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Drug testing effectiveness in identifying and preventing drug use

by Robert H. Coombs , Frank J. Ryan

INTRODUCTION

Drug testing has recently become a national issue, but little empirical data have been published to assess the effectiveness of these rapidly expanding testing programs. Although debated in and out of the courtroom [1], few systematic outcome studies have been reported [2, 3].

Increased awareness of drug use among intercollegiate and a growing awareness of the deleterious effects such use can have on them prompted the National Collegiate Athletic Association (NCAA), and many of its affiliated universities, to implement mandatory drug-testing programs for student athletes [4]. The expressed goal for urine testing is to create a drug-free environment for intercollegiate athletics. As expressed by one official, "It aims to protect the health and safety of all competitors, provide assistance for those found to engage in substance abuse, and prevent an unfair competitive edge by those who abuse certain chemical substances" [5].

An opportunity to evaluate a urine-testing program came in 1987 when campus officials at a large university implemented mandatory testing for intercollegiate athletes. Athletes on 21 of 23 intercollegiate teams were required to provide a urine sample during their preseason medical evaluation. Substances tested included anabolic steroids, central nervous system stimulants, narcotics analgesics, psychomotor stimulants, and other drugs (PCP, marijuana, Quaaludes, barbiturates, and related substances). Those who tested positive were notified by the team physician, offered voluntary counseling, and retested with randomly selected teammates.

Positive results on a second test, confirmed with an immediate retesting, resulted in notification of the Head Coach and mandatory counseling. Refusal to participate resulted in immediate suspension from all athletic participation, including practice sessions. Positive results on a third-testing incurred immediate suspension from all intercollegiate athletics and likely nonrenewal of an athletic grant-in-aid. An appropriate hearing and an appeals process was provided to ensure due process rights for student athletes.

The objectives of this report are to address two questions: To what extend does drug testing effectively 1) identify drug users and 2) prevent further drug use among these participants?

METHODS

The data resulted from two sources, a questionnaire completed anonymously by 624 intercollegiate athletes and personal interviews with a random sample of nearly 10% of them. The questionnaire, privately completed by all intercollegiate athletes, was completed in the Fall of 1987 during the initial team meetings and returned in sealed envelopes. The data were screened for accuracy, coded, and computer analyzed. Only four were omitted because of inappropriate or conflicting responses designed to assess validity.

Interviews were held between January and May of 1987 with 57 of 60 randomly selected subjects (a 95% response); 39 were from the original random sample (68.4% of the 57 subjects), and 18 were from an alternate randam sample. The latter were interviewed when the selected athlete was no longer in school or was otherwise inaccessible--too busy, unavailable, or unwilling. Typically lasting 45 minutes to an hour, each interview was tape recorded and transcribed.

The responses of 500 drug-tested athletes were contrasted with a comparison group of 124 intercollegiate athletes who were not tested. This comparison group is similar to the tested subjects in most ways: they competed in intercollegiate athletics for the same university--all but 17 were members of either the women's (n = 42) or men's (n = 65) crew teams; they have similar marital status (about 97% unmarried in each group), had similar expectations for graduation (99% of each planned to graduate), and were equally enthusiastic about their sport (about 56% of each group planned to participate in their sport after graduation).

Comparison subjects differed in other ways: A smaller proportion was male (58.3% of the comparison subjects and 71.4% of the tested athletes); they were also younger (50% of comparison subjects and 34.2% tested athletes were 17-18 years of age; 27.5% of the former and 41.4% of the later were ages 19-20). This age difference is reflected in class standing (freshmen, 49.2% of comparison and 32.6% of tested subjects; sophomore, 14.2% versus 23.8%; juniors 23.3% versus 26.3%; and seniors, 13.3% versus 17.3%), and in year of athletic eligibility (60.2% of comparisons versus 40.0% of tested subjects were in their first year of athletic eligibility).

Comparison subjects were significantly less likely to have athletic scholarships (5.9% compared to 30.9%), to finance their own schooling, and to depend financially upon parents or their relatives (69.5% compared to 48.0%) or on loans or financial aid (9.3% compared 2.5%). Comparison subjects were also less likely to live with a teammate (18.6% compared to 49.5%), and to hope for a career as a professional athlete (18.9% compared to 59.5%). By contrast, they were more likely to plan on graduate or professional school 69.2% versus 49.8%).

EFFECTIVENESS IN IDENTIFYING USERS

Most athletes believed that urine testing effectively identified drug users. Two-thirds (68.7%) agreed with the questionnaire statement, "Mandatory drug testing is effective in identifying athletes who use drugs" (Table 1A). Fewere subjects from the comparison group agreed (p < .05).

The high tech equipment, "the most sophisticated in the world," is, most believed, too precise, and the monitoring system too rigorous to avoid detection. "With all your clothing stripped off and two guys watching you from five feet away," one concluded, "it's next to impossible to cheat. There is no way you

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can alter the urine or use someone's else's sample." Media accounts of athletes disqualified from competition because of positive test results reinforced this opinion. "It hits the front page of the sports section every time an athlete tests positive and is banned from playing," one remarked.

Knowledge of teammates who tested positive also strengthened this view; one-third (35.8%) knew at least one drug-using athlete who had been caught. "The tests showed positive for a number of them," one observed. "They knew they were going to get caught. They were slapped on the wrist, encouraged to seek counseling, and randomly tested again about a month later." No athlete was aware of a more severely disciplined drug-using teammate. Significantly fewer subjects from the comparison group could identify someone who tested positive (Table 1B).

But drug testing is not foolproof, as many students acknowledged. Despite high technology equipment and rigorous monitoring, many participants knew effective ways to avoid detection. More than half (58.6%) disagreed with the questionnaire statement, "There is no way to avoid detection when using drugs" (Table 1C).

Personal knowledge of drug-using athletes who escaped detection reinforced this view. "I know guys who are heavy, heavy users that weren't caught," one acknowledged. "These guys do marijuana four or five times a week--almost every day--and they weren't caught." "I know guys who did drugs four days before the test and weren't caught," another added. Asked how these false-negatives occur, one said, "I can't explain it; maybe drug testing is just to make the athletic department look good and put people's minds to rest."

A variety of detection-avoiding techniques were identified, the most popular of which were: 1) the timing of drug use so that substances clear the body prior to testing, 2) the use of certain drinks, foods, or food supplements thought to dilute or otherwise disguise the residue of drugs in the urine, and 3) the use of someone else's urine. Drug-tested athletes, compared to the comparison group, were significantly more knowledgeable about these techniques.

The first method, the stop-and-go technique, was the most popular. Twice as many tested athletes (40.3%) compared with comparison subjects (20.5%, p < .001) acknowledged an awareness of avoiding detection through skillfully timed drug use (Table 1D). When a test was anticipated, these athletes simply avoided drugs long enough for the residue to clear their bodies. Information about the length of time various drugs remain in the body was disseminated in educational sessions, and informal communication networks conveyed fairly accurate estimates of testing dates. "If you have an idea when the test is coming up, you lay off until it's over," one explained; "Then you begin again." "Give or take a week or two," another added, "and you can usually anticipate when the test will be given; you stop for awhile so you will be clean for the test, then you can start up again."

Official notice alerted athletes that testing would occur during their preseason medical examinations, so they simply stayed clean for the preceding month; then they resumed their use of drugs until the next testing, usually the NCAA finals. "You can usually count the days to do drugs," one admitted. "But if you're dumb enough to use the day before, you'll get caught." Obviously, this stop-and-go system is ineffective when drug testing dates are unpredictable.

The second escape method, the use of liquids and other substances to confuse the chemical analysis, was considered effective by one-third (31.5%) of the tested athletes and 14% of the comparison group (Table 1E; p < .001). Hearsay rather than direct experiences was the basis of most opinions. "I've heard that results can be masked by drinking this or that substance," one said. "I don't know if it's true, but people have been saying that drinking a lot of water flushes out your system and dilutes the urine."

Cranberry juice was believed to be a good body cleanser. "It does something to the crystalline in the urine, or something like that," one explained. Mineral water, caster oil, lemon juice, and other diuretics were also mentioned. Vinegar, the most frequently reported, "screws up the test." But this approach is problematic. "Downing a glass of vinegar isn't worth the trouble," one confessed. "I can barely stand to smell it, it makes me nauseous." "I know players who tried it and threw up five minutes later," another added.

Vitamin pills and over-the-counter medication were also thought to fool the test. Cold medications such as Contac or Sudafed, for example, reportedly obscure results by creating chemical reactions with the drugs. "The you tell them that you're using these medications as decongestants for sinus problems."

The most extreme method thought effective involves excreting someone's else's urine through a catheter. "The Russians have figured out how to do it," one reported; "You have someone else's clean urine come through a tube from the bladder to your penis."

EFFECTIVENESS IN PREVENTING DRUG USE

Significantly less drug use was found among tested athletes than among comparison subjects: Less marijuana--one-third (30.8%) of the drug-tested athletes smoked marijuana at least once during the testing year compared to nearly half (46.2%) of the comparison group (p < .02), less LSD (p < .05), and fewer barbiturates (p < .05; Table 2). Although not statistically significant, this pattern was consisted for 16 of the 18 other substances.

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Nearly two-thirds (62.4%) of the tested athletes agreed, "Drug testing is an effective way to prevent drug use" (Table 3A). Even more (76.0%) believed, "Mandatory drug testing deters some athletes from substance use" (Table 3B). Twice as many tested athletes (46.6%) as comparison subjects (21.5%) acknowledged that drug users worry about being identified (Table 3C). "It stopped me," one confessed. "I used to do marijuana and occasionally try some other things, but since I've been here I only drink beer, and that's it."

Diminished drug use among teammates was also reported in personal interviews. "I have a couple of friends who totally quit," one observed. "The team I play on is more drug-free than before the program started. About five people have either quit or cut down due to drug testing; most of them were lightweight users, borderline people who did it a few times, but now, with drug testing, they say, 'Forget it'."

Fear that negative test results will jeopardize current and future pportunities motitivated some users to quit. "Sports are up toward the top of the important things in my life and must not be jeopardized by drug testing results," one

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acknowledged. "I can't afford to mess up; I get 'paid' in lots of ways for my athletic skills. I come from a lower socioeconomic background and athletics is my future!"

The deleterious effects that substances can have on their bodies and minds concerned athletes less than a possible loss of standing on the team. "People are much more worried about passing the test than about what the drug does to them," one observed. "They now think twice before using the recreational stuff."

Team loyalty acted as a deterrent. "The minutes somebody gets busted," one explained, "it reflects on everybody." "Drug testing has focused us to make a commitment to the team and has kept us clean."

Testing also provided a socially acceptable excuse for refusing durgs offered in friendship. "When my teammates and I are at a party and someone asks us if we want to get stoned--offer us a 'hit' off a 'joint,' or a 'piece of candy' we say, 'No I can't, I'm going to be drug tested.' It gives us a way out."

Nearly a fourth (23.3%) of the tested athletes said that durg testing caused them to reduce their "partying" (Table 3E). Other selected new friends. "I don't hang around with the people I used to because of what they do," one acknowledged. "When I'm around them when they smoke, I'm afraid I will breath in." "I'm a little more careful now about who I party with," another added. "Before I go out with friends, I ask them what is on their agenda for the evening." And, when offered drugs, athletes now have a socially accepted excuse to decline. "It's easier now to say 'No'." More than half (52.8%) credited the drug testing policy as giving them a socially acceptable way to refuse drugs (Tabe 3F).

Nonetheless, strong consensus about the preventive impact of drug testing was lacking. Although viewed as a deterrent by the majority, unqualified responses were given by only a third of those interviewed. Citing personal examples of testing ineffectiveness, the remainder perceived it as only partially preventive. More than a third (37.6%) thought it ineffective (Table 3A). Referring to the stop-and-go technique, one explained, "No drugs are taken prior to the test, but once in the clear we start up again; once it's over, life resumes." "Some drugs will be out of your system in a few days, while other will stay," one explained. "You can usually figure out when the tests are going to be given and avoid being nailed. If you're stupid enough to take drugs before the testing date, you're an idiot."

A few athletes unabashedly continued use of drugs, preferring to take their chances. Since the testing system is not infallible and the first offense penalty is only a warning, what is there to risk? "There's not much to lose the first time," one explained, "It doesn't slow some guys down until they get caught the first time. They live-it-up then and, 'boom,' they lay-off."

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Results show in Table 4 confirm that, despite drug testing, some drug-using athletes continued their former drug pattern: 12.9% (62 athletes) smoked marijuana just as often (compared to 21.7% who decreased marijuana consumption), 5.3% (25 athletes) used cocaine as often (compared to 8.4% who decreased their use of cocaine), and 3.6% (17 athletes) used the same steroids (compared to 2.5% who decreased steroid use). Relatively few athletes decreased their use of nontested substances: 64.0% (n = 308) drank as much alcohol, 45.3% (n = 217) consumed the same prescription drugs, and 57.5% (n = 277) used the same amount of over-the-counter drugs. It is noteworthy that some of the comparison group also decreased marijuana (22.8%) and other drugs. The milieu created by the drug testing policy may have influenced them to decrease their drug use.

Suprisingly, a few athletes increased their use of various substances during the testing year--2.3% (n = 11) increased marijuana consumption, 1.3% (n = 6) increased cocaine, 0.6% (n =3) increased steroids, 9.2% (n = 44) increased alcohol, 2.1% (n = 10) increased prescription drugs, and 2.3% (n = 11) increased over-the-counter drugs (Table 4). This is consistent with other results (Table 3D) indicating that one-sixth (15.4%) of the tested athletes, compared with 5.1% of the comparison group, perceived drug testing as encouraging, not discouraging, drug use (p < .01). Citing themselves and their teammates as examples, these athletes were slowed down only temporarily; after testing was completed, their drug use increased. Before mandatory testing, they explaiend, the use of recreational drugs was "no big deal." "They would do it every once in awhile; but now, after being tested, they go right out and get stoned. 'Hooray! There won't be any more drug testing for awhile.' People who normally wouldn't use drugs that much get together after testing and say, 'let's celebrate'."

SUMMARY AND CONCLUSION

Heightened national concern about the widespread traffic in illegal drugs has encouraged executives in the federal government, private industry, and other organizations around the nation to initiate urine testing programs. The objectives have been to ferret out drug users and to prevent them from further drug use.

The controversial nature of drug testing has been noted [6,7] and guidelines proposed [8], but little follow-up assessment is available. Although widely adopted as a deterrent, few outcome studies have been reported [2, 3]. Olympic, intercollegiate, and professional athletes have received considerable attention in the popular press and the professional literature [9-12], but only a few attitude surveys have been reported [13, 14].

The results of this study show that, although drug testing is generally effective in identifying and preventing drug use, it is not foolproof. Some mandatory participants avoided detection altogether. Despite high technology and rigorous monitoring, effective ways are known to escape detection. While most drug-using athletes decreased their drug consumption during the testing year, some continued in the same usage patterns, unaffected by urine testing. A few actually increased their drug consumption, claiming that a mandatory policy encouraged them to celebrate once the test was completed. For them, mandatory testing was not only ineffective but counterproductive.

REFERENCES

[1] Angerola, R. T., Substance abuse testing in the workplace: Legal issues and corporate responses, in Drug Testing: Issues and Options (R. H. Coombs and L. J. West, eds.), Oxford University Press, New York, In Press.

[2] Gust, S. W., and Walsh, J. M., Drugs in the Workplace: Research and Evaluation Data, NIDA Research Monograph Series No. 91, Alcohol, Drug Abuse and Mental Health Administration, U.S. Public Health Service, Department of Health and Human Services, DHHS Publication No. ADM 89-16, 1989.

[3] Gust, S. W., Thomas, L., and Walsh, J. M., Researh on the Prevalence, Impact and Treatment of Drug Abuse in the Workplace, NIDA Research Monograph Series No. 100, Alcohol, Drug Abuse and Mental Health Administration, U.S. Public Health Service, Department of Health and Human Services, In Press.

[4] Zemper, E. D., Drug testing in athletics, in Drug Testing: Issues and Options (R. H. Coombs and L. J. West, eds.), Oxford University Press, New York, In Press.

[5] University Policy Statement on Drug Education and Testing Program for Student Athletes, 1987.

[6] Dougherty, R. J., Controversies regarding urine testing, J. Substance Abuse Treatment 4:115-117 (1987).

[7] Coombs, R. H. and West, L. J. (eds.), Drug Testing: Issues and Options, Oxford University Press, New York, In Press.

[8] Pickett, A. D., Drug testing: What are the rules?, Athl. Train. 21(4):331-336 (1986).

[9] Mallios, H. C., Drug testing of student athletes: Storm clouds on the horizon, Athl. Adm. pp. 12-13, 16 (June 1987).

[10] Rovere, G. D., Haupt, H. A., and Yates, C. S., Drug testing in a university athletic program: Protocol and implementation, Phys. Sports Med. 14 (4):69-76 (1986).

[10] Cowart, V. S., Accord on drug testing, sanctions sought before 1992 Olympics in Europe, J. Am. Med. Assoc. 260(23):3397-3398 (1988).

[12] Cowart, V. S., Random testing during training, competition may be only way to combat drugs in sports, J. Am. Med Assoc. 260(24):3556-3557 (1988).

[13] Gaskins, S. E., and deShazo, W. F., Attitudes toward drug abuse and screening for an intercollegiate athletic program, Phys. Sports Med. 13(9):93-100 (1985).

[14] Abdenour, T. E., Miner, M. J., and Weir, N., Attitudes of intercollegiate football players toward drug testing, Athl. Train. 22(3): 199-201 (1987).

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