Lived experiences of urine drug testing among individuals with a substance use disorder: A punitive or supportive intervention?

Background/Objectives: Urine drug testing (UDT) is a core component of nursing interventions within the treatment of substance use disorder (SUD). Beyond the detection of psychoactive substance use and medication adherence, UDT also provides opportunities for therapeutic dialogue, patient support, and recovery monitoring. Despite its routine use, little is known about how patients experience UDT and its potential as a therapeutic nursing tool within recovery-oriented care. This study aimed to explore patients’ lived experiences with UDT to understand its role in recovery-oriented addiction treatment. Methods: A phenomenological study with in-depth, semi-structured interviews was conducted among 12 residents of a supervised living facility at Addiction Care North Netherlands. Data were analyzed using Colaizzi’s seven-step method. Results: Four main themes were constructed in relation to trust within the therapeutic relationship—empowerment, accountability, and autonomy. Patients stated that their perception of UDTs as either supportive or punitive depended strongly on the level of trust within the therapeutic relationship. When trust was present, UDTs were experienced as supportive nursing tools that fostered empowerment and positive self-image, reinforced accountability for recovery goals, and upheld autonomy in decision-making. Conversely, in the absence of trust, UDTs were often perceived as punitive, coercive measures that undermined self-confidence and diminished accountability, ultimately hindering recovery progress. Nursing practices that emphasized nonjudgmental interpretation of results, collaborative decision-making, and patient-centered support contributed to positive experiences. Conclusions: Patients’ experiences indicate that the therapeutic value of UDT is highly dependent on the quality of the patient–nurse relationship. Nurses play a key role in ensuring that UDT is used as a supportive intervention rather than merely a control measure. Integrating UDT into holistic, recovery-oriented care can foster engagement, empowerment, and a sense of accountability. Future research should investigate nursing-led strategies to optimize UDT implementation tailored to treatment phase and patient needs.