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Resource Guide for Independent Study of SUD

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Resource Guide for Independent Study of SUD

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Guide to resources to explore during Independent Study time during VA Addiction rotation

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HPM Fellow Didactic: Pain Management for Outpatients & Hospice Patients with SUD and Comorbid Serious Illness 2024

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HPM Fellow Didactic: Pain and Symptom Management for Hospitalized Patients with SUD and Comorbid Serious Illness 2023

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HPM Fellow Didactic: Intro to Addiction & Treatment of Patients with SUD and Comorbid Serious Illness

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Expert Panel on Treating Cancer Pain in OUD. JAMA Open 2021

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Expert Panel on Treating Cancer Pain in OUD. JAMA Open 2021

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Pub: Should Buprenorphine be First Line for Cancer Pain? JPSM 2023

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Pub: Should Buprenorphine be First Line for Cancer Pain? JPSM 2023

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Pub: Top 10 Tips PC Clinicians Should Know about Buprenorphine

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Pub: Top 10 Tips PC Clinicians Should Know about Buprenorphine

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Penn Medicine, The University of Pennsylvania is the oldest and one of the finest medical schools in the United States. Penn is rich in tradition and heritage and at the same time consistently at the forefront of new developments and innovations in medical education and research.

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CAPC: OUD and SUD Training for DEA Clinicians

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CAPC: OUD and SUD Training for DEA Clinicians

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This Learning Pathway contains eight hours of AACME and ANCC accredited training in the management of opioid and substance use disorders required for all DEA-registered clinicians by The Medication Access and Training Expansion (MATE) Act. Visit the DEA Diversion Control website for complete instructions and an overview of this new requirement. Upon completion, learners will receive a downloadable certificate.

CAPC members, log in to complete the Pathway. Not sure if your organization is a member? Check here.

To learn more, after completing your eight hours of training, view CAPC's on-demand webinar How Opioid Use Disorder Intersects with Serious Illness and Chronic Pain and Case Review How to Screen for Opioid Use Disorder and Make Complex Opioid Decisions.

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Opioid and Substance Use Disorder Training for DEA-Registered Clinicians

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This Learning Pathway contains training in the treatment and management of opioid and substance use disorders to help DEA-registered clinicians.

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Recovery Specialists & Warm Handoff Series: Communicating Multiple Pathways to Recovery for People with OUD

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Advocacy

Our Commitment

ASAM is committed to improving access to high-quality, evidence-based addiction prevention and treatment through our national advocacy efforts.

ASAM believes in a future in which addiction prevention, treatment, remission, and recovery are accessible to all, and where they profoundly improve the health of all people.

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ASAM - American Society of Addiction Medicine

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The American Society of Addiction Medicine or ASAM, is the professional home of addiction medicine physicians and specialists. Founded in 1954, is a professional medical society representing over 7,000 physicians, clinicians, and associated professionals in the field of addiction medicine.

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The "Addictionary" from the Recovery Reseach Institute (Harvard and MGH)

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The "Addictionary" from the Recovery Reseach Institute (Harvard and MGH)

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ABSTINENCE

The absence of substance use. However, there are many different types of abstinence. Abstinence is typically interpreted as complete abstinence, defined below:

Continuous abstinence: not consuming the drug of choice during a specified period of time

Essentially abstinent: not consuming more than a specified amount of the drug over a period of time

Minimal abstinence: achieving a minimal period of recovery during a period of time

Point-in-time abstinence: not consuming the drug of choice at a single point in time (e.g., the past 30 days)

Complete abstinence: continuous abstinence from all alcohol and other drugs

Involuntary abstinence: enforced abstinence due to hospitalization or incarceration

ABUSER

(Stigma Alert) A person who exhibits impaired control over engaging in substance use (or other reward-seeking behavior, such as gambling) despite suffering severe harms caused by such activity.

In experimental research, the word "abuser" was found to increase stigma, which can affect quality of care and act as a barrier to treatment-seeking in individuals suffering from addiction. Instead, many have recommended the use of terms that reflect a disorder (e.g., "substance use disorder") and the use of " person first" language. Consequently, instead of describing someone as a "drug abuser," it may be less stigmatizing and more medically accurate to describe them as "a person with, or suffering from, addiction or substance use disorder."
Learn more about: The Real Stigma of Substance Use Disorders
ACUTE CARE

Immediate, short-term medically managed or monitored care, lasting up to 31 days in length. Most addiction treatment programs (e.g., "rehab") follow an acute care model. Understanding substance use disorder to be a chronic illness, recovery may require ongoing continuing care beyond acute treatment episodes.

ADDICT

(Stigma Alert) A person who exhibits impaired control over engaging in substance use (or other reward-seeking behavior, such as gambling) despite suffering severe harms caused by such activity. While this language is commonly used, in order to help decrease stigma associated with these conditions, it has been recommended to use "person first" language; instead of describing someone as an "addict," describe them as "a person with, or suffering from, addiction or substance use disorder."

ADDICTION

According to the American Society of Addiction Medicine (ASAM), addiction is a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestation. Addiction is characterized by behaviors that include:

Impaired control over drug use

Compulsive use

Continued use despite harm

Cravings

Learn more about: Addiction
ADDICTION TOURISM

The practice of sending individuals with substance use disorder to treatment centers or rehabilitation facilities outside of their states of permanent residence.

ALCOHOL

A liquid that is or contains ethanol or ethyl alcohol produced by the fermentation of sugars. Alcohol acts as a depressant to the central nervous system, producing feelings of relaxation and pleasure, reduced inhibitions, motor impairment, memory loss, slurred speech, and additionally at high doses can cause breathing problems, coma, or death. Alcohol consumption is also connected to increased risk of accidents (e.g., car crashes), risky sexual behavior, violent behavior, suicide, and homicide. Also known as juice, the hard stuff, sauce, suds, or most often by variety or brand name.

Long-term health consequences include: neurological impairment, liver disease, pancreatic disease, cancer (mouth, esophagus, throat, liver, breast), high blood pressure, stroke, heart problems, weakened immune system, Wernicke's Encepalopathy, Wernicke-Korsakoff syndrome, and fetal alcohol syndrome (in children of users).

ALCOHOLIC

(Stigma Alert) A person who exhibits impaired control over engaging in alcohol use despite suffering severe harms caused by such activity.

While this language is commonly used, in order to help decrease stigma associated with these conditions, it has been recommended to use "person first" language; instead of describing someone as an "addict," describe them as "a person with, or suffering from, addiction or substance use disorder."
Read the research: The Real Stigma of Substance Use Disorders
ALCOHOLICS ANONYMOUS (AA)

International fellowship for individuals with problematic drinking. Founded in 1935, AA is a nonprofessional, financially self-supporting, multiracial, apolitical organization that is open to all ages, and as the largest mutual-help organization, offers meetings in most locations in North America and most countries around the world.
Learn more about: Peer-Based Recovery Support
ALCOHOL USE DISORDER

A problematic pattern of alcohol consumption, characterized by compulsive use of alcohol, impaired control over alcohol intake, and a negative emotional state when not using. According to the 5 th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association, an alcohol use disorder is present if two or more of the following situations occur within a 12-month period:

Drinking more or for a longer period than intended

On more than one occasion feeling the need or attempting to cut down or stop drinking

Spending a lot of time drinking or recovering from the aftereffects of alcohol

Craving or thinking about wanting a drink, or having the urge to use alcohol

Failing to fulfill major work, school, or home responsibilities due to drinking

Continuing to drink even though it is causing relationship troubles with your family or friends

Prioritizing drinking by giving up or cutting back on activities that were important to you or gave you pleasure

Drinking before or during situations that are physically dangerous-while driving a car, operating machinery, swimming, or having unsafe sex

Continuing to drink even though drinking is making you feel depressed or anxious, is linked to another health problem, or results in having memory blackouts

Developing a tolerance for drinking-needing much more than you once did to get the desired effect from alcohol, or not experiencing the same effect when drinking the same amount of alcohol

Withdrawal, as characterized by having withdrawal symptoms (trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, a seizure, or sensing things that are not there [hallucinations])

ASSERTIVE LINKAGE

A strategy designed to ensure a patient or client reaches the next level of clinical care or becomes connected to a recovery support resource. This typically involves an in-person introduction directly to the next level of care or resource (e.g., a recovery coach takes a patient to their first AA meeting, and introduces them to other members of the meeting or drives them to a clinical appointment). Also known as a "warm hand-off."

Shown in research to have greater effectiveness than passive referral in increasing patients' engagement in continuing care and recovery support services. Peer linkages tend to have a higher efficacy than doctor or provider linkages, but clinicians can play a powerful role in creating this peer linkage infrastructure.

C

CASE MANAGEMENT

The collaborative process of assessment, planning, care coordination, evaluation, and advocacy for options and services to facilitate disease management (e.g. connecting individuals to mutual help organizations, peer & family support services and counseling, employment, housing, basic healthcare, childcare, etc.).

CHARITABLE CHOICE

Direct United States government funding of religious organizations to provide substance use prevention and treatment.

CLAIM

A bill (or invoice), typically in a standardized form, containing a description of care provided, applicable billing codes and a request for payment, submitted by the provider to the patient's insurance company (or the plan's third party administrator).

Appealing a Claim: The process to seek reversal of a denied behavioral health or medical claim. Most insurance carriers have their own process and timeline, but are subject to state and federal regulations.
Learn more about: Addiction Treatment Insurance
CLEAN

(stigma alert) A reference to a state of a person being abstinent from drugs of misuse. It may also be used in describing urine test results that are not positive for substance use. The term has been viewed as potentially stigmatizing because of its pejorative connotation, with the opposite being "dirty." Instead, many in the field advocate for use of proper medical terminology such as describing someone as an individual in remission or recovery and describing urine toxicology test results as either negative or positive.

( Kelly, Saitz, Wakeman, 2015)

COCAINE

A stimulant drug derived from the leaves of the coca plant, that activates the reward centers of the brain to produce sensations of extreme happiness and energy, increased mental alertness, hypersensitivity to sight, sound, and touch, irritability or anxiety, constricted blood vessels, dilated pupils, nausea, tremors and muscle twitches, rapid and/or irregular heartbeat, and increased blood pressure and body temperature. Also known as blow, coke, crack, rock, snow.

Long-term health consequences include: loss of sense of smell, extreme bowel decay, increased risk of HIV and Hepatitis.

Cocaine can be: inhaled (e.g. smoked, or vapors inhaled), snorted, or injected.

CODEINE

An analgesic opioid synthetically produced for the treatment of mild to moderate pain that works by activating the reward centers of the brain to provide pain relief. Side effects include headache, skin rash, constipation, changes in heart rate, hallucinations, loss of coordination, decreased sexual desire or irregular menstruation, and trouble breathing. Approved by the Food and Drug Administration in 1950, Codeine is frequently combined with acetaminophen () or as a prescription pain medication.

Long-term health consequences include: dependency, addiction, insomnia, nightmares, liver damage, and seizures.

CO-DEPENDENCY

(stigma alert) Immoderate emotional or psychological reliance on a partner. Often used with regard to a partner requiring support due to an illness or disease (e.g. substance use disorder).

The term has been viewed as stigmatizing as it tends to pathologize family members' concern and care for their loved one and may increase their shame.

COERCION

The intimidation of a victim to compel the individual to act against his or her will by the use of psychological pressure, physical force, or threats.

COLD TURKEY

Slang term for the abrupt and complete cessation in intake of an addictive substance. It stems from the appearance of goosebumps on the skin often observable in addicted individuals when physiologically withdrawing from a substance.

COMORBIDITY

The occurrence of two disorders or illnesses in the same person, also referred to as co-occurring conditions or sometimes dual diagnosis.
Learn more about: co-occurring disorders
CONTINGENCY MANAGEMENT

The contingency management (CM) approach, sometimes also referred to as motivational incentives, the prize method, or the carrot and stick method. It is based on the principle of operant conditioning - that behavior is shaped by its consequences.

It is comprised of a broad group of behavioral interventions that provide or withhold rewards and negative consequences quickly in response to at least one measurable behavior (e.g., substance use as measured by a drug test, also called a toxicology screen).
Learn more about: contingency management
CONTINUING CARE

Ongoing care of patients suffering from chronic incapacitating illness or disease. Understanding substance use disorder to be a chronic illness, it requires continuing care and ongoing recovery management rather than acute care or treatment delivered in isolated episodes.

CO-OCCURRING DISORDERS

This is used most often to describe in with both mental illness & substance use disorder. Personality disorder may also co-exist with psychiatric illness and/or substance use disorders. Also known as comorbidity or dual diagnosis.
Learn more about: co-occurring disorders
COPING STRATEGIES

The specific efforts, both behavioral & psychological, utilized to master, tolerate, reduce, or minimize the effects of stressful events.
Two general coping strategies have been distinguished as:

1. problem solving strategies (active efforts to alleviate stressful circumstances)

2. emotion focused strategies to regulate the emotional consequences of stressful or potentially stressful events.

CROSS-DEPENDENCE

The ability of one drug to prevent the withdrawal symptoms of one's physical dependence on another.

CROSS-TOLERANCE

An individual's tolerance for one drug results in their lessened response to another, typically in the same class of substances (e.g., alcohol, benzodiazepines), but may be observed across different classes of substances as well (e.g., alcohol, opioids).

D

DEATHS OF DESPAIR

Deaths by drug, alcohol, and/or suicide.

DENIAL

In a psychological sense: denial describes individuals who deny substance use problems. It is the tendency of addicted individuals to either disavow or distort variables associated with their drinking or drug use in spite of evidence to the contrary. It's a common misconception that all addicted individuals with substance use disorder are "in denial." In fact, individuals have various levels of awareness of their substance use problems and readiness to change behavior. Individuals may accurately recognize certain facts concerning their use, such as number of arrests or how often they drink, while at the same time, misperceive the impact that their use has on the individuals around them, their relationships, how they feel about themselves, or the implications of their substance use history.
Learn more about: addiction

In an insurance sense: denial refers to the refusal of a request for payment or reimbursement of behavioral health or medical treatment services.
Denied Claim: Non-payment of a claim for reimbursement of behavioral health or medical services delivered to the insured patient. The insurance company must inform the patient of the non-payment of the claim and explain why the services are not being reimbursed.

Learn more about: Addiction Treatment Insurance
DEPOT INJECTION

DEPRESSANT

Psychoactive substance that decreases levels of physiological or nervous system activity in the body decreasing alertness, attention, and energy through decreased heart rate, blood pressure, and respiration rates. Informally referred to as "downers" (e.g., alcohol; benzodiazepines, barbiturate).

DESIGNER DRUGS

A synthetic analog of an illegal drug, devised to circumvent drug laws through changes to chemical compounds.

DETERRENCE

The use of punishment as a threat to deter people from committing offences. Often contrasted with retributivism, which holds that punishment is a necessary consequence of a crime and should be calculated based on the gravity of the wrong done. A foundational concept of the United States "war on drugs."

DIRTY

(stigma alert) A reference to a urine test that is positive for substance use. A person still using substances. This term is viewed as stigmatizing because of its pejorative connotation. Instead, it is recommended to use proper medical terminology such as an individual having positive test results or currently to exhibit symptoms of substance use disorder.

DOPE SICK

(stigma alert) A slang term used to reference withdrawal symptoms from opioids, such as heroin. It is preferable to use more accurate terminology such as suffering from withdrawal.

DRUG

(stigma alert) Drug can mean either a "medication" or a "non-medically used psychoactive substance." The term drug has a stigma alert due to the ambiguity of the term. This ambiguity may create a barrier to accessing prescription (psychoactive) medications in cases where their use IS medically appropriate. Many advocate instead to use "medication" or "non-medically used psychoactive substances" to decrease stigma and communicate with greater specificity.

DRUG ABUSE

(stigma alert) A term sometimes used to describe an array of problems resulting from intensive use of psychoactive substances. It has also been used as a diagnostic label. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), "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, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).

2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)

3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)

4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Read the research: The Real Stigma of Substance Use Disorders
DRUG CLASSES

Substances can belong to one or more drug categories or classes. A drug class is a group of substances that while not identical, share certain similarities such as chemical structure, elicited effects, or intended usage.
Three common classes of commonly medications and non-medically used psychoactive substance include:

1. opioids (e.g. oxycodone, hydrocodone, fentanyl, morphine, heroin)

2. depressants (diazepam, clonazepam, alcohol)

3. stimulants (dextroamphetamine, methylphenidate, cocaine)

DRUG COURTS

Drug courts are problem-solving courts that operate under a specialized model in which the judiciary, prosecution, defense bar, probation, law enforcement, mental health, social service, and treatment communities work together to help non-violent offenders find restoration in recovery and become productive citizens. With an emphasis on rehabilitation and treatment, drug courts serve only a fraction of the estimated 1.2 million individuals suffering from Substance Use Disorder in the United States criminal justice system.

Learn more about:

DRUG DREAM

Reoccurring dreams that occur during the recovery process from substance use disorder that concern depictions of substance use, often vivid in nature, and frequently involving a relapse scenario. These dreams decrease in frequency with time in recovery from substance use disorder.

DRY DRUNK

(stigma alert) Originating in the 1970's book, The Dry Drunk Syndrome, by R.J. Solberg, the term is defined as the presence of actions and attitudes that characterize the individual with the alcohol use disorder prior to recovery.

Widely adopted by the Alcoholics Anonymous and peer support communities, this term identifies individuals who no longer utilize alcohol, but continue to behave dysfunction-ally (e.g. express rage/anger, intense fear), or regress in personal growth or within their recovery program.

DSM-5

DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS - Fifth Edition: The 2013 update to the American Psychiatric Association's (APA) classification and diagnostic tool. In the United States, the DSM-5 serves as a universal authority for psychiatric diagnosis.
Read more about: differences between the DSM-5 and DSM-IV
DUAL DIAGNOSIS

Describes patients with both mental illness and substance use disorder. Personality disorder may also co-exist with psychiatric illness and/or substance use disorders. Also known as comorbidity or co- occuring disorders.
Learn more about: co-occurring disorders
DYSYNERGY

The tendency of one addiction to predispose an individual to another type or form of addiction.

F

FENTANYL

A potent opioid synthetically produced in laboratories, that activates the reward centers of the brain to produce sensations of euphoria and provide pain relief. Side effects have included alterations in consciousness, sensations of heaviness, decreases in mental function, constipation, anxiety, changes in mood and appetite, nausea, dry mouth, intense itching, constricted pupils, and increased body temperature. Fentanyl is 50 to 100 times more potent than morphine, and is available in legal prescription form, and increasingly, in illegal illicit forms. Also known as Apache, China Girl, or Jackpot.

Long-term health consequences (most often through injection use) include: insomnia, infection of the heart lining and valves, collapsed veins, loss of sense of smell, abscesses, constipation, liver or kidney disease, pneumonia, sexual dysfunction (men), irregular menstrual cycles (women), increased risk of HIV and Hepatitis, coma or death.
Fentanyl can be:

In prescription form: injected, worn as a transdermal patch, or ingested through lozenges

In non-prescription illicit form: ingested (eaten), snorted, injected

See Infographic: Introduction to Fentanyl
FETAL ALCOHOL SYNDROME

An irreversible syndrome inherited by children exposed to alcohol consumption by the mother during pregnancy. This syndrome is characterized by physical and mental birth defects. This is currently more commonly referred to as fetal alcohol spectrum disorder.

H

HALLUCINOGEN

A substance that induces hallucinations (i.e. visions, sounds, smells, tastes, or sensations) that do not actually exist. Common examples include LSD ("acid") and psilocybin ("magic mushrooms"). Cannabis/marijuana in high doses also can act as a hallucinogen.

HARM REDUCTION

Policies, programs and practices that aim to reduce the harms associated with the use of alcohol or other drugs.

The defining features include a focus on the prevention of harm, rather than on the prevention of substance use itself, with attention and focus on the individual's active substance use (e.g., a clean needle exchange program can reduce rates of transmission of hepatitis C, HIV, or other infectious disease for individuals suffering from heroin use disorder).

HEROIN

A drug made from the opium poppy plant, that activates the reward centers of the brain to produce sensations of euphoria. Heroin can also produce alterations in consciousness, sensations of heaviness, decreases in mental function, nausea, dry mouth, intense itching, increased body temperature, coma or death. Also known as smack, hell dust, H.

Long-term health consequences (most often related to injection use) include: insomnia, infection of the heart lining and valves, collapsed veins, loss of sense of smell, abscesses, constipation, liver or kidney disease, pneumonia, sexual dysfunction (men), irregular menstrual cycles (women), increased risk of HIV and Hepatitis.

Heroin can be: inhaled (e.g. smoked), snorted, or injected.

HIGHER POWER

A supreme deity or being, a malleable conception of God, or a "power greater than ourselves," popularized by the recovery mutual-help organization, Alcoholics Anonymous.
Learn more about: peer-based recovery support
HYDROCODONE

An analgesic opioid semi-synthetically produced for the treatment of moderate to severe pain, that activates the reward centers of the brain to provide pain relief. Side effects include constipation, nausea, vomiting, upset stomach, sleepiness, drowsiness, dizziness, blurred vision, itching, headache, dry mouth, sweating, changes in heart rate, and trouble breathing. Hydrocodone is more likely to cause constipation and stomach pain than Oxycodone. Also known as Vicodin or dihydrocodeinone.

I

IBOGAINE

A naturally occurring psychoactive substance found in plants in the Apocynaceae family (NMDA receptor antagonist). Known to have psychedelic or dissociative properties, Ibogaine is not approved for treatment of substance use disorder in the United States due to lack of proper testing with regard to toxicology, and both the safety and effectiveness of the substance are largely unknown.

ICD-10

The International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 14,400 different codes, including those pertaining to alcohol and other drug-related illness, and permits the tracking of many new diagnoses.

Substances that produce chemical vapors that are inhaled to induce a psychoactive or mind-altering effect. There are four general categories of inhalants - volatile solvents, aerosols, gases, and nitrites.

INHALANT

Substances that produce chemical vapors that are inhaled to induce a psychoactive or mind-altering effect. There are four general categories of inhalants - volatile solvents, aerosols, gases, and nitrites.

IN-PATIENT TREATMENT

Admission to a hospital or facility for treatment that requires at least one overnight stay and typically requires medical management. (see residential treatment)

INTEGRATED HEALTH CARE

An approach characterized by a high degree of collaboration and communication among health professionals, with sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the physical, psychological and social needs of the patient.

The inter-professional health care team can include a diverse group of members (e.g., physicians, nurses, psychologists, social workers, and other health professionals), depending on patient needs.

INTEGRATED TREATMENT PROGRAMS

Treatment programs that work to treat substance use disorder alongside other co-occuring mental, physical, emotional or social considerations, recognizing how the presence of each can be a risk factor for relapse to either. The term is most often used to indicate the combination of addiction treatment services with mental health treatment services, or on-site pregnancy, parenting, or child-related services.

INTENSIVE OUTPATIENT TREATMENT

A time limited, intensive, non-residential clinical treatment that often involves participation in several hours of clinical services several days per week. It is a step below partial hospitalization in intensity.

INTERVENTION

1. A procedure of varying duration typically conducted by a clinician and implemented to stimulate, facilitate, and induce changes in signs, symptoms, or behavior.

2. A meeting of an individual with an identifiable substance-related problem with family or other significant others held to directly address the problems being caused by the individuals' substance use and typically involves expression of care, concern, and explicit demands for behavioral change or the receipt of addiction treatment. Typically conducted when other attempts to influence change have failed. Also known as the Johnson Intervention.

Learn more about: Resources for family and friends
M

MACRO DISCRIMINATION

The systematic unjust or prejudicial treatment of individuals or a group of individuals with, or in recovery, from a substance use disorder.

Examples of addiction-related macro discriminations include: left a recovery or addiction treatment program due to unfair treatment, difficulties getting health insurance or coverage, denied housing, food stamps, the right to vote, or a loan, could not get a job, was fired from your job, or could not get promoted at your job, unfair treatment by police, inadequate medical treatment.
See also Micro Discrimination
MARIJUANA

The leaves, flowers, stems and seeds of the hemp plant Cannabis sativa, containing the active ingredient of delta-9 tetrahydrocannabinol (THC) that can produce altered senses and perceptions of time, changes in mood and appetite, pain relief, impaired body movement, impaired problem-solving and memory, and at high doses, hallucinations, delusions, and psychosis. Also known as weed, pot, hashish, hash, ganga, herb, grass, 420, Mary Jane.

Long-term health consequences include: brain development in individuals under age 25, motivation and cognition

Long-term health benefits include: more research is needed according to the standards of evidence-based medicine.

Marijuana can be: inhaled (e.g. smoked, vaporized), ingested (e.g. edibles)

MATRIX MODEL

Implemented over the course of several months, the Matrix model is a highly-structured outpatient method generally used to treat stimulant-based substance use disorders (methamphetamines, cocaine, etc.). This model of treatment focuses on the patient working within a variety of group settings (i.e. family education groups, social support groups, early recovery skills groups, relapse prevention groups, 12-step groups, etc.).

MEASUREMENT-BASED PRACTICE

Measurement-based practice is a framework in which validated (evidence-based) symptom rating scales and screening tools are routinely used in clinical practice to inform treatment decisions and adjustments.

Scales and tools look to screen for and diagnose substance use disorder, measure severity, and monitor disease progression or improvement at every point of care, akin to the management of other chronic diseases such as hypertension and diabetes.
Listen to more about: Measurement-based practice
(Kelly JF, Mee-Lee D. Quality, accountability, and effectiveness in addiction treatment: The measurement-based practice model. In: Danovitch I, Mooney L, editors. The assessment and treatment of addiction: Best practices and new frontiers. In press.)

MEDICAL MODEL

An addiction theory that considers addiction a medical, rather than social issue.

MEDICAL NECESSITY

Health care services that are clinically indicated for the diagnosis and/or treatment of a medical or behavioral health condition.

Medical Necessity Appeal:An appeal filed when the health plan has denied payment or reimbursement for level of care or service based on a "lack of medically necessity." Synonymous with clinical utilization management appeals.
Learn more about: Addiction Treatment Insurance
MEDICATION ASSISTED DETOX

Detoxification in a medical setting, often with use of medications to support initial withdrawal and stabilization following cessation of alcohol or other drugs.

METHAMPHETAMINES

A stimulant drug synthetically produced, that activates the reward centers of the brain to produce sensations of euphoria, increased wakefulness and physical activity, decreased appetite, faster breathing, rapid and/or irregular heartbeat, and increased blood pressure and body temperature. Also known as meth, ice, crystal meth, speed, crank.

Long-term health consequences include: Extreme weight loss, severe dental problems (e.g. meth mouth, skin sores from intense itching, anxiety, confusion, sleeping problems, paranoia, hallucinations, increased risk of HIV and Hepatitis.

Methamphetamines can be: inhaled (e.g. smoked), swallowed as a pill, snorted, or injected.

MICRO DISCRIMINATION

The minor personal slights perceived to occur among people with, or in recovery from, a substance use disorder.

Examples of addiction-related micro discriminations include: avoided or ignored by people, people assuming you will relapse, people saying you look like an alcoholic or addict, treated less favorably, held to a higher standard, disrespected, perceived as dangerous, treated like a criminal, accused of being dishonest, reject by family or friends
See also Macro Discrimination
MODERATE DRINKING

According to HHS, moderate drinking is per day no more than 1 alcoholic drink for women and no more than 2 alcoholic drinks for men.

MORPHINE

An analgesic opioid derived from the opium poppy, that activates the centers of the brain to provide pain relief. Side effects have included nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, increased sweating, or dry mouth. Also known as Kadian or Avinza.

MOTIVATIONAL ENHANCEMENT THERAPY

Motivational Enhancement Therapy (MET) is an intervention based on Motivational Interviewing approaches and practices.

Unique to Motivational Enhancement Therapies is the use of clinically relevant patient reported assessment data that is summarized and subsequently fed back to the patient in an Motivational Interviewing (MI), client-centered, counseling style in order to enhance motivation for change.
Learn more about: Motivational Enhancement Therapies (MET)
MOTIVATIONAL INTERVIEWING (MI)

A clinical approach that helps people with mental health and substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health by helping them to explore and resolve ambivalence about changes.
The approach upholds four principles:

1. expressing empathy and avoiding arguing

2. developing discrepancy

3. rolling with resistance

4. supporting self-efficacy (client's belief s/he can successfully make a change)

This is non-directive approach to counseling that attempts to help patients resolve ambivalence about changing substance use and mobilize motivation and action toward healthier change.
Learn more about: Motivational Interviewing (MI)
MUTUAL HELP ORGANIZATIONS

Also known as self-help groups, peer support groups, and mutual aid, mutual help organizations are for the most part peer run volunteer organizations that focus on socially supportive communication and exchange of addiction and recovery experiences and skills.
Mutual help organizations include such organizations as:

Alcoholics Anonymous (AA)

Narcotics Anonymous (NA)

Marijuana Anonymous (MA)

Cocaine Anonymous (CA)

Smart Recovery

All Recovery Groups

Celebrate Recovery

LifeRing

Women For Sobriety

Other online forums.

For family members and friends mutual help organizations include: Learn more about: peer-based recovery support Learn more about: resources for family and friends
N

NALOXONE

An opioid antagonist, similar to Naltrexone, that works by blocking opioid receptors in the brain, thereby blocking the effects of opioid agonists (e.g., heroin, morphine). Naloxone has poor bio-availability when taken sublingually. Naloxone has a high affinity to the mu opioid receptor, yet not as high of an affinity as buprenorphine, at the mu receptor. Brand name: Narcan.
Learn more about: Pharmacotherapy and medications for substance use disorder See Infographic: How To Identify a Drug Overdose See Map: States with Layperson Access to Overdose Reversal Medication
NALTREXONE

An opioid antagonist, works by blocking opioid receptors in the brain, without activating them, therefore blocking the effects of opioids (e.g., heroin, morphine). Naltrexone has a high affinity to the Mu opioid receptor, but not as high as buprenorphine.
Learn more about: Pharmacotherapy and medications for substance use disorder
NARCOTIC

Originally, narcotic referred to psychoactive compounds with sleep inducing properties (typically opioids such as heroin). In moderate doses, narcotics will dull the senses, relieve pain, and induce sleep. In large doses, narcotics will cause stupor, coma, and death.

Today however, narcotic is often used in a legal context, where narcotic is used generally to refer to illegal or illicit substances.

NARCOTICS ANONYMOUS

Born out of the principles, practices, and structure of Alcoholics Anonymous (AA), Narcotics Anonymous is an international fellowship for individuals with problematic drug use. NA is a nonprofessional, self-supporting, multiracial, apolitical organization that is open to all ages, offering meetings in over 100 countries. NA is a 12-step program that revolves around its main text, known as the Basic Text.
Learn more about: peer-based recovery support
NETWORK (IN-NETWORK, OUT-OF-NETWORK)

In Network: The group of physicians, hospitals and other medical care professionals that a managed care plan has contracted with to deliver medical and/or behavioral health services to its members.

Out-of-Network: Physicians, hospitals, facilities and other health care providers that are not contracted with the plan or insurer to provide health care services at discounted rates. Depending on an individual's plan, expenses incurred by services provided by out-of-plan health care professionals may not be covered or may be only partially covered.

Learn more about: Addiction Treatment Insurance
NICOTINE

A toxic colorless or yellowish oily liquid that is the chief active constituent of tobacco. It acts as a stimulant in small doses, but in larger amounts blocks the action of autonomic nerve and skeletal muscle cells acting as a depressant.

NIMBY ("Not In My Backyard")

A characterization of opposition by residents to a proposed development within their local area, such as for addiction treatment centers or harm reduction programs. It often correlates with strong fears of increased crime, poverty, drug use, or community degradation. The term tends to carry the connotation that residents would tolerate or even support the new development, if it was not proposed in such close proximity to themselves (i.e., "Not In My Back Yard" or NIMBY).

NUMBER NEEDED TO TREAT (NNT)

The number needed to treat (NNT) is the average number of people who need to be treated to achieve one additional good outcome. The ideal number need to treat is 1, where everyone in the treatment group improves when no one in the control group improves. The higher the NNT, the less effective is the treatment.

P

PARADOXICAL DRUG EFFECT

Effects or reactions to a substance that are opposite to the substance's normal expected effect or outcome (e.g., feeling pain from a pain relief medication).

PARITY

The state or condition of being equal, especially regarding status, pay, or coverage.

PARTIAL HOSPITALIZATION

A time-limited, intensive, clinical service that is often medically monitored but is a step in intensity below inpatient hospitalization. A patient may participate in clinical services all day long for days to weeks but resides at home. Definitions of levels of care may vary by state.

PASSIVE REFERRAL

An attempt by a clinician or service worker to connect a patient with substance use disorder to another service.

Shown in research to be less effective than " assertive linkages" (which actively link a patient through personal contact with the service) in increasing patients' engagement in continuing care and recovery support services.

PATIENT ACTIVATION

How well patients are equipped to take an active role in their addiction related care, and to use the primary care services available to them, are unclear. More specifically defined as "understanding one's role in the care process and having the knowledge, skill, and confidence to manage one's health and health care."

PEER SUPPORT GROUP

Also known as mutual help organizations, peer support groups are structured non-clinical relationships, in which individuals participate in activities that engage, educate, and support patients recovering from substance use disorder. Peer to peer groups include such organizations as: AA, NA, Smart Recovery, All Recovery groups, LIfeRing, Women for Sobriety, and online forums.

As part of a larger treatment plan, peer providers offer valuable guidance and connection to individuals in recovery through the process of sharing their own experiences in recovery from substance use disorder.
Peer support groups include such organizations as:

Alcoholics Anonymous (AA)

Narcotics Anonymous (NA)

Marijuana Anonymous (MA)

Cocaine Anonymous (CA)

Smart Recovery

All Recovery Groups

Celebrate Recovery

LifeRing

Women For Sobriety

Other online forums.

For family members and friends peer support groups include: Learn more about: peer-based recovery support Learn more about: resources for family and friends
PERSON-FIRST LANGUAGE

A linguistic prescription structuring sentences to name the person first and the condition or disease from which they suffer, second. It is recommended to use "person first" language; instead of describing someone as an "addict", for instance, to describe them as a person with, or suffering from, addiction or a substance use disorder. Person-first language articulates that the disease is a secondary attribute and not the primary characteristic of the individual's identity.
Read more about: How to correctly talk about addiction Read more about: Does it really matter how we talk about addiction?
PINK CLOUD

An intense euphoric feeling experienced by some individuals in early recovery from substance use disorder in which the patient experiences highly positive and optimistic sentiments.

PHYSICAL DEPENDENCE

(stigma alert) This term may be stigmatizing when used to describe tolerance and withdrawal, as the term implies true dependence. However, this term does not meet the World Health Organization (WHO) International Classification of Diseases (ICD-10) diagnostic criteria for dependence, which would include at lease one psychological component.
Learn more about: addiction
POTENCY

The degree of concentration of the psychoactive ingredient of a substance.

PRESCRIPTION DRUG MISUSE

(stigma alert) The use of a medication without a prescription or usage of a drug in a way other than as prescribed; or for the experience or euphoric feeling elicited. This term is used interchangeably with "non-medically used psychoactive substance" or "prescription drug abuse". This term has a stigma alert as the word "misuse" is thought by some people as an expression of negative judgement. Instead, use clear, unambiguous, non-stigmatizing terminology such as "non-medical use of a psychoactive substance."
Read the research: The Real Stigma of Substance Use Disorders
PREVENTION PARADOX

A contradictory scenario whereby the majority of cases of substance-related harm come from a population at low or moderate risk of addiction, while only a minority of cases come from the population who are at high risk of substance-related harm.

Taking alcohol use as an example, an alcohol "prevention paradox" would be a case where low-risk drinkers would also require some kind of prevention/intervention to prevent overall harm in the population, despite the fact the incidence of risk is much lower in this group relative to the heavy drinking population.

PROBLEM-BEHAVIORAL THEORY

Proposed by Richard Jessor in 1991, Problem Behavior Theory is a conceptual framework that examines factors leading to adolescent substance use. The theory proposes that behavior is tied to goals, and adolescent substance use results when a teen holds goals and values that are unconventional or do not align with typical social values of society.

PSYCHODYNAMIC PSYCHOTHERAPY

A form of talk therapy that focuses on the psychological developmental histories and internal unconscious processes (e.g. needs, urges, desires) in the patients psyche that may present outwardly in a patient's behavior. A major goal is to help the patient gain insight into these implicit processes to help resolve internal conflict and behavioral problems.

PUBLIC HEALTH APPROACH

An approach to drug policy that is a coordinated, comprehensive effort that balances public health & safety in order to create safer, healthier communities, measuring success by the impact of both drug use & drug policies on the public's health.

PUNISHMENT

A negative consequence occurring following a behavior with the intention of decreasing the frequency of the behavior. It can take the form of "positive punishment" (e.g., the application of an adverse condition such as a mild electric shock) or "negative punishment" (e.g., the withdrawal of a privilege; "Time out" or "being grounded" is a good example of negative punishment for children).

PSYCHOSOCIAL THERAPY

They can also involve significant others such as a marriage or domestic partner (e.g., behavioral couples therapy) or one or more family members (e.g., family therapy) in an attempt to help attain and sustain remission from a substance use disorder.

R

RAPID DETOX

Anesthesia assisted detoxification; injection of high doses of an opiate antagonist.

RECOVERY CAPITAL

The resources (social, physical, human and cultural), which are necessary to begin and maintain recovery from substance use disorder.

( Best & Laudet, 2010; Cloud & Granfield, 2008)

RECOVERY RATES

The percentage of addicted persons undergoing treatment, who achieve abstinence or remission following treatment in some stated time period (e.g., in the year following discharge from treatment) Sometimes referred to as "success rate".

REINFORCEMENT (POSITIVE & NEGATIVE)

The application or withdrawal of a stimulus or condition with the goal of increasing the frequency of a behavior. Positive reinforcement uses the application of a reward following the behavior to increase behavior; negative reinforcement uses the withdrawal of a negative stimulus or condition to increase the frequency of behavior.

RELAPSE

(stigma alert) Relapse often indicates a recurrence of substance use. More technically, it would indicate the recurrence and reinstatement of a substance use disorder and would require an individual to be in remission prior to the occurrence of a relapse.

The highest risk for recurrence of substance use disorder symptoms occurs during the first 90 days following the initial intervention. The risk for recurrence of symptoms decreases after 90 days. This indicates that individuals attempting to recover from substance use disorder need the most intensive support during this first 3-month period, as individuals are experiencing substantial physiological, psychological, and social changes during this early recovery phase. There is typically a greater sensitivity to stress and lowered sensitivity to reward that makes continued recovery challenging.

This term has a stigma alert, as it can imply a moral failing for some people. Instead it may be preferable to use morally neutral terms such as "resumed," or experienced a "recurrence" of symptoms.
Learn more about: Relapse prevention
REMISSION

The complete absence of symptoms or the presence of symptoms but below a specified threshold. An individual is considered to "in remission" if they once met criteria for a substance use disorder, but have not surpassed the threshold number of criteria within the past year or longer.

Long-term recovery from a substance use disorder is considered by many to occur after 5 years, at which time the likelihood of meeting criteria for substance use disorder in the following year is no greater than that of the general population.

RESPONDENT-DRIVEN SAMPLING

Respondent-driven sampling is a method for creating a population sample for a research study that combines "snowball sampling" (where individuals refer people they know to the study, who then refer people they know, and so on), with mathematical models that weight the sample based on certain characteristics to help compensate for the sample not being collected at random.

S

SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT)

An evidence-based method used to detect, reduce, and prevent problematic substance use and substance use disorder.

SCREENING -An assessment - usually brief such as a paper and pencil self-report measures or a biological assay (e.g., urine/blood) - to help detect risky or harmful substance use. This is often conducted by healthcare professionals using standardized screening tools in a specific clinic or other setting.

BRIEF INTERVENTION -A short conversation or counseling session in which healthcare providers typically offer feedback and advice in order to motivate individuals identified as at-risk for substance-related harm to become more aware of the risk and to reduce or eliminate substance use or to seek treatment.

REFERRAL TO TREATMENT -The 3rd and final stage in the SBIRT model, when a healthcare provider formally refers a patient identified as having or is at-risk for substance use disorder to additional services such as brief therapy or longer-term treatment.

SEMI-SYNTHETIC OPIOIDS

Opioids derived from a combination of the opium poppy and synthetically man-made analogues.

SHAME

A painful, negative emotion, which can be caused or exacerbated by conduct that violates personal values. Can also stem from deeply held beliefs that one is somehow flawed and unworthy of love, support, and connection, leading to increased odds of isolation.

SNOWBALL SAMPLING

A method of creating a population sample for a research study where individuals who are participating in the study invite people they know to also participate, who then invite people they know, and so on.

SOBER

A state in which one is not intoxicated or affected by the use of alcohol or drugs.

STAGES OF CHANGE MODEL

From the Transtheoretical Model (TTM). The stages of change model is an integrative, biopsychosocial model used to conceptualize the process of intentional behavior change. It emerged from research that found individuals move through a series of stages when modifying behavior. Developed by Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992, the five stages of change are: pre-contemplation, contemplation, preparation, action, and maintenance. A sixth stage of relapse has also been suggested that occurs for many in the process of behavioral change before eventually reaching remission and recovery.

PRE-CONTEMPLATION -1st stage of the transtheoretical stage of change model Used to describe an individual who does not yet acknowledge an objectively observable substance-related problem (see also denial), and has no intention of changing behavior.

CONTEMPLATION - the 2nd stage in the transtheoretical "Stages of Change" model. It refers to acknowledging that there is a problem related to substance use/activity, but the individual is not yet ready or sure of wanting to make a change.

PREPARATION - the 3rd stage of the transtheoretical "Stages of Change" model signifying someone who has made a decision to change and is getting ready to do so.

ACTION - Changing behavior; the 4th stage of the "Stages of Change" transtheoretical behavioral change model. This stage marks the process or state of doing something, or getting something done, especially for a particular purpose: the exertion of power or energy.

MAINTENANCE - The 5th stage of the transtheoretical "Stages of Change" model. This stage marks the continuous process of maintaining or preserving abstinence, remission, or recovery. A type of treatment used to sustain a level of stability and health (e.g., methadone maintenance treatment for opioid use disorder).

Learn more about: the stages of recovery View infographic: Stages of Change Diagram
STIMULANT

A psychoactive substance that increases or arouses physiologic or nervous system activity in the body. A stimulant will typically increase alertness, attention, and energy through a corresponding increase in heart rate, blood pressure, and respiration rates. Informally referred to as "uppers" (e.g., cocaine, amphetamine/methamphetamine).

SUBOXONE

Approved by the FDA in 2002 as a medication treatment for opioid dependence, Suboxone contains the active ingredients of buprenorphine hydrochloride and naloxone. The mixture of agonist and antagonist is intended to reduce craving while preventing misuse of the medication.
Learn more about: Pharmacotherapy and medications for substance use disorder
SUBSTANCE ABUSE

(stigma alert) A term sometimes used to describe an array of problems resulting from intensive use of psychoactive substances. It has also been used as a diagnostic label. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), "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, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).

2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)

3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)

4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Read more about: How to correctly talk about addiction Read more about: Does it really matter how we talk about addiction? Read the research: The Real Stigma of Substance Use Disorders
SUBSTANCE DEPENDENCE

A term used synonymously with "addiction" but sometimes also used to distinguish physiological dependence from the syndrome of addiction/substance use disorder. It was used in prior iterations of the DSM to signify the latter.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

1. Tolerance, as defined by either of the following:

A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or

Markedly diminished effect with continued use of the same amount of the substance.

2. Withdrawal, as manifested by either of the following:

The characteristic withdrawal syndrome for the substance or

The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

3. The substance is often taken in larger amounts or over a longer period than intended.

4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.

6. Important social, occupational, or recreational activities are given up or reduced because of substance use.

7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

SUBSTANCE MISUSE

(stigma alert) The use of a substance for unintended or intended purposes in improper amounts or doses. Term has a stigma alert, as some people believe it implies negative judgement and blame. Instead, many recommend using the terms "substance use" or "non-medical use."

SUBSTANCE USE DISORDER

The clinical term describing a syndrome consisting of a coherent set of signs and symptoms that cause significant distress and or impairment during the same 12-month period.
Learn more about: Addiction View Infographic: Diagnosing Substance Use Disorder
SUSTAINED REMISSION

Someone who once met diagnostic criteria for an alcohol or other drug use disorder, and then no longer meets the threshold for the disorder for at least 1 year.

SYNDROME

A group of signs and symptoms that appear together and characterize a disease or medical condition.

SYNERGISTIC EFFECT

An effect caused by the interaction of two or more substances that magnifies the effect to be greater than the sum of each substance's individual effects.

SYNTHETIC

Made synthetically or entirely from chemicals, and not made as a derivative of the original substance or plant (e.g. the opium poppy, marijuana plant, etc.) Examples of synthetic drugs include: carfentanil/carfentanyl, sufentanil, fentanyl, spice, bath salts, & herbal incense.

SYNTHETIC MARIJUANA

Synthetic compounds produced in laboratories to mimic the effects of the active ingredient in marijuana, delta-9 tetrahydrocannabinol (THC). While the intention of these compounds are to mimic the effects of marijuana, this is not always achieved. As one strain of synthetic marijuana is banned and made illegal, new compound combinations are created to avoid regulation. The result is the ongoing creation of compounds that are structurally more and more different from the natural THC found in marijuana, increasing the potential risks associated. Side effects have included vomiting, sweating, seizures, body spasms, rapid and/or irregular heartbeat, increased blood pressure, severe paranoia and hallucinations. Also known as K2, spice.
Long-term health consequences are unknown.
K2 can be: inhaled (e.g. smoked, vaporized), ingested (e.g. edibles)

T

TOLERANCE

A normal neurobiological adaptation process characterized by the brain's attempt to accommodate abnormally high exposure to a drug. Tolerance results in a need to increase the dosage of a drug overtime to obtain the same original effect obtained at a lower dose. A state in which a substance produces a diminishing biological or behavioral response (e.g. an increasingly higher dosage is needed to produce the same euphoric effect experienced initially).

TOUGH LOVE

A controversial approach to promotion of behavioral change through love or affectionate concern expressed in a stern or unsentimental manner (as through discipline).

First used in 1976, the term "tough love" was not applied to the addiction model until the 1980s, when David and Phyllis York wrote an influential book about the addiction and rehabilitation of their daughter entitled Toughlove. In the book, the authors outline a view of rehabilitation techniques parents should use with their addicted children that relies on consequences ranging from mild to severe such as: take legal custody of the children of the individual with substance use disorder, refusal to provide financial assistance, asking the individual to leave the home, or refusing to provide bail money or legal assistance.

The logic behind the "tough love" approach is founded in the belief that the parent is in control of the household, and the child is in control of their behavior. If the child does not accept the rules of the house, the child is not allowed to stay in the house. When faced with the choice of being asked to leave the house, the ideal outcome would be that the child would choose sobriety.

Today a balance in the implementation of the tough love concept as a practice is suggested, and individuals should seek professional help rather than trying to produce results by themselves.
Learn more about: Resources for family and friends
TREATMENT LIMITATIONS

Quantitative Treatment Limitation (QTL) Limits based on frequency of treatment, number of visits, days of coverage or days in a waiting period. A limitation that is expressed numerically, such as an annual limit of 50 outpatient visits.

Non-Quantitative Treatment Limitation (NQTL) Any non-financial treatment limitation imposed by a health plan that limits the scope or duration of treatment (i.e. pre-authorization, medical necessity, utilization review, exclusions, etc.).
Learn more about: Addiction Treatment Insurance
TRIGGER

A specific stimulus that sets off a memory or flashback, transporting the individual back to a feeling, experience, or event which may increase susceptibility to psychological or physical symptom recurrence and reinstatement of substance use disorder.

TWO-STEPPING

A derisory term used to describe individuals in Alcoholic Anonymous (AA) or other 12-step programs, who practice step one and portions of the 12 th step of the 12-step program (i.e., remain abstinent and carry the message of recovery to other individuals suffering from addiction) but do not practice any other steps or principles of the 12-step program.
Learn more about: peer-based recovery support

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SAMHSA - The Substance Abuse Mental Health Services Administration

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SAMHSA - Substance Abuse and Mental Health Services Administration

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SAMHSA.gov, Substance Abuse and Mental Health Services Administration

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Publication: Top 10 Things Palliative Care Doctors Need to Know About OUD

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Publication: Top 10 Things Palliative Care Doctors Need to Know About OUD

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Publication: Primary addiction med skills for HPM physicians

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Publication: Primary addiction med skills for HPM physicians

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Publication: opioid risk tool to predict OUD in non-cancer patients with pain

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Publication: opioid risk tool to predict OUD in non-cancer patients with pain

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Publication: Nonmedical opioid use behaviors in cancer patients

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Publication: Nonmedical opioid use behaviors in cancer patients

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Publication: Things we do for no reason - Discontinuing bup when treating acute pain

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Publication: Things we do for no reason - Discontinuing bup when treating acute pain

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things we do for no reason stopping buprenorphine

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Publication: Acute Pain Management for Patients on Methadone or Bup

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Publication: Acute Pain Management for Patients on Methadone or Bup

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pain management for pts on methadone or bup

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Publication: Dying on Hospice in the Midst of an Opioid Crisis

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Publication: Dying on Hospice in the Midst of an Opioid Crisis

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Publication: Chronic Pain and OUD in Palliative Care Outpatient Clinic

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Publication: Chronic Pain and OUD in Palliative Care Outpatient Clinic

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CHILDERS chronic pain and OUD in palliative care clinic

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Publication: Managing OUD in Setting of Terminal Illness 

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Publication: Managing OUD in Setting of Terminal Illness 

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Intersections of OUD and Serious Illness Handout by Jen Olenik and Erin Haley

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Intersections of OUD and Serious Illness Handout by Jen Olenik and Erin Haley

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Intersections of Opioid Use Disorder and Serious Illness Handout