What to do after a positive drug or alcohol test

First, take a breath

A positive test can bring up fear, anger, shame and grief all at once, for the person tested and for the people who love them. Those reactions are normal. But the first hours after a positive result are when people most often say things they regret or make decisions they later reverse. The goal right now is not to punish or to fix everything. It is to understand what happened and choose a sensible next step.

If anyone is in danger, act on that first. If someone may have overdosed or is unresponsive, call 911. If someone is thinking about harming themselves, call or text 988 to reach the 988 Suicide and Crisis Lifeline.

Step 1: Make sure the result is right

An instant screen is presumptive. SAMHSA advises laboratory confirmation when a person disputes a positive result or when legal or employment consequences are possible (SAMHSA TAP 32). Some prescription and over the counter medicines can cross-react with screens. Before reacting, ask:

• Is the person disputing the result?
• Were any medications, supplements or alcohol based products used?
• Does the result need to be confirmed by a laboratory before it is shared further?

Our guide on screening vs confirmation explains the difference.

Step 2: Have an honest conversation

If use did happen, honesty now is worth more than the result itself. For the person tested, saying “yes, I used” early opens the door to help. For families, a response that is calm and curious makes honesty more likely next time.

If you are the person who tested positive

• Tell the truth to the people who need to know. Minimizing usually costs more trust than the use did.
• Describe what led up to it: stress, a trigger, people, places, a gap in support.
• Say what you think you need. You often know better than anyone.

If you are a parent, partner or family member

• Lead with concern, not accusation. “I am worried about you” lands differently than “you lied to me.”
• Ask open questions and listen more than you talk.
• Keep consequences you have already agreed on, and avoid inventing new ones in the heat of the moment.

Step 3: Remember what a test can and cannot tell you

A positive result shows use. It does not, by itself, tell you whether someone has a substance use disorder, how serious it is or what treatment they need. NIDA notes that drug testing does not diagnose a substance use disorder and should not be the sole basis for decisions about care (NIDA). That is why a professional assessment is often the most useful next step after a confirmed positive.

It also helps to keep perspective. NIDA’s principles of treatment note that lapses during treatment do occur and that monitoring provides an early indication of a return to drug use, which can signal that a treatment plan needs adjusting (NIDA Principles of Drug Addiction Treatment). A positive test caught early is an opportunity, not proof that recovery has failed.

Step 4: Match the response to the situation

• A single slip with strong support around it

  Increase testing frequency for a while, add accountability, and revisit what led to the slip.

• A pattern of use or rising risk

  Get a professional assessment from a therapist or psychiatrist experienced in substance use.

• An unstable living situation

  A structured, substance free living environment may help while the person regains footing.

• Use that is clearly escalating

  A higher level of care, such as outpatient or residential treatment, may be needed. The SAMHSA National Helpline at 1-800-662-4357 is free, confidential and available 24/7, and Los Angeles County runs a Substance Abuse Service Helpline at 1-844-804-7500 for screening and referral.

Step 5: Decide who needs to know

If results are being shared with an attorney, a professional program or an employer, follow those requirements carefully and get legal advice where it matters. Inside a family, agree on who will be told and by whom. Results should go only to the people the person tested has agreed to in writing, which protects both privacy and trust.

Step 6: Keep testing

Stopping testing after a positive is a common mistake. The weeks after a lapse are exactly when objective information is most useful, and a run of negative results afterward is one of the best ways to rebuild trust. See rebuilding trust with family.

How Blackburn Monitoring can help

At Blackburn Monitoring, a positive result is the start of a conversation with a real person, not just a line on a report. Presumptive positives can be confirmed by our partner laboratories, results go only to the people you authorize in writing, and your monitoring coordinator can adjust your testing plan and connect you with more support across Blackburn: therapy and psychiatric care, sober living, one-on-one mentoring for accountability and structure, and treatment scholarship help. Testing is low cost and by appointment in Los Angeles.

See more support beyond testing, ongoing monitoring and our support finder. If a professional assessment is the right next step, we can make an introduction to Blackburn Clinical Services for therapy and psychiatric care.