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Absolute risk

The likelihood of an event or outcome occurring (for example, an adverse reaction to the drug being tested) among the group being studied. Studies that compare two or more groups of people may report results in terms of the absolute risk reduction.


Absolute risk reduction (ARR):
A reduction in the likelihood of an event or outcome occurring as a result of a treatment or another intervention. For example, if a treatment reduces the absolute risk of death from 0.25 (25%) to 0.10 (10%), the ARR is 0.15 (15%), that is, 0.25 minus 0.10 equals 0.15.

The estimate of absolute risk reduction often comes from clinical trials. The percentage of people taking part who are receiving treatment (treatment group) and experience a specific outcome is compared with the percentage of people taking part but not receiving treatment (control group) who experience the same outcome.

National Institute for Health and Clinical Excellence

Abstinence

Refraining from drug use or (particularly) from drinking alcoholic beverages, whether as a matter of principle or for other reasons. Those who practise abstinence from alcohol are termed "abstainers", "total abstainers", or-in a more old-fashioned formulation-"teetotallers". The term "current abstainer", often used in population surveys, is usually defined as a person who has not drunk an alcoholic beverage in the preceding 12 months; this definition does not necessarily coincide with a respondent's self-description as an abstainer.

The term "abstinence" should not be confused with "abstinence syndrome", an older term for withdrawal syndrome. See also: temperance

WHO Lexicon of alcohol and drug terms

Acute intoxication

ICD-10 (Mental and behavioural disorders due to psychoactive substance use; F10-F19), describes acute intoxication as a transient condition following the administration of alcohol or other psychoactive substance, resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psycho-physiological functions and responses (WHO, 2007). This diagnosis is not appropriate where harmful use or dependence exist, but covers conditions such as acute drunkenness in alcoholism and “bad trips” (due to hallucinogenic drugs).

WHO ICD-10

Addiction

Addiction is not a diagnostic term in ICD-10, but continues to be very widely employed by professionals and the general public alike.

See also: Classification of substance misuse or abuse

See also dependence syndrome

WHO Lexicon of alcohol and drug terms

Administration, method of route or mode of administration

The way in which a substance is introduced into the body, such as oral ingestion, intravenous (IV), subcutaneous, or intramuscular injection, inhalation, smoking, or absorption through skin or mucosal surfaces, such as the gums, rectum, or genitalia.

WHO Lexicon of alcohol and drug terms

Adulterant

Often synonymous with cutting agent – a substance added as a diluent to a drug. It may be inert or pharmacologically active. Such diluents can be found in illicit powders as well as tablets, in which case the term might also include tablet binders.

EMCDDA drug profiles glossary

Advocate

Someone who speaks on behalf of themselves or another person. In health, an advocate is usually a person who speaks on behalf of a patient, or a group of patients to help them make their wishes known.

National Institute for Health and Clinical Excellence

Affective disorder, residual, alcohol- or drug-related

Alcohol- or drug-induced changes in affect that persist beyond the period during which a direct effect of the alcohol or drug might reasonably be assumed to be operating. See also: Psychotic disorder.

WHO Lexicon of alcohol and drug terms

Agonist / Antagonist

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.

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.

PubMed Health glossary

AIDS (Acquired Immunodeficiency Syndrome)

The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people's surveillance and defense systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can fight off.

The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations.

Risk factors
Behaviours and conditions that put individuals at greater risk of contracting HIV include:
• having unprotected anal or vaginal sex;
• having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis;
• sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions, medical procedures that involve unsterile cutting or piercing; and
• experiencing accidental needle stick injuries, including among health workers

For more information see the WHO HIV/AIDS factsheet

World Health Organization

Alcohol

In chemical terminology, alcohols are a large group of organic compounds " derived from hydrocarbons and containing one or more hydroxyl (-OH) groups. Ethanol (C2H5OH, ethyl alcohol) is one of this class of compounds, and is the main psychoactive ingredient in alcoholic beverages. By extension the term "alcohol" is also used to refer to alcoholic beverages. Ethanol results from the fermentation of sugar by yeast. Under usual conditions, beverages produced by fermentation have an alcohol concentration of no more than 14%. In the production of spirits by distillation, ethanol is boiled out of the fermented mixture and re-collected as an almost pure condensate. Apart from its use for human consumption, ethanol is used as a fuel, as a solvent, and in chemical manufacturing.

Absolute alcohol (anhydrous ethanol) refers to ethanol containing not more than 1% by mass of water. In statistics on alcohol production or consumption, absolute alcohol refers to the alcohol content (as 100% ethanol) '80s, of alcoholic beverages. Methanol (CH3 OH), also known as methyl alcohol and wood alcohol is chemically the simplest of the alcohols. It is used as an industrial solvent and also as an adulterant to denature ethanol and make it unfit to drink (methylated spirits). Methanol is highly toxic; depending on the amount consumed, it may produce blurring of vision, blindness, coma, and death.

Other non-beverage alcohols that are occasionally consumed, with potentially harmful effects, are isopropanol (isopropyl alcohol, often in rubbing alcohol) and ethylene glycol (used as antifreeze for automobiles). Alcohol is a sedative/hypnotic with effects similar to those of barbiturates. Apart from social effects of use, alcohol intoxication may result in poisoning or even death; long-term heavy use may result in dependence or in a wide variety y of physical and organic mental disorders. Alcohol-related mental and behavioural disorders (f10) are classified as psychoactive substance use disorders in ICD-10 (f10-f19).

WHO Lexicon of alcohol and drug terms

Alcohol policy

The aggregate of measures designed to control the supply of and/or affect the demand for alcoholic beverages in a population (usually national), including education and treatment programmes, alcohol control, harm reduction strategies, etc. Implying the need for a coordination of governmental efforts from a public health and/or public order perspective, the term originated in the Scandinavian countries and has spread widely since the 1960s.

WHO Lexicon of alcohol and drug terms

Alcohol-related brain damage

A generic term that encompasses chronic impairment of memory and of higher mental functions associated with the frontal and limbic system. Thus, it incorporates both the alcohol-induced amnesic syndrome (ICD-10 F10.ó) and the "frontal lobe syndrome" (included in ICD-10 F10.7). However the term is often used when only one of these disorders is present. Memory loss in the amnesic syndrome is typically of recent memory. Frontal lobe damage is manifested by defects in abstract thought, conceptualization, planning, and processing of complex material. Other cognitive functions are relatively well preserved, and consciousness is not clouded. A distinction is made between alcohol-related brain damage and alcoholic dementia. In the latter condition there is a more global impairment of cognitive function and usually evidence of other etiologies such as repeated head trauma.
See also: alcoholic dementia

WHO Lexicon of alcohol and drug terms

Alcoholic brain syndrome

A general term for a range of disorders due to the effects of alcohol on the brain-acute intoxication, pathological intoxication, withdrawal syndrome, delirium tremens, hallucinosis, amnesic syndrome, dementia, psychotic disorder. More specific terms are preferred.

WHO Lexicon of alcohol and drug terms

Alcoholic cardiomyopathy

A diffuse disorder of heart muscle seen in individuals with a history of hazardous consumption of alcohol, usually of at least 10 years' duration. (ICD-10 I42.6) Patients typically present with biventricular heart failure; common symptoms include shortness of breath on exertion and while recumbent (nocturnal dyspnoea), palpitations, ankle oedema, and abdominal distension due to ascites. Disturbance of the cardiac rhythm is usual: atrial fibrillation is the most frequent arrhythmia. Alcoholic cardiomyopathy should be distinguished from beri-beri heart disease and from a form of "beer drinkers' cardiomyopathy" caused by cobalt poisoning. Synonym: alcoholic heart muscle disease.

WHO Lexicon of alcohol and drug terms

Alcoholic cirrhosis

A severe form of alcoholic liver disease, characterized by necrosis and permanent architectural distortion of the liver due to fibrous tissue formation and regeneratory nodules. This is a strictly histological definition, but diagnosis is often made on clinical grounds only. (ICD-10 K70.3)

Alcoholic cirrhosis occurs mainly in the 40-60-year age group, after at least 10 years of hazardous drinking. Individuals show symptoms and signs of hepatic decompensation such as ascites, ankle oedema, jaundice, bruising, gastrointestinal haemorrhage from oesophageal varices, and confusion or stupor due to hepatic encephalopathy. About 30% of patients are "well compensated" at the time of diagnosis and report nonspecific complaints such as abdominal pain, bowel disturbance, weight loss, and muscle wasting and weakness. Liver cancer is a late complication of cirrhosis in approximately 15% of cases.

Alcoholic cirrhosis is sometimes termed "portal cirrhosis" or "Laënnec cirrhosis'', although neither of these terms necessarily implies an alcohol causation.

In non-tropical countries in which alcohol consumption is substantial, alcohol use is a dominant cause of cirrhosis. Because of under-recording of the alcohol connection, total cirrhosis mortality-rather than "cirrhosis with mention of alcoholism"-is often used as an indicator of alcohol problems.

WHO Lexicon of alcohol and drug terms

Alcoholic dementia

A term of variable usage, most commonly implying a chronic or progressive disorder occurring as a result of harmful drinking, characterized by impairment of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not clouded. The cognitive impairments are commonly accompanied by deterioration in emotional control, social behaviour, or motivation. The existence of alcoholic dementia as a discrete syndrome is doubted by some, who ascribe the dementia to other causes. (ICD-10 F10.7)

WHO Lexicon of alcohol and drug terms

Alcoholic fatty liver

Accumulation of fat in the liver following exposure to hazardous levels of alcohol intake, with consequent enlargement of liver cells and sometimes hepatomegaly, abnormal liver function, nonspecific abdominal recurrent pain, anorexia, and-less commonly-jaundice. Definitive diagnosis can be made only on histological examination of the liver, the pancreas (e.g. malabsorptiol)

Fatty liver may develop after only a few days' drinking, and the condition should therefore not be taken to indicate a dependence on alcohol. Abstinence results in regression of the histological abnormalities. The preferred term for the condition is "alcohol-induced fatty liver", although it is not in common usage. (ICD-10 K70.0)

WHO Lexicon of alcohol and drug terms

Alcoholic gastritis

Inflammation of the mucosal lining of the stomach caused by alcohol. It is commonly accompanied by oesophagatis. In most cases the condition is self-limiting and resolves with abstinence. (ICD-10 K29.2)

WHO Lexicon of alcohol and drug terms

Alcoholic hepatitis

A disorder of the liver characterized by liver ce1l necrosis and inflammation following chronic consumption of hazardous levels of alcohol. It is a well documented precursor of alcoholic cirrhosis, particularly in those whose alcohol intake remains high.

Although the diagnosis is, strictly speaking, a histological one, it is often made on the basis of clinical and biochemical evidence, even if confirmation by biopsy is not possible. The diagnosis is suggested on clinical grounds by the presence of jaundice (which may be deep) and tender hepatomegaly, and sometimes ascites and haemorrhage. (ICD-10 K70.1)

WHO Lexicon of alcohol and drug terms

Alcoholic pancreatitis

A disorder characterized by inflammation and necrosis of the pancreas, often accompanied by fibrosis and malfunction, related to the consumption of hazardous levels of alcohol. Alcoholic pancreatitis may be acute or chronic. The acute form presents with upper abdominal pain, anorexia, and vomiting, and can be complicated by hypotension, renal failure, lung disease, and psychosis. The chronic form usually presents with recurrent or persistent abdominal pain, anorexia, and weight loss; there may be signs of pancreatic deficiency involving the exocrine functions of the pancreas (e.g. malabsorption, nutritional deficiency) or the endocrine functions of the pancreas (e.g. malabsorption, nutritional deficiency) or the endocrine functions(diabetes mellitus). (ICD-10 K86.0)

WHO Lexicon of alcohol and drug terms

Alcoholism, disease concept of,

The belief that alcoholism is a condition of primary biological causation and predictable natural history, conforming to accepted definitions of a disease. They lay perspective of Alcoholics Anonymous (1939)-that alcoholism, characterized by the individual’s loss of control over drinking and thus over his or her life, was a "sickness"-was carried into the scholarly literature in the 1950s in the form of the disease concept of alcoholism. The concept was rooted in 19th-century medical and lay conceptions of inebriety as a disease. In 1977, a WHO Group of Investigators* responding to the loose and varying usage of alcoholism, proposed substituting the term alcohol dependence syndrome in psychiatric nosology.

See also Alcoholism (ICD-10 F10.2)

WHO Lexicon of alcohol and drug terms

Alkaloid

A naturally occurring nitrogenous base, often with psychoactive properties and which may be active in very low doses (e.g. cocaine, morphine and certain other constituents of opium, dimethyltryptamine). Alkaloids are often regarded as end-products of plant metabolism, which may have evolved as protection against herbivores.

EMCDDA Drug profiles glossary

Alternatives to drugs

Alternative-providing programmes offer activities that are considered incompatible with substance use. These programmes were initially proposed by Dohner (1972). He postulated that individuals use drugs because of the reward and pleasure they bring, which cannot be obtained through other non-chemical mechanisms. For that reason, to prevent or reduce drug abuse, it is necessary to provide positive “alternatives” to individuals, i.e. means to obtain the desired reward and pleasure through healthy and socially acceptable activities (Alonso et al., 2004).

EMCDDA glossary

Alternatives to prison / imprisonment

Alternatives to imprisonment’ include a range of measures that replace prison sentences for those who have committed a drug-related offence that is normally punishable by imprisonment according to national law. Prisoners may be diverted to i.e. treatment either at the pre-trial or at the post-trial stage.

EMCDDA glossary

Amnesic syndrome (Korsakov syndrome / psychosis)

A syndrome associated with chronic prominent impairment of recent and remote memory. Immediate recall is usually preserved and recent memory is characteristically more disturbed than remote memory. Disturbances of time sense and ordering of events are usually evident, as are difficulties in learning new material. Confabulation may be marked but is not invariably present. Other cognitive functions are usually relatively well preserved and amnesic defects are out of proportion to other disturbances.

Including:
• Amnestic disorder, alcohol- or drug-induced
• Korsakov psychosis or syndrome, alcohol- or other psychoactive substance-induced or unspecified
• Use additional ICD code, (E51.2+, G32.8*), if desired, when associated with Wernicke’s disease or syndrome.

Excluding:
• Non-alcoholic Korsakov psychosis or syndrome (ICD-10 F04)

WHO Lexicon of alcohol and drug terms

Amphetamine

A synthetic substance. Normally seen as a white powder, it acts as a stimulant of the central nervous system (CNS). It is believed that amphetamine was first manufactured in the 1880s by the German chemist Leuckart, although evidence for this is lacking. It appears that, as in the case of methamphetamine, systematic studies of its chemistry did not come about until the early twentieth century. Amphetamine has some limited therapeutic use, but most is manufactured in clandestine laboratories in Europe. It is under international control and closely related to methamphetamine

For more information on this substance see the EMCDDA webpage on amphetamine
Also see methamphetamine

EMCDDA Drug profiles glossary

Analgesic

A substance that reduces pain and may or may not have psychoactive properties.

See also: opioid

WHO Lexicon of alcohol and drug terms

Antidepressant

One of a group of psychoactive agents prescribed for the treatment of depressive disorders; also used for certain other conditions such as panic disorder.

There are three main classes: tricyclic antidepressants (which are principally inhibitors of noradrenaline uptake); serotonin receptor agonists and uptake blockers; and the less commonly prescribed monoamine oxidase inhibitors. Tricyclic antidepressants have a relatively low abuse liability, but are sometimes used non-medically for their immediate psychic effects. Tolerance develops to their anticholinergic effects but it is doubtful whether a dependence syndrome or withdrawal syndrome occurs. For these reasons, misuse of antidepressants is included in category F55 of ICD-10, abuse of non- dependence-producing substances.

WHO Lexicon of alcohol and drug terms

AOD - Alcohol and other drugs

The acronym AOD is widely used to mean 'alcohol and other drugs'.  

It is used, for example, in the NIAAA AOD Thesaurus, which provides a US guide to terminology in this field.

NIAAA AOD thesaurus

AUDIT (Alcohol Use Disorders Identification Test)

The AUDIT was developed as a simple method of screening for excessive drinking and to assist in brief assessment. It can help identify excessive drinking as the cause of the presenting illness. It provides a framework for intervention to help risky drinkers reduce or cease alcohol consumption and thereby avoid the harmful consequences of their drinking. The AUDIT also helps to identify alcohol dependence and some specific consequences of harmful drinking. Of utmost importance for screening is the fact that people who are not dependent on alcohol may stop or reduce their alcohol consumption with appropriate assistance and effort. The manual is particularly designed for health care practitioners and a range of health settings, but with suitable instructions it can be self-administered or used by non-health professionals.

Screening for alcohol consumption among patients in primary care carries many potential benefits. It provides an opportunity to educate patients about low-risk consumption levels and the risks of excessive alcohol use. Information about the amount and frequency of alcohol consumption may inform the diagnosis of the patient's presenting condition, and it may alert clinicians to the need to advise patients whose alcohol consumption might adversely affect their use of medications and other aspects of their treatment. Screening also offers the opportunity for practitioners to take preventative measures that have proven effective in reducing alcohol-related risks.

For more information about AUDIT and to download the manual visit the WHO website

See also screening test

World Health Organization

Audit (research)

A systematic review of a practice, process or performance to establish how well it meets predetermined criteria. For example, audit may be carried out on a specific service (such as stop smoking services), to check whether it complies with laws, regulations or policies.

Clinical audit
A process for monitoring standards of clinical care to see if it is being carried out in the best way possible (known as 'best practice'). Clinical audit can be described as a systematic 'cycle' or 'spiral'. It involves measuring care against specific criteria, taking action to improve it if necessary, and monitoring the process to sustain improvement. As the process continues, each 'cycle' moves to a higher level of the 'spiral', that is, an even higher level of quality is achieved.

National Institute for Health and Clinical Excellence

B
Bad trip

In drug users' jargon, an adverse effect of drug use, consisting of any mixture of the following: feelings of losing control, distortions of body image, bizarre and frightening hallucinations, fears of insanity or death, despair, suicidal thoughts, and strong negative affect. Physical symptoms may include sweating, palpitations, nausea, and paraesthesias. Although adverse reactions of this type are usually associated with the use of hallucinogens, they may also be caused by the use of amphetamines and other psychomotor stimulants, anticholinergics, antihistamines, and sedatives/hypnotics.

WHO Lexicon of alcohol and drug terms

Barbiturates

Barbiturates are synthetic substances manufactured as pharmaceutical products. They act as depressants of the central nervous system. The parent compound barbituric acid was first synthesised in 1864 but the first pharmacologically active agent, barbital, was not produced until 1881 and introduced to medicine in 1904. The most widely used compound, phenobarbital, was synthesised in 1911 and first used clinically the following year. While some 2 500 derivatives have been synthesised, only about 50 have ever been used medically.

The use of barbiturates as sedative/hypnotics has largely been superseded by the benzodiazepine group. Some barbiturates are now more widely used in the treatment of epilepsy and shorter acting molecules are used in anaesthesia. Twelve barbiturates are under international control.

For more information on this substance see the EMCDDA webpage on barbiturates

EMCDDA Drug profiles glossary

Basic assumptions / theory

The rationale or theoretical concept that orientates the methodology chosen to reach programme objectives. Examples are life-skills models, alternative models, drug substitution models, behavioural models, social learning theory, and so on. The strategies chosen may be drawn from existing models or they may be entirely new. In such cases, a brief explanation of the hypothesis underlying the approach would be necessary. A brief overview of models and theories can be found in PERK.

EMCDDA glossary

Benchmark

A measure or standard that can be used to compare an activity, performance, service or result.
'Benchmarking' is the process of measuring the performance of people or organisations with broadly similar characteristics. The aim is to improve quality by encouraging all organisations or services to raise their own performance to that of the best.

National Institute for Health and Clinical Excellence

Benzodiazepines

One of a group of structurally related drugs used mainly as sedatives/hypnotics, muscle relaxants, and anti-epileptics, and once referred to by the now-deprecated term "minor tranquillisers". These agents are believed to produce therapeutic effects by potentiating the action of gamma- aminobutyric acid (GABA), a major inhibitory neurotransmitter. Benzodiazepines were introduced as safer alternatives to barbiturates. They do not suppress REM sleep to the same extent as barbiturates, but have a significant potential for physical and psychological dependence and misuse.

Short-acting benzodiazepines include halazepam and triazolam, bothh with rapid onset of action; alprazolam, flunitrazepam, nitrazepam, lorazepam, and temazepam, with intermediate onset; and oxazepam, with slow onset. Profound anterograde amnesia ("blackout") and paranoia have been reported with triazolam, as well as rebound insomnia and anxiety. Many clinicians have encountered particularly difficult problems on discontinuing treatment with alprazolam.

Long-acting benzodiazepines include diazepam (with the fastest onset of action), clorazepate (also fast onset), chlordiazepoxide (intermediate onset), f1urazepam (slow onset), and prazepam (slowest onset). The long-acting benzo- diazepines may produce a cumulative disabling effect and are more likely than the short-acting agents to cause daytime sedation and motor impairment.

Even when benzodiazepines are taken in therapeutic doses, their abrupt discontinuation induces a withdrawal syndrome in up to 50% of people treated for 6 months or longer. Symptoms are more intense with shorter-acting preparations; with the long-acting benzodiazepines, withdrawal symptoms appear one or two weeks after discontinuation and last longer, but are less intense. As with other sedatives, a schedule of slow detoxification is necessary to avoid serious complications such as withdrawal seizures.

Some benzodiazepines have been used in combination with other psycho-active substances to accentuate euphoria, e.g. 40-80 mg of diazepam taken shortly before or immediately after a daily maintenance dose of methadone. Benzodiazepines are frequently misused in conjunction with alcohol or in opioid dependence (see Multiple drug use). Fatal overdose is rare with any benzodiazepine unless it is taken concurrently with alcohol or other central nervous system depressants.

For more information see the EMCDDA webpage on benzodiazepines

WHO Lexicon of alcohol and drug terms

Best practice(s)

Best practice(s) refer(s) to interventions that are supposed to lead to desired outcomes.

EMCDDA glossary

Bias

Influences on a study that can make the results look better or worse than they really are. (Bias can even make it look as if a treatment works when it does not.) Bias can occur by chance, deliberately or as a result of systematic errors in the design and execution of a study. It can also occur at different stages in the research process, for example, during the collection, analysis, interpretation, publication or review of research data.

· Selection bias - Selection bias occurs if:- a) The characteristics of the people selected for a study differ from the wider population from which they have been drawn, or - b) There are differences between groups of participants in a study in terms of how likely they are to get better.

· Performance bias - This can occur if study participants know which group they are in. For example, if they know they are in the control group they may use other forms of care. Similarly, if care providers know which group they are in, they may treat patients differently. Ensuring neither the recipients or providers of care know who is in which group (blinding) protects against performance bias.

· Information bias - This can affect all types of research study. It can be caused by questionnaires that have difficult or biased questions, observer or interviewer errors (for example, lack of blinding), response errors (for example, if patients are aware of the treatment they receive) or measurement error (for example, a faulty machine).

· Publication bias - Publication bias occurs when researchers publish the results of studies showing that a treatment works well and don't publish those showing it did not have any effect. If this happens, analysis of the published results will not give an accurate idea of how well the treatment works. This type of bias can be assessed by a funnel plot.

· Confounder or confounding factor - Something that influences a study and can result in misleading findings if it is not understood or appropriately dealt with. For example, a study of heart disease may look at a group of people that exercises regularly and a group that does not exercise. If the ages of the people in the two groups are different, then any difference in heart disease rates between the two groups could be because of age rather than exercise. Therefore age is a confounding factor.

National Institute for Health and Clinical Excellence

Biological (genetic) marker

A biological compound or attribute that provides evidence of the presence of, or vulnerability to, a specific disorder. In general, two types of marker are distinguished. A state marker identifies a current abnormality that most typically reflects a transient or reactive condition of the subject, such as the degree of activity of an underlying disorder or the recent use of a drug. A trait marker identifies a relatively stable and enduring attribute that reflects a continuing condition or, particularly in the case of a genetic marker, a predisposition to a specific disorder.

Most biological markers for alcohol and other drugs are state markers, and many simply reflect the recent history of consumption. A high blood alcohol level, for example, may identify a state of alcoholic intoxication, but it does not confirm alcohol dependence. Many, but not all, state markers for alcohol are in fact tests of hepatic damage (such as elevated plasma ?- glutamylfransferase). They are diagnostic tests of alterations in liver status secondary to chronic drinking, and not valid indicators of alcohol dependence. Other biological state markers for heavy alcohol consumption include de- sialotransferrin and acetaldehyde-protein adducts or antibodies to them.

WHO Lexicon of alcohol and drug terms

Blood alcohol level (BAL)

The concentration of alcohol (ethanol) present in blood. (ICD-10 Y90, ICD-10 Y91) It is usually expressed as mass per unit volume, but different countries may express it differently or use different units; examples include milligrams per 100 millilitres (mg/100 ml or, incorrectly, mg percent), milligrams per litre (mg/1), grams per 100 millilitres (g/100 ml), grams percent, and millimoles per litre. A concentration of 8 parts per thousand would be expressed in legal terminology in USA as .08%, in Scandinavia as 0.8 promille, and in Canada and elsewhere as 80 mg/100 ml. National differences also exist in the BAL set as the legal limit for driving under "per se" laws, with most limits in the range 50-100 mg/100 ml.

The BAL is often extrapolated from measurements made on breath or urine or other biological fluids in which the alcohol concentration bears a known relationship to that in the blood. The Widmark calculation is a technique for estimating BAL at a given time after alcohol ingestion by extrapolating from BALs at known times and assuming a fixed rate of alcohol elimination (zero order kinetics). In some jurisdictions this is considered a dubious assumption, and estimates of BALs at previous points in time are not accepted.

WHO Lexicon of alcohol and drug terms

Brief Intervention

A treatment strategy in which structured therapy of short duration (typically 5-30 minutes) is offered with the aim of assisting an individual to cease or reduce the use of a psychoactive substance or (less commonly) to deal with other life issues. It is designed in particular for general practitioners and other primary health care workers. To date, brief intervention-sometimes known as minimal intervention-has been applied mainly to cessation of smoking and as therapy for harmful use of alcohol.

The rationale for brief intervention is that, even if the percentage of individuals who alter their substance use after a single intervention is small, the public health impact of large numbers of primary health care workers providing these interventions systematically is considerable. Brief intervention is often linked to systematic screening testing for hazardous and harmful substance use, particularly of alcohol and tobacco. (WHO Lexicon of alcohol and drug terms)
See also: early intervention
______________

The use of brief intervention and brief therapy techniques has become an increasingly important part of the continuum of care in the treatment of substance abuse problems. With the health care system changing to a managed model of care and with changes in reimbursement policies for substance abuse treatment, these short, problem-specific approaches can be valuable in the treatment of substance abuse problems. They provide the opportunity for clinicians to increase positive outcomes by using these modalities independently as stand-alone interventions or treatments and as additions to other forms of substance abuse and mental health treatment. They can be used in a variety of settings including opportunistic settings (e.g., primary care, home health care) and specialized substance abuse treatment settings (inpatient and outpatient).

Used for a variety of substance abuse problems from at-risk use to dependence, brief interventions can help clients reduce or stop abuse, act as a first step in the treatment process to determine if clients can stop or reduce on their own, and act as a method to change specific behaviors before or during treatment. For example, there are some issues associated with treatment compliance that benefit from a brief, systematic, well-planned intervention such as attending group sessions or doing homework. In other instances, brief interventions address specific family problems with a client and/or family members or deal with specific individual problems such as personal finances and work attendance. The basic goal for a client regardless of setting is to reduce the risk of harm that may result from continued use of substances. The reduction of harm, in its broadest sense, pertains to the clients themselves, their families, and the community.
(Brief interventions and brief therapies for substance abuse. 1999, TIP Series 34)

________________

Brief interventions can be used opportunistically in a variety of settings for people not in contact with drug services (for example, in mental health, general health and social care settings, and emergency departments) and for people in limited contact with drug services (such as at needle and syringe exchanges, and community pharmacies).

1. During routine contacts and opportunistically (for example, at needle and syringe exchanges), staff should provide information and advice to all people who misuse drugs about reducing exposure to blood-borne viruses. This should include advice on reducing sexual and injection risk behaviours. Staff should consider offering testing for blood-borne viruses.

2. Group-based psychoeducational interventions that give information about reducing exposure to blood-borne viruses and/or about reducing sexual and injection risk behaviours for people who misuse drugs should not be routinely provided.

3. Opportunistic brief interventions focused on motivation should be offered to people in limited contact with drug services (for example, those attending a needle and syringe exchange or primary care settings) if concerns about drug misuse are identified by the service user or staff member. These interventions should:
• normally consist of two sessions each lasting 10–45 minutes
• explore ambivalence about drug use and possible treatment, with the aim of increasing motivation to change behaviour, and provide non-judgemental feedback.

4. Opportunistic brief interventions focused on motivation should be offered to people not in contact with drug services (for example, in primary or secondary care settings, occupational health or tertiary education) if concerns about drug misuse are identified by the person or staff member. These interventions should:
• normally consist of two sessions each lasting 10–45 minutes
• explore ambivalence about drug use and possible treatment, with the aim of increasing motivation to change behaviour, and provide non-judgemental feedback.

National Institute for Health and Clinical Excellence

Buprenorphine

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

PubMed Health glossary

BZP and other piperazines

1-Benzylpiperazine (BZP) is one of a small group of benzyl-substituted piperazines, but a much larger group comprises the phenylpiperazines (see Tables 1 and 2 on EMCDDA webpage). Despite claims by some tablet and capsule suppliers that they are herbal products, piperazine and its derivatives are synthetic substances that do not occur naturally. The large-scale misuse of certain piperazine derivatives (often known as ‘party pills’) started in New Zealand several years ago, but became common in Europe only after 2004. BZP is a central nervous system (CNS) stimulant with around 10 % of the potency of d-amphetamine. Neither BZP nor any other substituted piperazine is listed in the Schedules of the United Nations 1971 Convention on Psychotropic Substances, although several members of this family have been proposed for critical review by WHO in 2009. Following a risk assessment by Europol and the EMCDDA in 2007, a Council Decision of 2008 introduced controls on BZP in the European Union.

One of the phenylpiperazines, 1-(3-chlorophenyl)piperazine (mCPP), has been even more widespread than BZP. By 2006, it was estimated that almost 10 % of illicit tablets sold in the EU, as part of the illicit ecstasy market, contained mCPP. At the end of 2008 and beginning of 2009, this percentage seems to have increased up to 50% in some Member States. However, because mCPP is used as a starting material for the synthesis of several antidepressant drugs (e.g. trazodone), it could not be subjected to formal risk assessment under the terms of the Council Decision 2005/387/JHA of 2005 on the information exchange, risk assessment and control of new psychoactive substances. Apart from mCPP, the next most commonly-found substituted piperazine was 1-(3-trifluoromethyl-phenyl)piperazine (TFMPP), although it was nearly always seen in combination with BZP. Other mixtures of piperazine derivatives became common during 2008, but most consisted of variations of BZP, TFMPP, mCPP and DBZP, sometimes mixed with other substances such as amphetamine, cocaine, ketamine and MDMA.

For more information on this substance see the EMCDDA webpage on BZP and other piperazines

EMCDDA Drug profiles glossary

C
Caffeine

A xanthine, which is a mild central nervous system stimulant, vasodilator, and diuretic. Caffeine is found in coffee, chocolate, cola and some other soft drinks, and tea, in some cases with other xanthines such as theophylline or theobromine. Acute or chronic overuse (e.g. a daily intake of 500 mg or more) with resultant toxicity is termed caffeinism. Symptoms include restlessness, insomnia, flushed face, muscle twitching, tachycardia, gastrointestinal disturbances including abdominal pain, pressured or rambling thought and speech, and sometimes exacerbation of pre-existing anxiety or panic states, depression, or schizophrenia. The substance use disorders in ICD-10 include caffeine use disorder and caffeine dependence (classified in ICD-10 FI5).

WHO Lexicon of alcohol and drug terms

CAGE (Cut-down, Annoyed, Guilty, Eye-opener)

The prototype alcohol dependence questionnaire is the MAST (Selzer 1971). Instruments such as the MAST and the CAGE questionnaire were derived on the basis of their ability to distinguish chronic alcohol dependent individuals from nonalcohol dependent individuals (Mayfield et al. 1974).

The CAGE is a four-item screening instrument intended to identify alcohol abuse and dependence. Because of its brevity, it is less sensitive than the AUDIT or the MAST. It is not a diagnostic instrument, however a ‘yes’ to two or more questions indicates the need for further assessment for alcohol abuse (Mayfield et al. 1974).

C Have you ever felt you needed to Cut down on your drinking? Yes No
A Have people Annoyed you by criticizing your drinking? Yes No
G Have you ever felt Guilty about drinking? Yes No
E Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? Yes No

For more information, see Guidelines for the treatment of alcohol problems (the appendix contains screening instruments)

See also, screening

Australia Government, Department of Health and Ageing

Cannabis

Cannabis is a natural product, the main psychoactive constituent of which is tetrahydrocannabinol (Δ9-THC). The cannabis plant (Cannabis sativa L.) is broadly distributed and grows in temperate and tropical areas. Together with tobacco, alcohol and caffeine, it is one of the most widely consumed drugs throughout the world, and has been used as a drug and a source of fibre since historical times. Herbal cannabis consists of the dried flowering tops and leaves.

Cannabis resin is a compressed solid made from the resinous parts of the plant, and cannabis (hash) oil is a solvent extract of cannabis. Cannabis is almost always smoked, often mixed with tobacco. Almost all consumption of herbal cannabis and resin is of illicit material. Some therapeutic benefit as an analgesic has been claimed for cannabis, and dronabinol is a licensed medicine in some countries for the treatment of nausea in cancer chemotherapy. Cannabis products and Δ9-THC are under international control.

For more information on this substance see the EMCDDA webpage on cannabis
And see synthetic cannabinoids and 'Spice'

WHO Lexicon of alcohol and drug terms

Case Management

Case management is a client-centred strategy involving assessment, planning, linking to relevant services and community resources and advocacy. Its intent is to improve the co-ordination and continuity of delivery of services. Brokerage case management sets out to help clients identify their needs and broker services in one or two contacts; intensive case management involves a closer interaction between case manager and client; assertive community treatment (provides assertive outreach and direct counselling services; strengths-based case management focuses on self-direction and the use of informal networks rather than agency resources by applying active outreach. (Hesse et al Cochrane review (2007) Case management for persons with substance use disorders)

Other resources:

Substance Abuse and Mental Health Services Administration. (1998) Comprehensive case management for substance abuse treatment.

Homeless Agency, Progression Routes Initiative. (2010) Case management guidebook

Case-control study

An observational analytic study that enrols one group of persons with a certain disease, chronic condition, or type of injury (case-patients) and a group of persons without the health problem (control subjects) and compares differences in exposures, behaviours, and other characteristics to identify and quantify associations, test hypotheses, and identify causes.
(Principles of Epidemiology in Public Health Practice, 3rd Ed. US Department of Health and Human Services, Centers for Disease Control and Prevention).

EMCDDA glossary

Central Statistics Office (CSO)

The Central Statistics Office was established in 1949 as Ireland's national statistical office. Its status was formalised in legislation with the enactment of the Statistics Act, 1993. The mandate of the CSO, as set out in that Act, is "The collection, compilation, extraction and dissemination for statistical purposes of information relating to economic, social and general activities and conditions in the State". The CSO is also responsible for coordinating the official statistics of other public authorities and for developing the statistical potential of administrative records.

The Office meets the needs of Government for quality statistical information, which is vital for the formation, implementation and monitoring of policy and programmes at national, regional and local levels in a rapidly changing economic and social environment. The Office also serves the needs of the wider national and international community (media, researchers, students, businesses, representative organisations, the EU, international organisations, and the public generally) for impartial and relevant information on social and economic conditions. Particular attention is paid to the specialist needs of business and the research/academic community for more detailed and focused data.

Regular publications include those on:

• Population
• Births, Deaths and Marriages
• Crime and Justice
• Social Conditions
• Health
• Education
• Housing and Households
• Information Society

Central Statistics Office, Ireland

Central Treatment List (CTL)

Administrative database to regulate the dispensing of methadone treatment in Ireland. The CTL was established under Statutory Instrument No. 225 (Minister for Health and Children 1998) and is a complete register of all patients receiving methadone (as treatment for problem opiate use) in Ireland. When a person is considered suitable for methadone detoxification or maintenance, the prescribing doctor applies to the CTL for a place on the list and a unique number is allocated to the client.

The database is maintained by the Drug Treatment Centre Board (DTCB), on behalf of Health Service Executive.

For more information see the database entry by HIQA

Drug Treatment Centre Board

Classification, Substance misuse or abuse (DSM / ICD)

Substance misuse or abuse is frequently classified as experimental, recreational, or dependant that may result in adverse physical and/or psychological effects (i.e. harmful use). This represents a wide-ranging spectrum of the use of therapeutic drugs or substances with physiological and psycho-active effects on the body or mind which are out with legal or medical guidelines.

Drug misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). A further definition by the Royal College of Psychiatrists states “… any taking of a drug which harms or threatens to harm the physical or mental health or social well-being of an individual or other individuals or society at large, or which is illegal” (Royal College of Psychiatrists, 1987).

Care should be taken when defining drug use in terms of addiction or dependence as these terms are not necessarily used with consistent meaning and also have social and cultural implications to their use. Definitions are provided below from the two most recognised disease classification systems - the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (2000) – usually referred to as DSM-IV-TR - and the International Classification of Diseases (ICD-10) coding system published by the World Health Organisation (2007) in order to clearly describe the processes of substance abuse an dependence.

Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision (DSM-IV-TR) Classification
DSM-IV-TR Substance Abuse
The term Substance Abuse is used when an individual will repeatedly consume an illicit substance but the pattern of this abuse does not lead to addiction or compulsive behaviour, nor withdrawal symptoms.
DSM-IV-TR describes substance abuse as: a ‘maladaptive’ pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following within a 12 month period:
1. Recurrent use leading to failure to fulfil major role obligations (work, home, school, etc.)
2. Recurrent use in situations where it is physically hazardous (e.g. drunk driving)
3. Repeated substance related legal problems (repeated disorderly conduct while drunk)
4. Persistent use despite recurrent social/interpersonal problems caused or exacerbated by the effects of a substance (e.g. arguments with spouse or physical fights)

Alternatively, the symptoms have never met the criteria for substance dependence for this class of substance.

DSM- IV-TR Substance Dependence
The term Substance Dependence is used when an individual compulsively and repetitively consumes an illicit drug despite problems related to the consumption of that drug, possible tolerance to the effects of the drug, and possible withdrawal symptoms should the drug use be reduced or stopped altogether.

DSM-IV-TR describes Substance dependence as a: ‘maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following within a 12 month period:
1. Tolerance: a need for increased amounts of a substance to achieve the desired effect or a diminished effect with ongoing use of the same amount of substance
2. Withdrawal symptoms
3. The substance taken in larger amounts over longer periods than was intended
4. Persistent desire or unsuccessful efforts to cut down or control use
5. A great deal of time spent in activities relating to obtaining the substance, using the substance or recovering from use
6. Significant social, occupational or recreational activities are given up or reduced because of use
7. Use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance’

DSM-IV criteria for substance dependence include several specifiers, one of which outlines whether substance dependence is:
• With physiologic dependence (evidence of tolerance or withdrawal) or
• Without physiologic dependence (no evidence of tolerance or withdrawal).

In addition, remission categories are classified into four subtypes: (1) full, (2) early partial, (3) sustained, and (4) sustained partial; on the basis of whether any of the criteria for abuse or dependence have been met and over what time frame. The remission category can also be used for patients receiving agonist therapy (such as methadone maintenance) or for those living in a controlled, drug-free environment.
[(American Psychiatric Association, 2000) From BearingPoint et al. (2013) Substance and drug dependency]

World Health Organisation: International Classification of Diseases 10th Edition (ICD-10) Classification
ICD-10 classifies substance abuse mainly under the code F10-F19 Mental and behavioural disorders due to psychoactive substance use. However, an additional code exists for non-dependence producing substances such as aspirin.
The codes in this range represent an individual diagnostic code for different substances.
• F10. – Mental and behavioural disorders due to use of alcohol
• F11. – Mental and behavioural disorders due to use of opioids
• F12. – Mental and behavioural disorders due to use of cannabinoids
• F13. – Mental and behavioural disorders due to use of sedative hypnotics
• F14. – Mental and behavioural disorders due to use of cocaine
• F15. – Mental and behavioural disorders due to use of other stimulants, including caffeine
• F16. – Mental and behavioural disorders due to use of hallucinogens
• F17. – Mental and behavioural disorders due to use of tobacco
• F18. – Mental and behavioural disorders due to use of volatile solvents
• F19. – Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances
• F55 – abuse of non-dependence-producing substances (e.g laxatives or Aspirin)

See also WHO ICD-10 Version:2010

BearingPoint et al. (2013) Substance and drug dependency

Co-dependent

A relative, dose friend, or colleague of an alcohol- or drug-dependent person, whose actions are defined by the term as tending to perpetuate that person's dependence and thereby retard the process of recovery. In the early 1970s, the terms co-alcoholic and co-alcoholism came into use among those treating alcoholism in USA to characterize close relatives of the alcoholic (initially the wife in particular}. With the shift in terminology from alcoholism to alcohol dependence, co-dependent and co-dependence came into use, also referring to relatives of those dependent on other drugs. Use of the term implies an attributed need for treatment or help, and some have proposed classifying co-dependence as a psychiatric disorder. The term is also now used figuratively to refer to the community or society acting as an enabler of alcohol or drug dependence.

• Enabler
Any person or social group whose actions or policies intentionally or unintentionally facilitate the continuing misuse of alcohol or other substance.

WHO Lexicon of alcohol and drug terms

Cocaine and crack

Cocaine is a natural product extracted from the leaves of Erythroxylon coca Lam (coca leaves). This tropical shrub is cultivated widely on the Andean ridge in South America and is the only known natural source of cocaine. Normally produced as the hydrochloride salt, it has limited medical use as a topical anaesthetic. The free base, sometimes known as crack, is a smokable form of cocaine. Coca leaves have been used as a stimulant by some indigenous people of South America since historical times. Purified cocaine has been misused as a central nervous system (CNS) stimulant since the early years of the twentieth century. Cocaine is under international control.

For more information on this substance see the EMCDDA webpage on cocaine and crack
Also see synthetic cocaine derivatives

EMCDDA drug profiles glossary

Cochrane Collaboration

The Cochrane Collaboration is an international not-for-profit and independent organisation, dedicated to providing up-to-date, accurate information about the effects of healthcare readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

Systematic reviews of the effects of healthcare interventions are available in The Cochrane Library

Among other topics, reviews are produced for drugs and alcohol, and for tobacco

EMCDDA glossary

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.


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).


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).

Key CBT publications in the NDC collection

See also, NICE pathway Drug misuse: psychosocial interventions

Pilling et al (2010) Psychosocial interventions in drug misuse: a framework and toolkit for implementing NICE-recommended treatment interventions

PubMed Health glossary

Cohort

A group used as part of a research study. The group is made up of people sharing a common characteristic (for example, pupils in the same school year).

Cohort study:
A study with two or more groups of people - cohorts - with similar characteristics. One group receives a treatment, is exposed to a risk factor or has a particular symptom and the other group does not. The study follows their progress over time and records what happens.

National Institute for Health and Clinical Excellence

Community programmes

Activities carried out at community level stimulating the involvement of community actors/institutions (for example: school, youth centre, neighbourhood, city, city districts) in order to intervene in people's immediate surroundings and to facilitate active participation in a social context.

EMCDDA glossary

Community-located prevention (community-based prevention)

The ideal understanding of “community” as an active social network of participating individuals independently from their professional background is not shared in all EU member states, and accordingly the meaning of “community-based prevention” differs substantially across the EU.

As the participatory character of community-based prevention is in practice not a universal principle throughout Europe, it has been impossible until now to describe community-based prevention in a comparable manner. Therefore, the only feasible way to compare community-based prevention interventions across member states is using a minimal common denominator – i.e. “community” just as a geographical and administrative setting – for a common information collection.

In order to reflect the reduced definition, the EMCDDA and its partner use the term community-located prevention (i.e. referring just to the setting) instead of community-based prevention (which would imply active community involvement).

EMCDDA glossary

Comparison group

A group of people whose characteristics may be measured against those of a treatment group (intervention group); comparison group members have characteristics and demographics similar to those of the treatment (intervention) group, but members of the comparison group receive no intervention.

EMCDDA glossary

Composite International Diagnostic Interview (CIDI)

The CIDI is a comprehensive, fully-structured interview designed to be used by trained lay interviewers for the assessment of mental disorders according to the definitions and criteria of ICD-10 and DSM-IV. It is intended for use in epidemiological and cross-cultural studies as well as for clinical and research purposes. The diagnostic section of the interview is based on the World Health Organization's Composite International Diagnostic Interview (WHO CIDI, 1990).

The CIDI allows the investigator to:
• Measure the prevalence of mental disorders
• Measure the severity of these disorders
• Determine the burden of these disorders
• Assess service use
• Assess the use of medications in treating these disorders
• Assess who is treated, who remains

For more information about CIDI see the CIDI website

See also, screening

The WMH-CIDI

Compulsion

When applied to psychoactive substance use, the term refers to a powerful urge-attributed to internal feelings rather than external influences- to take the substance (or substances} in question. The substance user may recognize the urge as detrimental to well-being and may have a conscious intent to refrain. These feelings are less characteristic of alcohol and drug dependence than of the psychiatric syndrome of obsessive-compulsive disorder.

WHO Lexicon of alcohol and drug terms

Confidence interval (CI)

There is always some uncertainty in research. This is because a small group of patients is studied to predict the effects of a treatment on the wider population. The confidence interval is a way of expressing how certain we are about the findings from a study, using statistics. It gives a range of results that is likely to include the 'true' value for the population.

The CI is usually stated as '95% CI', which means that the range of values has a 95 in a 100 chance of including the 'true' value. For example, a study may state that 'based on our sample findings, we are 95% certain that the 'true' population blood pressure is not higher than 150 and not lower than 110'. In such a case the 95% CI would be 110 to 150.

A wide confidence interval indicates a lack of certainty about the true effect of the test or treatment - often because a small group of patients has been studied. A narrow confidence interval indicates a more precise estimate (for example, if a large number of patients have been studied).

National Institute for Health and Clinical Excellence

Contingency management

Contingency management (CM) is an evidence-based treatment intervention recommended by the National Institute for Health and Clinical Excellence (NICE). It is based on principles of behaviour modification and aims to incentivise and then reinforce changes in behaviour with the aid of vouchers, privileges, prizes or modest financial incentives that are of value to the client.


Providing incentives is supported by government as a way to “nudge” people to change their behaviour in a positive direction across a wide range of health and social policy domains.

Used properly and implemented carefully, CM can be a useful intervention within a balanced treatment system. Alongside other interventions, it can be used to encourage and support:
• abstinence from drugs of dependence, usually alongside substitute medication and relapse prevention
• engagement in recovery related activities
• engagement in treatment by incentivising attendance
• Improved compliance with health promotion, such as preventing BBVs, an example of which is hepatitis B vaccination.

NICE recommended:
“Drug services should introduce contingency management programmes… to reduce illicit drug use and/or promote engagement with services for people receiving methadone maintenance treatment. … Where possible, implementation in the NHS should draw on the experience so far (albeit limited) of contingency management in the NHS and on the experience of agencies such as the National Treatment Agency for Substance Misuse (NTA) in the implementation of service developments in drug misuse.”

NICE, Drug misuse – psychosocial interventions

Click on Public Health England for more information on contingency mangagement

Public Health England

Control group

A group of people in a study who do not receive the treatment or test being studied. Instead, they may receive the standard treatment (sometimes called 'usual care') or a dummy treatment (placebo). The results for the control group are compared with those for a group receiving the treatment being tested. The aim is to check for any differences.

Ideally, the people in the control group should be as similar as possible to those in the treatment group, to make it as easy as possible to detect any effects due to the treatment.
Also called comparison group.

National Institute for Health and Clinical Excellence

Control, impaired / loss of

Control, impaired
Diminished ability of an individual to control his or her use of a psychoactive substance in terms of onset, level, or termination. "Impaired capacity to control'. is a criterion for the dependence syndrome in ICD-10. Impaired control is distinguished from loss of control in that the latter implies that the phenomenon prevails at all times and in all circumstances.

Control, loss of:
An inability to modulate the amount and frequency of psycho-active substance use: the inability to cease ingesting substances such as alcohol and cocaine once their initial effect has been experienced. In recent discussions of the dependence syndrome, the term "loss of control" has been replaced by impaired control.

WHO Lexicon of alcohol and drug terms

Controlled substances

Psychoactive substances and their precursors whose distribution is forbidden by law or limited to medical and pharmaceutical channels. The substances actually subject to this control differ somewhat between countries. The term is often used to refer to psychoactive drugs and precursors covered by international drug conventions {the 1961 Single Convention on Narcotic Drugs, amended by a 1972 Protocol; the 1971 Convention on Psychotropic Substances: the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances). At both international and national levels (as in the 1970 United States Controlled- Substances Act), controlled drugs are commonly classified according to a hierarchy of schedules, reflecting different degrees of restriction of availability.

For information about drug law, see the European Legal Database on Drugs

WHO Lexicon of alcohol and drug terms

Controlled trial

A clinical trial that has a control. Such trials are not necessarily randomised.

• Control group (in a controlled trial)
The arm that acts as a comparator for one or more experimental interventions. Also called comparison group
• Comparison group:
A group of people whose characteristics may be measured against those of a treatment group (intervention group); comparison group members have characteristics and demographics similar to those of the treatment (intervention) group, but members of the comparison group receive no intervention.

EMCDDA glossary

Conventions, international drug

International treaties concerned with the control of production and distribution of psychoactive drugs. Early treaties (General Brussels Act, 1889-90, and St Germain-en-Laye Convention of 1912) controlled liquor traffic in Africa in the colonial era. The first treaty dealing with currently controlled substances was the Hague Convention of 1912: its provisions and those of succeeding agreements were consolidated in the Single Convention on Narcotic Drugs (1961; amended by a 1972 Protocol). To this have been added the 1971 Convention on Psychotropic Substances and the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.

For more information on drug laws, see the European Legal Database on Drugs

WHO Lexicon of alcohol and drug terms

Cost effectiveness

Value for money. A test or treatment is said to be 'cost-effective' if it leads to better health than would otherwise be achieved by using the resources in other ways.

Cost-benefit analysis: Cost-benefit analysis is one of the tools used to carry out an economic evaluation. The costs and benefits are measured using the same monetary units (for example, pounds sterling) to see whether the benefits exceed the costs.
Cost-consequence analysis: Cost-consequence analysis is one of the tools used to carry out an economic evaluation. This compares the costs (such as treatment and hospital care) and the consequences (such as health outcomes) of a test or treatment with a suitable alternative. Unlike cost-benefit analysis or cost-effectiveness analysis, it does not attempt to summarise outcomes in a single measure (like the quality-adjusted life year) or in financial terms. Instead, outcomes are shown in their natural units (some of which may be monetary) and it is left to decision-makers to determine whether, overall, the treatment is worth carrying out.
Cost-effectiveness analysis: Cost-effectiveness analysis is one of the tools used to carry out an economic evaluation. The benefits are expressed in non-monetary terms related to health, such as symptom-free days, heart attacks avoided, deaths avoided or life years gained (that is, the number of years by which life is extended as a result of the intervention).

Cost-minimisation analysis: Cost-minimisation analysis is one of the tools used to carry out an economic evaluation. Cost-minimisation analysis compares the costs of different interventions that provide the same benefits. If they are equally effective, only the costs are compared and the cheapest intervention will provide the best value for money. In practice, there are relatively few cost-minimisation analyses because it is rare for two healthcare interventions to provide exactly the same benefits.
Cost-per-QALY analysis: Another name for a cost-effectiveness analysis. The benefits of different treatments or tests are stated as quality-adjusted life years (QALYs).
Cost-utility analysis: Cost-utility analysis is one of the tools used to carry out an economic evaluation. The benefits are assessed in terms of both quality and duration of life, and expressed as quality-adjusted life years (QALYs).

National Institute for Health and Clinical Excellence

Craving

Very strong desire for a psychoactive substance or for the intoxicating effects of that substance. Craving is a term in popular use for the mechanism presumed to underlie impaired control: it is thought by some to develop, at least partly, as a result of conditioned associations that evoke conditioned withdrawal responses. Craving may also be induced by the provocation of any physiological arousal state resembling an alcohol or drug withdrawal syndrome.
See also: compulsion; control, impaired; dependence syndrome; withdrawal

WHO Lexicon of alcohol and drug terms

Critical appraisal

Reviewing a piece of research or a systematic review of the evidence to judge the quality of the method used and the content. Critical appraisals are also used to judge the effectiveness of a test or treatment that is being studied.

National Institute for Health and Clinical Excellence

Cross-sectional study

A 'snapshot' observation of a set of people at one time. This type of study contrasts with a longitudinal study, which follows a set of people over a period of time.

National Institute for Health and Clinical Excellence

Cutting agent

A substance added as a diluent to a drug – often synonymous with adulterant. It may be inert or pharmacologically active. Such diluents can be found in illicit powders as well as tablets, in which case the term might also include tablet binders.

EMCDDA glossary

D
Death, drug-related

The National Drug Related Deaths Index is a census of drug-related deaths (such as those due to accidental or intentional overdose) and deaths among drug users (such as those due to hepatitis C and HIV) in Ireland. It will also record alcohol-related deaths. The information collected will be used to develop health and social service responses aimed at reducing the number of deaths. The number of drug-related deaths and deaths among drug users is one of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) key indicators to measure the consequences of drug use.

• Non-poisoning deaths:
Deaths in individuals with a history of drug dependency or non-dependent abuse of drugs (ascertained from toxicology results and from Central Treatment List, medical or coronial records) whether or not the use of the drug was directly implicated in the death.

• Poisoning deaths:
Deaths which are directly due to the toxic effect of the presence in the body of one or more drugs and/or other substance(s).

National Drug-Related Deaths Index, Ireland

Decriminalisation (Legalisation)

The repeal of laws or regulations that define a behaviour, product, or condition as criminal. The term is used in connection with both illicit drugs and the crime of public drunkenness. It is sometimes also applied to a reduction in the seriousness of a crime or of the penalties the crime attracts, as when possession of marijuana is downgraded from a crime that warrants arrest and a jail term to an infraction to be punished with a warning or fine. Thus decriminalization is often distinguished from legalization, which involves the complete repeal of any definition as a crime, often coupled with a governmental effort to control or influence the market for the affected behaviour or product

• Legalisation (legalization):
Legal actions that make legal what was previously a criminalized behaviour, product, or condition.

WHO Lexicon of alcohol and drug terms

Delirium

An acute organic cerebraI syndrome characterized by concurrent disturbances of consciousness, attention, perception, orientation, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake cycle. Duration is variable, from a few hours to a few weeks and the degree of severity ranges from mild to very severe. An alcohol-induced withdrawal syndrome with delirium is known as delirium tremens.

• Delirium tremens:
Withdrawal syndrome with delirium; an acute psychotic state occurring during the withdrawal phase in alcohol-dependent individuals and characterized by confusion, disorientation, paranoid ideation, delusions, illusions, hallucinations (typically visual or tactile, less commonly auditory, olfactory, or vestibular), restlessness, distractibility, tremor {which is sometimes gross), sweating. tachycardia, and hypertension. It is usually preceded by signs of simple alcohol withdrawal. Onset of delirium tremens is usually 48 hours or more after cessation or reduction of alcohol consumption, but it may present up to one week from this time. It should be distinguished from alcoholic hallucinosis, which is not always a withdrawal phenomenon. The condition is known colloquially as "the DTs" or "the horrors."

WHO Lexicon of alcohol and drug terms

Delphi method

A technique used to reach agreement on a particular issue without those involved meeting or having any direct contact. Participants are sent a series of postal questionnaires asking them to record their views. After the results of the first questionnaire are distributed, participants are asked to comment in light of the group feedback.

National Institute for Health and Clinical Excellence

Demand reduction

A general term used to describe policies or programmes directed at reducing the consumer demand for psychoactive drugs. It is applied primarily to illicit drugs, particularly with reference to educational, treatment, and rehabilitation strategies, as opposed to law enforcement strategies that aim to interdict the production and distribution of drugs (supply reduction).

WHO Lexicon of alcohol and drug terms

Demography

The study of a population, particularly its size, density, fertility, death rates, growth rates, age range, geographic distribution and migration.

National Institute for Health and Clinical Excellence

Dependence syndrome

ICD-10 (Mental and behavioural disorders due to psychoactive substance use; F10-F19) describes dependence syndrome as a cluster of physiological, behavioural, and cognitive phenomena in which the use of a drug becomes a high priority for the user, overtaking other activities.

A central descriptive characteristic of dependence syndrome is the desire (often strong, sometimes overpowering) to take psychoactive drugs (which may or may not have been medically prescribed), alcohol, or tobacco – the element of taking or desire to take in terms of dependence being the key; this diagnosis would not apply for example, so someone taking Opioid analgesics following major surgery even though an element of withdrawal may be present when such drugs are discontinued. There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.

WHO ICD-10

Depressant

Any agent that suppresses, inhibits, or decreases some aspects of central nervous system (CNS) activity. The main classes of CNS depressants are the sedatives/hypnotics, opioids, and neuroleptics. Examples of depressant drugs are alcohol, barbiturates, anaesthetics, benzodiazepines, opiates and their synthetic analogues. Anticonsulvants are sometimes included in the depressant group because of their inhibitory action on abnormal neural activity. Disorders related to depressants use are classified as psychoactive substance use disorders in ICD-IO in categories FI0 (for alcohol), F11 (for opioids), and F13 (for sedatives or hypnotics).

See also: alcohol;  benzodiazepines; opioid; sedative/hypnotic.

WHO Lexicon of alcohol and drug terms

Design

A design is a plan which indicates how often, when and from whom information will be gathered during the course of an evaluation. Good design is essential if the results of an evaluation are to have any future use. A design with at least one experimental group and one control group is known as a control group design; a time-series design uses only one experimental group but at least three data collections; and a design which does not use a control group or time series analysis is the pre- and post- design.

EMCDDA glossary

Designer drug

A novel chemical substance with psychoactive properties, synthesized specifically for sale on the illicit market and to circumvent regulations on controlled substances. In response, these regulations now commonly cover novel and possible analogues of existing psychoactive substances. The term was coined in the 1980s.

WHO Lexicon of alcohol and drug terms

Determinants of health

The range of personal, social, economic and environmental factors that determine the health of people and communities. They include behaviours that can affect health (such as smoking), income, education, employment, working conditions, access to health services, housing and general living conditions.

National Institute for Health and Clinical Excellence

Detoxification

(1) The process by which an individual is withdrawn from the effects of a psychoactive substance.
(2) As a clinical procedure, the withdrawal process carried out in a safe and effective manner, such that withdrawal symptoms are minimized. The facility in which this takes place may be variously termed a detoxification centre, detox centre, or sobering-up station.

Typically, the individual is clinically intoxicated or already in withdrawal at the outset of detoxification. Detoxification may or may not involve the administration of medication. When it does, the medication given is usually a drug that shows cross-tolerance and cross-dependence to the substance(s) taken by the patient. The dose is calculated to relieve the withdrawal syndrome without inducing intoxication, and is gradually tapered off as the patient recovers. Detoxification as a clinical procedure implies that the individual is supervised until recovery from intoxication or from the physical withdrawal syndrome is complete. The term "self-detoxification" is sometimes used to denote unassisted recovery from a bout of intoxication or withdrawal symptoms.

WHO Lexicon of alcohol and drug terms

Diagnosis

The process of identifying a disease or condition by carrying out tests or by studying the symptoms.

Diagnostic study
A study to assess the effectiveness of a test or measurement in detecting whether someone has (or does not have) a specific disease.

National Institute for Health and Clinical Excellence

Diagnostic test / instrument

• Diagnostic test:
A procedure or instrument used in conjunction with observation of behaviour patterns, history , and clinical examination to help in establishing the presence, nature, and source of, or vulnerability to, a disorder, or to measure some specified characteristic of an individual or group. Physical specimens tested vary according to the nature of the investigation: examples include urine (e.g. for the presence of drugs), blood (e.g. for blood alcohol level), semen (e.g. for motility of spermatozoa), faeces (e.g. for the presence of parasites), amniotic fluid (e.g. for the presence of a heritable disorder in the fetus), and tissues (e.g. for the presence and activity of neoplastic cells).The methods of testing also vary and include biochemical, immunological, neurophysiological and histological examinations. Diagnostic imaging techniques include X-ray, computed tomography (CAT scan), positron emission tomography (PET), and magnetic resonance imaging (MRI). Psychological investigations may involve intelligence tests, personality tests, projective tests (such as the Rorschach ink blot test), and neuro-psychological batteries of tests to assess the type, location, and degree of any brain dysfunction and its behavioural expressions. See also: biological marker; screening test

• Diagnostic instrument:
In general medical usage, any machine or instrument, and by extension-any clinical procedure or interview schedule used for the determination of an individual's medical condition or the nature of his or her illness. With respect to substance use and other behavioural disorders, the term refers principally to lists of questions oriented to diagnosis, including structured interview schedules that can be administered by trained lay interviewers. The Composite International Diagnostic Interview (CIDI) and the Diagnostic Interview Schedule (DIS) are examples of such schedules, which allow diagnosis of psychoactive substance use disorders as well as a range of other mental disorders. See also: screening test

WHO Lexicon of alcohol and drug terms

Disulfiram (Antabuse)

The prototypic alcohol-sensitizing drug, prescribed to assist in maintaining abstinence from alcohol. Disulfiram inhibits aldehyde dehydrogenase activity and, in the presence of alcohol, causes accumulation of acetaldehyde and an aversive facial flushing reaction, accompanied by nausea, dizziness, and palpitations. These effects are sometimes termed "the Antabuse reaction".

WHO Lexicon of alcohol and drug terms

Diversion programme

A programme of treatment or re-education for individuals referred from criminal courts (criminal diversion) after being charged with driving under the influence of alcohol (drinking-driver diversion) or another drug, with the sale or use of drugs (drug diversion), or with a general crime not defined in terms of drugs or alcohol. In strict legal use of the term, individuals are assigned to diversion programmes in lieu of prosecution, which is usually held in abeyance pending successful completion of the diversion programme. "Diversion" is also used more broadly for any pattern of referral from the court at any stage of processing, including as a sentence or condition of probation.

WHO Lexicon of alcohol and drug terms

Dopamine / dopaminergic

An example of a neurotransmitter, it is a naturally occurring substituted phenethylamine. Substances that interact with this receptor are said to be dopaminergic.

EMCDDA glossary

Doping

Defined by the International Olympic Committee and the International Amateur Athletic Federation as the use or distribution of substances that could artificially improve an athlete's physical or mental condition, and thus his or her athletic performance. The substances that have been used in this way are numerous and include various steroids, stimulants, beta blockers, antihistamines, and opioids. Official screening tests for doping substances have been carried out at the Olympic Games since 1968 and are now a regular practice in a range of professional and amateur sports in many countries.

Outside the context of drugs, "dope" refers to any thick liquid or pasty preparation. By the late 19th century, one meaning of "doping" was the administration of psychoactive substances to racehorses to affect their performance, and "dopey" came to describe a person whose senses were apparent1y dulled, as by drugs. In slang usage, "dope" has long been used to refer to any psychoactive substance, and in North America in recent decades particularly to cannabis.

WHO Lexicon of alcohol and drug terms

Drinking, binge

A pattern of heavy drinking that occurs in an extended period set aside for the purpose. In population surveys, the period is usually defined as more than one day of drinking at a time. The terms "bout drinking" and "spree drinking" are also used for the activity, and "drinking bout" for the occasion. A binge drinker or bout drinker is one who drinks predominantly in this fashion, often with intervening periods of abstinence.

WHO Lexicon of alcohol and drug terms

Drinking, problem

Drinking that results in problems, individual or collective, health or social. Earlier usages included drinking in response to a life problem. The term has been used since the mid-1960s in a more general sense that avoids commitment or reference to the disease concept of alcoholism. In some usages, problem drinking is assimilated to the alcoholism concept as an earlier or less serious stage. A problem drinker is a person whose drinking has resulted in health or social problems. Formulations that avoid the labelling inherent in the term include "drinking-related problems" and "drinking problems" . The term "problematic drinking" has been used by some to cover the related concept of drinking that has the potential to cause problems (roughly equivalent to hazardous use of alcohol), while "the drink problem" is a term that dates from the temperance era and—like "the liquor question"-referred to alcohol policy as a whole.

WHO Lexicon of alcohol and drug terms

Drug

A term of varied usage. In medicine, it refers to any substance with the potential to prevent or cure disease or enhance physical or mental welfare, and in pharmacology to any chemical agent that alters the biochemical physiological processes of tissues or organisms. Hence, a drug is a substance that is, or could be, listed in a pharmacopoeia. In common usage, the term often refers specifically to psychoactive drugs, and often, even more specifically, to illicit drugs, of which there is non-medical use in addition to any medical use. Professional formulations (e.g. "alcohol and other drugs") often seek to make the point that caffeine, tobacco, alcohol, and other substances in common non- medical use are also drugs in the sense of being taken at least in part for their psychoactive effects.

WHO Lexicon of alcohol and drug terms

Drug consumption rooms

Locations where confirmed drug users are allowed to consume their drugs in hygienic conditions and without fear of arrest

For more details see the EMCDDA consumption room webpage.

EMCDDA glossary

Drug Legislation (Ireland)

The Misuse of Drugs Acts, 1977 and 1984 and the Regulations made thereunder are the main laws regulating drugs in Ireland. They include controls relating to cultivation, licensing, possession, administration, supply, record-keeping, prescription-writing, destruction and safe custody. They also establish the offences and penalties.

The Misuse of Drugs Act, 1977 (Controlled Drugs) Declaration Order, 1987 extend the list of substances, products and preparations to be controlled for the purposes of the Misuse of Drugs Act, 1977.

In 1984 the Criminal Justice Act, 1984 widened the scope of the criminal law and procedures to deal more effectively with serious crime, including serious offences under the Misuse of Drugs Acts.

In November 1993 a new text was introduced to control precursors and essential chemicals, the Misuse of Drugs (Scheduled Substances) Regulations, 1993. With these acts Ireland meets with the obligations relevant to the control of precursors, under the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988, and under EC Directives 92/109 and EC Regulation 3677/90. The Regulations control production, supply, importation, exportation and possession of the precursors substances.

In 1994 the Criminal Justice Act, 1994 provided for the seizure and confiscation of assets derived from the proceeds of drug trafficking and other offences. It contains provisions related to money laundering and allows for international co-operation in respect of certain criminal law enforcement procedures, the forfeiture of property used in the commission of crime, and related matters. The Criminal Justice (Drug Trafficking) Act, 1996 permits the detention of a person suspected of having committed a drug trafficking offence for up to a maximum of seven days. The Misuse of Drugs Regulations, 1988 sets out the arrangement to facilitate the licence control over the lawful production, supply, importation and exportation of the drugs to which the Misuse of Drugs Acts 1977 and 1984, apply.

The Criminal Justice Act, 1999 amends the Misuse of Drugs Act, 1977 to provide for a new drug related offence. The new section (15A) creates a new offence related to the possession of drugs, with a value of €12 700 or more, for the purpose of sale or supply. A person found guilty of such an offence may be imprisoned for up to life and be subject to an unlimited fine. The Act also provides for a mandatory minimum sentence of ten years in prison. However, the mandaory minimum sentence shall not apply where the court is satisfied that there are exceptional and specific circumstances which would make it unjust in all the circumstances to impose the minimum ten year sentence. In addition, where it is found that addiction was a substantial factor leading to the commission of the offence, the sentence may be reviewed after half of the mandatory period, at which time the court may suspend the remainder of the sentence on any condition it sees fit.

In 2000 new regulations (Customs-free Airport (Extension of Laws) Regulations, 2000) were introduced to extend drug controls under the Misuse of Drugs Acts, 1977 and 1984, and the Irish Medicines Board Act, 1995, to include the Customs free area at Shannon airport. This instrument extends the import/export controls under the Misuse of Drugs Acts, 1977 and 1984 to this area. It also allows Irish Medicines Board to inspect any company within the customs free area at the Customs Free Airport.

The Criminal Justice Act 2006 includes: provisions for creating criminal offences in relation to participation in criminal organisations; proposals to strengthen the provisions on the imposition of the 10-year mandatory minimum sentence for drug trafficking; new offences of supplying drugs to prisoners and provisions in relation to a drug offenders register. The Irish Human Rights Commission has raised a number of concerns about some of the provisions of the Act. (For more information see the Irish National Report 2006)

The Criminal Justice Act 2007 provides for increased Garda detention powers, changes to existing provisions in relation to the right to silence and the introduction of mandatory sentencing for a range of offences. Many of these changes have been introduced in the context of growing concern about drug-related crime. (For more information see the Irish National Report 2007)

The Criminal Justice (Psychoactive Substances) Act 2010 covers substances which are not specifically proscribed under the Misuse of Drugs Acts, but which have psychoactive effects. (For more information see the Irish National Report 2010)

Further resources:

Wikipedia - Regulations (Lists drugs under each schedule)
Legislation provides for the Minister for Health to make regulations scheduling drugs according to their use perceived medical usability and their risk to the public. Additionally, these regulations outline the requirements for distribution and monitoring of the listed substances. The principal regulations are the Misuse of Drugs Regulations 1988 (SI 328/1988) as amended by the Misuse of Drugs (Amendment) Regulations 1993 (SI 342/1993), the Misuse of Drugs (Amendment No. 1) Regulations 1999 (SI 273/1999), the Misuse of Drugs (Amendment) Regulations 2006 (SI 53/2006), the Misuse of Drugs (Amendment) Regulations 2007 (SI 200/2007), the Misuse of Drugs (Amendment) (No. 1) Regulations 2009 (SI 63/2009), the Misuse of Drugs (Amendment) (No. 2) Regulations 2009 (SI 122/2009) and the Misuse of Drugs (Amendment) (No. 2) Regulations 2010 (SI 200/2010).

EMCDDA

Drug policy

(1) In the context of psychoactive drugs, the aggregate of polices designed to affect the supply and/or the demand for illicit drugs, locally or nationally, including education, treatment, control, and other programmes and policies. In this context, "drug policy" often does not include pharmaceutical policy (except with regard to diversion to non-medical use), or tobacco or alcohol policy.

(2) In the context of WHO' s Action Programme on Essential Drugs, "national drug policy" refers to a national pharmaceutical policy concerning the marketing, availability, and therapeutic use of medicines. WHO recommends that every country should have such a policy, formulated in the context of a national health policy. The WHO List of Essential Drugs is an effort to assist developing countries to develop a pharmaceutical policy attuned to allocating scarce funds for pharmaceuticals on the basis of health needs rather than market considerations*

* The use of essential drugs. Model List of Essential Drugs (seventh list). Fifth report of the WHO Expert Committee.Geneva, World Health Organization. 1992 (WHO Technical Report Series. No.825).

See all Irish policy documents

EMCDDA -EU policy and law

WHO Lexicon of alcohol and drug terms

Drug Task Forces

Local Drugs Task Forces were established in Ireland following the report of the Ministerial Task Force on Measures to Reduce the Demand for Drugs (1996). There are 14 Local Drugs Task Forces, 12 in Dublin, one in Cork and one in Bray. There are also 10 Regional Drugs Task Forces. Task Forces include representatives from statutory agencies, the voluntary sector, local communities and public representatives.

Drugs Task Force areas:

• ECRDTF East Coast Regional Drugs Task Force (DTF) - South-east Dublin city and county and East Wicklow, including the two LDTF areas within these boundaries
• MRDTF Midland Regional DTF - Counties Laois, Longford, Offaly and Westmeath
• MWRDTF Mid West Regional DTF - Counties Clare and Limerick, and North Tipperary
• NDRDTF North Dublin City and County Regional DTF - North Dublin city and county, including the five LDTF areas within these boundaries
• NERDTF North Eastern Regional DTF - Counties Cavan, Louth, Meath and Monaghan
• NWRDTF North West Regional DTF - Counties Donegal, Leitrim and Sligo, and north-west Cavan
• SERDTF South East Regional DTF - Counties Carlow, Kilkenny, Waterford and Wexford, and South Tipperary,
• SRDTF Southern Regional DTF - Counties Cork and Kerry, including the Cork LDTF area
• SWRDTF South Western Regional DTF - South-west Dublin, west Wicklow and County Kildare, including the six LDTF areas within these boundaries
• WRDTF Western Region DTF - Counties Galway, Mayo and Roscommon

Drug Task Force websites

Report on the review of drugs task forces, 2012

Drug testing

The analysis of body fluids (such as blood, urine, or saliva) or hair or other tissue for the presence of one or more psychoactive substances. Drug testing is employed to monitor abstinence from psychoactive substances in individuals pursuing drug rehabilitation programmes, to monitor surreptitious drug use among patients on maintenance therapy, and where employment is conditional on abstinence from such substances.

See blood alcohol level for testing specifically for alcohol.

WHO Lexicon of alcohol and drug terms

Drug-free treatment

Term previously used in EDDRA, this refers to psychosocial interventions

EMCDDA glossary

Drug-related problem

Any of the range of adverse accompaniments of drug use, particularly il1icit drug use. "Related" does not necessarily imply causality. The term was coined by analogy with alcohol-related problem but is less used, since it is drug use itself, rather than the consequences, that tends to be defined as the problem; it can be used to refer to problems at an individual or societal level. In international drug control, drug-related problems are taken into account in setting a level of control for a controlled substance through a WHO assessment of the drug's dependence potential and abuse liability. "Drug problems" is a possible cognate term, but can be confused with "the drug problem", meaning illicit drugs as a policy issue.

WHO Lexicon of alcohol and drug terms

Dual diagnosis (Comorbidity)

A general term referring to comorbidity or the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder. Such an individual is sometimes known as a mentally ill chemical abuser (MICA). Less commonly, the term refers to the co-occurrence of two psychiatric disorders not involving psychoactive substance use. The term has also been applied to the co-occurrence of two diagnosable substance use disorders (see multiple drug use). Use of this term carries no implications of the nature of the association between the two conditions or of any etiological relationship between them.

WHO Lexicon of alcohol and drug terms

E
Early intervention

A therapeutic strategy that combines early detection of hazardous or harmful substance use and treatment of those involved. Treatment is offered or provided before such time as patients might present of their own volition, and in many cases before they are aware that their substance use might cause problems. It is directed particularly at individuals who have not developed physical dependence or major psychosocial complications. Early intervention is therefore a pro-active approach, which is initiated by the health worker rather than the patient. The first stage consists of a systematic procedure for early detection. There are several approaches: routine enquiry about use of alcohol, tobacco, and other drugs in the clinical history, and the use of screening tests, for example, in primary health care settings. Supplementary questions are then asked in order to confirm the diagnosis. The second component, treatment, is usually brief and takes place in the primary health care setting (lasting on average 5-30 minutes). Treatment may be more extensive in other settings.

See also: brief intervention

WHO Lexicon of alcohol and drug terms

Effect size

A measure that shows the magnitude of the outcome in one group compared with that in a control group. For example, if the absolute risk reduction is shown to be 5% and it is the outcome of interest, the effect size is 5%.

The effect size is usually tested, using statistics, to find out how likely it is that the effect is a result of the treatment and has not just happened by chance (that is, to see if it is statistically significant).

National Institute for Health and Clinical Excellence

Effectiveness

Effectiveness refers to whether the interventions are effective in “real-world” conditions or “natural” settings, (Flay B.R. et al., 2005). The term effectiveness is also used to describe whether a programme achieves its stated goals and produces measurable outcomes.

See also efficacy

EMCDDA glossary

Efficacy

Efficacy is the extent to which an intervention (technology, treatment, procedure, service, or programme) produces a beneficial result under ideal conditions. Efficacy is distinguished from effectiveness.

See also the definition for effectiveness

EMCDDA glossary

Encephalopathy

An inexact term referring to organic brain disorder of any degree. Some authors use the term in a more restricted sense to refer to chronic brain disease with irreversible pathological changes; others use it to describe an acute delirium. Still others use it for early signs of brain tissue dysfunction that are too subtle to warrant a definitive diagnosis. Alcoholic encephalopathy (ICD-10 G31.2) indicates that the damage to brain tissue damage is caused by or associated with alcohol use.

See also: alcoholic brain syndrome.

WHO Lexicon of alcohol and drug terms

Environmental strategies

Environmental strategies are prevention strategies aimed at the immediate cultural, political and social environment of people.

For more details see the EMCDDA prevention web page

EMCDDA glossary

Epidemiology

The study of the causes, distribution, control and prevention of disease. Epidemiologists collect and examine medical data and spot health trends to establish which diseases are on the increase and where, which treatments and other activities work and which do not. (This includes activities to prevent disease and to improve health and wellbeing.) In other words, they consider the possible risk factors for a whole population or area, not just for individual patients.

National Institute for Health and Clinical Excellence

Ethnic approach

The project either solely targeted other ethnic groups or included them specifically in the intervention.

EMCDDA glossary

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was established in 1993. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies.

The EMCDDA exists to provide the EU and its Member States with a factual overview of European drug problems and a solid evidence base to support the drugs debate. Today it offers policymakers the data they need for drawing up informed drug laws and strategies. It also helps professionals and practitioners working in the field pinpoint best practice and new areas of research.

At the heart of the agency’s work is the promotion of scientific excellence. To achieve its core task of providing sound and comparable information on drugs in Europe, the EMCDDA has developed the infrastructure and tools needed to collect country data in a harmonised way. These data are then fed by national drug monitoring centres (Reitox network) to the Lisbon agency for analysis, resulting in a variety of information products conveying the broader European picture.

EMCDDA

European School Survey Project on Alcohol and other Drugs (ESPAD)

ESPAD is a collaborative effort of independent research teams in more than forty European countries and the largest cross-national research project on adolescent substance use in the world. The overall aim with the project is to repeatedly collect comparable data on substance use among 15–16 year old students in as many European countries as possible.

ESPAD publications in library collection

ESPAD

Evaluation

Systematic and scientific collection, processing and analysis of data related to the implementation of an intervention, in order to assess whether the objectives of an intervention have been achieved.

For more information see the EMCDDA Evaluation Instruments Bank . This is an online document archive of tools created to encourage evaluation using reliable methods, and to help to standardise these tools at European level. The Instruments Bank contains tools for evaluating both prevention and treatment programmes.

EMCDDA glossary

Evaluation method

The methodology/approach used in the process of evaluation. This includes quantitative methods as well as qualitative approaches.

EMCDDA glossary

Evaluation of programme planning

The planning and design phase. The evaluation of this phase starts, at the latest, when the idea of beginning the intervention becomes concrete. This is the time when objectives and methods are chosen. The evaluation of the programme planning reflects the process of defining the problem, the need for intervention, the target population and the objectives. Furthermore, it includes the evaluation of the resources, and ends with planning for further evaluation.

For more information see the EMCDDA Evaluation Instruments Bank (EIB)
The EIB is an online document archive of tools created to encourage evaluation using reliable methods, and to help to standardise these tools at European level. The Instruments Bank contains tools for evaluating both prevention and treatment programmes.

EMCDDA glossary

Evidence

Evidence comprises the interpretation of empirical data derived from formal research or systematic investigations, using any type of science or social science method (Rychetnik, M et al., 2002). Depending on how it was obtained, evidence varies greatly in strength.

Best available evidence: The strongest, best-quality research evidence available on the topic being investigated.
Evidence-based: 'Evidence-based' decisions or recommendations are based on research findings that have been systematically appraised - that is, the best available evidence.
Evidence-based clinical practice: Decisions about patient care based on the best research evidence available, rather than on personal opinions or common practice (which may not always be evidence-based).
Appraisal of evidence: Formal assessment of the quality of research evidence and its relevance to the clinical question or topic being considered. It is assessed according to predetermined criteria.
Empirical evidence: Evidence that is based on experience (observation or an experiment) rather than on reasoning alone (NICE glossary)

See also: Evidence-based medicine and Evidence-based practice

EMCDDA glossary

Evidence-based medicine

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Sackett et al., 1996). The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research (Centre for Evidence-Based Medicine Oxford, United Kingdom).

EMCDDA glossary

Evidence-based practices

There are different definitions of evidence-based practices. At a minimum they are interventions that show consistent evidence of being related to preferred outcomes based on best available evidence. The American Psychology Association defines evidence-based practices as the integration of the best available research with expertise in the context of patient characteristics, culture, and preferences. This definition parallels with the definition of the Institute of Medicine as adapted from Sackett et al. (2000) that states: evidence-based practice is the integration of best research evidence with clinical expertise and patient values

EMCDDA glossary

Experimental study

A study in which the investigators actively intervene to test a hypothesis. In a controlled trial, one type of experiment, the people receiving the treatment being tested are said to be in the experimental group or arm of the trial.

Non-experimental study: Participants are selected on the basis of their availability, with no attempt to avoid bias.

Quasi-experimental study: A study based on a true experimental design meets two criteria: manipulation of a variable factor between two or more groups, and random assignment of participants to those groups. A quasi-experimental study uses the first criterion but participants are not randomly assigned to groups. This means a researcher can't draw conclusions about 'cause and effect'. This design is frequently used when it is not feasible, or not ethical, to conduct a randomised controlled trial.

EMCDDA glossary

Experimental use

Usually, the first few instances of using a particular drug (sometimes including tobacco or alcohol). The term sometimes refers to extremely infrequent or non-persistent use.

WHO Lexicon of alcohol and drug terms

External evaluation

Collection, analysis‚ and interpretation of data conducted by an individual or organisation outside the organisation being evaluated.

EMCDDA glossary

F
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.

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).

PubMed Health glossary

Family-based prevention

Universal prevention approach that targets the family.

For more details see the EMCDDA prevention web page. and family prevention page

EMCDDA glossary

Fentanyl

Fentanyl is a narcotic analgesic with a potency at least 80 times that of morphine. Fentanyl and its derivatives (Alfentanil, Sufentanil, Remifentanil and Carfentanil) are used as anaesthetics and analgesics in both human and veterinary medicine (Carfentanil). They are subject to international control as are a range of highly potent non-pharmaceutical fentanyl (NPF) derivatives, such as 3-methylfentanyl, synthesised illicitly and sold as ‘synthetic heroin’, or mixed with heroin.

For more information on this substance see the EMCDDA webpage on fentanyl

EMCDDA Drug profiles glossary

Fetal (Foetal) alcohol syndrome (FAS) (alcohol-related birth defects)

A pattern of retarded growth and development, both mental and physical, with cranial, facial, 1imb, and cardiovascular defects, found in some children of mothers whose alcohol consumption during pregnancy can be classed as hazardous. The commonest abnormalities are: prenatal and postnatal growth deficiency, microcephaly, developmental delay or mental retardation, short palpebral fissures, a short upturned nose with sunken nasal bridge and a thin upper lip, abnormal palmar creases, and cardiac (especially septal) defects. Many other more subtle abnormalities have also been attributed to the effects of alcohol on the fetus (fetal alcohol effects, FAE), but there is controversy regarding the level of maternal consumption that produces such effects. (ICD-10 Q86.0).

WHO Lexicon of alcohol and drug terms

Fidelity of implementation

Fidelity of implementation refers to the degree to which teachers and other programme providers implement programmes as intended by the programme developers (Dusenbury et al.,2003).

EMCDDA glossary

Flashback

An unexpected, episodic recurrence of the effects of a hallucinogenic drug long after its original use. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association, it is named ‘Hallucinogen Persisting Perception Disorder’.

EMCDDA Drug profiles glossary

Focus group

A small group of people with shared characteristics who typically participate, under the direction of a facilitator, in a focused discussion designed to identify perceptions and opinions on a specific topic. Focus groups may be used to collect background information, create new ideas and hypotheses, assess how a programme is working, or help to interpret results from other data sources.

EMCDDA glossary

Follow-up assessment

Expected programme outcomes are measured after the intervention has been implemented and are not compared to the results of some baseline assessment.

EMCDDA glossary

Formative evaluation

Formative evaluation is a method of judging the worth of a programme while the program activities are forming or happening. Formative evaluation focuses on the process. (Bhola 1990). Example: Collecting continuous feedback from participants in a programme in order to revise the programme as needed.

EMCDDA Evaluation Instruments Bank

EMCDDA glossary

G
Gamma-aminobutyric acid (GABA)

This is an abbreviation of Gamma-aminobutyric acid which is the chief inhibitory neurotransmitter in the CNS. GABA binds to any three classes of GABA receptors in brain cells. Drugs such as benzodiazepines, which also activate these receptors (agonists), typically have relaxing, anti-anxiety and anticonvulsant effects.

EMCDDA glossary

Gateway drug

An illicit or licit drug, use of which is regarded as opening the way to the use of another drug, usually one viewed as more problematic.

WHO Lexicon of alcohol and drug terms

Generalisability

The extent to which the results of a study hold true for groups that did not participate in the research. See also external validity

National Institute for Health and Clinical Excellence

Gray/grey literature

Reports that are unpublished or have limited distribution and are not included in bibliographic retrieval systems. Examples include conference proceedings, academic reports, newsletters and industry and technical reports.

National Institute for Health and Clinical Excellence

Growkits

Kits consisting of all the requirements necessary to grow hallucinogenic mushrooms (e.g. Psilocybe cubensis, Psilocybe tampensis). They usually contain a box with colonised substrate, a bag with an air filter and paperclips. Depending on the species, a growkit can produce an average yield of several hundred grams in a few weeks (200–300 grams in 3 weeks).

EMCDDA Drug profiles glossary

Guidelines

Guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate interventions for specific circumstances (Field and Lohr, 1990). Guidelines often include a set of recommendations or steps that can be followed when implementing an intervention. The content of guidelines are commonly based on available research evidence. Other terms used for guidelines: practice guidance, clinical guidelines, guides, practice recommendations.

EMCDDA glossary

H
Half-life

The time required for the concentration of a drug in a tissue (e.g. blood) to fall to 50% of its initial value.

EMCDDA Drug profiles glossary

Hallucination

Apparent perception of an external object or person when no such object or person is present.

EMCDDA Drug profiles glossary

Hallucinogen

A substance that produces as a main effect perceptual distortions, especially visual and auditory. The effects can also extend beyond perceptions to changes of thought, mood and personality integration (self-awareness).The term is somewhat misleading as the hallucinogenic substances do not generally cause true hallucinations (i.e. sensory perceptions in the absence of external stimuli). However, the term is widely accepted by the scientific community.

EMCDDA Drug profiles glossary

Hallucinogenic mushrooms

Hallucinogenic mushrooms’ is the name commonly given to psychoactive fungi, containing hallucinogenic compounds, most commonly psilocybin and psilocin. At low doses, hallucinogenic drugs have as their primary effects perceptual distortions and alterations of thought, or mood, with the presence of lucid awareness and minimal effects on memory and orientation. Despite their name, the use of hallucinogenic drugs rarely results in true hallucinations. The hallucinogens are a chemically diverse class. Grouping the hallucinogens based on their chemical structure includes, but is not limited to, three major classes: indolealkylamines or tryptamines (e.g. LSD, psilocybine and psilocin), phenethylamines, including mescaline and methylenedioxymethamphetamine (MDMA); and cannabinoids.

For more information on this substance see the EMCDDA webpage on hallucinogenic mushrooms

EMCDDA Drug profiles glossary

Hangover

A post-intoxication state comprising the immediate after-effects of drinking alcoholic beverages in excess. Non-ethanol components of alcoholic beverages may be involved in the etiology. Physical features may include fatigue, headache, thirst, vertigo, gastric disorder, nausea, vomiting, insomnia, fine tremors of the hands, and raised or lowered blood pressure. Psychological symptoms include acute anxiety, guilt, depression, irritability, and extreme sensitivity.

The amount of alcohol needed to produce hangover varies with the mental and physical condition of the individual, although generally the higher the blood alcohol level during the period of intoxication, the more intense the subsequent symptoms. The symptoms vary also with social attitude. Hangover usually lasts no more than 36 hours after all traces of alcohol have left the system. Some of the symptoms of hangover are similar to those of the alcohol withdrawal syndrome, but the term "hangover" is usually reserved for the after-effects of a single drinking episode and does not necessarily imply any other alcohol use disorder

WHO Lexicon of alcohol and drug terms

Harm reduction

In the context of alcohol or other drugs, describes policies or programmes that focus directly on reducing the harm resulting from the use of alcohol or drugs. The term is used particularly of policies or programmes that aim to reduce the harm without necessarily affecting the underlying drug use; examples includes needle/syringe exchanges to counteract needle-sharing among heroin users, and self-inflating airbags in automobiles to reduce injury in accidents, especially as a result of drinking-driving. Harm reduction strategies thus cover a wider range than the dichotomy of supply reduction and demand reduction. Synonym: harm minimization

WHO Lexicon of alcohol and drug terms

Harmful use (hazardous use)

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (e.g. hepatitis following injection of drugs) or mental (e.g. depressive episodes secondary to heavy alcohol intake). Harmful use commonly, but not invariably, has adverse social consequences; social consequences in themselves, however, are not sufficient to justify a diagnosis of harmful use. The term was introduced in ICD-I0 and supplanted "non-dependent use" as a diagnostic term. The closest equivalent in other diagnostic systems (e.g. DSM-IIIR) is substance abuse, which usually includes social consequences.

• Hazardous use
A pattern of substance use that increases the risk of harmful consequences for the user. Some would limit the consequences to physical and mental health (as in harmful use); some would also include social consequences. In contrast to harmful use, hazardous use refers to patters of use that are of public health significance despite the absence of any current disorder in the individual user. The term is used currently by WHO but is not a diagnostic term in ICD-I0.

WHO Lexicon of alcohol and drug terms

Health Behaviour in School-aged Children Survey (HBSC)

HBSC is a cross-national research study conducted in collaboration with the World Health Organisation (WHO) Regional Office for Europe. HBSC Ireland is one of 43 countries and regions across Europe and North America that make up the HBSC Network.

HBSC collects data every four years on children and adolescent’s health and well-being, social environments and health behaviours. The findings are used at both a national and international level to:

  • Gain new insight into young people’s health and well-being
  • Understand the social determinants of health
  • Inform policy and practice to improve young people’s lives

HPSC publications in NDC collection

HPSC Ireland

Health impact assessment

A combination of procedures, methods and tools used to judge a policy, programme or project. For example, a health impact assessment could be used to determine how a proposal for a new road or new airport runway will affect local people's health. The process involves: gathering information on the areas and communities affected and using various tools to predict how it will impact on health; evaluating the options; and making recommendations to ensure any potential harm is minimised or opportunities to improve health are maximised. Other similar procedures include strategic environmental assessment, sustainability appraisal and environmental impact assessment.

National Institute for Health and Clinical Excellence

Health inequalities / inequities

Health inequalities relate to differences in health state or status between individuals or groups. These differences could be measured in terms of, for example, socioeconomic group, men and women, ethnic groups or geographical communities. Health inequalities may be partly biological in origin but may also be the consequence of human activity. If inequalities arise as a consequence of human actions, they can be changed if the causes are changed. .

Health inequities: A health inequity is an unnecessary, avoidable, unfair and unjust difference between the health or healthcare of one person, and that of another.

'Health inequity' should not be used interchangeably with the term 'health inequality' because the differences in health or healthcare that people experience are not necessarily unfair or unjust. Health inequity is concerned with social justice, values or politics, while inequalities in health are a matter of fact. Health inequities, like health inequalities, can be eradicated or reduced because they are products of human action. However, addressing them can have considerable political implications because of the value judgement involved: not all people will judge the same health difference to be unfair. See health inequalities.

National Institute for Health and Clinical Excellence

Health promotion

Giving people the information or resources they need to improve their health. As well as improving people's skills and capabilities, it can also involve changing the social and environmental conditions and systems that affect health.

National Institute for Health and Clinical Excellence

Health Service Executive (HSE)

The Health Service Executive is a large organisation of over 100,000 people, whose job is to run all of the public health services in Ireland. The HSE manages services through a structure designed to put patients and clients at the centre of the organisation.

The HSE Code of Governance provides an overview of the principles, policies, procedures and guidelines by which the HSE directs and controls its functions and manages its business, it is intended to guide the Board, the management team and all those working within the HSE and the agencies funded by the HSE, in performing their duties to the highest standards of accountability, integrity and propriety.

The HSE Code of Governance was first approved by the Minister for Health and Children in 2007. The Code has been reviewed and updated in line with best practice and to ensure it meets the requirements of the Code of Practice for the Governance of State bodies (2009). The revised Code was approved by the Minster for Health in August 2011.

Each of the HSE's four administrative areas has a Regional Health Forum, which includes representatives from the city and county councils within that area.

HSE regions Local health offices
HSE Dublin
North East
North West Dublin
North Central Dublin
North Dublin
Cavan/Monaghan
Louth
Meath
HSE Dublin
Mid-Leinster
Dublin South
Dublin South East
Dublin South City
Dublin South West
Dublin West
Kildare/West Wicklow
Wicklow
Longford/Westmeath
Laois/Offaly
HSE South Cork South Lee
Cork North Lee
West Cork
North Cork
Kerry
Carlow/Kilkenny
Tipperary South
Waterford
Wexford
HSE West Donegal
Sligo/Leitrim/West Cavan
Galway
Mayo
Roscommon
Tipperary North/East Limerick
Limerick
Clare

In the case of data presented by region, treatment data refers to the areas covered by the regional drugs task forces (RDTFs), together with the local drugs task forces (LDTFs) within their boundaries, as follows:

Drugs Task Force Area included
ECRDTF East Coast Regional Drugs Task Force (DTF) South-east Dublin city and county and East Wicklow, including the two LDTF areas within these boundaries
MRDTF Midland Regional DTF Counties Laois, Longford, Offaly and Westmeath
MWRDTF Mid West Regional DTF Counties Clare and Limerick, and North Tipperary
NDRDTF North Dublin City and County Regional DTF North Dublin city and county, including the five LDTF areas within these boundaries
NERDTF North Eastern Regional DTF Counties Cavan, Louth, Meath and Monaghan
NWRDTF North West Regional DTF Counties Donegal, Leitrim and Sligo, and north-west Cavan
SERDTF South East Regional DTF Counties Carlow, Kilkenny, Waterford and Wexford, and South Tipperary,
SRDTF Southern Regional DTF Counties Cork and Kerry, including the Cork LDTF area
SWRDTF South Western Regional DTF South-west Dublin, west Wicklow and County Kildare, including the six LDTF areas within these boundaries
WRDTF Western Region DTF Counties Galway, Mayo and Roscommon

Health Service Executive

Heroin

Heroin is a crude preparation of diamorphine. It is a semisynthetic product obtained by acetylation of morphine, which occurs as a natural product in opium: the dried latex of certain poppy species (e.g. Papaver somniferum L.). Diamorphine is a narcotic analgesic used in the treatment of severe pain. Illicit heroin may be smoked or solubilised with a weak acid and injected. Whereas opium has been smoked since historical times, diamorphine was first synthesised in the late nineteenth century. Heroin is under international control.

For more information on this substance see the EMCDDA webpage on heroin

EMCDDA Drug profiles glossary

Heterogeneity / Homogeneity

The term is used in meta-analyses and systematic reviews to describe when the results of a test or treatment (or estimates of its effect) differ significantly in different studies. Such differences may occur as a result of differences in the populations studied, the outcome measures used or because of different definitions of the variables involved. It is the opposite of homogeneity.

Homogeneity
A term used in meta-analyses and systematic reviews to indicate that the results of studies are similar; the opposite of heterogeneity. Study results are also regarded as homogeneous if any differences could have occurred by chance.

National Institute for Health and Clinical Excellence

HIV (Human Immunodeficiency Virus)

The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people's surveillance and defense systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can fight off.

The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations.

Risk factors
Behaviours and conditions that put individuals at greater risk of contracting HIV include:
• having unprotected anal or vaginal sex;
• having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis;
• sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions, medical procedures that involve unsterile cutting or piercing; and
• experiencing accidental needle stick injuries, including among health workers

For more information see the WHO factsheet on HIV

World Health Organization

Hospital In-Patient Enquiry Scheme (HIPE)

HIPE is a computer-based system designed to collect demographic, clinical and administrative data on discharges and deaths from acute hospitals nationally.

HIPE is the only source of morbidity data available nationally for acute hospital services in Ireland. All acute public hospitals participate in HIPE reporting on over 1.3 million records annually.

You can access HIPE data on the ESRI site

Economic and Social Research Institute

I
Illicit drug

A psychoactive substance, the production, sale, or use of which is prohibited. Strictly speaking, it is not the drug that is illicit, but its production, sale, or use in particular circumstances in a given jurisdiction (see controlled substances). "illicit drug market", a more exact term, refers to the production, distribution, and sale of any drug outside legal1y sanctioned channels.

WHO Lexicon of alcohol and drug terms

Incidence

Incidence is the number of new cases of a disease divided by the total population at risk during a certain period. It is often expressed as numbers per million. See also prevalence

As an example, in 2007, in a county with a population of 31,182, 10 opiate users sought treatment for the first time in 2007. The incidence is the number of new cases treated divided by the county population, expressed per given number of the population, i.e., per 100, per 1,000, per 10,000, per 100,000 etc. The rate in this example may be calculated as follows: (10/31,182) x 100,000, which gives an incidence rate of 32 per 100,000 of the county population in 2007.

National Institute for Health and Clinical Excellence

Indicated prevention

Indicated prevention aims to identify individuals who are exhibiting early signs of substance abuse (but not DSM-IV criteria for addiction) and other problem behaviour and to target them with special interventions.

For more details see the EMCDDA prevention web page.

EMCDDA glossary

Indicators

Indicators in the context of evaluation are simply one-dimensional measures that help to measure, to express, or at least to reflect and to simplify the more complex formulation of the objectives.

• Outcome indicators relate the results of a project in the target group to its specific objectives (and the underlying working hypothesis).

• Process indicators relate the outputs of a project (its deliverables, structures created, opportunities given, materials published) to its operational objectives.

For more details see the EMCDDA resource PERK.

EMCDDA Drug profiles glossary

Initial situation

Information relating to the target population such as drug knowledge/use, socio-economic and demographic data can all be included to assess initial situation. Data sources, social perceptions and public discussion related to the situation can also be added.

EMCDDA glossary

Instruments

Instruments refer to all the tools that are used to collect information on the target group, the evaluation, etc. The most widely used instruments in evaluation are self-report questionnaires. Other instruments include tests, ratings, interviews and observation instruments.

EMCDDA glossary

Interactive programmes

Programmes that use participatory teaching and learning methods (i.e. group discussions, group exercises).

EMCDDA glossary

Internal evaluator

An individual (or group of individuals) from within the organisation being evaluated who is (are) responsible for collecting, analysing and interpreting data.

EMCDDA glossary

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.

PubMed Health glossary

Intervention

The act of intervening, interfering or interceding with the intent of modifying the outcome (Medical Dictionary 2nd Edition, 2003).

Intervention in the criminal justice system:
An intervention that is targeted at drug users in contact with the criminal justice system. This may be when they are arrested, appear before court, are in prison or when they are released from prison.

EMCDDA glossary

Intervention-specific instruments

Instruments of examination, observation‚ or evaluation that were specifically constructed for an intervention.

EMCDDA glossary

Interview

In evaluation research, the interview is an instrument used to assess data on the implementation process and outcome. Interviews can differ in their degree of standardisation (structured, semi-structured or unstructured interviews/indepth), the type of contact (face-to-face, telephone or written), or the number of people interviewed at the same time (individual or group interviews).

Semi-structured interview: The interviewer asks a number of open-ended questions and follows up on areas of interest in response to the information given. It allows more flexibility than a structured interview, which involves asking pre-set questions.
Indepth interview: A qualitative research technique that involves a detailed, face-to-face conversation between a researcher and a respondent on a particular issue or topic. It does not use pre-set questions.
Structured interview A research technique in which the interviewer asks all study participants a list of pre-set questions.

EMCDDA glossary

Intoxication

A condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgement, affect, or behaviour, or other psychophysiological functions and responses. The disturbances are related to the acute pharmacological effects of, and learned responses to, the substance and resolve with time, with complete recovery, except where tissue damage or other complications have arisen. The term is most commonly used with regard to alcohol use: its equivalent in everyday speech is "drunkenness". Alcohol intoxication is manifested by such signs as facial flushing, slurred speech, unsteady gait, euphoria, increased activity, volubility, disorderly conduct, slowed reactions, impaired judgement and motor incoordination, insensibility, or stupefaction.

Intoxication is highly dependent on the type and dose of drug and is influenced by an individual's level of tolerance and other factors. Frequently, a drug is taken in order to achieve a desired degree of intoxication. The behavioural expression of a given level of intoxication is strongly influenced by cultural and personal expectations about the effects of the drug.

Acute intoxication is the term in ICD-I0 for intoxication of clinical significance. Complications may include trauma, inhalation of vomitus, delirium, coma, and convulsions, depending on the substance and method of administration.

Habitual intoxication (habitual drunkenness), applied primarily to alcohol, refers to a regular or recurrent pattern drinking to intoxication. Such a pattern has sometimes been treated as a criminal offence, separately from the individual instances of intoxication. Other general terms for intoxication or intoxicated include: drunkenness, high, under the influence, inebriation.

WHO Lexicon of alcohol and drug terms

K
Key informant

Person with the particular background, knowledge, or special skills required to contribute information relevant to topics under examination in an evaluation.

EMCDDA glossary

Khat

Khat (also known as qat or chat) comprises the leaves and fresh shoots of Catha edulis Forsk, a flowering evergreen shrub cultivated in East Africa and the South-West Arabian Peninsula. Khat leaves are typically wrapped as a bundle in banana leaves. The principal active components in khat are cathinone and cathine (norpseudoephedrine) (see also Drug profile on synthetic cathinones). Chewing khat releases these substances into the saliva; they are rapidly absorbed and eliminated. Both cathinone and cathine are closely related to amphetamine, and the pharmacological effects of cathinone are qualitatively similar to those of amphetamine, although it is less potent. Only fresh leaves are chewed, because cathinone soon degrades into old or dry plant material. Analysis relies on the characteristic appearance of khat and the presence of cathinone and/or cathine. Khat is not under International control, but is scheduled by some Member States. Cathinone and cathine are listed in the 1971 United Nations Convention on Psychotropic Substances under Schedules I and III respectively.

For more information on this substance see the EMCDDA webpage on khat

EMCDDA Drug profiles glossary

Kratom (Mitragyna speciosa)

Mitragyna speciosa Korth. (of the Rubiaceae family*) is a 4 to 16 metre high tropical tree indigenous to South East Asia, the Philippines and New Guinea but now cultivated elsewhere. In Thailand, the tree and leaf-preparations from it are called kratom. Traditionally, fresh or dried kratom leaves are chewed or made into tea; they are seldom smoked. At a low dose, kratom has stimulant effects and is used to combat fatigue during long working hours. At high dosages, however, it can have sedative-narcotic effects. It is also used in traditional medicine and as an opium substitute. The phytochemicals isolated from various parts of the tree include over 40 structurally related alkaloids as well as several flavonoids, terpenoid saponins, polyphenols, and various glycosides. The main psychoactive components in the leaves are mitragynine and 7-hydroxymitragynine, both found only in Mitragyna speciosa ~.

For more information on this substance see the EMCDDA webpage on Kratom

* Rubiaceae is a family of flowering plants that are concentrated in warmer and tropical climates around the world. The family includes Coffea of which seeds of several species are the source of the popular beverage coffee.

~ Mitragynine is a psychoactive alkaloid with a complex structure present in the leaves of Mitragyna speciosa. Mitragynine and its 7-hydroxylated derivative are agonists at the μ-opioid receptor (MOR).

EMCDDA Drug profiles glossary

L
Licit drug

A drug that is legally available by medical prescription in the jurisdiction in question, or, sometimes, a drug legally available without medical prescription.

WHO lexicon of alcohol and drug tersm

Life skills programmes

Interventions that implement the concept of life skills. Life skills refers to a large group of psychosocial and interpersonal skills which can help people make informed decisions, communicate effectively, and develop coping and self-management skills that may help them lead a healthy and productive life. Life skills commonly include components that focus on social skills, personal skills and knowledge and also resistance skills. Life skills based interventions are often classified as part of the broader category of social influence based interventions, Morgan (2001), Sussmann et al. (2004).

A standardised life-skill based intervention, the Life Skills Training (LST) was developed by the US researcher Gilbert J. Botvin.
See Life skills programme website.

EMCDDA glossary

Literature review

Collecting, reading and assessing the quality of published (and unpublished) articles on a given topic. Also called a narrative review.

National Institute for Health and Clinical Excellence

Logic model

A logic model is a graphic representation of a programme that describes the programme’s essential components and expected accomplishments and conveys the logical relationship between these components and their outcomes.

See alsoEMCDDA resource: PERK.

EMCDDA glossary

Longitudinal study

A study of the same group of people at different times. This contrasts with a cross-sectional study, which observes a group of people at one point in time.

National Institute for Health and Clinical Excellence

Low threshold services

Services that help drug-addicts with daily survival and help avoid their further deterioration. A main characteristic is that services require little motivation on the part of the drug user and offer basic assistance such as shelter, hygiene and food. They aim at establishing or re-establishing social contacts and getting in contact with hidden populations of drug-users

See also the EMCDDA webpage on low threshold services

EMCDDA glossary

Lysergide (LSD)

Lysergide (LSD) is a semi-synthetic hallucinogen, and is one of the most potent drugs known. Recreational use became popular between the 1960s to 1980s, but is now less common. It is generally believed that most LSD is produced outside Europe, but secondary preparation of dosage units by dipping or spotting paper squares is more widespread. These dosage units usually bear coloured designs featuring cartoon characters, geometric and abstract motifs. LSD is related to other substituted tryptamines*, and is under international control.

For more information on this substance see the EMCDDA webpage on lysergide (LSD)

*Tryptamines are a group of biologically active compounds, including neurotransmitters (e.g. serotonin) and hallucinogens (e.g. LSD, psilocin and psilocybin). The chemical nucleus of these compounds is the monoamine alkaloid tryptamine that can be found in numerous plants and animals. Tryptamine is based around an indole ring structure, and is chemically related to the amino acid tryptophan

EMCDDA Drug profiles glossary

M
Maintenance therapy

Treatment of drug dependence by prescription of a substitute drug for which cross-dependence and cross-tolerance exist. The term is sometimes in reference to a less hazardous form of the same drug used in the treatment. The goals of maintenance therapy are to eliminate or reduce use of a particular substance, especially if it is illegal, or to reduce harm from a particular method of administration, the attendant dangers to health (e.g. from needle sharing) and the social consequences. Maintenance therapy is often accompanied by psychological and other treatment.

Examples of maintenance therapy are the use of methadone for the treatment of heroin dependence and nicotine gum to replace smoking tobacco. Maintenance therapy can last from several weeks to 20 or more years. It is sometimes distinguished from tapering-off therapy (see detoxification).

WHO Lexicon of alcohol and drug terms

Mass media campaigns

Mass media reach all or a large part of the general population (broad coverage). They may be used to enhance public awareness on drugs, provide information on drugs or how to confront drug addiction. Examples are TV and cinema, advertising, press and radio (Internet, posters, leaflets, stickers, t-shirts, might be part of such a campaign).

EMCDDA glossary

MAST (Michigan Alcoholism Screening Test)

The MAST is a 24-item instrument designed to identify alcohol abuse and dependence. It has adequate sensitivity and specificity at a cut-off score of 13 in identifying both of these disorders, but is very long, taking at least 10 minutes. The SMAST, a shorter 13-item version of the MAST, has also demonstrated good reliability as a self-administered questionnaire. However there is little recent published research on these instruments. The Brief Michigan Alcohol Screening Test (b-MAST) has been validated against AUDIT, found significantly correlated, and proved effective in measuring severity of problem drinking in a treatment-seeking population (Connor et al. 2007). The MAST and its shorter versions have been criticised for their lack of sensitivity in detecting alcohol problems among women (Dawe et al 2002).

For more information see The treatment of alcohol problems: a review of the evidence, chapter 3

See also, screening

Australia Government, Department of Health and Ageing

Meta-analysis

The use of statistical techniques in a systematic review to integrate the results of included studies. Sometimes misused as a synonym for systematic reviews, where the review includes a meta-analysis.

EMCDDA glossary

Methadone

A synthetic opiate drug used in maintenance therapy for those dependent on opioids. It has a long half-life, and can be given orally once daily with supervision. Methadone has agonist properties.

See also: maintenance therapy; opioid

WHO Lexicon of alcohol and drug terms

Methamphetamine

A synthetic substance. Normally seen as a white powder, it acts as a stimulant of the central nervous system (CNS). First manufactured in Japan in 1919, methamphetamine has some limited therapeutic use, but most is manufactured in clandestine laboratories, particularly in the USA and the Far East. It is under international control and closely related to amphetamine.

For more information on this substance see the EMCDDA webpage on methamphetamine

EMCDDA Drug profiles glossary

Methylenedioxymethamphetamine (MDMA or Ecstasy)

MDMA is a synthetic substance commonly known as ecstasy, although the latter term has now been generalised to cover a wide range of other substances. Originally developed in 1912 by the Merck chemical company, it was never marketed as such. Although proposed as an aid to psychiatric counselling, therapeutic use is extremely limited. Illicit MDMA is normally seen as tablets, many of which are manufactured in Europe. It acts as a central nervous system (CNS) stimulant and has a weak hallucinogenic property more accurately described as increased sensory awareness. MDMA is under international control.

For more information on this substance see the EMCDDA webpage on MDMA / Ecstasy

EMCDDA Drug profiles glossary

Misuse, drug or alcohol

Use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. The term is preferred by some to abuse in the belief that it is less judgmental.

See also: hazardous use.

WHO Lexicon of alcohol and drug terms

Morbidity rate

The number of cases of an illness, injury or condition within a given time (usually a year).

It can also refer to the percentage of people with a particular illness, injury or condition within a defined population.

National Institute for Health and Clinical Excellence

Mortality rate

The proportion of a population that dies within a particular period of time. The rate is often given as a certain number per 1000 people.

See also, drug-related death

National Institute for Health and Clinical Excellence

Motivational Interviewing

Motivational interviewing (MI) is a psychological treatment that aims to help people cut down or stop using drugs and alcohol. The drug abuser and counsellor typically meet between one and four times for about one hour each time. The counsellor expresses that he or she understands how the clients feel about their problem and supports the clients in making their own decisions. He or she does not try to convince the client to change anything, but discusses with the client possible consequences of changing or staying the same. Finally, they discuss the clients' goals and where they are today relative to these goals.  (Smedslund et al. Cochrane review (2011) Motivational interviewing for substance abuse)

Key resources:

Key documents on Motivational Interviewing from the NDC collection

Multiple drug use (polydrug)

The use of more than one drug or type of drug by an individual, often at the same time or sequentially, and usually with the intention of enhancing, potentiating, or counteracting the effects of another drug. The term is also used more loosely, to include the unconnected use of two or more drugs by the same person. It carries the connotation of illicit use, though alcohol, nicotine, and caffeine are the substances most frequently used in combination with others in industrialized societies.

Multiple drug use disorder (ICD-10 F19) is one of the ''Mental and behavioural disorders due to psychoactive substance use" in ICD-I0, diagnosed only when two or more substances are known to be involved and it is impossible to assess which substance is contributing most to the disorder. The category is also used when the exact identity of some or even all of the substances being used is uncertain or unknown, since many multiple drug users often do not know themselves what they are taking.

WHO Lexicon of alcohol and drug terms

Mutual-help group (Self-help group)

A group in which participants support each other in recovering or maintaining recovery from alcohol or other drug dependence or problems, or from the effects of another' s dependence, without professional therapy or guidance. Prominent groups in the alcohol and other drug field include Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon (for members of alcoholics' families), which are among a wide range of twelve-step groups based on a non-denominational, spiritual approach. Mutual-help groups in the alcohol field date back to the American Washingtonians of the 1840s, and include such Europe-based groups as Blue Cross, Gold Cross, Hudolin groups, and Links. The approach of some of these groups allows for professional or semi-professional guidance. Some recovery homes or halfway houses in the alcohol field and therapeutic communities for those dependent on other drugs might be seen as residential mutual-help groups.

"Self-help group" is a more common term, but "mutual-help group" more exactly expresses the emphasis on mutual aid and support.

WHO Lexicon of alcohol and drug terms

Myopathy, alcohol- or drug-related

A disorder of skeletal muscle related to the use of alcohol and other drugs. The disorder can be acute (when it is termed acute rhabdomyolysis), with extensive necrosis of muscles, which are tender and swollen, and may be complicated by myoglobinuria and renal failure. The chronic form presents with insidious weakness and wasting of the proximal muscles. (ICD-10 G72.0, G72.1).

WHO Lexicon of alcohol and drug terms

N
Naloxone

Naloxone is a semisynthetic opioid receptor antagonist developed in the 1960s. It is relatively short-acting and used clinically to reverse the effect of opioids (e.g. heroin) in overdose or postoperative sedation.

EMCDDA glossary

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.

PubMed Health glossary

Narcotic

A chemical agent that induces stupor, coma, or insensibility to pain. The term usually refers to opiates or opioids, which are called narcotic analgesics. In common parlance and legal usage, it is often used imprecisely to mean illicit drugs, irrespective of their pharmacology. For example, narcotics control legislation in Canada, USA, and certain other countries includes cocaine and cannabis as well as opioids (see also conventions, international drug). Because of this variation in usage, the term is best replaced by one with a more specific meaning (e.g. opioid).

• Narcotic analgesic
A type of analgesic acting on the central nervous system rather than on peripheral nerves. Many opioids (e.g. heroin/diamorphine) are typical narcotic analgesics. (EMCDDA drug profiles glossary)

WHO Lexicon of alcohol and drug terms

National Advisory Committee on Drugs and Alcohol (NACDA)

The NACDA was established in response to the drug problem to assist in our continued need to improve our knowledge and understanding of problem drug use.

The goal of the NACDA is to advise the Government on problem drug use in Ireland in relation to prevalence, prevention consequences and treatment based on our analysis and interpretation of research findings.

NACDA publications in the NDC collection

NACDA

National Drug Treatment Reporting System (NDTRS)

The National Drug Treatment Reporting System (NDTRS) is an epidemiological database on treated drug and alcohol misuse in Ireland. It was established in 1990 in the Greater Dublin Area and was extended in 1995 to cover all areas of the country. Since 2004, clients reporting alcohol as their main problem drug have been recorded by the system.
• Treatment is broadly defined as any activity which aims to ameliorate the psychological, medical or social state of individuals who seek help for their substance misuse problems. Clients who attend needle-exchange services are not included in this reporting system.
• Treatment options include one or more of the following: medication (detoxification, methadone reduction, substitution programmes and psychiatric treatment), brief intervention, counselling, group therapy, family therapy, psychotherapy, complementary therapy and life-skills training.
• Treatment is provided in both residential and non-residential settings.

NDTRS Links:

Health Research Board

National Drug-Related Deaths Index (NDRDI)

The NDRDI is a census of drug-related deaths (such as those due to accidental or intentional overdose) and deaths among drug users (such as those due to hepatitis C and HIV) in Ireland. It also records alcohol-related deaths.

Data is collected from a number of sources, including:
• The Coroner Service;
• The General Mortality Register;
The Central Treatment List;
HIPE

The information is used to develop health and social service responses aimed at reducing the number of deaths.

Links:

Health Research Board

National Institute for Health and Care Excellence (NICE)

NICE guidance supports healthcare professionals and others to make sure that the care they provide is of the best possible quality and offers the best value for money.
They provide independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation.
NICE guidance is for the NHS, local authorities, charities, and anyone with a responsibility for commissioning or providing healthcare, public health or social care services. They also support these groups in putting guidance into practice.

NICE publications in NDC collection

National Institute for Health and Care Excellence

Needle and syringe exchange programmes

Needle and syringe exchange programmes describe the provision of sterile syringes and hypodermic needles as well as further injecting paraphernalia to injecting drug users.

EMCDDA glossary

Needle-sharing

The use of syringes or other injecting instruments (e.g. droppers) by more than one person, particularly as a method of administration of drugs. This confers the risk of transmission of viruses (such as human immunodeficiency virus and hepatitis B) and bacteria (e.g. Staphylococcus aureus).Many interventions such as methadone maintenance and needle/syringe exchanges are designed partly or wholly to eliminate needle-sharing.

WHO Lexicon of alcohol and drug terms

Needs assessment

Needs assessment (or needs analysis) is the systematic appraisal of a perceived phenomenon as well as the appropriateness of the proposed intervention.

EMCDDA glossary

Neuroadaptation

The neuronal changes associated with both tolerance and the appearance of a withdrawal syndrome. It is possible for an individual to exhibit neuroadaptation without showing the cognitive or behavioural manifestations of dependence. For example, surgical patients given opiate substances to relieve pain may sometimes experience withdrawal symptoms but may not recognize them as such or have any desire to continue taking drugs.

WHO Lexicon of alcohol and drug terms

Neurotransmitter

A chemical messenger involved in passing a signal from one neuron to adjacent neurons in the brain or spinal cord.

They include:

For more information see washington.edu website Neurotransmitters and Neuroactive Peptides

EMCDDA Drug profiles glossary

Nicotine

An alkaloid, which is the major psychoactive substance in tobacco. It has both stimulant and relaxing effects. It produces an alerting effect on the electroencephalogram and, in some individuals, an increased capacity to focus attention. In others, it reduces anxiety and irritability. Nicotine is used in the form of inhaled tobacco smoke, "smokeless tobacco" (such as chewing tobacco), snuff, or nicotine gum. Each puff of inhaled tobacco smoke contains nicotine that is rapidly absorbed through the lungs and delivered to the brain within seconds. Considerable tolerance and dependence develop to nicotine. Because of its rapid metabolism, brain levels of nicotine fall rapidly and the smoker experiences craving for a further cigarette 30-40 minutes after finishing the last one.

In the nicotine user who has become physically dependent, a withdrawal syndrome develops within a few hours of the last dose: craving for a smoke, irritability, anxiety, anger, impaired concentration, increased appetite, decreased heart rate, and sometimes headaches and sleep disturbances. Craving peaks at 24 hours and then declines over a period of several weeks, although it may be evoked by stimuli associated with previous smoking habits. Tobacco products contain many constituents besides nicotine. Sustained use of tobacco products may result in lung, head, or neck cancers, heart disease, chronic bronchitis, emphysema, and other physical disorders. Nicotine dependence (ICD-10 FI7.2) is classed as a tobacco use disorder under the psychoactive substance use disorders in ICD-10.

WHO Lexicon of alcohol and drug terms

Nodding

A semi-stuporous state experienced by heroin and high-dose methadone users after the euphoric effects accompanying use have subsided; characterized by head bobbing, bowed head, and drooping eyelids. Synonym: nodding out.

WHO Lexicon of alcohol and drug terms

Non-interactive programmes

Programmes that use didactic methods (i.e. lecturers, presentation of films).

The theory of Didactic Learning methods focuses on the baseline knowledge students possess and seeks to improve upon and convey this information. It also refers to the foundation or starting point in a lesson plan, where the overall goal is knowledge. A teacher or educator functions in this role as an authoritative figure, but also as both a guide and a resource for students.

EMCDDA glossary

Non-medical use

Use of a prescription drug, whether obtained by prescription or otherwise, other than in the manner or for the time period prescribed, or by a person for whom the drug was not prescribed. The term sometimes also covers the use of illicit drugs.

WHO Lexicon of alcohol and drug terms

Noradrenaline

Also known as norepinephrine. An example of a neurotransmitter, it is a naturally occurring substituted phenethylamine. Substances that interact with the noradrenaline receptor are said to be noradrenergic.

EMCDDA Drug profiles glossary

O
Objectives

Objectives are specific and measurable statements regarding the desired outcome of a prevention intervention. For evaluation purposes, the formulation of objectives must specify the variables to be changed and establish measurable success criteria. A plausible, testable assumption must link programme activities to objectives, and objectives to intended outcomes. If the objectives are vague, it will not be possible to implement an intervention or assess the effectiveness of the intervention.

EMCDDA glossary

Objectivity

Objectivity is, along with reliability and validity, an important indicator for the quality of an instrument. It refers to the fact that the results yielded by the instrument must be independent of the person measuring the data - different people using the same instrument should come to the same results.

EMCDDA glossary

Observational study

A study in which the investigators do not seek to intervene, and simply observe the course of events. Changes or differences in one characteristic (e.g. whether or not people received the intervention of interest are studied in relation to changes or differences in other characteristic(s) (e.g. whether or not they develop a disease), without action by the investigator. There is a greater risk of selection bias than in experimental studies.

See also randomised controlled trial (also called non-experimental study), See also Cochrane Collaboration.

(Observation: A research technique that involves watching, listening to and recording behaviours, actions, activities and interactions).

EMCDDA glossary

Odds ratio

Odds are a way to represent how likely it is that something will happen (the probability). An odds ratio compares the probability of something in one group with the probability of the same thing in another.

An odds ratio of 1 between two groups would show that the probability of the event (for example a person developing a disease, or a treatment working) is the same for both. An odds ratio greater than 1 means the event is more likely in the first group. An odds ratio less than 1 means that the event is less likely in the first group.

Sometimes probability can be compared across more than two groups - in this case, one of the groups is chosen as the 'reference category', and the odds ratio is calculated for each group compared with the reference category. For example, to compare the risk of dying from lung cancer for non-smokers, occasional smokers and regular smokers, non-smokers could be used as the reference category. Odds ratios would be worked out for occasional smokers compared with non-smokers and for regular smokers compared with non-smokers. See also confidence interval, relative risk, risk ratio.

National Institute for Health and Clinical Excellence

Operational_objectives

These are technical, intermediate aims in order to achieve the changes in the target group previously defined as specific objective. Operational objectives are the outputs or products of the intervention, for instance training sessions held, manuals published and distributed, teachers trained, schools involved, peers recruited, but also the demands for repetition of the intervention and the degree of acceptance.

EMCDDA glossary

Opiate

One of a group of alkaloids derived from the opium poppy (Papaver somniferum) with the ability to induce analgesia, euphoria, and, in higher doses, stupor, coma, and respiratory depression. The term opiate excludes synthetic opioids. See also: opioid

WHO Lexicon of alcohol and drug terms

Opioid

The generic term applied to alkaloids from the opium poppy (Papaver somniferum), their synthetic analogues, and compounds synthesized in the body, which interact with the same specific receptors in the brain, have the capacity to relieve pain, and produce a sense of well-being (euphoria). The opium alkaloids and their synthetic analogues also cause stupor, coma, and respiratory depression in high doses.

Opium alkaloids and their semi-synthetic derivatives include morphine, diacetylmorphine (diamorphine, heroin), hydromorphine, codeine, and oxycodone. Synthetic opioids include levorphanol, propoxyphene, fentanyl, metha- done, pethidine (meperidine) and the agonist-antagonist pentazocine.

Endogenously occurring compounds with opioid actions include the endorphins and enkephalins (see opioid, endogenous). The most commonly used opioids (such as morphine, heroin, hydromorphine, methadone, and pethidine) bind preferentially to the .u-receptors; they produce analgesia, mood changes (such as euphoria, which may change to apathy or dysphoria), respiratory depression, drowsiness, psychomotor retardation, slurred speech, impaired concentration or memory, and impaired judgement.

Over time, morphine and its analogues induce tolerance and neuroadaptive changes that are responsible for rebound hyperexcitability when the drug is withdrawn. The withdrawal syndrome includes craving, anxiety, dysphoria, yawning, sweating, piloerection (waves of gooseflesh), lacrimation, rhinorrhoea, insomnia, nausea or vomiting, diarrhoea, cramps, muscle aches, and fever. With short-acting drugs such as morphine or heroin, withdrawal symptoms may appear within 8-12 hours of the last dose of the drug, reach a peak at 48-72 hours, and clear after 7-10 days. With longer-acting drugs such as methadone, onset of withdrawal symptoms may not occur until 1-3 days after the last dose; symptoms peak between the third and eight day and may persist for several weeks, but are generally milder than those that follow morphine or heroin withdrawal after equivalent doses.

There are numerous physical sequelae of opioid use (principally as a result of the usual, intravenous, method of administration). They include hepatitis B, hepatitis C, human immunodeficiency virus infection, septicaemia, endocarditis, pneumonia and lung abscess, thrombophlebitis, and rhabdomyolysis. Psychological and social impairment, often reflecting the illicit nature of non-medical use of these drugs, is prominent.

Opioid, endogenous:

Any one of the naturally occurring brain neuropeptides, which include at least two major groups, the enkephalins and the endorphins. Both can interact with opiate-binding sites (receptors) and may thus modulate the perception of pain; endorphins, in addition, appear to modulate mood and responses to stressful stimuli.

WHO Lexicon of alcohol and drug terms

Opium

The dried latex of the seed capsule of the opium poppy (Papaver somniferum L.).

See also opioid

EMCDDA Drug profiles glossary

Outcome

The impact that a test, treatment, policy, programme or other intervention has on a person, group or population. Outcomes from interventions to improve the public's health could include changes in knowledge and behaviour related to health, societal changes (for example, a reduction in crime rates) and a change in people's health and wellbeing or health status. In clinical terms, outcomes could include the number of patients who fully recover from an illness or the number of hospital admissions, and an improvement or deterioration in someone's health, functional ability, symptoms or situation. Researchers should decide what outcomes to measure before a study begins.

National Institute for Health and Clinical Excellence

Outcome evaluation

Systematic process of collecting, analysing and interpreting data to assess and evaluate what outcomes an intervention has achieved, (Chinman M, Imm P, Wandersman A (2004). In other words, outcome evaluation measures how clients and their circumstances change and whether the intervention experience has been a factor in causing this change (WHO/UNDCP/EMCDDA Workbooks on evaluation, 2000).

See also, EMCDDA Evaluation Instruments Bank

EMCDDA glossary

Outpatient treatment

Out-patient treatment is treatment where the patient does not spend the night on the premises.

EMCDDA glossary

Outreach work

Community-based activities with the aim of getting in touch with persons who are not effectively reached by existing services. One key element is active contact-making with high-risk groups in a setting where they are comfortable, and keeping in close contact with them, instead of waiting for these people to approach services. Activities range from prevention to healthcare and advice for untreated drug users.

EMCDDA glossary

Overall objective

The main purpose of the intervention- the solution or modification of the stated problem. Its definition should include a brief description of the expected change, preferably a quantifiable measure of outcomes, with regard to population and when it is expected to be achieved.

EMCDDA glossary

Overdose

The use of any drug in such an amount that acute adverse physical or mental effects are produced. Deliberate overdose is a common means of suicide and attempted suicide. In absolute numbers, overdoses of licit drugs are usually more common than those of illicit drugs. Overdose may produce transient or lasting effects, or death; the lethal dose of a particular drug varies with the individual and with circumstances.

See also: intoxication; and death.

WHO Lexicon of alcohol and drug terms

P
P value

The p value is a statistical measure that indicates whether or not an effect is statistically significant.

For example, if a study comparing two treatments found that one seems more effective than the other, the p value is the probability of obtaining these results by chance. By convention, if the p value is below 0.05 (that is, there is less than a 5% probability that the results occurred by chance) it is considered that there probably is a real difference between treatments. If the p value is 0.001 or less (less than a 1% probability that the results occurred by chance), the result is seen as highly significant.

If the p value shows that there is likely to be a difference between treatments, the confidence interval describes how big the difference in effect might be.

National Institute for Health and Clinical Excellence

Passive smoking

The involuntary inhalation of smoke, usually tobacco smoke, from another person's smoking. Coined in the 1970s in connection with studies of the effects of such inhalation, the term helped to draw attention to the detrimental effects of smoking on people in the smoker's immediate environment. Synonym: environmental tobacco smoke (ETS) exposure

WHO Lexicon of alcohol and drug terms

Peer review

Review of a study, service or recommendation by those with similar interests and expertise to the people who produced it to make sure the study results are accurate and valid. (Note: the review cannot guarantee that the results of the study will not be flawed - that is, prone to bias.) Peer reviewers can include both professionals and 'lay' experts. Lay experts are people whose expertise derives from their personal experience rather than formal training.

National Institute for Health and Clinical Excellence

Peer-led approach

A psychological support that is provided by a person of a background that is similar to the client’s. When active drug users take part in an outreach activity they provide peer support, as do students who are actively involved in the implementation of a prevention programme for fellow students.

EMCDDA glossary

Phencyclidine (PCP)

A psychoactive drug with central nervous system depressant, stimulant, analgesic, and hallucinogenic effects. It was introduced into clinical medicine as a dissociative anaesthetic but its use was abandoned because of the frequent occurrence of an acute syndrome consisting of disorientation, agitation, and delirium. It appears to be of value in treatment of stroke. PCP is relatively cheap and easy to synthesize and has been in use as an illicit drug since the 1970s. Related agents that produce similar effects include dexoxadrol and ketamine.

In illicit use PCP may be taken orally, intravenously, or by sniffing, but it is usually smoked; effects begin within 5 minutes and peak at about 30 minutes. At first, the user feels euphoria, body warmth, and tingling, floating sensations, and a feeling of calm isolation. Auditory and visual hallucinations may appear, as well as altered body image, distorted perceptions of space and time, delusions, and disorganization of thought. Accompanying neurological and physiological symptoms are dose-related and include hypertension, nystagmus, ataxia, dysarthria, grimacing, profuse sweating, hyperreflexia, diminished re- sponsiveness to pain, muscle rigidity, hyperpyrexia, hyperacusis, and seizures.

Effects usually last for 4-6 hours, although residual effects may take several days or longer to clear. During the immediate recovery period there may be self-destructive or violent behaviour. PCP delirium, PCP delusional disorder, and PCP mood disorder have been observed. As is the case with the hallucinogens, it is not known whether such disorders are specific drug effects or a manifestation of pre-existing vulnerability. In ICD-10, PCP-related disorders are classed with hallucinogens (F16).
poisoning, alcohol or drug (T40, Ts1, X61, X61, X6s, X66) A state of major disturbance of consciousness level, vital functions, and behaviour following the administration in excessive dosage (deliberately or accidentally) of a psychoactive substance. (See overdose & intoxication). In the field of toxicology, the term poisoning is used more broadly to denote a state resulting from the administration of excessive amounts of any pharmacological agent, psychoactive or not.

WHO Lexicon of alcohol and drug terms

Phenethylamine

A chemical substance comprising a phenyl group attached to a linear chain of two carbon atoms and terminating in an amino group. The expanded name is 2-phenylethylamine. The phenethylamine family includes a range of substances that may be stimulants, entactogens* or hallucinogens.

*Entactogen is a substance that produces a socialising effect and desire for contact, most often applied to MDMA and related drugs.

EMCDDA Drug profiles glossary

Pilot study

A small-scale 'test' of a particular approach. For example, a new questionnaire could be piloted with a small group of people before it is sent out to a wider audience. The aim would be to highlight any problems or areas of concern and amend it before the full-scale study begins.

National Institute for Health and Clinical Excellence

Placebo

A fake (or dummy) treatment given to participants in the control group of a clinical trial. It is indistinguishable from the actual treatment (which is given to participants in the experimental group). The aim is to determine what effect the experimental treatment has had - over and above any placebo effect caused because someone has received (or thinks they have received) care or attention.

National Institute for Health and Clinical Excellence

Placebo

A fake (or dummy) treatment given to participants in the control group of a clinical trial. It is indistinguishable from the actual treatment (which is given to participants in the experimental group). The aim is to determine what effect the experimental treatment has had - over and above any placebo effect caused because someone has received (or thinks they have received) care or attention.

Placebo effect: A beneficial (or adverse) effect resulting from someone thinking they have been given a treatment. This can occur when people in the control group of a study take a placebo.

National Institute for Health and Clinical Excellence

Population

A group of people with a common link, such as the same medical condition or living in the same area or sharing the same characteristics. The population for a clinical trial is all the people the test or treatment is designed to help (such as adults with diabetes). The group taking part in a clinical trial need to be typical of the whole population of interest.

National Institute for Health and Care Excellence

Potency

A quantitative measure of the activity or strength of a drug: a different concept to purity, which is the proportion of active drug.

EMCDDA Drug profiles glossary

Pre-post design

Pre-post design with comparison group – quasi-experimental:
In this case, to the simple pre-post design a comparison/control group is added that undergoes the same evaluation procedures as before but does not receive the intervention. With this design one can demonstrate that the effects are most likely due to the intervention, but some critics could still say that there were pre-selection or context effects that made the intervention group more likely to show results than the comparison/control group: e.g. having less risk factors.

Pre-post design without comparison group – naturalistic:
The pre- and post-test design (also called naturalistic design) is a simple way to plan an outcome evaluation without the benefits of a control group. In this design, the only people measured are those who receive the intervention. They are tested on their knowledge, attitudes or intentions, for example, before and after the intervention. The differences between the two measurements are then checked for statistical significance. The advantage of this design is its simplicity and the fact that it is not very time consuming. The major drawback is that without a control group, it is difficult to know whether the results are really due to the intervention, or to some other confounding factors.

Pre-post design with comparison group and randomisation:
See definition for randomised controlled trial.

EMCDDA glossary

Prevalence

The term prevalence refers to the proportion of a population who have used a drug over a particular time period. In general population surveys, prevalence is measured by asking respondents in a representative sample drawn from the population to recall their use of drugs.

In the NACD drug prevalence surveys the following terms are used:

The three most widely used recall periods are: lifetime (ever used a drug), last year (used a drug in the last twelve months), and last month (used a drug in the last 30 days). Provided that a sample is representative of the total population, prevalence information obtained from a sample can be used to infer prevalence in the population.

• Lifetime prevalence refers to the proportion of the sample that reported ever having used the named drug at the time they were surveyed. A person who records lifetime prevalence may or may not be currently using the drug. Lifetime prevalence should not be interpreted as meaning that people have necessarily used a drug over a long period of time or that they will use the drug in future.

• Last year prevalence refers to the proportion of the sample that reported using a named drug in the year prior to the survey. Last year prevalence is often referred to as recent use.

• Last month prevalence refers to the proportion of the sample that reported using a named drug in the 30 day period prior to the survey. Last month prevalence is often referred to as current use. A proportion of those reporting current use may be occasional (or first-time) users who happen to have used in the period leading up to the survey. It should therefore be appreciated that current use is not synonymous with regular use.

When examining the data and comparing results over time, last year use is the best reflection of changes as it refers to recent use. Last month use is equally valuable as it refers to current use.

Related terms:incidence

NACD prevalence bulletins

National Institute for Health and Care Excellence

Prevention Evaluation Resource Kit (PERK)

PERK is an EMCDDA resource which compiles basic but evidence-based prevention principles, planning rules and evaluation tips. It also provides related documentation or references for download. This additional material is particularly useful for readers who have difficulty accessing scientific prevention literature. Each theoretical discussion is illustrated with an intervention example, partly based on a real-life situation, to give a practical perspective.

EMCDDA glossary

Preventive intervention

Prevention intervention describes an activity that will be carried out in order to prevent substance use behaviour. Prevention interventions can be realised in different settings and with different methods and contents. The duration can vary between one-off activities and long-term projects running for several months or more.

See the EMCDDA prevention web page and prevention evaluation instruments

EMCDDA glossary

Primary level research

Any investigation study (or trial) that is designed to investigate a hypothesised cause-effect relation by modifying the supposed causal factor(s) in the study population. A trial is an umbrella term for a variety of designs, including uncontrolled trials, controlled trials and randomised controlled trials.

EMCDDA glossary

Probability

How likely it is that an event will occur. For example, the likelihood that a treatment or intervention will help alleviate a health problem. See also odds ratio.

National Institute for Health and Clinical Excellence

Process evaluation

Process evaluation assesses the implementation of the intervention and its effects on the various participants. It questions how the intervention took place, whether it was performed in conformity with its design, and whether the designated target group was reached. The process evaluation will help to explain outcome data and to discuss improvement of the intervention in the future

See EMCDDA Evaluation Instruments Bank

Also Workbook 4 of WHO/UNDCP/EMCDDA Workbooks on evaluation, 2000

EMCDDA glossary

Prospective study

A research study in which the health or other characteristic of participants is monitored (or 'followed up') for a period of time, with events recorded as they happen. This contrasts with retrospective studies.

National Institute for Health and Care Excellence

Pseudo-Cushing syndrome, alcohol-induced

An endocrine disorder (ICD-10 E24.4), induced by alcohol, in which there is excessive production of corticosteroids by the adrenal glands. It is manifested by a bloated and reddened face (similar to that of true Cushing syndrome), obesity, and hypertension, and distinguished from true Cushing syndrome by the more ready suppression of cortisol levels by administration of dexamethasone, and by resolution of the biochemical abnormalities after cessation of alcohol use.

WHO Lexicon of alcohol and drug terms

Psilocybin

One of the naturally occurring hallucinogens found in over 75 species of mushrooms of the genera Psilocybe, Panaeolus, and Conocybe, which grow throughout much of the world. Psilocybin is the major hallucinogenic constituent of the mushrooms and psilocin is present in small amounts. After ingestion, however, psilosybin is converted to psilocin by the enzyme alkaline phosphatase; psilocin is about 1.4 times as potent as psilocybin.

See also: hallucinogen

WHO Lexicon of alcohol and drug terms

Psychoactive drug or substance

A substance that, when ingested, affects mental processes, e.g. cognition or affect. This term and its equivalent, psychotropic drug, are the most neutral and descriptive terms for the whole class of substances, licit and illicit, of interest to drug policy. "Psychoactive" does not necessarily imply dependence-producing, and in common parlance, the term is often left unstated, as in "drug use" or "substance abuse". (See also drug)

A cultural-political debate over whether general descriptive terms would give a favourable or unfavourable cast to the experience of mind-changing was conducted in many European and English-speaking countries in the 1960s and 1970s with regard to LSD and similar drugs. The terms ''psychotomimetic'' and ''hallucinogen'' (the latter became the accepted name for this class of drugs) conveyed an unfavourable connotation, while "psychedelic" and ''psycholytic'' gave a more favourable cast. ''psychedelic'', in particular, was also used with the same broad scope as "psychoactive" (The Journal of psychedelic drugs eventually changed to "psychoactive" in its title in 1981.) see also: psychotropic.

WHO Lexicon of alcohol and drug terms

Psychoactive substance use disorders

A shortened version of the term used in ICD-10—Mental and behavioural disorders associated with psychoactive substance use. The term encompasses acute intoxication (F1x.0), harmful use (F1x.1), dependence syndrome (F1x.2), withdrawal state (F1x.3), withdrawal state with delirium (F1x.4), psychotic disorder (F1x.5) and amnesic syndrome (F1x.6). For a particular substance these conditions may be grouped together as, for example, alcohol use disorders, cannabis use disorders, stimulant use disorders. Psychoactive substance use disorders are defined as being of clinical relevance; the term "psychoactive substance use problems" is a broader one, which includes conditions and events not necessarily of clinical relevance. See also: alcohol-related problem; drug-related problem

WHO Lexicon of alcohol and drug terms

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 (Pubmed Health glossary)

Psychosocial interventions include structured counselling, motivational enhancement, case management, care-coordination, psychotherapy and relapse prevention.

Resources:

NICE Drug misuse pathway - psychosocial interventions

Key psychosocial intervention publications in the NDC collection

EMCDDA glossary

Psychotic disorder

This occurs during or after substance use and will result in individuals experiencing vivid hallucinations, misidentifications, delusions, possibly paranoid type behaviours, psychomotor disturbances (excitement or stupor), and an abnormal affect, which may range from intense fear to ecstasy. The effects of this disorder resolve partially within 1 month and fully within 6 months.
(From BearingPoint et al (2013) Substance and drug dependency)

ICD-10 (Mental and behavioural disorders due to psychoactive substance use; F10-F19) describes a psychotic disorder as a cluster of psychotic phenomena that occur during or following psychoactive substance use but that are not explained on the basis of acute intoxication alone and do not form part of a withdrawal state. The disorder is characterized by hallucinations (typically auditory, but often in more than one sensory modality), perceptual distortions, delusions (often of a paranoid or persecutory nature), psychomotor disturbances (excitement or stupor), and an abnormal affect, which may range from intense fear to ecstasy. The sensorium is usually clear but some degree of clouding of consciousness, though not severe confusion, may be present.
Including: Alcoholic:
• hallucinosis
• jealousy
• paranoia
• psychosis NOS

 

Residual and late-onset psychotic disorder:
A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect, personality, or behaviour persist beyond the period during which a direct psychoactive substance-related effect might reasonably be assumed to be operating. Onset of the disorder should be directly related to the use of the psychoactive substance. Cases in which initial onset of the state occurs later than episode(s) of such substance use should be coded here only where clear and strong evidence is available to attribute the state to the residual effect of the psychoactive substance. Flashbacks may be distinguished from psychotic state partly by their episodic nature, frequently of very short duration, and by their duplication of previous alcohol- or other psychoactive substance-related experiences.
Including:
o Alcoholic dementia NOS
o Chronic alcoholic brain syndrome
o Dementia and other milder forms of persisting impairment of cognitive functions
o Flashbacks
o Late-onset psychoactive substance-induced psychotic disorder
o Post-hallucinogen perception disorder
o Residual:
• affective disorder
• disorder of personality and behaviour
Excluding:
alcohol- or psychoactive substance-induced:
• Korsakov syndrome (F10-F19 with common fourth character .6)
• psychotic state (F10-F19 with common fourth character .5)

WHO ICD-10

Psychotropic drug

A generic term for substances that modify normal behaviour. Examples can be found in the 1971 UN Convention on Psychotropic Substances. Many are subclassified as stimulants or hallucinogens, but the term can also include sedatives, tranquillisers and hypnotics. Psychotropic drugs are differentiated from narcotics, which are more correctly known as narcotic analgesics.

From WHO Lexicon of alcohol and drug terms

Psychotropic:
In its most general sense, a term with the same meaning as "psychoactive'', i.e. affecting the mind or mental processes. Strictly speaking, a psychotropic drug is any chemical agent whose primary or significant effects are on the central nervous system. Some writers apply the term to drugs whose primary use is in the treatment of mental disorders—anxiolytic sedatives, antidepressants, antimanic agents, and neuroleptics. Others use the term to refer to substances with a high abuse liability because of their effects on mood, consciousness, or both—stimulants, hallucinogens, opioids, sedatives/hypnotics (including alcohol), etc. In the context of international drug control, "psychotropic substances" refers to substances controlled by the 1971 Convention on Psychotropic Substances (see conventions, international drug).

EMCDDA Drug profiles glossary

Purity

The proportion (%) of active drug in a preparation: a different concept topotency, which is quantitative measure of the activity or strength of a drug. Most laboratories determine purities with respect to the base because in a sample sent for analysis the particular salt form cannot be determined without further, often unnecessary, investigation. So, for example, pure amphetamine base has a purity defined as 100%. When amphetamine base reacts with, for example, sulfuric acid to form the sulfate salt, then the purity of that salt, with respect to the base, is 79%; the remaining 21% is the sulfate residue. If the purity is expressed with respect to a specific salt form, then pure amphetamine sulfate has a purity of 100%.

EMCDDA Drug profiles glossary

Q
Qualitative research

Qualitative research is a collection of methodological approaches used to study the social world, in which activities are studied in naturalistic settings rather than under experimental conditions, and where the subjective experiences of ordinary people are of greater interest than objective categories and measurements of researchers. (Davies, 2000).

Qualitative research uses a variety of methods, including interviews, observations of naturally-occurring activities, detailed description and ethnography, conversation and discourse analysis, analysis of text and semiotic representations, personal accounts, biographies and oral histories. In qualitative approaches to evaluation, the aim is to understand a programme or particular aspects of it as a whole. Instead of entering the study with a pre-existing set of expectations for examining or measuring processes and outcomes (quantitative approach), the emphasis is on detailed description and in-depth understanding as it emerges from direct contact and experience with the programme and its participants.

See also, quantitative research

EMCDDA glossary

Quality assurance

Quality assurance can be defined as a system of procedures, checks, audits and corrective actions to ensure that a service and reporting activities are of the highest achievable quality, (Last, 1995). Quality assurance can be implemented as a more or less formal control measure and with a higher or lower level of reporting through providers and public control institutions. Among the most traditional measures are quality standards and guidelines, evaluation (monitoring) and training of staff.

EMCDDA glossary

Quality standards

Quality standards are generally accepted principles or sets of rules for the best/most appropriate way to implement an intervention. Frequently they refer to structural (formal) aspects of quality assurance, such as environment and staff composition. However, they may also refer to process aspects such as adequacy of content, process of the intervention or evaluation processes.

EMCDDA glossary

Quality-adjusted life years (QALYS)

A measure of the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life. One QALY is equal to 1 year of life in perfect health.

QALYS are calculated by estimating the years of life remaining for a patient following a particular treatment or intervention and weighting each year with a quality of life score (on a zero to one scale). It is often measured in terms of the person's ability to perform the activities of daily life, freedom from pain and mental disturbance.

National Institute for Health and Care Excellence

Quantitative research

Research that generates numerical data or data that can be converted into numbers. An example is research using clinical trials. Another example is the national Census, which counts people and households. It might involve questions like: 'How many people visit their GP each year?'; or 'What proportion of children have had this vaccine?'.

See also, qualitative research

National Institute for Health and Care Excellence

R
Randomised controlled trial

An experiment in which two or more interventions, possibly including a control intervention or no intervention, are compared by being randomly allocated to participants. In most trials one intervention is assigned to each individual but sometimes assignment is to defined groups of individuals (for example, in a household) or interventions are assigned within individuals (for example, in different orders or to different parts of the body),

Random assignment:
The arbitrary process through which eligible study participants are assigned to either a control group or the group of people who will receive the intervention (Chinman et al. 2004).

Non-randomised controlled trial:
A clinical trial with a control group in which patients are not put in the study or control group by chance (randomisation). Instead, they are sorted using other methods.

EMCDDA glossary

Rapid Alcohol Problem Screen

The Rapid Alcohol Problem Screen (RAPS) is a screening instrument which is used to screen for alcohol dependence – it is suggested that two positive scores may be indicative of dependence. It contains four questions and was asked of current drinkers: ‘During the past 12 months have you:

1) had feelings of guilt or remorse after drinking?

2) Had a friend or family member tell you about things you said or did while drinking that you did not remember?

3) Failed to do what was normally expected from you because of drinking?

4) Needed a first drink in the morning to get yourself going after a heavy drinking session?’

RAPS4 tool

NACDA Alcohol bulletin

Recovery

From Advisory Council on the Misuse of Drugs (2012) Recovery from drug and alcohol dependence

Recovery capital
Recovery capital refers to the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery‟ from substance misuse (dependency) (Granfield and Cloud, 2001). In 2009, Granfield and Cloud revisited their initial concept and argued that there are four components to recovery capital:

  • Social capital is defined as the sum of resources that each person has as a result of their relationships, and includes both support from and obligations to groups to which they belong; thus, family membership provides supports but will also entail commitments and obligations to the other family members.
  • Physical capital is defined in terms of tangible assets such as property and money that may increase recovery options (e.g. being able to move away from existing friends/networks or to fund an expensive detox service).
  • Human capital includes skills, positive health, aspirations and hopes, and personal resources that will enable the individual to prosper. Traditionally, high educational attainment and high intelligence have been regarded as key aspects of human capital, and will help with some of the problem-solving that is required on a recovery journey.
  • Cultural capital includes the values, beliefs and attitudes that link to social conformity and the ability to fit into dominant social behaviours

What is recovery?
There are multiple definitions of recovery, some of which are presented below. Most of these recognise that recovery is a process, not a single event or end point.

  • The 2010 UK Drug Strategy notes that recovery: involves three overarching principles– wellbeing, citizenship, and freedom from dependence...It is an individual, person-centred journey, as opposed to an end state, and one that will mean different things to different people.
  • The Scottish Government (2008) defines recovery as: a process through which an individual is enabled to move from their problem drug use, towards a drug-free lifestyle as an active and contributing member of society... recovery is most effective when service users’ needs and aspirations are placed at the centre of their care and treatment…an aspirational and person-centred process.
  • The UK Drug Policy Commission (UKDPC) recovery consensus group (2008) defined recovery as: voluntarily sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society.The consensus group suggests that there are various routes to recovery, including „medically-maintained abstinence‟.
    The UKDPC discusses recovery as accruing positive benefits, not just reducing or removing harms caused by substance use. Recovery is about building a satisfying and meaningful life, as defined by the person themselves, and involves participation in the rights, roles and responsibilities of society. Recovery may be associated with a number of different types of support and interventions or may occur without any formal external help: no „one size fits all‟. Recovery also embraces inclusion, or a re-entry into society and the improved self-identity that comes with a productive and meaningful role. For many people this is likely to include being able to participate fully in family life and be able to undertake work in a paid or voluntary capacity (UKDPC, 2008).
  • In the USA, The Betty Ford Institute Consensus Panel (2007) defined recovery as: ‘a voluntarily maintained lifestyle characterised by sobriety, personal health and citizenship.’ The Consensus Panel further detailed the meaning of sobriety by explicitly stating that: ‘formerly opioid-dependent individuals who take naltrexone, buprenorphine, or methadone as prescribed and are abstinent from alcohol and all other non-prescribed drugs would meet this definition of sobriety’.
  • Also in the USA, the Substance Abuse and Mental Health Services Administration (SAMHSA) defined “recovery from mental disorders and substance use disorders” as: ‘A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential’. SAMHSA noted four major dimensions that support a life in recovery: health, home, purpose and community.  (SAMHSA 2011)
  • William White notes that recovery from a substance use disorder has been characterised by three core dimensions of change: remission of the substance use disorder; enhancement in global health (physical, emotional, relational, occupational and spiritual); and positive community inclusion (White, 2007).

The ACMD Recovery Committee notes that recovery is an ambitious concept that may require someone with drug or alcohol dependence to both overcome that dependence and also achieve a way of life, improvements to well-being and social integration that they did not have prior to developing substance misuse problems. (Advisory Council on the Misuse of Drugs (2012) Recovery from drug and alcohol dependence)

Advisory Council on the Misuse of Drugs

Recreational use

Use of a drug, usually an illicit drug, in sociable or relaxing circumstances, by implication without dependence or other problems. The term is disfavoured by those seeking to define all illicit drug use as a problem. Compare social drinking

WHO Lexicon of alcohol and drug terms

Rehabilitation

In the field of substance use, the process by which an individual with a substance use disorder achieves an optimal state of health, psychological functioning, and socia1 well-being. Rehabilitation follows the initial phase of treatment (which may involve detoxification and medical and psychiatric treatment). It encompasses a variety of approaches including group therapy, specific behaviour therapies to prevent relapse, involvement with a mutual-help group, residence in a therapeutic community or half-way house, vocational training, and work experience. There is an expectation of social reintegration into the wider community.

WHO Lexicon of alcohol and drug terms

Reinstatement

Reversion to a pre-existing level of substance use and dependence in an individual who has resumed use following a period of abstinence. As described, not only does the individual return to the previous pattern of regular or intensive substance use, but there is also a rapid reinstatement of other dependence elements, such as impaired control, tolerance, and withdrawal symptoms. The term is used primarily in the phrase "rapid reinstatement", which features in some descriptions of the alcohol dependence syndrome but is not included as a criterion in ICD-IO.

WHO Lexicon of alcohol and drug terms

Relapse

A return to drinking or other drug use after a period, of abstinence, often accompanied by reinstatement of dependence symptoms. Some writers distinguish between relapse and lapse ("slip"), with the latter denoting an isolated occasion of alcohol or drug use.

• Relapse prevention:
A set of therapeutic procedures employed in case of alcohol or other drug problems to help individuals avoid or cope with lapses or relapses to uncontrolled substance use. The procedures may be used with treatment based on either moderation or abstinence, and in conjunction with other therapeutic approaches. Patients are taught coping strategies that can be used to avoid situations considered dangerous precipitants of relapse, and shown, through mental rehearsal and other techniques, how to minimize substance use once a slip has occurred.

WHO Lexicon of alcohol and drug terms

Relative risk (risk ratio)

The ratio of the risk of disease or death among those exposed to certain conditions compared with the risk for those who are not exposed to the same conditions (for example, the risk of people who smoke getting lung cancer compared with the risk for people who do not smoke).

If both groups face the same level of risk, the relative risk is 1. If the first group had a relative risk of 2, subjects in that group would be twice as likely to have the event happen. A relative risk of less than one means the outcome is less likely in the first group. Relative risk is sometimes referred to as risk ratio.

National Institute for Health and Care Excellence

Reliability

The degree to which results obtained by a measurement procedure can be replicated. Lack of reliability can arise from divergences between observers or measurement instruments, measurement error, or instability in the attribute being measured.

EMCDDA glossary

Remission, spontaneous

Cessation of alcohol or drug misuse, dependence, or problems without benefit of therapy or a mutual-help group; also called natural remission. Epidemiological data suggest that many remissions occur without therapy or mutual-help group membership. Some prefer the term "natural recovery", to avoid the disease connotations of the word remission.

WHO Lexicon of alcohol and drug terms

Replicate

To implement a programme in a setting other than the one for which it originally was designed and implemented, with attention to the faithful transfer of its core elements to the new setting (Chinman et al. 2004).

EMCDDA glossary

Residential treatment

Treatment programmes which require participants to live in a hostel, home or hospital unit. These programmes generally strive to provide a positive drug-free environment in which residents are expected to participate in a full-time programme of counselling, and group work developing social and other life skills (UNODC, Demand reduction, Glossary of terms).

EMCDDA glossary

Retrospective study

A research study that focuses on the past and present. The study examines past exposure to suspected risk factors for the disease or condition. Unlike prospective studies, it does not cover events that occur after the study group is selected.

National Institute for Health and Care Excellence

Review

A review article in medical literature which summarises a number of different studies and may draw conclusions about a particular intervention (as secondary level research). Review articles are often not systematic. Review articles are also sometimes called overviews.

See also Cochrane Collaboration.

Review of reviews:  
These are systematic and explicit methods to identify, select, and critically appraise relevant findings from systematic reviews and/or meta-analyses. They may also include individual studies (i.e. randomised controlled trials).

EMCDDA glossary

Risk factor

Any aspect of a person's lifestyle, environment or pre-existing health condition that may increase their risk of developing a specific disease or condition.

National Institute for Health and Care Excellence

Rush

An immediate, intense, pleasurable effect that follows intravenous injection of certain drugs (e.g. heroin, morphine, amfetamine (amphetamine), cocaine, propoxyphene).

WHO Lexicon of alcohol and drug terms

S
Salience (of substance-seeking behaviour)

The degree of prominence of substance-seeking or substance use in the user's thoughts or actions, e.g. giving a higher priority to obtaining and using substances than to other activities. The concept is included in the criteria for dependence in ICD-I0 and DSM-IIIR although without use of the term "salience".

WHO Lexicon of alcohol and drug terms

Salvia divinorum

The psychoactive plant Salvia divinorum, or the ‘diviner’s sage’, is a rare member of the mint family (Lamiaceae; formerly Labiatae), characterised in the mid-twentieth century. The plant is endemic to a limited area of the highlands of the Mexican Oaxaca state, where the Mazatec Indians ingest its fresh leaves or leaf preparations for divinatory rituals, healing ceremonies and medical purposes. Since the late 1990s, the use of the plant as a ‘legal’ herbal hallucinogen has been increasing, partly due to its availability. Smoking the dried and crushed leaves provides short-lived but intense hallucinations. The effective dose of salvinorin A, the active ingredient of the plant, is comparable to that of the synthetic hallucinogens LSD or DOB. The toxicity of Salvia divinorum is currently poorly understood.

• Salvinorin A:
An extremely potent neoclerodane-type diterpenoid hallucinogen from the Salvia divinorum plant. It was once also called divinorin A.

For more information on this substance see the EMCDDA webpage on Salvia

EMCDDA Drug profiles glossary

Sample (sampling)

Sample: Participants of a study recruited from part of the study's target population. If they are recruited in an unbiased way, the results from the sample can be generalised to the target population as a whole.
Sampling: The way participants are selected for inclusion in a study.
Sampling frame: A list or register of names that is used to recruit participants to a study

National Institute for Health and Care Excellence

Screening test (tool or instrument)

An evaluative instrument or procedure, either biological or psychological, whose main purpose is to discover, within a given population, as many individuals as possible who currently have a condition or disorder or who are at risk of developing one at same point in the future. Screening tests are often not diagnostic in the strict sense of the term, although a positive screening test will typically be followed by one or more definitive tests to confirm or reject the diagnosis suggested by the screening test. A test with high sensitivity is able to identify the majority of genuine cases of the condition under consideration. For example, sensitivity of 90% means that the test will identify as positive 90 out of 100 people known to have the condition (and will miss the other 10, who are termed "false negatives"). Specificity, on the other hand, refers to a test's ability to exclude false cases; that is, the greater its specificity, the less likely the test is to give positive results for individuals who do not, in fact, have the disease in question ("false positives").

The term "screening instrument" is also in widespread use, typically referring to a questionnaire or brief interview schedule. Examples of screening instruments for alcohol-use disorders include Alcohol Use Disorders Identification Test (AUDIT), Michigan Alcoholism Screening Test (MAST), Munich Alcoholism Test (MALT), the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) test, and the Le-Go grid. See also: biological marker & diagnostic test.

Resources
• Deady, Mark (2009) A review of screening, assessment and outcome measures for drug and alcohol settings
• NICE Alcohol-use disorder pathway
• NICE Drug-misuse disorder pathway
• NDC collection - Screening evidence resources

• HSE, Ireland - Quick question (alcohol use leaftlet)

Haber et al (2009) Guidelines for the treatment of alcohol problems, appendix 1 provides Screening and diagnostic instruments.
(See also Chapter 3 Screening, assessment and treatment planning)
1. Alcohol Use Disorders Identification Test (AUDIT)
2. TWEAK
3. T-ACE
4. CAGE
5. Michigan Alcohol Screening Test (MAST)
6. Severity of Alcohol Dependence Questionnaire Form-C (SADQ-C)
7. Short Alcohol Dependence Data Questionnaire (SADD)
8. Readiness to Change Questionnaire (RTCQ)
9. Stages of Change Readiness and Treatment Eagerness scale (SOCRATES)
10. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST V3.0: WHO)
11. Mini-Mental State Examination
12. Indigenous Risk Impact Screen (IRIS)
13. Alcohol Problems Questionnaire (APQ)
14. University of Rhode Island Change Assessment (URICA)
15. The Clock Drawing Test

WHO Lexicon of alcohol and drug terms

Secondary level research

Synthesis (summary) of primary level research (trials, studies), in the form of reviews, systematic reviews or meta-analyses.

See also Cochrane Collaboration

EMCDDA glossary

Sedative/hypnotic (Anxiolytics)

Any of a group of central nervous system depressants with the capacity of relieving anxiety and inducing calmness and sleep. Several such drugs also induce amnesia and muscle relaxation and/ or have anticonvulsant properties. Major classes of sedatives/hypnotics include the benzodiazepines and the barbiturates. Also included are alcohol, buspirone, chloral hydrate, acetylcarbromal, glutethimide, methyprylon, ethchlorvynol, ethinamate, meprobamate, and methaqualone. Some authorities use the term sedatives/hypnotics only for a subclass of these drugs used to calm acutely distressed persons or to induce sleep, and distinguish them from (minor) tranquillizers used for the treatment of anxiety.

Barbiturates have a narrow therapeutic-to-toxic dosage ratio and are lethal in overdose. Their abuse liability is high; physical dependence, including tolerance, develops rapidly. Chloral hydrate, acetylcarbromal, glutethimide, methyprylon, ethchlorvynol, and ethinamate also have a high liability for physical dependence and misuse and are also highly lethal in overdose. Because of such dangers, none of the sedatives/hypnotics should be used chronically for the treatment of insomnia.

All sedatives/hypnotics may impair concentration, memory, and coordination; other frequent effects are hangover, slurred speech, incoordination, unsteady gait, drowsiness, dry mouth, decreased gastrointestinal motility, and lability of mood. A paradoxical reaction of excitement or rage may be produced occasionally. The time before onset of sleep is reduced but REM sleep is suppressed. Withdrawal of the drug concerned may produce a rebound of REM sleep and deterioration of sleep patterns. In consequence, patients treated over a long period can become psychologically and physically dependent on the drug even if they never exceed the prescribed dose. Withdrawal reactions can be severe and may occur after no more than several weeks of moderate use of a sedative/hypnotic or anxiolytic drug. Symptoms of withdrawal include anxiety, irritability, insomnia (often with nightmares), nausea or vomiting, tachycardia, sweating, orthostatic hypotension, hallucinatory misperceptions, muscle cramps, tremors and myoclonic twitches, hyperreflexia, and grand mal seizures that may progress to fatal status epilepticus. A withdrawal delirium may develop, usually within one week of cessation or significant reduction in dosage.

Long-term sedative/hypnotic abuse is likely to produce impairments in memory, verbal and nonverbal learning, speed, and coordination that last long after detoxification and, in some, result in a permanent amnestic disorder. Mental and behavioural disorders due to use of other sedatives or hypnotics (FI3) are distinguished from those due to use of alcohol (FIO) in ICD-I0.

WHO Lexicon of alcohol and drug terms

Selective prevention

Selective prevention strategies target subsets of the total population that are deemed to be at risk for substance abuse by virtue of their membership in a particular population segment, e.g. children of adult alcoholics, dropouts, or students who are failing academically.

For more details see the Selective prevention page on the EMCDDA website.

EMCDDA glossary

Self-help group

Bottom-up approach involving concerned persons who organise themselves for mutual support or in order to get more information on drug-related matters. Examples: parents' groups, narcotics anonymous, etc.

See also, mutual-help group

EMCDDA glossary

Sensitivity

How well a test detects the thing it is testing for.

If a diagnostic test for a disease has has high sensitivity, it is likely to pick up all cases of the disease in people who have it (that is, give a 'true positive' result). But if a test is too sensitive it will sometimes also give a positive result in people who don't have the disease (that is, give a 'false positive').

For example, if a test were developed to detect if a woman is 6 months pregnant, a very sensitive test would detect everyone who was 6 months pregnant, but would probably also include those who are 5 and 7 months pregnant.

If the same test were more specific (sometimes referred to as having higher specificity), it would detect only those who are 6 months pregnant, and someone who was 5 months pregnant would get a negative result (a 'true negative'). But it would probably also miss some people who were 6 months pregnant (that is, give a 'false negative').

Breast screening is a 'real-life' example. The number of women who are recalled for a second breast screening test is relatively high because the test is very sensitive. If it were made more specific, people who don't have the disease would be less likely to be called back for a second test but more women who have the disease would be missed.

National Institute for Health and Care Excellence

Serotonin

Also known as 5-hydroxytryptamine. An example of a neurotransmitter, it is a naturally occurring substance closely related to naturally occurring and synthetic hallucinogenic tryptamines.

• Serotonin uptake inhibitor:
A drug that inhibits neuronal re-uptake of serotonin, and consequently prolongs its action. Drugs of this class have been reported to be capable of reducing alcohol consumption. Certain antidepressants inhibit both the uptake of serotonin and that of noradrenaline (norepinephrine).

EMCDDA Drug profiles glossary

Social influence-based interventions

These are interventions that adopt the social influence approach to drug prevention. They are based on the idea that immunisation in the classroom against active or indirect social pressure to use drugs will help prevent substance use (Donaldson et al., 1996, Morgan, 2001). They commonly include components that focus on normative beliefs and values but also life skills, social skills, personal skills, knowledge and resistance skills.

EMCDDA glossary

Social marketing

Using marketing principles and techniques as part of a health promotion campaign to persuade people to make a positive change in their behaviour to improve their health or prevent ill health.

National Institute for Health and Care Excellence

Social reintegration

Social reintegration is defined as ‘any social intervention with the aim of integrating former or current problem drug users into the community’. The three ‘pillars’ of social reintegration are (1) housing, (2) education, and (3) employment (including vocational training). Other measures, such as counselling and leisure activities, may also be used.

EMCDDA glossary

Socioeconomic status

Description of a person's position in society using criteria such as their occupation, income or level of education achieved.

National Institute for Health and Care Excellence

Specific objectives

Intermediate result necessary to achieve the general objective. Specific objectives always relate to changes in the target groups so that the outcomes are clearly measurable. The specific objectives need not necessarily relate to drug use but each of them, if achieved, should lead plausibly to fulfillment of the general objective. The measurement of specific objectives through outcome indicators lead to an outcome evaluation.

EMCDDA glossary

Specific target group

The population in which the change defined as a general objective is to be reached.

EMCDDA glossary

Speedball

A combination of a stimulant and an opioid, e.g. cocaine and heroin, amphetamine and heroin.

WHO Lexicon of alcohol and drug terms

Standard deviation

A measure used to summarise numerical data and describe how 'spread out' a set of measures (or 'values') are from the average. For example, the average height of a group of schoolchildren can be calculated using the total of all their heights added together and then divided by the number of schoolchildren in the group. Standard deviation measures the 'spread' of those heights. So, in the example it tells you whether all those in the group were about the same height or whether some were very tall and some were short.

National Institute for Health and Care Excellence

Standard drink

A volume of beverage alcohol ( e.g. a glass of wine, a can of beer, or a mixed drink containing distilled spirits) that contains approximately the same amounts (in grams) of ethanol regardless of the type of beverage. The term is often used to educate alcohol users about the similar effects associated with consuming different alcoholic beverages served in standard-sized glasses or containers (e.g. the effects of one glass of beer are equal to those of one glass of wine). In the UK, the term ''unit" is employed, where one unit of an alcoholic beverage contains approximately 8-9 grams of ethanol; in North American literature, ''a drink" contains about 12 grams of ethanol. In other countries, the amounts of alcohol chosen to approximate a standard drink may be greater or less, depending on local customs and beverage packaging.

For Irish standards, see Health Service Executive. (2012) A quick question

WHO Lexicon of alcohol and drug terms

Standardised instruments

Instruments of examination, observation‚ or evaluation that share a standard set of instructions for their administration, use, scoring, and interpretation (Chinman et al. 2004).

EMCDDA glossary

Statistical power

The ability of a study to demonstrate an association or causal relationship between two variables (if an association exists) means that the study is statistically significant. The statistical power of a study is primarily related to the number of people included. If too few people are included, any differences in the outcomes will not be statistically significant.

See also, P value

National Institute for Health and Care Excellence

Steroid

One of a group of naturally occurring or synthetic hormones which are complex lipids based on the cholesterol molecule, and which affect chemical processes in the body, growth, and sexual and other physiological functions. They include adrenal cortical, testicular, and ovarian hormones and their derivatives.

In the context of drug use and drug problems, anabolic steroids are of principal concern. These compounds are related to male sex hormones; they increase muscle mass and, in women, cause masculinization. Anabolic steroids are misused by athletes with the aim of increasing strength and performance. Misuse of adrenal cortical steroids is rare.

WHO Lexicon of alcohol and drug terms

Stimulant

In reference to the central nervous system, any agent that activates, enhances, or increases neural activity; also called psychostimulant. Included are the amphetamines (amphetamines), cocaine, caffeine and other xanthines, nicotine, and synthetic appetite suppressants such as phenmetrazine or methylphenidate. Other drugs have stimulant actions which are not their primary effect but which may be manifest in high doses or after chronic use; they include antidepressants, anticholinergics, and certain opioids.

Stimulants can give rise to symptoms suggestive of intoxication, including tachycardia, pupillary dilatation, elevated blood pressure, hyperreflexia, sweating, chills, nausea or vomiting, and abnormal behaviour such as fighting, grandiosity, hypervigilance, agitation, and impaired judgement. Chronic misuse commonly induces personality and behaviour changes such as impulsivity, aggressivity, irritability, and suspiciousness. A full-blown delusional psychosis may occur. Cessation of intake after prolonged or heavy use may produce a withdrawal syndrome, with depressed mood, fatigue, sleep disturbance, and increased dreaming.

In ICD-I0, mental and behavioural disorders due to use of stimulants are subdivided into those due to the use of cocaine (ICD-10 F14) and those due to the use of other stimulants, including caffeine (ICD-10 F15). Prominent among them are amphetamine psychosis and cocaine psychosis. See also: psychotic disorder, alcohol- or drug-induced

WHO Lexicon of alcohol and drug terms

Study type

The way a study is designed. Case-control study, cohort study, non-randomised controlled trial, and randomised controlled trial are all examples of study types using different research methodologies.

National Institute for Health and Care Excellence

Substance use disorders

A group of conditions related to alcohol or other drug use. In ICD-I0, section FI0-F19, ''Mental and behavioural disorders due to psychoactive substance use", contains a wide variety of disorders of different severity and clinical form, all having in common the use of one or more psychoactive substances, which may or may not have been medically prescribed. The substances specified are alcohol, opioids, cannabinoids, sedatives or hypnotics, cocaine, other stimulants including caffeine, hallucinogens, tobacco, and volatile solvents.

The clinical states that may occur, though not necessarily with all psychoactive substances, include acute intoxication, harmful use, dependence syndrome, withdrawal syndrome (state), withdrawal state with delirium, psychotic disorder, late-onset psychotic disorder, and amnesic syndrome.

Abuse of non-dependence-producing substances (e.g. laxatives or steroids) is included in category F55 of ICD-I0, "Behavioural syndromes associated with physiological disturbances and physical factors".

WHO Lexicon of alcohol and drug terms

Substitution / maintenance treatment

Treatment of drug dependence by prescription of a substitute drug (agonists and antagonists) for which cross-dependence and cross-tolerance exists, with the goal to reduce or eliminate the use of a particular substance, especially if it is illegal, or to reduce harm from a particular method of administration, the attendant dangers for health (e.g. from needle sharing), and the social consequences, (UNODC, Demand reduction, Glossary of terms).

EMCDDA glossary

Summative evaluation

Summative evaluation is a method of judging the worth of a programme at the end of the programme activities. The focus is on the outcome, (Bhola 1990).

EMCDDA glossary

Supply reduction

A general term used to refer to policies or programmes aiming to interdict the production and distribution of drugs, particularly law enforcement strategies for reducing the supply of illicit drugs. See also: demand reduction; harm reduction

WHO Lexicon of alcohol and drug terms

Survey

A list of structured questions. The aim is to collect information systematically from people for a study. (Information is usually collected from a sample within a defined population.)

National Institute for Health and Care Excellence

Sympathomimetic

Denoting neural action, endogenous* chemical agents, or drugs that simulate the action of sympathetic postganglionic nerves or their transmitters. Synonymous with adrenergic.

*Endogenous  - The property of a naturally occurring substance that originates or produces within an organism, tissue, or cell.

EMCDDA Drug profiles glossary

Synthetic cannabinoids and 'Spice'

Synthetic cannabinoids are functionally similar to Δ9-tetrahydrocannabinol (THC), the active principle of cannabis. Like THC, they bind to the same cannabinoid receptors in the brain and other organs as the endogenous ligand anandamide. More correctly designated as cannabinoid receptor agonists, they were initially developed over the past 40 years as therapeutic agents, often for the treatment of pain. However, it proved difficult to separate the desired properties from unwanted psychoactive effects.

In late 2008, several cannabinoids were detected in herbal smoking mixtures or so-called incense/room odorisers. Typical of these were Spice Gold, Spice Silver and Yucatan Fire, but many other products later appeared. They do not contain tobacco or cannabis but when smoked, produce effects similar to those of cannabis. These products are typically sold via the Internet and in ‘head shops’.

For more information on this substance see the EMCDDA webpage on synthetic cannabinoids and 'Spice'

Also see cannabis

EMCDDA Drug profiles glossary

Synthetic cathinones

Synthetic cathinones are related to the parent compound cathinone (Figure 1), one of the psychoactive principals in khat (Catha edulis Forsk). Cathinone derivatives are the β-keto (βk) analogues of a corresponding phenethylamine. The group includes several substances that have been used as active pharmaceutical ingredients (API) of medicinal products, e.g. amfepramone (diethylpropion). Since the mid-2000s, unregulated ring-substituted cathinone derivatives have appeared in the European recreational drugs market. The most commonly available cathinones sold on the recreational market in the period up to 2010 appear to be mephedrone and methylone. These products are usually encountered as highly pure white or brown powders. Ring-substituted cathinone derivatives are claimed to have effects similar to those of cocaine, amphetamine or MDMA (ecstasy), but little is known of their detailed pharmacology. Apart from cathinone, methcathinone (Figure 5) and two API’s amfepramone and pyrovalerone, cathinone derivatives are not under international control.

For more information on this substance see the EMCDDA webpage on Synthetic cathinones

EMCDDA Drug profiles glossary

Synthetic cocaine derivatives

A number of synthetic derivatives of cocaine have been investigated as potential pharmaceutical agents (e.g. 4-fluorococaine and 2-hydroxycocaine), but only two have been reported as potential substances of misuse, namely 3-(p-fluorobenzoyloxy)tropane, pFBT and dimethocaine. Both are available as ‘research chemicals’ from retail websites or have been identified in ‘legal highs’ products.

The structure of pFBT is closely related to that of cocaine, however dimethocaine lacks a tropane ring and more closely resembles the structure of procaine, a local anaesthetic drug without psychoactive properties. There is therefore some doubt as to whether dimethocaine itself has psychoactive effects in humans. Neither substance is under international control, and apart from Denmark (pFBT) and Romania (dimethocaine) there are no national controls in the EU.

For more information on this substance see the EMCDDA webpage on synthetic cocaine derivatives

EMCDDA Drug profiles glossary

Systematic review

A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies.

See also, Cochrane Collaboration

EMCDDA glossary

T
Temperance

A term of varying usage concerning alcohol and other drugs; originally meaning a commitment to moderation in personal drinking habits (e.g. by abstaining from drinking spirits), but after the 1840s usually meaning a personal commitment to total abstinence (the temperance pledge). After the 1850s it often implied a commitment to local, national, or global alcohol control, usually with the aim of eventual prohibition of the sale of alcoholic beverages (hence prohibitionist). In line with the broad concerns of such temperance societies as the Women's Christian Temperance Union (WCTU), temperance sometimes referred also to a broader range of behaviours, including abstinence from tobacco and other drug use.

"New temperance" or "neo-temperance" has been used since the 1980s to characterize individuals and groups committed to greater alcohol control or a more coherent alcohol policy, or the shift in public sentiment reflected in many countries in a decline in alcohol consumption. "Neo-prohibitionist" is used more pejoratively for the same referents.

WHO Lexicon of alcohol and drug terms

Tertiary level research

Synthesis (summary) of secondary level research, i.e. of systematic reviews and meta-analyses in the form of review of reviews.

See also, Cochrane Collaboration

EMCDDA glossary

THC

Δ9-Tetrahydrocannabinol, the major active principle in cannabis.

EMCDDA Drug profiles glossary

Therapeutic communities

These are structured environments in which individuals with drug-related problems live while undergoing rehabilitation. Such communities are often specifically designed for drug-dependent people. They operate under strict rules, are run mainly by people who have recovered from dependence, and are often geographically isolated. Therapeutic communities are also used for the management of patients with psychotic disorders and anti-social personalities. Therapeutic communities are often characterised by a combination of “reality testing” (through confrontation of the individual’s drug problem) and support for recovery from staff and peers. They are usually closely aligned with mutual help groups such as Narcotic Anonymous (UNODC, Demand reduction, Glossary of terms).

EMCDDA glossary

Therapeutic index

A measure of the relative safety of a drug expressed as the ratio of the lethal or toxic dose to the therapeutically effective dose.

EMCDDA glossary

Tobacco

Any preparation of the leaves of Nicotiana tabacum, an American plant of the nightshade family. The main psychoactive ingredient is nicotine.

See also: nicotine & passive smoking
Tobacco use disorders (ICD-10 F17)

WHO Lexicon of alcohol and drug terms

Tolerance

A decrease in response to a drug dose that occurs with continued use. Increased doses of alcohol or other drugs are required to achieve the effects originally produced by lower doses. Both physiological and psychosocial factors may contribute to the development of tolerance, which may be physical, behavioural, or psychological. With respect to physiological factors, both metabolic and/or functional tolerance may develop. By increasing the rate of metabolism of the substance, the body may be able to eliminate the substance more readily.

Functional tolerance is defined as a decrease in sensitivity of the central nervous system to the substance. Behavioural tolerance is a change in the effect of a drug as a result of learning or alteration of environmental constraints. Acute tolerance is rapid, temporary accommodation to the effect of a substance following a single dose. Reverse tolerance, also known as sensitization, refers to a condition in which the response to a substance increases with repeated use. Tolerance is one of the criteria for the dependence syndrome.

WHO Lexicon of alcohol and drug terms

Tranquillizer

A calming agent; a general term for several classes of drugs employed in the symptomatic management of various mental disorders. The term can be used to differentiate between these drugs and the sedatives/hypnotics: the tranquillizers have a quieting or damping effect on psychomotor processes without–except at high doses–interference with consciousness and thinking.

The term tranquillizer now refers mainly to any drug used for the treatment of anxiety disorders, for which "minor tranquillizer" is a synonym. The latter term was introduced to distinguish these drugs from "major tranquillizers" (neuroleptics) used for the treatment of psychotic disorders. However, the term "minor tranquillizer" has been incorrectly assumed to indicate an absence of significant harmful effects. Because of the dependence potential of these drugs, the term is best avoided.

WHO Lexicon of alcohol and drug terms

Treatment

Treatment comprises all structured interventions' specific pharmacological and/or psychosocial techniques aimed at reducing or abstaining from the use of illegal drugs (EMCDDA Structured Questionnaire 27, treatment programmes).

In the Pompidou Group-EMCDDA Treatment Demand Indicator Protocol, the following definition is provided: treatment is any activity that directly targets individuals who have problems with their drug use and which aims to improve the psychological, medical or social state of those who seek help for their drug problems. This activity often takes place at specialized facilities for drug users, but may also occur in the context of in general services offering medical and/or psychological help to people with drug problems (Pompidou Group-EMCDDA Treatment Demand Indicator Protocol version 2.0, 2000). (Version 3.0 is also available)

EMCDDA glossary

Treatment centre

A treatment centre is any agency that provides treatment to people with drug problems. Treatment centres can be based within structures that are medical or non-medical, governmental or non-governmental, public or private, specialised or non-specialised. They include in-patient detoxification units, outpatient clinics, drug substitution programmes (maintenance or shorter-term), therapeutic communities, counselling and advice centres, street agencies, crisis centres, drug-treatment programmes in prisons and special services for drug users within general health or social-care facilities (Pompidou Group-EMCDDA Treatment Demand Indicator Protocol version 2.0, 2000). (Version 3.0 is also available)

EMCDDA glossary

Tryptamines

Group of biologically active compounds, including neurotransmitters (e.g. serotonin) and hallucinogens (e.g. LSD, psilocin and psilocybin). The chemical nucleus of these compounds is the monoamine alkaloid tryptamine that can be found in numerous plants and animals. Tryptamine is based around an indole ring structure, and is chemically related to the amino acid tryptophan.

EMCDDA Drug profiles glossary

Twelve-step group

A mutual-help group organized around the twelve-step programme of Alcoholics Anonymous (AA) or a close adaption of that programme. AA ' s programme of twelve steps involves admitting one is powerless over one' s drinking and over one' s life because of drinking, turning one' s life over to a ''higher power" , making a moral inventory and amends for past wrongs, and offering to help other alcoholics. A recovering alcoholic " on the programme" must never drink again, although this objective is accomplished one day at a time. AA is organized in terms of "twelve traditions", which enjoin anonymity, an apolitical stance, and a non-hierarchical organizational structure. Other twelve-step groups vary in their adherence to the twelve traditions.

There are now some hundreds of organizations of twelve-step groups, each focused on one of a wide range of behavioural, personality, and relationship problems. Others operating in the drug field include Cocaine Anonymous, Drugs Anonymous, Narcotics Anonymous, Nicotine or Smokers Anonymous, and Pill Addicts Anonymous. For families of alcoholics or addicts, there are Al-Anon, Alateen, and CoDependents Anonymous.

Treatment institutions with a strong AA emphasis are often loosely described as "twelve-step programmes".

WHO Lexicon of alcohol and drug terms

U
Universal prevention

Universal prevention strategies address the entire population (national, local community, school, neighbourhood) with messages and programmes aimed at preventing or delaying the abuse of alcohol, tobacco, and other drugs.

For more details see the EMCDDA web page.

WHO Lexicon of alcohol and drug terms

Universal target group

The universal target group is the group of people, households, organisations, communities or any other identifiable unit which a prevention intervention is directed towards. A careful analysis and estimation of the size and nature of the target group are essential preconditions when documenting the need for a prevention activity.

EMCDDA glossary

V
Validated instrument

One way of ensuring the quality of data collected by instrument (questionnaire) is to use only those which have been validated. A validated instrument is one which has undergone a validation procedure to show that it accurately measures what it aims to do, regardless of who responds, when they respond, and to whom they respond. Elements of a validation procedure may include the examination of reliability, the comparison of results with other sources of data, the translation and reverse translation to reduce ambiguity, the examination of feasibility: acceptability, time needed to respond, cost etc. as well as the examination of variation in response due to data inquiry methods (self-administered, personal interview, telephone interview etc.), (International Epidemiological Association /IEA European Questionnaire Group).

EMCDDA glossary

Validity

In a study, validity is the degree to which the conclusions that the researchers make can be considered to be 'true', based on how well the study was designed and how well it matched 'real life' situations.

External validity:
The degree to which the results of a study hold true in non-study situations, for example in routine NHS practice. May also be referred to as the generalisability of study results to non-study populations. For example, the external validity of the study that took place in Spain may be questioned if the population the results were applied to was people in Australia.

Internal validity:
A measure of how well a research study has been designed. That is, the extent to which the cause-and-effect relationships in a study are true for the people and conditions of the study.

National Institute for Health and Care Excellence

Variable

Variability refers to the differences that can be seen between people (or in the same person) over time. An example of the former could be the age, sex and genetic background of participants in a study

National Institute for Health and Care Excellence

Volatile substances

Domestic products such as spray deodorants, glue, lighter refills and spray air fresheners can be used as drugs.


Volatile substance use may be defined as the deliberate inhalation of volatile compounds to produce psychoactive effects. These compounds have few characteristics in common, other than their intoxication effects and the behavioural effects they produce. Such volatile substances are often referred to as inhalants, a term which encompasses a diverse group of psychoactive chemicals that are defined by the route of administration, rather than their mechanism of action on the central nervous system or psychoactive effects.

The use of volatile substances is unlike most other forms of drug use in that it involves various compounds contained in readily accessible domestic or commercial products. These compounds, that are safe when used for their intended purposes, may cause intoxication and in some cases death when their vapours are deliberately concentrated and inhaled.

A specific subgroup of volatile substances — alkyl nitrites — are used on the dance club scene because they cause relaxation of vascular smooth muscle and produce a ‘rush’, or to enhance a sexual experience. They are generally known as ‘poppers’ and can be found on the ‘street’ market in bars and clubs. In some countries, they are available in sex shops and ‘head’ shop.

For more information on this substance see the EMCDDA webpage on volatile substances

EMCDDA glossary

W
Wernicke encephalopathy

An acute, life-threatening, neurological syndrome consisting of confusion, apathy, dullness, a dreamy delirium, palsies of the ocular muscles and of gaze, nystagmus and disturbances in equilibrium, and ataxia. Its most common cause in industrialized countries is thiamine deficiency associated with alcoholism. If not treated immediately with thiamine, the patient is likely to die or progress to an amnesic syndrome. (ICD-10 E51.2)

WHO Lexicon of alcohol and drug terms

Withdrawal

• Withdrawal, conditioned:
A syndrome of withdrawal-like signs and symptoms sometimes experience by abstinent alcohol- or opiate-dependent individuals who are exposed to stimuli previously associated with alcohol or drug use. According to classical conditioning theory, environmental stimuli temporarily linked to unconditioned withdrawal reactions become conditioned stimuli capable of eliciting the same withdrawal-like symptoms. In another version of conditioning theory , an innate compensatory response to the effects of a substance (acute tolerance) become conditionally linked to the stimuli associated with substance use. If the stimuli are presented without actual administration of the substance, the conditioned response is elicited as a withdrawal-like compensatory reaction. synonym: conditioned abstinence

• Withdrawal, protracted:
The occurrence of symptoms of a withdrawal syndrome, usually minor but nonetheless discomforting, for several weeks or months after the acute physical withdrawal syndrome has abated. This is an ill-defined condition that has been described in alcohol- dependent, sedative-dependent, and opioid-dependent individuals. Psychic symptoms such as anxiety, agitation, irritability, and depression are more prominent than physical symptoms. Symptoms may be precipitated or ex- acerbated by the sight of alcohol or the drug of dependence, or by return to the environment previously associated with alcohol or other drug use. See also: withdrawal, conditioned

• Withdrawal syndrome::
A group of symptoms of variable clustering and degree of severity which occur on cessation or reduction of use of a psychoactive substance that has been taken repeatedly, usually for a prolonged period and/ or in high doses. The syndrome may be accompanied by signs of physiological disturbance. A withdrawal syndrome is one of the indicators of a dependence syndrome. It is also the defining characteristic of the narrower psycho-pharmacological meaning of dependence. (ICD-10 Flx.3)

The onset and course of the withdrawal syndrome are time-limited and are related to the type of substance and dose being taken immediately before cessation or reduction of use. Typically, the features of a withdrawal syndrome are the opposite of those of acute intoxication.

The alcohol withdrawal syndrome is characterized by tremor, sweating, anxiety, agitation, depression, nausea, and malaise. It occurs 6-48 hours after cessation of alcohol consumption and, when uncomplicated, abates after 2-5 days. It may be complicated by grand mal seizures and may progress to delirium (known as delirium tremens).

Sedative withdrawal syndromes have many features in common with alcohol withdrawal, but may also include muscle aches and twitches, perceptual distortions, and distortions of body image.

Opioid withdrawal is accompanied by rhinorrhoea (running nose), lacrimation (excessive tear formation), aching muscles, chills, gooseflesh, and, after 24-48 hours, muscle and abdominal cramps. Drug-seeking behaviour is prominent and continues after the physical symptoms have abated.

Stimulant withdrawal (the ''crash") is less well defined than syndromes of withdrawal from central nervous system depressant substances; depression is prominent and is accompanied by malaise, inertia, and instability. See also: hangover Synonyms: abstinence syndrome; withdrawal reaction; withdrawal state.

WHO Lexicon of alcohol and drug terms

Y
Youth programme outside school

Activities directed at youth outside schools, ranging from leisure time activities to interventions for school drop-outs. Examples are cultural events, video productions, exhibitions, peer-group approaches, sports events, and so on.

See EMCDDA prevention page and Selective prevention page

EMCDDA glossary