Beyond a Buzzword: TCs to Eliminate Harmful Drug Testing Practices
The landscape of drug testing in Treatment Courts (TCs) is facing increasing scrutiny, as noted in a 2024 commentary in the Drug Court Review by Huddleston and colleagues.[1] A key question arises regarding the continued reliance on human-observed urine drug testing as the “gold standard” despite its potentially traumatizing effect and the availability of more advanced testing technologies.
The commentary emphasizes the urgent need for TCs to integrate trauma-informed approaches into their drug testing practices, aligning with both SAMHSA’s established principles of trauma-informed care[2] and the BJA’s technical report on implementing trauma-informed drug testing protocols in child welfare and family courts.[3]
“Yet, despite advancements in technology, the stigmatising and traumatizing practices of human-observed urine drug testing remain the “gold standard” in treatment courts. As leaders in justice reform and trauma-informed legal systems for the past three decades, we must strive to eliminate any practices that could harm our participants. The time has come to implement trauma-informed drug testing and provide not just lip service and piecemeal, but end-to-end trauma-informed services to our clients.”
(Huddlestone et al., 2024, p2)
Using Trauma-Informed Approach in Treatment Courts
Trauma is often unseen, unidentified, and unmeasured.[4] And though it does not spare anyone, it disproportionately affects justice-involved individuals who struggle with substance use and/or mental health disorders.[5] Youth and veterans are highly exposed to trauma and potential mental health disorders, such as post-traumatic stress Disorder (PTSD). Over 90% of justice-involved youth have experienced at least one trauma,[6] with PTSD ranging from between 3%-50%.[7] Among justice-involved veterans, trauma exposure rates range from 60% – to 90%, and PTSD rates range from 27% to 40%.[8]
Rates of traumatic experiences among justice-involved populations, particularly those with mental illness are “so high as to be considered an almost universal experience.”
(Freeman & Lautar 2015)
From the participants’ perspective, they face a complex challenge: they must not only navigate potentially harmful environments and relationships in their daily lives but also contend with numerous triggers for re-traumatization within the justice system itself.
From a TC perspective, PTSD is a mental health disorder (DSM-5 diagnosis) [9] that can be identified with hypervigilance, avoidance behaviours and emotional dysregulation, which, in TCs, are linked to disengagement and higher rates of recidivism. Therefore, TCS need to minimize the adverse potential of protocols, practices and environments that trigger trauma-related reactions.
TCs move towards a trauma-informed approach when they (1) recognize the widespread impact of trauma, (2) understand how trauma affects everyone involved in a program, including staff and service providers, and (3) use this understanding to create practical and actionable protocols.[10] Using a TIC in the justice system is “not about having to know the story of trauma. It’s about building skills to deal with the lingering effects of the trauma”. Justice professionals are aware of the widespread impact of trauma, they understand potential paths for recovery, and they use a precautionary approach to avoid re-traumatization.[11]
In a TC setting, the trauma-informed approach shifts focus on creating a safe and supportive environment that minimizes distress and reduces stigma. Judges and the team use empathetic communication skills to ensure people feel understood and respected. Communication is done in person; follow-up is provided in writing if needed. If possible, the number of screenings and assessments is lowered to avoid repeatedly reliving painful experiences. [12] The staff greets people, assists with directions, and answers questions to make the court process less intimidating. Participants are provided private spaces to gather thoughts or sit with their children before hearings. The design of the courtroom itself plays a key role in reducing stress. For example, lowering the judge’s bench, allowing natural light, ensuring well-lit parking and walkways, and displaying welcoming signs and artwork can help people feel safer and less anxious during their experience in court.[13]
The shift toward TIC represents a fundamental change in perspective and practice that reflects a deeper understanding of trauma’s role in shaping behaviour and outcomes. Instead of asking, “What is wrong with you?” professionals learn to ask, “What happened to you?”
(Behavioral Health
State Court Leadership Brief, 2022)
Oral Fluid Testing: Trauma-Informed Approach to Drug Testing in TCs
Urine drug screening (UDS) is a required everyday practice in TCs, and it is considered a necessary prerequisite for effective treatment and supervised monitoring. Because human-observed urine collection can be very intrusive, shaming, humiliating, unsafe, and invasive for individuals with a trauma history, a trauma-informed approach to drug testing is more than needed.For this, in 2019, Trauma Informed Oregon[14] published a tip sheet on integrating SAMHSA-defined TIC principles into USD protocol (see Table 1).
Nevertheless, traditionally done UDS might still fall short compared to new technologies, which have great potential to provide less traumatizing testing methods. Specifically, (1) use DNA-matched urine collections and (2) OF collection via video observation. Both ways fall into self-collected drug-testing methods that can be done anytime, anywhere, and without human observation. By doing so, they can significantly:
(a) reduce the stress and potential re-traumatization,
(b) empower justice-involved individuals to provide accurate and effective drug testing with dignity,
(c) support professionals in their mission to provide compassionate care.
For example, if TCs used non-invasive oral fluid (OF) testing in their drug testing procedures, they could create a more supportive environment and help prevent re-traumatization (#3). This approach would also reduce feelings of shame and embarrassment by offering testing at home or at work (#5) and respecting individuals’ privacy and dignity (#7). Additionally, it would help minimize wasted time by reducing the need for extensive training (#10) and prevent staff burnout (See Table 2).
Conclusion
Trauma-informed drug testing empowers TCs to create a compassionate, respectful environment that minimizes re-traumatization and tackles stigma, especially for vulnerable communities. The benefits are clear: participants experience more substantial outcomes, build trust, and stay engaged in the program, while staff enjoy lower burnout and reduced turnover.
Implementing trauma-informed practices does not require a hefty budget but demands consistent leadership and a commitment to regular policy updates. TCs must examine their current procedures for maximum impact and make necessary adjustments. When everyone in the program is genuinely trauma-informed, it leads to better participant retention and success, ultimately setting the stage for a more effective and sustainable TC program.
Table 1: Six Principles of TIC Integrated in Drug Testing
| 6 Principles of TIC integrated in Drug Testing | Examples: |
| 1 SAFETY: Ensure that participants and staff feel emotionally and physically safe. | (a) Provide the physical environment (clean, hazard-free facilities, clear procedural signage, private testing spaces, and alternative testing methods (e.g., mouth swabs). (b) Offer staff guidelines (trained staff on trauma-aware testing procedures, who provide adequate time for sample collection and are ready to opt-out options. (c) Support participants (give consistent verbal and written instructions, maintain predictable testing routines and avoid rushing participants). |
| 2 TRUST & TRANSPARENCY: Ensure a trustworthy and honest relationship between staff and participants. | (a) Provide clear documentation & communication (clear written and verbal explanation of UDS purpose, substances tested, results, and potential outcomes; allow time for questions before and after testing; enable participants to witness sample sealing/labelling). (b) Be accountable: supply management contact information for questions or concerns and make supervisors accessible for process follow-up. |
| 3 COLLABORATION & MUTUALITY: Promote accountability, share power, and foster feedback. | (a) Allow participants to select comfort measures and testing options (music, conversation preferences, viewing method). (b) Establish feedback mechanisms for process improvement, focus on non-punitive accountability, and gather participant input on testing experience. |
| 4 POWER, VOICE & CHOICE: Empower Participants’ choice, autonomy, dignity and feedback. | (a) Restore agency, participant rights & choices in drug testing (can select testing staff and support persons, have flexible scheduling options and a selection of privacy measures, including clothing, gowns, and screens. (b) Support dignity-centered practices: (written documentation of participant rights, non-stigmatizing language for test results, respect personal preferences. |
| 5 PEER SUPPORT | Ensure that peers are always available and involved in UDS training. |
| 6 CULTURE, GENDER, & HISTORY: Consider cultural, gender, and historical disempowerment issues and systemic oppression. | (a) Educate the staff and ensure drug testing staff demographically reflect the served populations. (b) Offer practical accommodations, such as documenting special testing needs in health records, giving access to menstrual supplies, and enhancing privacy measures in common areas. |
Table 2: Considerations for a Trauma-Informed Drug Testing Protocol
| 1. Urine Collections: When urine testing is used, DNA-matched urine collections should be implemented. This technology ensures the sample belongs to the donor without the need for intrusive human observation. 2. Oral Fluid Collections: When oral fluid testing is used, the collection should be facilitated via a recorded process that is then reviewed, authenticated, and confirmed by a trained proctor. This can be done in a private and noninvasive manner, respecting the individual’s dignity. 3. Avoidance of Invasive Methods: Hair, blood, and patch drug testing methods should generally be avoided due to their invasive and potentially re-traumatizing nature. 4. Client Choice: If hair, blood, or patch testing is deemed necessary for specific cases, individuals should be given a choice as to their preference. This empowers them and helps mitigate potential trauma triggers. 5. Testing at Home or Workplace: Whenever possible, drug testing should permit the individual to test from their home or place of work. This approach reduces the potential for shaming or embarrassing experiences, promoting a sense of autonomy while also reducing the negative impact to a client’s work and childcare responsibilities. 6. Trauma-Informed Language: Language is crucial when explaining the reasons for a particular drug testing method. Trauma-informed scripts should be followed to communicate why a specific method is chosen and how the individual’s trauma is being considered and respected with sensitivity. 7. Dignity and Worth of the Individual: Emphasize noninvasive drug testing methods that respect the individual’s privacy and dignity. 8. Cross-Systems Collaboration: Work collaboratively with various systems and stakeholders involved in treatment courts to ensure a cohesive and supportive approach to drug testing. 9. Risk and Safety Planning: Establish comprehensive safety measures and risk assessment strategies for the drug testing process, ensuring the protocols are designed to safeguard the mental and physical well-being of participants and their families. This includes creating a supportive environment that minimizes potential stressors and triggers that could lead to re-traumatization. 10. Cost Considerations and Training Needs: Analyze the cost-effectiveness of implementing trauma-informed drug testing practices and develop a structured training program for staff. Numerous studies indicate, “a trauma-informed approach can improve patient satisfaction and outcomes while decreasing overall costs (National Council for Mental Wellbeing, 2017). Training should focus on the 4 principles of trauma-informed care, emphasizing the importance of respectful and non-invasive testing methods, and equipping staff with the skills needed to handle sensitive situations compassionately and effectively. (Huddlestone et al., 2024, p.4) |
[1] Huddleston, W., Breitenbucher, P., & Middleton, J. (2024). The Need for Trauma-Informed Drug Testing Protocols in Treatment Court Programs. Drug Court Review, Summer 2024. https://dcr.ntcrc.org/index.php/dcr/article/view/41/26
[2] SAMHSA’s Trauma and Justice Strategic Initiative (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://library.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884
[3] Breitenbucher, P., Middleton, J., & Huddleston, W. (2023). Implementing Trauma-Informed drug-testing Protocols in Child Welfare and Family Court Programs: A Technical Assistance Brief. Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP). https://cossup.org/ResourceLibrary/Details/075cfd29-b356-4951-814d-f58426b81b12
[4] Trauma results from an event or series of events that individuals experience as harmful or life-threatening, leading to lasting adverse effects on their functioning and mental, physical, social, emotional, or spiritual well-being. See: SAMHSA’s Trauma and Justice Strategic Initiative (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://library.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884
[5] Freeman, D., & Lautar, A. (2015). Trauma-Specific Interventions for Justice-Involved Individuals. Webinar-Supporting Document: Evidence-Based Practices and Criminal Justice Series.
[6] BEHAVIORAL HEALTH State Court Leadership Brief. (2022). Trauma and Trauma-Informed Responses. https://www.ncsc.org/newsroom/behavioral-health-alerts/2025/sep-3-2024
[7] Buffington, K., Dierkhising, C. B., & Marsh, S. C. Technical Assistant Bulletin: Ten Things Every Juvenile Court Judge Should Know About Trauma and Delinquency. https://www.ncjfcj.org/wp-content/uploads/2012/02/trauma-bulletin_0.pdf
[8] Desai, A., Holliday, R., Stimmel, M., & Borges, L. M. (2023). Trauma-Informed Training for Veterans Treatment Court Professionals: Program Development and Initial Feedback. Fed Pract, 40(2), 40-46. https://doi.org/10.12788/fp.0358. It is believed that PTSD occurs in approximately 11-20% of Veterans of the Iraq and Afghanistan wars; approximately 10% of Gulf War veterans; approximately 30% of Vietnam veterans. See: https://www.va.gov/homeless/nchav/docs/Trauma-Informed-Care-Fact-Sheet.pdf
[9] Individuals with PTSD relive traumatic events through intrusive memories or dreams. Triggers like places, sounds, or words can cause re-traumatization. They often avoid reminders of the trauma and may become easily startled, irritable, or angry. PTSD can lead to emotional numbness, withdrawal, self-blame, isolation, difficulty focusing, and sleep problems. Some may also engage in risky or destructive behavior.See: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/.
[10] SAMHSA’s Trauma and Justice Strategic Initiative. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://library.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884
[11] Haas, B. (2024). Trauma Informed Approaches with Justice Involved Individuals. https://svlas.org/wp-content/uploads/2024/10/Trauma-Informed-Justice-System-Becky-Haas.pdf
[12] Gibbons, C., Develde, K. V., Rogers, S., Williams, C., Geiger, S., DeVall, K., & Lanier, C. (2024). The Use of Language in Treatment Courts. Word Choice Matters. https://www.innovatingjustice.org/sites/default/files/media/document/2024/CJI_Guide-TA-Language-Paper-07292024.pdf
[13] Center for Court Innovation. (2024, January 24). Taking Trauma Seriously: How Trauma-Informed Practices Can Help People Heal. https://www.innovatingjustice.org/articles/trauma-informed-courts
[14] Trauma Informed Oregon (2019). Trauma Informed Urine Drug Screens. Oregon Health Authority.
https://traumainformedoregon.org/wp-content/uploads/2019/05/Urine-Drug-Screen-tip-sheet.pdf
