find out, you know, there really was a problem, and that Substance Use Evaluator had to determine what the extent of that problem was. So that’s when we generally need one of these, but we don’t always need one a lot of times, it can take a lot of time and cost a lot of money. So these are three to $4,000 now, I think less expensive than a full psych evaluation and parental responsibilities evaluation, but still, it can be very, very expensive.
So that is a huge amount of information on what is a Substance Use Evaluation. And really kind of, how do we test for substance misuse? Basically, how do we test for those things? And how do we protect children? Typically, in cases, next episode is going to be about what we need to do from this point, what is the new research showing, and what do we need to do to think about what this means for parenting time. Thank you.
For those of you who stuck with this whole thing, I know it’s been a lot of legal and alcohol substance use, language, about testing and all sorts of things, but I hope it will provide I think this kind of situation warrants you really understanding how we go about these things, because it is very complicated, and there are a lot of things that you need to know it’s a lot bigger than just, you know, something you might have seen in a movie or something about how we do drug and alcohol testing. It’s very, very extensive. And I hope you’ll stick with me into my next episode, which will discuss the other things we need to think about in the way that research has gone in more recent years. So thanks so much for your time today, and I look forward to your feedback. Please look at the show notes if you want to get any of these resources, and for now, I will sign off. Thanks so much.
Intro/Outro 1:06:28
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