Substance Abuse Evaluations in Child Custody Cases

I make a number of assumptions when conducting a substance use evaluation as part of a litigation process: 1) the individual?s use is usually not less than the individual reports, but it might often be more (or much more); 2) inaccurate accusations of substance abuse are common because there is usually little negative consequence for inaccurate accusations; 3) the parties to the litigation, and those connected with them, may provide biased and inaccurate information. Therefore outside corroboration of their reports is essential for determining the extent and consequences of substance use.

As a practical matter, getting outside corroboration (information from sources not connected with the litigation) is difficult because such information may simply not exist, or obtaining it would require work performed by other professionals (such as private investigators) rather than by psychologists. That work would be outside the scope of the psychological evaluation the individual has consented to. An evaluation that obtained outside corroboration could be conducted at great expense, but would require weeks to months of effort and at best would only establish the history of substance problems (or lack of them). Such an evaluation would be appropriate when litigation is only concerned with history and not with the future (as it is in child custody litigation).

In my typical evaluation I document what is reported by the parties, conduct basic psychological and addiction testing, review documentation, and interview collaterals, as appropriate to each case. In some cases I am able to identify reports that are unlikely or impossible (e.g., consuming only 2 beers would not result 90 minutes later in BAL of .22). In some cases the information I obtain allows me to offer a firm diagnostic opinion. However, in most cases I will not have a firm diagnostic opinion, because I will not have sufficient firm evidence.

Even with a firm diagnostic opinion, the prediction of future substance use is problematic. An individual?s substance use can change, suddenly, dramatically and without treatment or support group attendance, in response to changes in the environment. Litigation often produces substantial environmental changes, and therefore has the potential to lead to significant decreases (or increases) in substance use. The diagnostic manual (DSM-IV-TR, page 221) recognizes that ?some individuals (perhaps 20% or more) with Alcohol Dependence achieve long-term sobriety even without active treatment.?

Consequently, if the litigation has a future focus, my normal recommendation is to obtain substance testing on a continuous basis. I will monitor the results of this testing if the court requests it. Random testing might work in some cases, but it allows a significant potential for delay in discovering problems. Such delay is unacceptable when the best interests of children are involved. Depending on the substances of concern, testing involves the individual stopping at a drug testing facility two to three times per week to provide a urine sample. Modifications to the basic plan need to be made if the individual tested is a reportedly moderate drinker, but in some instances such individuals are willing to abstain completely for the sake of eliminating suspicions about their having alcohol problems.

I normally recommend that the testing be paid for by the other party, and continued as long as the other party feels it is worth paying for. Solomon knew that the true mother would only want what was best for her child. Even Solomon did not try, simply based on the reports he received, to determine which mother was telling the truth.

A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery (practicalrecovery.com), an addiction treatment facility in La Jolla (San Diego), CA, focusing on collaborative care and self-empowerment. alcohol treatment