Monitoring Client Sobriety in Private Practice
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Monitoring Client Sobriety in Private Practice

Updated: Mar 3

Even though I do not require sobriety monitoring for most clients, there are scenarios where regular sobriety monitoring is required or can improve a client’s chances of success.



Regular sobriety monitoring is not something I require of most clients in private practice. My experience has been that most clients, particularly when they are paying out of pocket for their sessions, are usually honest about their drug or alcohol consumption. There are no consequences for their honesty, and as a result, they are more honest. We’ll assume for the moment that a client only has an alcohol issue, and drugs are not a concern.


Even though I do not require sobriety monitoring for most clients, there are scenarios where regular sobriety monitoring is required or can improve a client’s chances of success. Here are some examples:


  • A student who has had problems with alcohol in the past has returned to college. The student has an agreement to remain sober and continue recovery activities so his parents will continue to support him financially. Since the college is out of state, there is no way for the parents to monitor continued compliance from a distance without some form of monitoring.

  • A business executive is motivated to remain sober and has been doing well in counseling. He has no problem staying sober at home when he is with family, attending counseling, and his 12-step meetings. However, he has a tough time staying sober on business trips where he may be gone for two or more at a time with no accountability.

  • A married mother of children in high school has difficulty staying sober when her teenagers are in school, and her husband is away on business travel. Some additional accountability could be beneficial to her recovery.

  • A parent has had a history of alcohol abuse, is performing well in recovery, but has an ongoing custody battle in family court. As a condition of visitation, he must submit to monitoring, to ensure he is adhering to the court’s order that he not consume alcohol before or during his visits with his children.

  • A young man is facing criminal charges for fighting while under the influence of alcohol. There is a possibility he may have to do jail time. He and his attorney want to prove his ongoing sobriety to the District Attorney and the Judge. He requests monitoring as the legal scenario plays out.

  • A single young adult female with an active social life has struggled to stay sober when home alone. She feels that ongoing monitoring will provide her with more accountability and make it easier for her to resist drinking when alone.


These are just a few of the examples in which regular alcohol monitoring can help improve the success of outpatient substance abuse counseling clients. So how does a counselor in private practice provide this type of monitoring to clients? There are several ways. Testing a client’s urine at a laboratory for the presence of alcohol or using an ethyl glucuronide (EtG) test, having the client wear an alcohol monitoring device, or utilizing the Soberlink monitoring system.


In my opinion, laboratory testing is the least effective option. It is much easier to drink at times and avoid detection. It also is less effective in providing an immediate deterrent. What is an immediate deterrent? A test in four hours is always a better deterrent than one in four days. If you are conducting regular testing for both the presence of alcohol and the EtG screen, the costs of testing over 30 days will become prohibitive.


A “wearable” device, such as a bracelet that is worn by the client at all times (it cannot be removed) and charged daily, is probably the least desirable. Over the past thirteen years, I have never had a client voluntarily want to wear a monitoring device. The most significant factor being that others can see it at times, and it hard to conceal completely. This destroys anonymity and can create fear and shame for clients. No more wearing shorts in the summer, and going through airport security produces even more anxiety.


The most convenient, affordable, and effective method I have found is the Soberlink system. Soberlink is a monitoring system that includes the device, reporting system, and real-time reminders and alerts. Clients can utilize it and realize the benefits without anyone knowing they are. It is small enough to carry in a purse, glove compartment, backpack, or in luggage – it’s handheld. It works from virtually anywhere and takes less than two minutes to complete a test. The scheduling options are completely customizable, and clients can perform additional tests if they wish to do so.


In my experience, it can have a very positive effect on a client as they feel a sense of accomplishment every time they use it. It positively reinforces their progress, and since they are testing multiple times per day, it adds a comfortable level of accountability that is almost impossible to cheat. Soberlink has state-of-the-art facial recognition technology and can detect other types of tampering. Soberlink has been working with treatment providers since 2011, and they provide excellent support to both treatment providers and your clients.

I have never had a case where I was unaware that a client was drinking who was using the Soberlink system. Historically, my clients who have used the Soberlink device have also had a higher level of success than clients who did not. If a client relapses, I receive an email and text message alerting me to the positive test. I can then quickly reach out to the client and help them get back on track immediately. I’ve found that if a client relapses in between sessions, and they are drinking for two, four, or six days or more before I see them for their next appointment, it is much tougher to get back on track. It could even mean the difference between life or death. I am also alerted if they miss a test, or the device detects someone else is attempting to use the unit. While I typically am the only person receiving the reporting or alerts, you do have the option to add other recipients.


The device costs as little as $299.00 to purchase (with a commitment) and is $150 per month for monitoring, reporting, and notifications. Soberlink has a buyback program, and the client can recapture some portion of the purchase price when they sell the unit back to Soberlink. If a client is one that I see regularly, I do not charge them any extra to monitor Soberlink. However, many clinicians do charge an additional fee, and it is perfectly within your rights to do so. I only do so in cases if someone needs to be monitored but does not need my counseling services.


You can learn more about Soberlink at www.soberlink.com. In case you are wondering, I am not receiving any compensation for this article, and I am not a member of any affiliate program with Soberlink. I truly believe in the product and have witnessed my clients succeed with it. I think you will experience the same! It’s one more tool that can make a difference in your practice for the right clients. Michael O’Brien, CADC II, NCAC I, SAP, is author of Addiction Private Practice: The Definitive Guide for Addiction Counselors and Therapists. Discover more resources, training, and support for addiction professionals in private practice at: https://www.addictionprofessionalsnetwork.com


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