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National Collaborating Centre for Mental Health (UK). Drug Misuse: Psychosocial Interventions. Leicester (UK): British Psychological Society; 2008. (NICE Clinical Guidelines, No. 51.)

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Drug Misuse: Psychosocial Interventions.

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11. GLOSSARY

12-step self-help group

A non-profit fellowship of people who meet regularly to help each other remain abstinent. The core of the 12-step programme is a series of 12 stages that include admitting to a drug problem, seeking help, self-appraisal, confidential self-disclosure, making amends (when possible) where harm has been done, achieving a spiritual awakening and supporting other people who misuse drugs who want to recover.

Abstinence

Abstinence-oriented treatments aim to reduce an individual’s level of drug use, with the ultimate goal of refraining from use altogether.

Agonist

An agonist is a substance that mimics the actions of a neurotransmitter or hormone to produce a response when it binds to a specific receptor in the brain. Opioid drugs, for example heroin and methadone, are agonists that produce responses such as ‘liking’, analgesia and respiratory depression.

Alcoholics Anonymous

Alcoholics Anonymous is an informal fellowship of people who, through shared experiences and support for one another, aim to achieve abstinence and help others to recover from alcoholism. The only requirement for membership is a desire to stop misusing alcohol. An international organisation, AA was founded in the US in 1935 and established in the UK in 1947. It was from AA that the 12-step treatment model originated.

Antagonist

In contrast to the action of an agonist, an antagonist, such as naltrexone, binds to a specific receptor in the brain but does not activate it. Therefore, if an agonist, for example heroin or methadone, is present and activating the receptor, taking naltrexone will counteract the activation, resulting in withdrawal.

Behavioural couples therapy

Behavioural couples therapy usually involves (a) the person who misuses drugs stating his or her intention not to use drugs each day and his or her partner expressing support for the former’s efforts to stay abstinent; (b) teaching more effective communication skills, such as active listening and expressing feelings directly; and (c) helping to increase positive behavioural exchanges between partners by encouraging them to acknowledge pleasing behaviours and engage in shared recreational activities (Fals-Stewart et al., 2002).

Brief intervention

Brief interventions are those with a maximum duration of two sessions, lasting up to an hour each. The main principles include expressing empathy with the service user, not opposing resistance and offering feedback in order to increase the motivation of the service user to make changes to his or her drug use.

Buprenorphine

An analgesic opioid substitute used in maintenance-oriented treatment, buprenorphine has both agonist and antagonist properties.

Cannabis

Cannabis is a generic term denoting the various psychoactive preparations of the hemp plant, including marijuana leaves, hashish resin and oil (WHO, 2006). It is the most commonly used illicit drug in the UK.

Case management

Case management is a method of co-coordinating care for people who misuse drugs. An individual worker, the case manager, is responsible for the coordination and, where necessary, provision of this care. Contact with the case manager is usually expected to be on a regular ongoing basis.

Cognitive behavioural therapy

Cognitive behavioural therapy encompasses a range of behavioural and cognitive behavioural therapies, in part derived from the cognitive behavioural model of affective disorders, in which the patient works collaboratively with a therapist using a shared formulation to achieve specific treatment goals. Such goals may include recognising the impact of behavioural and/or thinking patterns on feeling states and encouraging alternative cognitive and/or behavioural coping skills to reduce the severity of target symptoms and problems. Therapies relevant to the field of drug misuse include standard cognitive behavioural therapy and relapse-prevention cognitive behavioural therapy.

Confidence interval

The range within which the ‘true’ values (for example, size of effect of an intervention) are expected to lie with a given degree of certainty (for example, 95% or 99%). (Note: confidence intervals represent the probability of random errors, but not systematic errors or bias.)

Contingency management

Contingency management provides a system of incentives and disincentives designed to make continual drug use less attractive and abstinence more attractive (Griffith et al., 2000). The three main methods of providing incentives are voucher-based, whereby vouchers representing monetary values are provided upon receipt of biological samples (usually urine) that are negative for the tested drugs, prize-based (whereby participants receive prize-draw entries upon presentation of a negative biological sample) and privilege-based (whereby participants receive privileges such as take home methadone doses upon presentation of a negative biological sample).

Dependence

Dependence is defined by the WHO as a strong desire or sense of compulsion to take a substance, a difficulty in controlling its use, the presence of a physiological withdrawal state, tolerance of the use of the drug, neglect of alternative pleasures and interests and persistent use of the drug, despite harm to oneself and others (WHO, 2006).

Detoxification

Detoxification is the process by which an individual is withdrawn from the effects of a psychoactive substance. As a clinical procedure, the withdrawal process should be supervised and carried out in a safe and effective manner, such that withdrawal symptoms are minimised. Typically, the individual is clinically intoxicated or already in withdrawal at the outset of detoxification. Detoxification may involve the administration of medication, the dose of which is calculated to relieve withdrawal symptoms without inducing intoxication, and is gradually tapered off as the individual recovers.

Drug misuse/problem drug use

Drug misuse is the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). The ACMD defines problem drug use as a condition that may cause an individual to experience social, psychological, physical or legal problems related to intoxication and/or regular excessive consumption, and/or dependence; any injection drug use also constitutes misuse (ACMD, 1998).

Extended outpatient treatment

Treatment occurs in regularly scheduled sessions, usually totalling fewer than 9 contact hours per week. Examples include weekly or twice-weekly individual therapy, weekly group therapy or a combination of the two in association with participation in self-help groups.

False negative

A test result that fails to detect an effect, condition or drug when it is in fact present.

False positive

A test result that incorrectly shows an effect, condition or drug to be present when it is not.

Family-based intervention

Family-based interventions work jointly with the person who misuses drugs and his or her family members, partner or others from a wider social network (for example, a close friend) to seek reduced drug use or abstinence based on cognitive-behavioural principles.

Harm reduction

Measures aiming to prevent or reduce negative health or other consequences associated with drug misuse, whether to the drug-using individual or to society. Attempts are not necessarily made to reduce the drug use itself.

Incremental cost-effectiveness ratio

The difference in the mean costs in the population of interest divided by the differences in the main outcomes in the population of interest.

Interpersonal therapy

A discrete, time limited, structured psychological intervention that focuses on interpersonal issues and where therapist and service user: a) work collaboratively to identify the effects of key problematic areas related to interpersonal conflicts, role transitions, grief and loss, and social skills, and their effects on current drug misuse, feelings states and/or problems; and b) seek to reduce drug misuse problems by learning to cope with or resolve interpersonal problem areas.

Last observation carried forward

A type of data analysis used in clinical trials, often when data is lacking, in which the last results before a subject drops out of the trial are counted as if they occurred at the end of the trial.

Legally coerced (drug) treatment

This requires that the person who misuses drugs enter into treatment as an alternative or adjunct to criminal sanctions (Wild et al., 2002). Such treatment can either be legally ordered by the court or through diversion away from the judicial process, usually following arrest and charge for drug-related and other offences.

Maintenance

In the UK context this refers primarily to the pharmacological maintenance of people who are opioid dependent; that is, prescription of opioid substitutes (methadone or buprenorphine). This aims to reduce illicit drug use and its consequent harms.

Meta-analysis

The use of statistical techniques to integrate the results of several independent studies.

Methadone

A synthetic, psychoactive opioid substitute used in maintenance-oriented treatment, particularly heroin dependence. Methadone has agonist properties.

Naltrexone

An antagonist that blocks the effects of opioid drugs on receptors in the brain, naltrexone is used in maintenance treatment to prevent detoxified service users from relapsing to opioid use.

Narcotics Anonymous

Narcotics Anonymous is a non-profit fellowship of men and women for whom drug misuse has become a severe problem. Members meet regularly with the aim of helping each other to remain abstinent. The only requirement for membership is a desire to stop misusing drugs. Originating in the US in 1953, the first UK NA meeting was held in 1980. At the core of the NA programme is the 12-step treatment model, adapted from Alcoholics Anonymous.

National Collaborating Centre for Mental Health

One of seven centres established by the National Institute for Health and Clinical Excellence to develop guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales. Established in 2001, the NCCMH is responsible for developing mental health guidelines, and is a partnership between the Royal College of Psychiatrists and the British Psychological Society.

National Institute for Health and Clinical Excellence

An independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. It provides guidance on three areas of health: clinical practice, public health and health technologies.

National Treatment Agency for Substance Misuse

The NTA is a special health authority, which was established by the government in 2001. It is tasked with increasing the availability, capacity and effectiveness of treatment for drug misuse in England and embraces user involvement as a core component of its strategy.

Near-patient testing

This refers to the process of obtaining a biological sample from a service user and using a drug-testing kit to immediately detect the presence of any of a variety of substances (for example, opioids, amphetamines, cocaine metabolite, benzodiazepines, methadone and cannabis) on site. This process eliminates the need for external laboratory support and provides rapid results.

Needle and syringe exchange

A service aiming to reduce transmission of blood-borne viruses through the promotion of safer drug injection behaviour, primarily via the distribution of sterile needles, but often also by offering education and other psychosocial interventions.

Neurotransmitter

A chemical messenger (for example, dopamine or noradrenaline) used by nerve cells to transmit nerve impulses from one nerve cell (neuron) to another, or between neurons and other tissues, such as muscles or glands.

Opioid

Opioids refer to a class of psychoactive substances derived from the poppy plant, including opium, morphine and codeine, as well as their semi-synthetic counterparts, including heroin (WHO, UNODC & UNAIDS, 2004). In this guideline, the term ‘opioid’ is used more broadly to incorporate synthetic compounds (including methadone) with similar properties, also commonly known as opioids.

Outreach

Outreach involves targeting high risk and local priority groups. The general aims of outreach work are to: identify and contact hidden populations, refer members of these populations to existing care services, initiate activities aimed at prevention and at demand reduction, and to promote safer sex and safer drug use (European Monitoring Centre for Drugs and Drug Addiction, 1999).

Point abstinence

Point abstinence refers to evidence for the absence of drug use at a particular point in time (for example, at the end of treatment or at 12-month follow-up).

Psychoeducation

Psychoeducation is a programme designed for individuals or groups of people who misuse drugs that combines education about blood-borne viruses with skills training to improve communication, assertiveness and safe sexual and injection risk behaviour. It also provides people with an opportunity to ask questions and receive relevant feedback.

Psychosocial intervention

Any formal, structured psychological or social intervention with assessment, clearly defined treatment plans and treatment goals, and regular reviews (NTA, 2006), as opposed to advice and information, drop-in support or informal keyworking.

Purified protein derivative

The name given to the protein extracted from the bacterium responsible for TB and is used in a skin test for the virus. A small amount of the protein is injected under the skin; if the person has been previously infected, a reaction in the form of a hard red bump will form.

Quality adjusted life years

A form of utility measure calculated by estimating the total life years gained from a treatment and weighting each year with a quality-of-life score in that year.

Randomised controlled trial

An experiment in which investigators randomly allocate eligible people into groups to receive or not to receive one or more interventions that are being compared. The results are assessed by comparing outcomes in the different groups. Through randomisation, the groups should be similar in all aspects, apart from the treatment they receive during the study.

Relapse-prevention cognitive behavioural therapy

This differs from standard cognitive behavioural therapy in the emphasis on training drug users to develop skills to identify situations or states where they are most vulnerable to drug use, to avoid high-risk situations, and to use a range of cognitive and behavioural strategies to cope effectively with these situations (Carroll & Onken, 2005).

Relative risk

The ratio of risk in the intervention group to the risk in the control group. The risk (proportion, probability or rate) is the ratio of people with an event in a group to the total in the group. An RR of 1 indicates no difference between comparison groups. For undesirable outcomes, an RR that is less than 1 indicates that the intervention was effective in reducing the risk of that outcome.

Residential rehabilitation programme

Residential rehabilitation centres provide accommodation in a drug-free environment and a range of structured interventions to address drug misuse, including, but not limited to, abstinence-oriented interventions (NTA, 2006). Services vary and are based on a number of different treatment philosophies.

Screening

The systematic application of a test or enquiry to identify individuals at high risk of developing a specific disorder who may benefit from further investigation or preventative action (Peckham & Dezateux, 1998). Routine screening for drug misuse in the UK is largely restricted to criminal justice settings, including police custody and prisons (Matrix Research and Consultancy & NACRO, 2004).

Self-help group

A group of people who misuse drugs meet regularly to provide help and support for one another. The group is typically community-based, peer-led and non-professional.

Sensitivity

A term used to assess screening tools, sensitivity refers to the proportion of people with disease who test positive for that disease.

Short-term psychodynamic intervention

A psychological intervention, derived from a psychodynamic/psychoanalytic model in which: a) therapist and patient explore and gain insight into conflicts and how these are represented in current situations and relationships, including the therapy relationship; b) service users are given an opportunity to explore feelings and conscious and unconscious conflicts originating in the past, with the technical focus on interpreting and working through conflicts; c) therapy is non-directive and service users are not taught specific skills such as thought monitoring, re-evaluation or problem solving. Treatment typically consists of 16–30 sessions (Leichsenring et al., 2004).

Specificity

A term used to assess screening tools, specificity refers to the proportion of people without disease who test negative for that disease.

Standard cognitive behavioural therapy

A discrete, time limited, structured psychological intervention, derived from a cognitive model of drug misuse (Beck et al., 1993). There is an emphasis on identifying and modifying irrational thoughts, managing negative mood and intervening after a lapse to prevent a full-blown relapse (Maude-Griffin, 1998).

Standard deviation

A statistical measure of variability in a population of individuals or in a set of data. While the average measures the expected middle position of a group of numbers, the standard deviation is a way of expressing how different the numbers are from the average. The standard deviation is (approximately) the amount by which the average person’s score differs from the average of all scores.

Standardised mean difference

In a meta-analysis, an SMD is a way of combining the results of studies that may have measured the same outcome in different ways, using different scales. Statistically, it is calculated by dividing the weighted average effect size by the pooled standard deviation. The SMD is expressed as a standard value with no units.

Stimulant

Broadly any substances that activate, enhance or increase neural activity (WHO, 2006). Illicit stimulants include cocaine, crack cocaine and methamphetamine. Cocaine is one of the most commonly misused stimulants in the UK; crack cocaine refers to the cocaine alkaloid that has been purified from the other components of cocaine powder, and methamphetamine is one of a group of synthetic substances (amphetamines) with broadly similar properties to cocaine.

Systematic review

Research that summarises the evidence on a clearly formulated question according to a predefined protocol using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, collate and report their findings. It may or may not use statistical meta-analysis.

Therapeutic community

The primary goal of therapeutic communities is abstinence from illicit and prescribed drugs, with the residential ‘community’ acting as the key agent for change. Peer influence is used to help individuals acquire social skills and learn social norms, and so take on an increased level of personal and social responsibility within the unit (Smith et al., 2006).

Weighted mean difference

A method of meta-analysis used to combine measures on continuous scales, where the mean, standard deviation and sample size in each group are known. The weight given to each study (for example, how much influence each study has on the overall results of the meta-analysis) is determined by the precision of its estimate of effect and, in the statistical software used by the NCCMH, is equal to the inverse of the variance. This method assumes that all of the trials have measured the outcome on the same scale.

Withdrawal symptoms

Withdrawal symptoms ensue when a person who has become tolerant to the effects of a drug stops taking it. Such symptoms typically emerge within 6–12 hours for short-acting opioids such as heroin and about 24–36 hours after the last dose of methadone or buprenorphine, depending on the dose. Withdrawal can also ensue when an opioid antagonist, such as naloxone or naltrexone is taken; this is called precipitated or abrupt withdrawal. Opioid withdrawal symptoms can include pupil dilation, diarrhoea, low mood, irritability, anxiety, insomnia, muscular and abdominal pains, restlessness and ‘craving’. In addition, tachycardia, sweating, runny nose, hair standing on end and shivering are generally experienced.

Copyright © 2008, The British Psychological Society & The Royal College of Psychiatrists.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

Bookshelf ID: NBK53231

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