Addiction Glossary
Addiction Treatment and Rehabilitation Glossary
Source: United Nations Office on Drugs and Crime
Glossary of Addiction and Recovery Terms
The term refers to the act of refraining from alcohol or other drug use, whether for health, personal, social, religious, moral, legal or other reasons. Someone who is currently abstinent may be called an “abstainer,” a “total abstainer,” or a “teetotaler” (an old-fashioned term relating only to alcohol.) The term “current abstainer” is sometimes used for research purposes and is usually defined as a person who has not used drugs for a specified period of time; for example, three, six, or twelve months. In some studies, persons who drink or use other drugs only once or twice per year are also classified as abstainers.
A term in wide use but of varying meaning. In international drug control conventions “abuse” refers to any consumption of a controlled substance no matter how infrequent. In the Diagnostic and Statistical Manual of Mental Disorders (DSMIV, American Psychiatric Association, 1994), “psychoactive substance abuse” is defined as “a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following within a 12 month period: (1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home; (2) Recurrent substance use in situations in which it is physically hazardous; (3) recurrent substance-related legal problems; (4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance”. It is a residual category, with dependence taking precedence whenever applicable. The term “abuse” is sometimes used disapprovingly to refer to any use at all, in particular of illicit drugs. Because of its ambiguity, the term is only used in the ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines (WHO, 1992) for non-dependence producing substances. “Harmful” and “hazardous use” are the equivalent terms in WHO usage, although they usually relate only to effects on health and not to social consequences. The term “abuse” is also discouraged by the Centre for Substance Abuse Prevention in the United States, although the term “substance abuse” remains in wide use and refers generally to problems of psychoactive substance use. The term “drug abuse” has also been criticized as being circular when it is used without reference to specific problems arising from drug use.
See also: Drug abuse.
The process of recognition that a program meets specific operational and organizational standards that have been established to ensure the quality of services within a particular region or treatment system. Accreditation is usually awarded by an external professional body on the basis of a review or audit and is usually for a specific period.
One of the oldest and most commonly used terms to describe and explain the phenomenon of long-standing drug abuse. In some professional circles it has been replaced by the term “drug dependence”. According to the WHO Lexicon of Alcohol and Drug Terms, “addiction” is defined as: the repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means. Key indicators of “addiction” have traditionally been thought to be tolerance and experience of a withdrawal syndrome, that is, it is often equated with physical dependence. More recently, some drug researchers have suggested that “compulsion to use drugs” is a more central indicator of addiction. Addiction is otherwise regarded by the self-help or “recovery” movement as a discrete disease, a debilitating and progressive disorder rooted in the pharmacological effects of the drug for which the only cure is total abstinence. That view is most notably associated with the “self-help” or “recovery” movement, for example, Narcotics Anonymous and Alcoholics Anonymous. In the 1960s, WHO recommended that the term “addiction” be abandoned in favor of dependence, which can exist in various degrees of severity as opposed to an “all or nothing” disease entity. Addiction is not a diagnostic term in the ICD-10, but continues to be very widely employed by professionals and the general public alike.
See also: Dependence, dependence syndrome.
The range of information and non-medical treatment services which can variously provide drug information, details of services available, referral to other agencies, and direct clinical casework or psychotherapy. Services may be provided in a direct face-to-face setting or indirectly by telephone to individuals, families, groups, other workers or agencies. The term “advice” is usually reserved for the provision of factual information on specific issues. It also incorporates brief and specific advice to change behavior, for example in brief interventions (see below). Advice is usually distinguished from “counseling” where the emphasis is more on assisting individuals to evaluate their own situation and reach their own decisions about how to cope.
See also: Brief intervention, Counseling and psychotherapy, Treatment.
A broad range of community-based service supports designed to maintain benefit when a structured treatment has been completed. Aftercare may involve a continuation of individual or group counseling and other supports, but usually at a lower intensity and often by other agencies. Self-help groups such as Narcotics Anonymous are an important provider of aftercare.
See also: Self-help group.
A substance that acts on receptor sites to produce certain responses; for example, both methadone and heroin are agonists for opioid receptors.
The common abbreviation for a fatal viral condition known as Acquired immunodeficiency syndrome in which the immune System is weakened and unable to combat infectious diseases. The sharing of injecting equipment among injecting drug users is a major route of transmission for human immunodeficiency? virus (HIV). That is the virus that causes AIDS, and in many countries has led to programs discouraging injecting and to the establishment of programs to make clean injecting equipment more readily available for injecting drug users in order to reduce the likelihood of transmission of the virus through the sharing of used needles and other equipment.
See also: Harm reduction, Needle exchange, Risk reduction, Safer use.
A substance that counteracts the effects of another agent. Pharmacologically, an antagonist interacts with a neuronal receptor to inhibit the action of agents (agonists) that produce specific physiological or behavioral effects mediated by that receptor.
A treatment strategy in which structured therapy of a limited number of sessions (usually one to four) of short duration (typically 5-30 minutes) is offered with the aim of assisting an individual to cease or reduce the use of a psychoactive substance or (less commonly) to deal with other life issues. It is designed, in particular, for general practitioners and other primary health care workers.
Buprenorphine is a mixed agonist/antagonist which can be used in substitution treatment. It has been used extensively in many countries for the short-term treatment of moderate to severe pain. The mixed opioid-action/blocking-action appears to make buprenorphine safe in overdose and possibly less likely to be diverted than pure opioids. It may also provide an easier withdrawal phase, and due to a longer action, may allow for alternate day dosing. It is apparent from the research conducted to date that buprenorphine is at least as effective as methadone as a maintenance agent.
See also: Drug substitution, Methadone.
Capture recapture method (CRM) is an epidemiological technique which is used to estimate the prevalence of a specific behavior within a defined population (for example, the number of injecting drug users in a specified geographic area). CRM uses the overlap between two or more samples or registers of people to derive an estimate of the total population.
The process of oversight and practical management of patients within a particular treatment and across different treatments over time. For a particular patient, care coordination can involve assessment, referral, progress monitoring and review activities. In some treatment systems, the care coordinator has some degree of authority over the system that pays for the treatment of patients.
A broad concept that refers to whether a treatment meets the expectations and needs of a particular client (patient). Client satisfaction is usually assessed by a self-report questionnaire during or at completion of treatment. Client satisfaction is sometimes used as an outcome measure alongside primary clinical, social and economic outcome assessments.
Cognitive-behavioral techniques
A type of psychotherapy that stresses that the way in which people think about a problem is instrumental in causing feelings and behaviors that are unwanted. Cognitive-behavioral techniques (CBT) therefore aims to help a patient replace those unhelpful thoughts with others that lead to more desirable reactions. In the substance abuse field the CBT therapist helps a patient to acquire new skills to alter or maintain changes in their behavior. In that respect, relapse prevention programs may contain a CBT element to help patients resist urges to use substances.
Any treatment that is based in a non-residential setting. Outpatient treatments (day attendance-based services provided from a hospital) are often bracketed with community based treatments. Examples of community-based treatments are opioid substitution programs; counseling programs and aftercare services.
Interventions which encourage a community (for example, people in a locality, drug injectors, sex workers) to develop collective ownership and control over health-related choices and activities. To achieve that result, the community may also need to gain collective control of the wider social, political and economic factors which influence their access to health. “Empowerment” is a process of increasing personal, interpersonal or political power so that individuals can take action to improve their lives.
See: Dual diagnosis.
The organization of police, judiciary and penal structures that operate in a particular State. The terms “correctional system” and “criminal justice system” are synonymous.
Counseling is an intensive interpersonal process concerned with assisting normal people to achieve their goals or function more effectively. Psychotherapy is generally a longer-term process concerned with reconstruction of the person and larger changes in more fundamental psychological attributes such as personality structure. Psychotherapy is often restricted in conception to those with pathological problems.
A program of treatment, re-education or community service for individuals referred from criminal courts (criminal diversion) after being charged with driving under the influence of alcohol (drinking-driver diversion) or another drug, with the sale or use of drugs (drug diversion), or with another crime. Individuals are assigned to diversion programs in lieu of prosecution, which is usually held in abeyance pending successful completion of the diversion program. Pre-charge diversion refers to the systematic referral of those detected by the police to an alternative program without arrest. In some countries, the term “custody diversion” is used to make explicit that in many diversion schemes the individual may attend court but be diverted away from custody into a program of treatment or re-education.
Custody diversion
See: Court diversion.
Dependence, dependence syndrome
According to the WHO Lexicon of Alcohol and Drug Terms, “dependence, dependence syndrome” is defined as follows: as applied to alcohol and other drugs, a need for repeated doses of the drug to feel good or to avoid feeling bad. The terms “dependence” and “dependence syndrome” have gained favor with WHO and in other circles as alternatives to addiction since the 1960s. In the DSM-IV, dependence is defined as “a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.”
See also: Addiction.
The process by which a person who is dependent on a psychoactive substance ceases use, in such a way that minimizes the symptoms of withdrawal and risk of harm. While the term “detoxification” literally implies a removal of toxic effects from an episode of drug use, in fact it has come to be used to refer to the management of rebound symptoms of neuroadaptation, that is, withdrawal and any associated physical and mental health problems.
Dialectical behavior therapy (DBT)
A form of clinical behavior analysis (CBA) used in psychotherapy to treat people with borderline personality disorder (BPD), DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT may be the first therapy that has been experimentally demonstrated to be generally effective in treating BPD. A meta-analysis found that DBT reached moderate effects. Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Recent work suggests its effectiveness with sexual abuse survivors and chemical dependency.
Current international drug control treaties do not define drug abuse but make reference to a variety of terms, including abuse, misuse and illicit use. In the context of international drug control, drug abuse constitutes the use of any substance under international control for purposes other than medical and scientific, including use without prescription, in excessive dose levels, or over an unjustified period of time.
Treatment of drug dependence by prescription of a substitute drug for which cross-dependence and cross-tolerance exist. The term is sometimes used in reference to a less hazardous form of the same drug used in the treatment. The goals of drug substitution are to eliminate or reduce use of a particular substance, especially if it is illegal, or to reduce harm from a particular method of administration, the attendant dangers to health (for example, from needle sharing), and the social consequences. Drug substitution is often accompanied by psychological and other treatment.
The Diagnostic and Statistical Manual of Mental Disorders is the standard classification of mental disorders used by mental health professionals in the United States. It is also widely used in other parts of the world. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (for example, biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). DSM-IV (fourth edition), compiled and published by the American Psychiatric Association in 1994, was designed for use across settings. It is also a tool for collecting and communicating accurate public health statistics. The DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets and the descriptive text.
See also: Abuse.
The planned fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders. It is due for publication in May 2013 and will supersede the DSM-IV which was last revised in 2000. APA has an official development website for posting of draft versions of the DSM-5.
A person diagnosed as having an alcohol or drug abuse problem in addition to some other diagnosis, usually psychiatric, for example, mood disorder, schizophrenia. Making differential diagnoses is often complicated by overlapping signs and symptoms of dependence and diagnostic entries, for example, anxiety is a prominent feature of drug withdrawal. A further complication is with shared or reciprocal casual processes, for example, a mild disorder of mood leads to some drug use which eventually leads to an exacerbation of the mood disturbance, to further drug use, dependence and severe mood disturbance.
A therapeutic strategy that combines early detection of hazardous or harmful substance use and treatment of those involved. Treatment is offered or provided before such time as patients might present of their own volition and in many cases before they are aware that their substance use might cause problems. It is directed in particular at individuals who have not developed physical dependence or major psychosocial complications.
A set of medical, social and psychological conditions that are used to judge the appropriateness of a treatment for a particular individual. Eligibility criteria usually take into account the severity of patients' problems, their personal motivations or readiness for treatment, and the nature and extent of their social supports and stressors in terms of their suitability for a particular treatment. Use of eligibility criteria is part of a commitment to matching patients to the best or more appropriate treatment in the context of two or more alternatives.
The systematic and scientific process of determining the extent to which an action or sets of actions were successful in the achievement of predetermined objectives. It involves measurement of adequacy, effectiveness and efficiency of programs or services. Evaluation is to be distinguished from assessment and appraisal: both terms are used as more general terms than evaluation, connoting the drawing of conclusions from the examination of a situation or its elements. Evaluation, then, is a particular type of assessment.
An interviewer or patient self-report questionnaire that is used to record past behaviors and/or perceptions that assess the impact of a treatment. Ratings on an evaluation instrument for a recall period before treatment are commonly contrasted with ratings on the same measures during treatment and/or after treatment has ended.
A professional counselor, social worker or nurse whose role is to support the family (dependents and caregiver of a patient). The worker assists family members who are affected by a substance abuse problem and may provide information, supportive counseling and referral services. Helping the family understand and provide support to a member with a substance abuse problem is a core function.
A discussion-based, qualitative research data gathering method designed to explore a topic of interest and generate a range of opinions. A small number of members of a particular group meet together and their discussion is facilitated by a researcher known as a “moderator”.
A social, welfare or health care service that does not have as its primary function the treatment of substance abuse problems but may in the course of its work come into contact with people who are affected. Generic services may develop expertise in screening, assessing and treating substance abuse problems (so that the boundary between generic and speciality services may be difficult to draw) and may also have formal referral links with specialist substance abuse services.
Often, a place of residence that acts as an intermediate stage between an inpatient or residential therapeutic program and fully independent living in the community. The term applies to accommodation for alcohol- or drug-dependent individuals endeavoring to maintain their sobriety (compare therapeutic community). There are also half-way houses for individuals with psychiatric disorders and for individuals who are leaving prison.
In the context of alcohol or other drugs, harm reduction refers to policies or programs that focus directly on reducing the harm resulting from the use of alcohol or other drugs, both to the individual and the larger community. The term is used in particular for policies or programs that aim to reduce the harm without necessarily requiring abstinence. Some harm reduction strategies designed to achieve safer drug use may, however, precede subsequent efforts to achieve total abstinence. Examples of harm reduction include needle/syringe exchanges to reduce rates of needle sharing among injecting drug users.
According to the WHO Lexicon of Alcohol and Drug Terms, “harmful use” is defined as follows: a pattern of psychoactive substance use that is causing damage to the health of the drug user. The damage may be physical (for example, hepatitis following injection of drugs) or mental (for example, depressive episodes secondary to heavy alcohol intake). Harmful use generally has adverse social consequences as well. The term was introduced in the ICD-10 and supplanted “nondependent use” as a diagnostic term. The closest equivalent in other diagnostic systems (for example, in the DSM-IV) is substance abuse, which usually includes social consequences.
The Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems is the latest in a series that was formalized in 1893 as the Bertillon Classification or International List of Causes of Death. While the title has been amended to make clearer the context and purpose and to reflect the progressive extension of the scope of the classification beyond diseases and injuries, the familiar abbreviation “ICD” has been retained. ICD was developed by the World Health Organization (WHO) and is designed to promote international comparability in the collection, processing, classification, and presentation of morbidity and mortality statistics. The reported conditions are translated into medical codes through use of the classification structure and the selection and modification rules contained in the application of ICD. The tenth revision (ICD-10) was published in 1992.
Impact evaluation is a form of outcome evaluation that assesses the net effect of a program by comparing program outcomes with an estimate of what would have happened in the absence of the program. The time horizon for impact evaluations are often in the medium or longer term.
The rate at which a condition or illness occur, often expressed in terms of the number of cases per 10,000 people per year.
A description of the nature and anticipated course of substance abuse treatment. An integrated care pathway describes a predetermined plan of treatment for a particular patient group entering structured treatment and the anticipated outcomes that are expected. The pathway may relate to several treatment components to be delivered by a single agency program or it may include several treatments delivered by two or more agencies. Integrated care pathways form part of the set of documents and protocols that describe what a treatment program intends to do as well as the intended results.
An integrated treatment system is one that contains several treatment services, both specialist and generic, that operate in a structured and organized way. Most integrated treatment systems will contain community-based and residential services and have established referral and patient transfer arrangements.
According to the WHO Lexicon of Alcohol and Drug Terms, “intoxication” is defined as follows: a condition that follows the administration of a sufficient amount of a psychoactive substance and which results in disturbances in the level of consciousness, cognition, perception, judgment, affect, behavior, or other psychophysiological functions and responses. The disturbances are related to the acute pharmacological effects of, and learned responses to, the substance and resolve with time, with complete recovery, except where tissue damage or other complications have arisen. The term is most commonly used with regard to alcohol use.
From the chemical name levo-alpha-acetylmethadol, LAAM is a synthetic pure opioid agonist (related to methadone) of the morphine type. It was extensively investigated in the 1970s as a pharmacological alternative to methadone, its chief advantage being that it has a longer half-life and consequently patients can be dosed every 48 to 72 hours rather than every 24 hours as is required with methadone.
See also: Drug substitution, Methadone, Opiate, Opioid.
See: Drug substitution.
A characterization of treatment, sometimes called coercive treatment, that is organized by the criminal justice system. Typically, a court (or other criminal justice body) orders that an individual enters a therapeutic program (sometimes as an alternative to a custodial sentence). Treatment is mandated in the sense that failure to enter the program or comply with its rules and regulations may result in the individual receiving the criminal justice penalty that would normally be invoked.
The matrix model is a multi-component framework treatment for managing substance abusers, in particular stimulant abusers in treatment and helping them achieve abstinence. The model addresses the needs of stimulant abusers in a systematic way, separating the problem areas into distinct categories. The chosen categories are: behavioral, cognitive, emotional and relationships. The treatment focuses on particular issues in each of those areas which emerge in the “stages of recovery” encountered by recovering clients during the first year of stimulant abstinence. The model emphasizes individual therapist contact and education about drug abuse, relapse prevention, social support, 12-step participation and focuses on issues critical to addiction and relapse. The program includes educational sessions focusing on skills required to maintain abstinence and promoting recovery. Family members are encouraged to attend support and discussion groups and are provided with support as required.
A synthetic opiate drug used in maintenance therapy for those dependent on opioids. It has a long half-life, and can be given orally once daily with supervision. It is the most widely used treatment for opioid dependence in the developed world. When given in an adequate dose to opioid dependent individuals, methadone tends to reduce desire to use heroin and other opiates, eliminates opioid withdrawal, and blocks the euphoric effects of the other opioid drugs.
See also: Buprenorphine, Drug substitution, LAAM, Opiate, Opioid.
Usually used as a synonym for brief intervention. However, some authorities suggest that minimal intervention as a term should be restricted to person-to-person interventions lasting between 30 minutes and 3 hours, that is, somewhat longer than “brief intervention”.
See also: Brief intervention, Early intervention, Prevention.
A categorization of a specific type of drug abuse treatment. A given treatment modality can be described in terms of its specific therapeutic approach or philosophy and purpose. In the United Kingdom, for example, the following treatment modalities are available: residential rehabilitation; inpatient stabilization and detoxification; community specialist prescribing; community general practitioners prescribing; structured counseling and structured day services.
A counseling and assessment technique which essentially follows a non-confrontational approach to questioning people about difficult issues like alcohol and other drug use and assisting them to make positive decisions to reduce or stop their drug use altogether. The underlying philosophy is closely linked with the Stages of Change Model which posits the view that decision-making about behavioral change proceeds through defined stages termed pre-contemplation, contemplation, preparation, action and maintenance. Motivational interviewing comprises a set of techniques designed to move the drug user, smoker or drinker through those stages by assisting them to make an accurate appraisal of the benefits and drawbacks of their behavior in a non-judgmental interview.
See also: Counseling and psychotherapy.
A group in which participants support each other in recovering or maintaining recovery from personal problems. Those groups are often associated with alcohol and other drug dependence problems; however, they also operate in the context of other issues such as depression and various compulsive behaviors. Membership is usually established on a voluntary and confidential basis, with meetings organized with a prescribed format and time.
Naloxone is a narcotic antagonist which reverses the respiratory, sedative and hypotensive effects of heroin overdose. It can be injected intramuscularly, intravenously or subcutaneously. A nasal spray preparation is now also available in some countries. It is an opioid receptor blocker that antagonizes the actions of opioid drugs. It reverses the features of opiate intoxication and is prescribed for the treatment of overdose with that group of drugs.
See also: Antagonist, Naltrexone.
A drug that antagonizes the effects of opioid drugs. Its effects are similar to those of naloxone, but it is more potent and has longer duration of action. It is used in various ways in the treatment of opioid dependence and also alcohol dependence. The most widely adopted use is to prescribe at a dose that will block the psychoactive effects of all opioid drugs. The idea is that while the drug needs to be taken daily to maintain that blockade, it will minimize the chance of impulsive decisions to relapse.
See also: Antagonist, Drug substitution, Naloxone.
See: Self-help group, Twelve-step group.
A chemical agent that can induce stupor, coma, or insensibility to pain. The term usually refers to opiates or opioids, which are called narcotic analgesics. In common parlance and legal usage it is often used imprecisely to mean illicit drugs, irrespective of their pharmacology. For example, narcotics control legislation in Canada, the United States and several other countries includes cocaine and cannabis as well as opioids. It is also a term adopted by the Single Convention on Narcotic Drugs, 1961.
Provision to reduce the transmission of infectious diseases by the repeated use and sharing of needles in order to reduce the transmission of blood-borne viruses. It was first developed in response to the advent of HIV/AIDS and quickly spread to many countries in which injecting drug use was experienced as a problem. The concept involves the provision of clean needles in exchange for used needles which are then safely disposed of. In practice, an “exchange” is not always required and clean injecting equipment is provided on demand, sometimes for a small payment.
See also: AIDS, Harm reduction.
A systematic approach to determining the nature and extent of substance abuse problems in a target population or community that seeks to identify which (or how many) specific interventions should be made available to specific groups of people or how existing interventions and services can be better provided.
A service agency which is independent of government and operates in a broad social field. As most of them are non-profit, non-governmental organizations (NGOs) can be funded by Governments, public institutions and/or private donations. Often, such agencies have a mix of paid staff and voluntary workers and they have traditionally provided services in sectors where it would not be possible to provide funding for fully-paid staff.
Substance abuse services that can be used by any member of a community without a formal specialist referral.
According to the WHO Lexicon of Alcohol and Drug Terms, “opiate” is defined as follows: one of a group of alkaloids derived from the opium poppy (Papaver somniferum) with the ability to induce analgesia, euphoria, and, in higher doses, stupor, coma and respiratory depression. The term opiate excludes synthetic opioids such as heroin and methadone.
See also: Opioid.
According to the WHO Lexicon of Alcohol and Drug Terms, “opioid” is defined as follows: the generic term applied to alkaloids from the opium poppy (Papaver somniferum), their synthetic analogues, and compounds synthesized in the body, which interact with the same specific receptors in the brain, have the capacity to relieve pain, and produce a sense of well-being (euphoria). The opium alkaloids and their synthetic analogues also cause stupor, coma and respiratory depression in high doses.
See also: Narcotic drug, Opiate.
See: Agonist.
See: Antagonist.
Outcome evaluation measures the extent to which a program achieves its immediate objectives. It focuses on outputs and outcomes, including unintended effects, to judge the program effectiveness. It may also assess the program process to understand how the outcomes are produced. For UNDCP, outcome evaluations often address the effectiveness of immediate project objectives and the process through which they are achieved. The time horizon for outcome evaluation is usually with the life of the program or project.
A direct or indirect observation or record that concerns a specific patient's behavior or cognition that is relevant to their problems and to the objectives of a treatment or rehabilitation program. Outcome measures are usually drawn from a set of domains spanning substance abuse behaviors and cognitions; physical and psychological health symptoms and conditions and various aspects of personal, social and economic functioning, including relationship difficulties, housing and accommodation problems; education, training and employment problems; and illegal activities. Commonly, outcome measures are recorded for a suitable period immediately prior to a patient commencing treatment and recorded again at one or more follow-up points and changes in scores on the pairs of measures and then attributed to the treatment provided.
The recording, communication and application of information about the impact or benefit of treatment that is used to judge the value of the intervention and for the purpose of improving its operation and effectiveness.
A community-based activity with the overall aim of facilitating improvement in health and reduction of drug-related risk or harm for individuals and groups not effectively reached by existing services or through traditional health education channels. Outreach can be “detached”, “peripatetic”, or “domiciliary” or “peer”. Detached outreach takes place outside of an agency or organizational setting in public places such as the streets, public transport stations, nightclubs, hotels and cafes. Peripatetic outreach focuses on organizations (for example, half-way houses, needle exchanges, youth clubs, schools and prisons) rather than individuals. Domiciliary outreach takes place in people's homes. Peer (or indigenous) outreach projects use current and former members of the target group (such as injecting drug users) as volunteers and paid staff.
According to the WHO Lexicon of Alcohol and Drug Terms, “overdose” is defined as follows: the use of any drug in such an amount that acute adverse physical or mental effects are produced. Deliberate overdose is a common means of suicide and attempted suicide. Overdose may produce transient or lasting effects, or death; the lethal dose of a particular drug varies with the individual and with circumstances.
See also: Intoxication.
Essentially, a treatment that is delivered by a trained individual who is close in gender or age group or other socio-economic category to the target group. Peer interventions are usually, but not always, brief in duration and target individuals at risk of substance abuse problems or who have problems of moderate severity.
At one level, one of the components of a peer outreach relationship where the outreach worker provides some form of assistance to a peer. The assistance is usually ongoing rather than a single discrete episode. Examples include support provided by peer care givers of people living with AIDS who may be unwell. The term “peer support group” is used to describe collectives or self organizations of members of a community for the purpose of representing their shared interests at a socio-political level. Examples include the “Junkiebonden” in the Netherlands and other drug abuse groups which are found in many countries.
A measure that is used to assess the progress of a drug supply or demand strategy.
The measurement and communication of the results of strategic plans and treatment services designed to tackle substance abuse.
See also: Strategic plan.
A measure of the extent of a particular condition or illness usually expressed in terms of the numbers of cases per 10,000 people in a given population.
An intervention designed to avoid or substantially reduce risk for the acquisition or further development of adverse health and interpersonal problems. Drug abuse prevention programs vary widely in content and philosophy. The most effective programs are multidimensional and contain a mixture of straight-talking education sessions about drugs and drug abuse; skills to deal with stress and personal and relationship problems; and drug resistance skills. The specific content of a program can be specifically adapted to the nature and needs of the target population.
The doctors, nurses, psychologists and support personnel who work from community locations and who essentially provide general health-care services to the local population.
Identified groups of people in a country or community that have a particular set of substance-related risks and/or problems that require treatment (for example, children and young people; people with substance abuse and psychiatric co-morbidity; and those in the criminal justice system).
An evaluation to determine the degree to which program procedures were followed according to a written program plan: How much of the intervention was provided to whom, when, and by whom? A process evaluation can also be called a quality assurance review.
According to the WHO Lexicon of Alcohol and Drug Terms, “psychoactive substance” is defined as follows: a substance that, when ingested, alters mental processes, that is, thinking or emotion. That term and its equivalent, psychotropic drug, are the most neutral and descriptive terms for the whole class of substances, licit and illicit, of interest to drug policy. “Psychoactive” does not necessarily imply dependence-producing.
See also: Psychotropic drug.
A term for a largely discredited concept but which is still used in some quarters. It refers to dependence upon a drug in the absence of the development of either tolerance or withdrawal symptoms. Most modern uses of the term “dependence” avoid a strict distinction between “psychological” and “physical” dependence. If that phenomenon exists at all, it is likely to be a characteristic of the user and not a property of the drug.
See also: Dependence, Dependence syndrome.
Interventions based on psychological principles and methods involving individual and group counseling and therapy designed to modify problematic substance-related cognitions and behaviors.
In the context of international drug control, “psychotropic substance” refers to a substance controlled by the 1971Convention on Psychotropic Substances. According to the WHO Lexicon of Alcohol and Drug Terms, “psychotropic” is in its most general sense a term with the same meaning as “psychotropic”, that is, affecting the mind or mental processes. Strictly speaking, a psychotropic drug is any chemical agent whose primary or significant effects are on the central nervous system. Some writers apply the term to drugs whose primary use is in the treatment of mental disorders-anxiolytic sedatives, antidepressants, antimanic agents and neuroleptics. Others use the term to refer to substances with a high abuse liability because of their effects on mood, consciousness, or both-stimulants, hallucinogens, opioids and sedatives/hypnotics (including alcohol).
Quality assurance and improvement
A systematic approach to the organization, delivery and development of treatment based on a shared staff commitment to addressing the needs of patients/clients through appropriate and good quality services.
A variety of methods for rapid or focused data collection which since the early 1980s have grown out of a sense of urgency for social science input in disease control programs. Both UNDCP and WHO have developed guidelines for conducting such assessments. Rapid assessment methods can be used as an evaluation tool or in order to generate baseline data. Methods include knowledge, attitude and behavior surveys; community diagnosis; rapid rural analysis used in agriculture; rapid epidemiological assessments; and those rapid assessment procedures which use ethnographic methods. Rapid assessment methods may involve either quantitative or qualitative methods, but often involve both.
According to the WHO Lexicon of Alcohol and Drug Terms, “rehabilitation” is defined as follows: in the field of substance use, the process by which an individual with a drug-related problem achieves an optimal state of health, psychological functioning and social well-being. Rehabilitation typically follows an initial phase of treatment in which detoxification and, if required, other medical and psychiatric treatment occurs. It encompasses a variety of approaches including group therapy, specific behavior therapies to prevent relapse, involvement with a mutual-help group, residence in a therapeutic community or half-way house, vocational training, and work experience. There is an expectation of social reintegration into the wider community.
See also: Treatment.
According to the WHO Lexicon of Alcohol and Drug Terms, “relapse” is defined as follows: a return to drinking or other drug use after a period of abstinence, often accompanied by reinstatement of dependence symptoms. Some writers distinguish between relapse and lapse ("slip"), with the latter denoting an isolated occasion of alcohol or drug use. The rapidity with which signs of dependence return is thought to be a key indicator of the degree of drug dependence.
See also: Relapse prevention.
According to the WHO Lexicon of Alcohol and Drug Terms, “relapse prevention” is defined as follows: a set of therapeutic procedures employed in cases of alcohol or other drug problems to help individuals avoid or cope with lapses or relapses to uncontrolled substance use. The procedures may be used with treatment based on either moderation or abstinence, and in conjunction with other therapeutic approaches. Patients are taught coping strategies that can be used to avoid situations considered dangerous precipitants of relapse, and shown, through mental rehearsal and other techniques, how to minimize substance use once a relapse has occurred.
See also: Relapse.
The extant published research literature that describes the nature and strength of clinical, social and economic benefits associated with a particular treatment modality. To say that a treatment has a “research evidence base” is to state that its benefit has been demonstrated by a number of published outcome studies. The research evidence base is generally seen as relating only to reports published in scientific peer-reviewed journals, where the quality of the research undertaken can be assured. Systematic reviews of the evidence base for a particular treatment are also published in scientific journals and by the Cochrane Collaboration. Caution needs to be exercised when considering the published research on a particular treatment in particular when studies vary by nation, method and the populations treated.
Programmed that provide ancillary residential services on the same site as treatment services. The programs generally strive to provide an environment free of substance abuse, with an expectation for compliance in a number of activities such as detoxification, assessment, information/education, counseling, group work, and the development or recovery of social and life skills.
Risk reduction describes policies or programs that focus on reducing the risk of harm from alcohol or other drug use. Risk reduction strategies have some practical advantages in that risky behaviors are usually more immediate and easier to objectively measure than harms, in particular those harms which have a low prevalence. For example, it may be more practical to measure reduced sharing of needles and other injecting equipment than indices of harm such as the incidence of HIV.
See also: Harm reduction, Safer use.
In relation to drug use, risky behavior refers to behaviors that place persons at risk of some drug-related harm. Although most often used in relation to behaviors, such as sharing needles or other injecting equipment (spoon, water, tourniquet, etc.) which place drug injectors at risk of transmission of blood-borne viruses such as HIV or hepatitis C, the term can be applied to any drug and to any risk of harm to livelihood, relationships, legal sanctions, or health.
Most drugs may be used in a way in which risk of adverse consequences is reduced by means of a combination of safer preparation, low dose, safer route of administration and in safer settings. For example, the risk of adverse consequences from using heroin, or the extent to which a drug use episode is life threatening, is greatly determined by whether injecting equipment is shared; whether a new batch of heroin is tested first in a small dose in case it is unusually pure; or whether it is used concomitantly with other central nervous system depressants such as benzodiazepines and alcohol. In most cases it is possible to identify drug-using practices which reduce, though usually not eliminate, the risk of serious adverse consequences.
See also: Harm reduction, Risk reduction.
A rapid procedure designed to detect individuals who have a substance abuse problem.
Groups that offer programs of recovery on a voluntary basis principally through a twelve-step process for personal change. Those programs often include participation in meetings to share histories of problems, obtain help and support from other members in dealing with challenges that have led to relapses, and seeking a member who will serve as a sponsor or mentor to provide help in times of crisis. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) make up a significant sector of the self-help groups concerned with substance dependence, while Al-anon, Alateen and Adult Children of Alcoholics (ACOA) attract family members trying to reconcile and resolve current or past personal problems associated with substance abuse in the family. Numerous other groups also operate in a similar fashion within and outside the field of substance abuse.
A system within quality assurance that indicates that a treatment service or program meets a set of organizational, operational, clinical and professional performance standards and relevant legal requirements for its operation. There are currently no internationally agreed standards for service accreditation, but a wide range of countries have developed national standards and accreditation processes.
A formal arrangement or cooperation between one or more generic services (usually primary health care) and a specialist substance abuse treatment service for the management of patients. Shared care arrangements usually involve the transfer of a patient receiving continuing treatment from a specialist service to a generic service and vice versa.
A social, welfare or health-care service that has the treatment of people with substance abuse problems as its primary purpose.
The set of individuals in a community with an investment or expectation in the efficient and effective operation of a treatment service or system. That can include patients, caregivers/family members, treatment providers, planners and those providing financial support for service costs.
A formal government policy that describes the national vision and goals for tackling substance supply and demand. The strategic framework provides a summary description of the different agencies or bodies involved, how they will operate jointly and singly, the nature of resources that have been allocated and the specific actions and objectives that are sought.
An overall framework prepared at a national (and usually subnational) level that characterizes the nature of substance abuse problems, the vision underpinning demand reduction and other prevention efforts, the agencies and resources to be committed to tacking the problem and the specific time-based goals and objectives sought. Effective plans place considerable value on consultation and open communication with the community and target populations. Most strategic plans are published open access documents and can be accessed via the Internet.
Structured treatment describes a program of therapeutic care that has several components that are organized in a logical or sequential way and are based on an initial patient assessment, and personalized treatment plan. Those components may include short and longer stay residential care and community/outpatient settings and involve the provision of medical and/or psychosocial interventions and/or aftercare. Naturally, there is variation in the intensity and duration of the components and their goals and objectives.
A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. There may be repeated failure to fulfill major role obligations, repeated use in situations in which it is physically hazardous, multiple legal problems, and recurrent social and interpersonal problems.
A cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that usually results in tolerance, withdrawal and compulsive drug-taking behavior.
A generic term used in international systems (DSM-IV and ICD-10) for classifying diseases for various conditions and illnesses associated with the use of any psychotropic drug. It includes both problematic and dependent drug use. Any mental or behavioral disorder resulting from the use of one or more psychoactive substances, whether or not medically prescribed. The substances specified are alcohol, opioids, cannabinoids, sedatives or hypnotics, cocaine, other stimulants (including caffeine), hallucinogens, tobacco, and volatile solvents. The clinical states that may occur include: acute intoxication, harmful use, dependence syndrome, withdrawal state, withdrawal state with delirium, psychotic disorder, late-onset psychotic disorder and amnesic syndrome.
See: Drug substitution.
A set of indirect methods used to determine the prevalence of substance abuse for a specified locality using results from existing prevalence estimates and other demographic information for specified segments of the population.
See: Needle exchange.
Groups or categories of people who are selected for special attention by a program or policy, for example, indigenous peoples, single mothers, persons aged 14 to 19.
A program designed to reach particular high-risk groups in society, such as unemployed youth, street children and prisoners.
A structured environment in which individuals with drug related problems live while undergoing rehabilitation. Such communities are often specifically designed for drug-dependent people; they operate under strict rules, are run mainly by people who have recovered from dependence, and are often geographically isolated. Therapeutic communities are also used for management of patients with psychotic disorders and anti-social personalities. Therapeutic communities are characterized by a combination of “reality testing” (through confrontation of the individual's drug problem) and support for recovery from staff and peers. They are usually closely aligned with mutual-help groups such as Narcotics Anonymous.
A term for the well-established phenomenon of reduced drug effects following repeated drug administrations. Tolerance develops fastest with more frequent episodes of use and with larger amounts per occasion. It is useful to distinguish between metabolic tolerance and functional tolerance. Metabolic tolerance arises usually as a consequence of an induction of liver enzymes which result in the faster metabolism of a given drug dose, thereby reducing the level and duration of blood-drug levels. Functional tolerance refers to diminished effects of a given blood-drug level. That is thought to occur both by virtue of neuroadaptation, as well as by the user learning to anticipate and accommodate intoxicating effects.
According to WHO (WHO Expert Committee on Drug Dependence Thirtieth Report, Technical Report Series) the term “treatment” refers to “the process that begins when psychoactive substance abusers come into contact with a health provider or any other community service and may continue through a succession of specific interventions until the highest attainable level of health and well-being is reached”. More specifically, treatment may be defined "… as a comprehensive approach to the identification, assistance, ... (and) ... health care ... with regard to persons presenting problems caused by the use of any psychoactive substance." Essentially, by providing persons who are experiencing problems caused by their use of psychoactive substances, with a range of treatment services and opportunities which maximize their physical, mental and social abilities, those persons can be assisted to attain the ultimate goal of freedom from drug dependence and to achieve full social reintegration. Treatment services and opportunities can include detoxification, substitution/maintenance therapy and/or psychosocial therapies and counseling. Additionally, treatment aims at reducing the dependence on psychoactive substances, as well as reducing the negative health and social consequences caused by, or associated with, the use of such substances.
A document that is a complete description of the nature of the patients that are to be treated, the operational and organizational elements of the treatment to be provided, the staffing and clinical methods and procedures to be followed.
The process of priority allocation or assignment of an individual to an intervention, needed by services providing treatment for substance abuse problems.
A mutual-help group organized around the twelve-step program of Alcoholics Anonymous (AA) or a close adaptation of that program. AA's program of twelve steps involves admitting one is powerless over one's drinking and over one's life because of drinking, turning one's life over to a “higher power”, making a moral inventory and amends for past wrongs, and offering to help other alcoholics.
Analysis of urine samples to detect the presence of substances a person may have ingested, or for other medical or diagnostic purposes. Different drugs can be detected in the urine for different time periods. Heroin and amphetamines can only be detected in the urine at most within a few days of last ingestion, while cannabis can be detected up to several weeks after last ingestion in persons who have been long-term heavy users. In recent years, the analysis of saliva, blood, sweat and hair strands has also become available for the detection of past drug use.
Training in a particular field of potential employment (for example, computer skills) with the aim of helping clients to improve their chances of employment and/or a better income.
An agency whose human resources largely or wholly consist of staff who are not paid but provide their labor or services for free. They have tended to be agencies outside the government sector.
See also: Non-governmental organization.
A general term to describe the constellation of social welfare, economic supports, public health and housing services which are available in a certain country, jurisdiction, or locality which aim to protect people from poor health and economic and social destruction. Usually seen as comprising health and welfare benefits, such as health care and unemployment benefit schemes, as well as government and non-government health and welfare agencies. Often used in the context of people who may have “fallen through the welfare net” in the sense that they have not been “caught” by the existing government services and schemes.
A term used to refer to either the individual symptoms of, or the overall state (or syndrome), which may result when a person ceases use of a particular psychoactive drug upon which they have become dependent or after a period of repeated exposure. The level of central nervous system arousal and the accompanying mood state is usually directly opposite to the direct action of the drug.
See also: Withdrawal syndrome, Dependence syndrome.
According to the WHO Lexicon of Alcohol and Drug Terms, “withdrawal syndrome” is defined as follows: a group of symptoms of variable severity which occur on cessation or reduction of drug use after a prolonged period of use and/or in high doses. The syndrome may be accompanied by signs of both psychological and physiological disturbance. A withdrawal syndrome is one of the indicators of a dependence syndrome. It is also the defining characteristic of the narrower psycho-pharmacological meaning of dependence.
See also: Withdrawal, Dependence syndrome.
