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Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 43.)

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Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.

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Appendix C: Glossary

-A-

abstinence. Nonuse of alcohol or any illicit drugs, as well as nonabuse of medications normally obtained by prescription or over the counter. Abstinence in this TIP does not refer to nonuse of or withdrawal from maintenance medications (methadone, buprenorphine, LAAM, or naltrexone) when they are used in MAT. Compare medically supervised withdrawal.

accreditation. Process of periodic review of an OTP for conformance with accrediting-body standards. Accrediting bodies and their standards are approved by SAMHSA. See 42 CFR, Part 8 § 2, for other accreditation-related terms and definitions.

acute phase. Initial and usually the most symptomatic intensive-treatment phase of MAT.

addiction. Combination of the physical dependence on, behavioral manifestations of the use of, and subjective sense of need and craving for a psychoactive substance, leading to compulsive use of the substance either for its positive effects or to avoid negative effects associated with abstinence from that substance. Compare dependence.

administrative discharge. Release or discharge of a patient from an OTP, often against the patient's wishes. See involuntary discharge.

admission. Formal process of enrolling patients in an OTP, carried out by qualified personnel who determine that the patient meets acceptable medical criteria for treatment. Admission can include orientation to the program and an introduction to peer support, patient rights, services, rules, and treatment requirements related to MAT.

agonist. See opioid agonist.

analgesic. A compound that alleviates pain without causing loss of consciousness. Opioid analgesics are a class of compounds that bind to specific receptors in the central nervous system to block the perception of pain or affect the emotional response to pain. Such compounds include opium and its derivatives, as well as a number of synthetic compounds. Chronic administration or abuse of opioid analgesics may lead to addiction.

antagonist. See opioid antagonist.

assessment. Process of identifying the precise nature and extent of a patient's substance use disorder and other medical, mental health, and social problems as a basis for treatment planning. Assessment usually begins during program admission and continues throughout treatment. It includes a personal substance abuse history, physical examination, laboratory evaluation, and determination of disease morbidity. Severity of disease often is assessed further in terms of physiologic dependence, organ system damage, and psychosocial morbidity. Assessment also may involve determining patient motivation and readiness for change.

assessment tools. Instruments (e.g., questionnaires) used to capture the range of patient variables affecting treatment planning, methods, and outcomes. Valid assessment tools contain quantifiable indicators to measure patient progress and to track patients through treatment.

Axis I. DSM-IV-TR disorder classification comprising definitions and descriptions of major disorders (i.e., psychotic, mood, and substance use disorders) that may require clinical attention.

-B-

benzodiazepines. Group of medications having a common molecular structure and similar pharmacological activity, including antianxiety, sedative, hypnotic, amnestic, anticonvulsant, and muscle-relaxing effects. Benzodiazepines are among the most widely prescribed medications (e.g., diazepam, chlordiazepoxide, clonazepam, alprazolam, lorazepam).

best-treatment practices. Methods determined, often by a consensus of experts, to be optimal for defined therapeutic situations. Such guidelines usually are based on both an analysis of published research findings and the experience of experts.

blood testing. Identifying evidence of opioid and other psychoactive substance use and measuring the levels of substances or medications in the body by examining patient blood specimens for the presence and concentrations of identifiable drugs and their metabolites.

buprenorphine. Partial opioid agonist approved by FDA for use in detoxification or maintenance treatment of opioid addiction and marketed under the trade names Subutex® and Suboxone® (the latter also containing naloxone).

-C-

certification. Process by which SAMHSA determines that an OTP is qualified to provide opioid addiction treatment under the Federal opioid treatment standards.

civil commitment. Legal process that permits individuals to be confined against their will in psychiatric or other treatment facilities, which usually is justified by determining that a patient is a threat to himself or herself or others. Although statutes permitting involuntary civil commitment may remain in some States, such laws rarely have been used to commit people who abuse substances and are not under criminal justice jurisdiction.

Commission on Accreditation of Rehabilitation Facilities (CARF). One of several SAMHSA-approved accreditation organizations charged with ensuring that OTPs meet the standards set forth in Federal regulations and SAMHSA guidelines. Also known as CARF… The Rehabilitation Accreditation Commission.

comprehensive maintenance treatment. Continuous therapy with medication in conjunction with a wide range of medical, psychiatric, and psychosocial services. Compare medical maintenance.

comprehensive treatment assessment. Evaluation made after formal admission to an OTP, in which trained staff members determine the range and severity of a patient's problems and the patient's service needs. These determinations are used to establish short- and long-term treatment goals in the patient's treatment plan.

confidentiality regulations. Rules established by Federal and State agencies to limit disclosure of information about a patient's substance use disorder and treatment (described in 42 CFR, Part 2 § 16). Programs must notify patients of their rights to confidentiality, provide a written summary of these rights, and establish written procedures regulating access to and use of patient records.

consent to treatment. Form completed with and signed by an applicant for MAT and by designated treatment program staff members, which verifies that the applicant has been informed of and understands program procedures and his or her rights and treatment goals, risks, and performance expectations.

contingency contracting. Use of preestablished, mutually agreed-on privileges (e.g., take-home dosing) or consequences (e.g., loss of privileges) to motivate improvements in treatment outcomes. Many experts agree that negative contingencies in MAT (e.g., reduction in medication) are neither effective nor ethical and should be avoided.

continuing-care phase. Optional phase of MAT in which patients who have completed medically supervised withdrawal from treatment medication and are leading socially productive lives continue to maintain regular contact with their treatment program.

co-occurring disorder. In this TIP, a mental disorder, according to DSM-IV diagnosis, that is present in an individual who is admitted to an OTP.

counseling. In MAT, a treatment service in which a trained counselor and a case manager evaluate both a patient's external circumstances and immediate treatment progress and offer appropriate advice and assistance or referral to other experts and services as needed. A major objective in MAT is to provide skills and support for a substance-free lifestyle and encourage abstinence from alcohol and other psychoactive substances. Compare psychotherapy.

craving. Urgent, seemingly overpowering desire to use a substance, which often is associated with tension, anxiety, or other dysphoric, depressive, or negative affective states.

cross-tolerance. Condition in which repeated administration of a drug results in diminished effects not only for that drug but also for one or more drugs from a similar class to which the individual has not been exposed recently.

cultural competence. Capacity of a service provider or organization to understand and work effectively in accord with the beliefs and practices of persons from a given ethnic/racial/religious/social group or sexual orientation. It includes the holding of knowledge, skills, and attitudes that allow the treatment provider and program to understand the full context of a patient's current and past socioenvironmental situation.

cultural diversity. Differences in backgrounds and beliefs that may affect the way groups of patients in OTPs and individuals within these groups view the world and their place in it, their substance use, and treatment.

-D-

dependence. State of physical adaptation that is manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, and/or decreasing blood level of a substance and/or administration of an antagonist. Compare addiction.

detoxification. In this TIP, treatment for addiction to an illicit substance in which the substance is eliminated gradually from a patient's body while various types and levels of reinforcing treatment are provided to alleviate adverse physical or psychological reactions to the withdrawal process. This TIP avoids the term “detoxification” to designate the process of dose tapering from maintenance medication because that term incorrectly suggests that opioid treatment medications are toxic. Compare medically supervised withdrawal.

diagnosis. Classification of the nature and severity of the substance use, medical, mental health, or other problems present in a patient who is addicted to opioids. DSM-IV-TR and ICD-10 classifications commonly are used to classify substance use and mental disorders.

discharge. Release from or discontinuation of enrollment in treatment when maximum benefit has been achieved or when a patient is deemed no longer suitable for treatment. See administrative discharge, involuntary discharge.

diversion. Sale or other unauthorized distribution of a controlled substance, usually for a purpose other than the prescribed and legitimate treatment of a medical or mental disorder.

diversion control plan. Documented procedures to reduce the possibility that controlled substances are used for other than their legitimate use. Federal opioid treatment standards (42 CFR, Part 8 § 12(c)(2)) require a diversion control plan in an OTP as part of its quality assurance program

dosage determination. Process of identifying the amount of medication that will minimize withdrawal symptoms and craving in patients in MAT and eliminate their opioid abuse. Much evidence supports a linear relationship among the amount of medication provided, the timeframe over which it is allowed to act before another dose is administered (dose frequency), and treatment response.

dose tapering. See medically supervised withdrawal.

drug interaction. Action of one drug on the effectiveness or toxicity of another drug.

drug testing. Examination of an individual to determine the presence or absence of illicit or nonprescribed drugs or alcohol or to confirm maintenance levels of treatment medications, usually by a methodology that has been approved by the OTP medical director based on informed medical judgment. OTPs also must conform to State laws and regulations in this area. See blood testing, oral-fluid drug testing, urine testing.

duration of action. Length of time that a treatment medication effectively prevents withdrawal symptoms or craving. Duration of action can be affected by many factors, including drug interactions, certain diseases and medical conditions, patient cross-tolerance, and the relative affinity of a medication for its targeted cell receptor.

-E-

eligibility. See treatment eligibility.

elimination half-life. Time required after administration of a substance (e.g., methadone) for one-half the dose to leave the body. Elimination half-life affects the duration of action of a substance or medication and can be influenced by patient factors such as absorption rate, variable metabolism and protein binding, changes in urinary pH, concomitant medications, diet, physical condition, age, pregnancy, and even use of vitamins and herbal products.

-H-

half-life. See elimination half-life.

hepatitis C. Viral disease of the liver that is the leading cause of cirrhosis in the United States and a particular concern in MAT because of the high incidence of the disease and spread of the infection among people who inject drugs.

high-risk behavior. Activity that increases the likelihood that a recovering patient in substance abuse treatment will relapse to substance use or contract a substance use-related disorder, such as an infectious disease.

hospital-based treatment. Treatment of opioid addiction and related complications that requires patient residency for some period in a hospital setting or outpatient treatment in a hospital-linked facility to ensure that necessary services and levels of care are available.

-I-

iatrogenic opioid addiction. Addiction resulting from medical use of an opioid (i.e., under physician supervision), usually for pain management.

induction. Initial treatment process of adjusting maintenance medication dosage levels until a patient attains stabilization.

induction stage. The period of opioid pharmacotherapy, usually during the acute phase of treatment, in which steady-state blood levels of a medication are achieved.

intake. Initial screening of applicants for admission to an OTP.

intensity of treatment. Frequency and method of delivery for therapeutic services. In this TIP and in American Society of Addiction Medicine Patient Placement Criteria, intensity of treatment is one component, along with treatment setting, that determines the level of care for a patient. Levels of care are adjusted during MAT based on patient needs and the treatment plan. See, for example, intensive inpatient treatment and intensive outpatient treatment.

intensive inpatient treatment. Level of care in which addiction professionals and clinicians provide a regimen of around-the-clock evaluation, care, and therapy in an inpatient setting. Involvement of physicians can range from monitoring multidisciplinary staff members to direct management of cases, depending on the severity of patients' problems.

intensive outpatient treatment. Level of care (possibly including partial hospitalization) in which addiction professionals and clinicians provide therapeutic services to clients who live at home or in special residences. Treatment is delivered in two to five regularly scheduled sessions per week totaling 6 to 24 hours per week. Many treatment services and levels of care are compatible with intensive outpatient treatment, but most programs include structured psychoeducation and group counseling.

interim maintenance treatment. Time-limited pharmacotherapeutic regimen in conjunction with appropriate medical services while a patient awaits transfer to an OTP that provides comprehensive maintenance treatment (42 CFR, Part 8 § 2).

intervention. The process of providing care to a patient or taking action to modify a symptom, an effect, or a behavior. Also the process of interacting after assessment with a patient who is substance addicted to present a diagnosis and recommend and negotiate a treatment plan. Also frequently used as a synonym for treatment. Types of intervention can include crisis intervention, brief intervention, and long-term intervention.

involuntary discharge. Formal discontinuation of a patient's enrollment in an OTP without patient consent, usually for reasons related to program operations, safety, or treatment compliance—for example, violence or threats of violence; buying and selling drugs; repeated loitering; flagrant noncompliance with program rules resulting in an observable, negative impact on the program, staff, and other patients; nonpayment of fees; and incarceration or other confinement. See administrative discharge.

-J-

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). One of several SAMHSA-approved accreditation organizations charged with ensuring that OTPs meet the standards set forth in Federal regulations and SAMHSA guidelines.

-L-

LAAM. See levo-alpha acetyl methadol.

level of care. The setting or combination of settings in which the appropriate intensities and types of treatment services can be provided for individual patients.

levo-alpha acetyl methadol (LAAM; trade name ORLAAM). An opioid agonist medication derived from methadone that is effective for up to 72 hours. Reports in 2000 and 2001 of potential arrhythmogenic cardiac effects of LAAM led to tightening of guidelines, including recommendations that LAAM no longer be used for first-line therapy but only for treatment of patients who already have used it successfully or do not show an acceptable response to other addiction treatments. At this writing, LAAM's future availability for opioid pharmacotherapy is doubtful.

-M-

maintenance dosage. Amount of medication that is adequate to achieve desired therapeutic effects for 24 hours or more, with allowance for day-to-day fluctuations.

maintenance medication. Medication used for ongoing treatment of opioid addiction.

maintenance treatment. Dispensing of an opioid addiction medication at stable dosage levels for a period in excess of 21 days in the supervised treatment of an individual for opioid addiction (42 CFR, Part 8 § 2).

medical maintenance. (1) Phase of MAT and type of treatment by an OTP, medication unit, or physician affiliated with an OTP in which a person who has achieved a stable lifestyle and has remained abstinent from illicit drugs for at least 2 years (longer in some States) receives ongoing pharmacotherapy with methadone, buprenorphine, or LAAM but no longer requires the structure or frequency of psychosocial treatment services provided in an OTP, as determined by the OTP medical director. (2) Medical maintenance also can be provided by physicians using buprenorphine or naltrexone (42 CFR, Part 8 § 12(i)(3)(vi); 42 CFR, Part 8 § 11(h)).

medically supervised withdrawal. Dispensing of a maintenance medication in gradually decreasing doses to alleviate adverse physical or psychological effects incident to withdrawal from the continuous or sustained use of opioid drugs. The purpose of medically supervised withdrawal is to bring a patient maintained on maintenance medication to a medication-free state within a target period.

medication-assisted treatment for opioid addiction (MAT). Type of addiction treatment, usually provided in a certified, licensed OTP or a physician's office-based treatment setting, that provides maintenance pharmacotherapy using an opioid agonist, a partial agonist, or an antagonist medication, which may be combined with other comprehensive treatment services, including medical and psychosocial services.

medication unit. Facility established as part of, but geographically separate from, an opioid treatment program, from which certified private practitioners or community pharmacists may dispense or administer opioid agonist medications for observed ingestion (42 CFR, Part 8 § 11(i)(1)).

methadone. The most frequently used opioid agonist medication. Methadone is a synthetic opioid that binds to mu opiate receptors and produces a range of mu agonist effects similar to those of short-acting opioids such as morphine and heroin.

methadone maintenance treatment. Dispensing of methadone at stable dosage levels for more than 21 days in the supervised treatment of an individual for opioid addiction (42 CFR, Part 8 § 2).

mobile treatment services. Substance use treatment provided directly to patients from traveling units or vans, ranging from comprehensive maintenance services (with medication and counseling in one or several mobile units) to more limited care, usually medication maintenance therapy, in conjunction with a fixed-site program offering counseling and other psychosocial services.

multiple substance abuse. Concurrent opioid and other substance use—a serious problem in OTPs. Other substances commonly used by people addicted to opioids include alcohol, amphetamines, benzodiazepines (particularly alprazolam and diazepam), other prescription sedatives, cocaine, marijuana, and nicotine. Patterns of use range from periodic low doses to regular high doses that also can meet criteria for addiction. Some drugs—in particular, high-dose barbiturates—used in combination with opioids are immediately life threatening.

mutual-help program. Program offering the benefits of peer support to people who are substance addicted, through attendance at group meetings and other activities. Twelve-Step programs are one type of mutual-help program.

-N-

naloxone. Short-acting opioid antagonist. Because of its higher affinity than that of opioids for mu opiate receptors, naloxone displaces opioids from these receptors and can precipitate withdrawal, but it does not activate the mu receptors, nor does it cause the euphoria and other effects associated with opioid drugs. Naloxone is not FDA approved for long-term therapy for opioid addiction, except in the combination buprenorphine-naloxone tablet. Some programs use naloxone to evaluate an individual's level of opioid dependence. See naloxone challenge test.

naloxone challenge test. Test in which naloxone is administered to verify an applicant's current opioid dependence and eligibility for admission to an OTP. Withdrawal symptoms evoked by naloxone's antagonist interaction with opioids confirm an individual's current dependence.

naltrexone. Derivative of naloxone and the only opioid antagonist approved for use alone in long-term treatment of people with opioid addiction. Naltrexone is used primarily after medically supervised withdrawal from opioids to prevent drug relapse in selected, well-motivated patients.

narcotic. See opioid (preferred usage).

not-in-my-backyard (NIMBY) syndrome. Informal name used to label opposition to the placement of OTPs in communities.

-O-

office-based opioid treatment (OBOT). MAT provided in a physician's office or health care setting other than an OTP (42 CFR, Part 8 § 11(i)(1)). See medication unit.

opiate receptors. Areas on cell surfaces in the central nervous system that are activated by opioid molecules to produce the effects associated with opioid use, such as euphoria and analgesia. Opiate receptors are activated or blocked by opioid agonist or antagonist medications, respectively, to mediate the effects of opioids on the body. Mu and kappa opiate receptor groups principally are involved in this activity.

opioid. Natural derivative of opium or synthetic psychoactive substance that has effects similar to morphine or is capable of conversion into a drug having such effects. One effect of opioid drugs is their addiction-forming or addiction-sustaining liability.

opioid addiction. Cluster of cognitive, behavioral, and physiological symptoms resulting from continuation of opioid use despite significant related problems. Opioid addiction is characterized by repeated self-administration that usually results in opioid tolerance, withdrawal symptoms, and compulsive drug taking.

opioid addiction treatment. Dispensing of approved medication to prevent withdrawal and craving during the elimination of opioid use by a patient in MAT, with or without a comprehensive range of medical and rehabilitation services or medication prescribed when necessary to alleviate the adverse medical, psychological, or physical effects. This term encompasses medically supervised withdrawal, maintenance treatment, comprehensive maintenance treatment, and, under restricted timeframes, interim maintenance treatment (adapted from 42 CFR, Part 8 § 2).

opioid agonist. Drug that has an affinity for and stimulates physiologic activity at cell receptors in the central nervous system normally stimulated by opioids. Methadone and LAAM are opioid agonists.

opioid antagonist. Drug that binds to cell receptors in the central nervous system that normally are bound by opioid psychoactive substances and that blocks the activity of opioids at these receptors without producing the physiologic activity produced by opioid agonists. Naltrexone is an opioid antagonist.

opioid partial agonist. Drug that binds to, but incompletely activates, opiate receptors in the central nervous system, producing effects similar to those of a full opioid agonist but, at increasing doses, does not produce as great an agonist effect as do increased doses of a full agonist. Buprenorphine is a partial opioid agonist.

opioid treatment program (OTP). SAMHSA-certified program, usually comprising a facility, staff, administration, patients, and services, that engages in supervised assessment and treatment, using methadone, buprenorphine, LAAM, or naltrexone, of individuals who are addicted to opioids. An OTP can exist in a number of settings, including, but not limited to, intensive outpatient, residential, and hospital settings. Services may include medically supervised withdrawal and/or maintenance treatment, along with various levels of medical, psychiatric, psychosocial, and other types of supportive care.

oral-fluid drug testing. Method of identifying evidence of opioid and other psychoactive substance use and measuring the levels of substances or medications in the body by examining patient saliva for the presence and concentrations of identifiable drugs and their metabolites. Oral-fluid testing must be approved for drug testing by the OTP medical director for patient and program needs.

orientation. See patient orientation.

outcome-based evaluation. Measurement of program effectiveness based on patient response to treatment, such as measures of reduction in opioid and nonopioid drug use and improvement in social function. An outcome-based evaluation system requires that the measures and instruments that are used reflect a consensus of the field, provide incentives to programs to submit data, and include ways to validate and aggregate clinic-level data for national and regional evaluation purposes. Compare process-based evaluation.

outpatient psychosocial program. In this TIP, an approach to MAT that may involve the use of opioid addiction treatment medication for medically supervised withdrawal but not for ongoing maintenance pharmacotherapy. Counseling and other psychosocial interventions are the primary features of outpatient psychosocial treatment programs.

OxyContin ®. Long-acting class II opioid drug usually obtained by prescription for treatment of pain. OxyContin is one of several prescription opioids increasingly obtained by illicit means and abused by people addicted to opioids.

-P-

pain management. Treatment of acute or chronic pain by various treatment methods, often including administration of opioid medications.

patient. Any individual undergoing MAT in an opioid treatment program (42 CFR, Part 8 § 2).

patient advocacy. Term applied to two levels of activity in addiction treatment: (1) a social or political movement working for changes in legislation, policy, and funding to reflect patient concerns and protect their rights (i.e., advocacy for patients) and (2) a philosophy of substance abuse treatment practice maintaining that patients should be involved actively in their own treatment and have rights in its planning and implementation (i.e., advocacy by patients). Much of advocacy is about shifting the system from the directive model to one in which the patient is an empowered, involved participant in treatment decisions. This fits with the growing emphasis on individualized treatment.

patient exception. Special permission requested from and decided by SAMHSA for a substance abuse treatment program to dispense or arrange for the offsite delivery of maintenance medication to a patient in an emergency or hardship situation when the patient does not meet regulatory requirements for such services. Patient exceptions are requested on SAMHSA form SMA-168. In most States, patient exceptions are contingent on the approval of the appropriate State Methadone Authority.

patient handbook. Document provided to a patient in an OTP that contains the information he or she should know to understand MAT, program offerings, program structure, and patient limits and privileges, as well as rights and responsibilities of patients and treatment providers.

patient matching. See patient-treatment matching.

patient motivation for change. Relative readiness to modify one's lifestyle and the sincerity and purposefulness of a patient in an OTP toward achieving the goals of MAT.

patient orientation. Planned introduction to the structure, services, offerings, and methods used in an OTP and to patients' and treatment providers' rights and responsibilities within the program.

patient referral. Alternative to providing all necessary treatment services and levels of care at the program site by collaboratively outsourcing some services to other settings and providers. When a patient must obtain comprehensive services in multiple settings, treatment program staff members should arrange the referrals, monitor patient progress, and coordinate care.

patient-treatment matching. Process of individualizing therapeutic resources to patient needs and preferences, ideally by a participatory process involving both the treatment provider and patient. Because many people addicted to opioids have multiple needs, effective patient-treatment matching in an OTP is a three-step process: (1) assessing, (2) selecting the most suitable treatment modality and site, and (3) identifying the most appropriate services.

pharmacology. Science that addresses the origin, nature, chemistry, effects, and uses of medications and drugs.

pharmacotherapy. Treatment of disease with prescribed medications.

preliminary assessment. Basic assessment occurring before admission to a treatment program, in which an individual's eligibility for entry and level of any psychosocial crisis are determined.

prevalence. Number of cases of a disease in a population, either at a point in time (point prevalence) or over a period (period prevalence). Prevalence rate is the fraction of people in a population who have a disease or condition at one time (the numerator of the rate is the number of existing cases of the condition at a specified time and the denominator is the total population).

process-based evaluation. Evaluation of program effectiveness based on compliance with procedural standards. Compare outcome-based evaluation.

psychiatric comorbidity. See co-occurring disorder.

psychoactive drug. A substance that affects the mind, thoughts, feelings, and sometimes behaviors.

psychotherapy. Treatment service provided to patients in a comprehensive opioid treatment program, either directly or by referral, in which a trained therapist evaluates and treats patients for diagnosed psychiatric problems. Compare counseling.

-R-

readmission. Reenrollment of a patient who previously left an opioid treatment program. Readmission usually is preceded by a review of the patient's records to determine whether and how the individual's treatment plan should be modified.

referral. See patient referral.

rehabilitative phase. Phase of MAT in which patients who are stabilized on opioid treatment medication continue to eliminate addictive substances from their lives while gaining control of other major life domains (e.g., medical problems, co-occurring disorders, vocational and educational needs, family circumstances, legal issues).

relapse. Breakdown or setback in a person's attempt to change or modify a particular behavior; an unfolding process in which the resumption of compulsive substance use is the last event in a series of maladaptive responses to internal or external stressors or stimuli.

remission. State in which a mental or physical disorder has been overcome or a disease process halted.

residential treatment. Therapy received within the context of a cooperative living arrangement. Residential treatment programs vary in duration and intensity of services and general philosophy.

retention in treatment. Period during which a patient is able and willing to remain in therapy, which is influenced by a combination of patient and program characteristics. Retention in treatment should be considered the product of a continuing therapeutic relationship between recovering patients and their treatment providers.

-S-

saliva testing. See oral-fluid drug testing.

screening. Process of determining whether a prospective patient has a substance use disorder before admission to treatment. Screening usually involves use of one or more standardized techniques, most of which include a questionnaire or a structured interview. Screening also may include observation of known presenting complaints and symptoms that are indicators of substance use disorders.

sedative. Medication with central nervous system sedating and tranquilizing properties. An example is any of the benzodiazepines. Most sedatives also promote sleep. Overdoses of sedatives can lead to dangerous respiratory depression (slowed breathing).

self-help program. See mutual-help program.

self-medication. Medically unsanctioned use of drugs by a person to relieve any of a variety of problems (e.g., pain, depression).

serum half-life. Time required for the amount of a compound (e.g., an opioid) in blood serum to be halved through metabolism or excretion.

side effect. Consequence (especially an adverse result) other than that for which a drug is used—especially the result produced on a tissue or organ system other than that being targeted.

stabilization (stability). Process of providing immediate assistance (as with an opioid agonist) to eliminate withdrawal symptoms and drug craving.

stand-alone clinic. Facility that generally offers a comprehensive range of medication and psychosocial services for patients who are opioid addicted, including all levels of care and phases of treatment. Compare hospital-based treatment.

State Authority. Agency (sometimes referred to as a “Single State Agency”) designated by the governor or another official assigned by the governor to exercise the responsibility and authority within a State or territory for governing the treatment of addiction to opioid drugs (adapted from 42 CFR, Part 8 § 2).

stigma. Negative association attached to an activity or condition; a cause of shame or embarrassment. Stigma commonly is associated with opioid addiction and MAT.

stimulant. Agent, drug, or medication that produces stimulation. In this TIP, stimulant usually refers to drugs that stimulate the central nervous system (e.g., amphetamines, cocaine).

substance addiction. See opioid addiction.

substance dependence. See dependence.

substance use disorder (frequently referred to as substance abuse or dependence). Maladaptive pattern of drug or alcohol use manifested by recurrent, significant adverse consequences related to the repeated use of these drugs or alcohol. The substance-related problem must have persisted and occurred repeatedly during a 12-month period. It can occur sporadically and mainly be associated with social or interpersonal problems, or it can occur regularly and be associated with medical and mental problems, often including tolerance and withdrawal.

supportive-care phase. Phase of MAT in which patients maintain abstinence from substances and continue on maintenance medication while receiving other types of intervention as needed to resume primary responsibility for other aspects of their lives.

-T-

take-home medication. Opioid addiction treatment medication dispensed to patients for unsupervised self-administration.

tapering phase. Phase of MAT in which patients receiving medication maintenance attempt gradually to eliminate their treatment medication (e.g., methadone) while remaining abstinent from illicit substances.

therapeutic alliance. Joining of patients and their treatment providers in an effective collaboration to assess and treat patients' substance use disorders.

therapeutic community (TC). Consciously designed social environment or residential treatment setting in which social and group processes are harnessed with treatment intent. A TC promotes abstinence from substance use and seeks to decrease antisocial behavior and effect a global change in lifestyle, including attitudes and values. A TC views substance abuse as a disorder of the whole person, reflecting problems in conduct, attitudes, moods, values, and emotional management. Treatment focuses on drug abstinence, coupled with social and psychological change requiring a multidimensional effort along with intensive mutual help and support.

therapeutic dosage. Combination of amount of medication and frequency and timing of administration that is determined by laboratory analysis, professional observation, or patient self-report to be beneficial to control and ameliorate symptoms of withdrawal from addiction and drug-seeking behavior. Therapeutic dosage levels should be determined by what each patient needs to remain stable.

tolerance. Condition of needing increased amounts of an opioid to achieve intoxication or a desired effect; condition in which continued use of the same amount of a substance has a markedly diminished effect.

treatment barrier. Anything that hinders treatment. Examples include financial problems, language difficulties, ethnic and social attitudes, logistics (caring for children, transportation), and unhelpful patient behaviors (tardiness, missed appointments).

treatment efficacy. Ability of an intervention or medication in expert hands and under ideal circumstances to produce the desired therapeutic effect.

treatment eligibility. Relative qualification of a prospective patient for admission to an OTP according to Federal, State, or third-party payer requirements. In general, Federal guidelines are minimum requirements and restrict admission to individuals who have been demonstrably dependent on opioids for 1 year; however, certain high-risk populations including pregnant women are admitted more quickly.

treatment intensity. Frequency and methods for delivery of therapeutic services. OTPs aim to establish levels of treatment intensity that match patients' needs.

treatment outcomes. Observable results of therapy, including decreased use of illicit psychoactive substances, improved physical and emotional health, decreased antisocial activities, and improved social functioning; considered the best indicator of treatment program effectiveness.

treatment plan. Documented therapeutic approach for each patient that outlines attainable short-term goals mutually acceptable to the patient and the OTP and that specifies the services to be provided and their frequency and schedule (adapted from 42 CFR, Part 8 § 2).

treatment retention. See retention in treatment.

12-Step program. Self-help program requiring mastery of a set of steps to achieve and maintain abstinence, based on the program of Alcoholics Anonymous. Many addiction treatment programs use a 12-Step structure or philosophy as a construct for treatment design.

-U-

urine drug testing. Most common laboratory assessment technique in addiction treatment, which involves analysis of urine samples from patients for the presence or absence of specific drugs. Originally used as a measure of program effectiveness, urine testing now is used to make programmatic decisions, monitor psychoactive substance use, adjust medication dosage, and decide whether a patient is responsible enough to receive take-home medication. Methods of urine testing vary widely.

-V-

voluntary discharge. Departure from an OTP that is initiated by the patient. Tapering from medication is negotiated among the patient, program physician, and treatment providers.

-W-

withdrawal. Reduction and elimination of substance use. See medically supervised withdrawal, withdrawal syndrome.

withdrawal syndrome (or withdrawal). Predictable constellation of signs and symptoms after abrupt discontinuation of or rapid decrease in use of a substance that has been used consistently for a period. Signs and symptoms of withdrawal are usually opposite to the direct pharmacological effects of a psychoactive substance.

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