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A glossary

Our glossary is an alphabetical list of words relating to alcohol and other drugs, and relevant research terms, with explanations. We use a number of sources including:

For drug related terms and concepts:

For research terms and concepts:

HRB National Drugs Library glossary

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 increase: An increase in the likelihood of an event or outcome occurring as a result of a treatment or another intervention, sometimes called the risk difference. It is broadly the same as the absolute risk reduction but occurs in the opposite direction. For example, if a treatment increased the absolute risk of major haemorrhage from 0.10 (10%) to 0.25 (25%), the absolute risk increase (ARI) is 0.15 (15%), that is, 0.25 minus 0.10 (25% minus 10%). The ARI is related to the number needed to harm.

Absolute risk reduction: A reduction in the likelihood of an event or outcome occurring as a result of a treatment or another intervention, sometimes called the risk difference. For example, if a treatment reduces the absolute risk of death from 0.25 (25%) to 0.10 (10%), the absolute risk reduction (ARR) is 0.15 (15%), that is, 0.25 minus 0.10 (25% minus 10%). The estimate of ARR often comes from clinical trials. The percentage of people taking part who are having treatment (treatment group) and experience a specific outcome is compared with the percentage of people taking part but not having treatment (control group) who experience the same outcome. The ARR is related to the number needed to treat.

NICE glossary

Abstinence

Not using drugs or alcohol.

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)

NIDA glossary

Addiction

A chronic, relapsing disorder characterized by compulsive (or difficult to control) drug seeking and use despite harmful consequences, as well as long-lasting changes in the brain. In the past, people who used drugs were called “addicts.” Current appropriate term is people who use drugs.

Addiction is not a diagnostic term in WHO ICD-11, but continues to be very widely employed by professionals and the general public alike.

See also: Classification, disorders due to substance use

See also dependence syndrome

NIDA glossary

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

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.

Agonist: A chemical substance that binds to and activates certain receptors on cells, causing a biological response. Oxycodone, morphine, heroin, fentanyl, methadone, and endorphins are all examples of opioid receptor agonists. Antagonist: A chemical substance that binds to and blocks the activation of certain receptors on cells, preventing a biological response. Naloxone is an example of an opioid receptor antagonist (NIDA glossary).

Drug misuse: psychosocial interventions 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. Disorders due to use of alcohol are classified as psychoactive substance use disorders in ICD-11 (6C40).

WHO Lexicon of alcohol and drug terms

Alcohol dependence

Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol, which is manifested by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use alcohol. Physiological features of dependence may also be present, including tolerance to the effects of alcohol, withdrawal symptoms following cessation or reduction in use of alcohol, or repeated use of alcohol or pharmacologically similar substances to prevent or alleviate withdrawal symptoms. The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 3 months.

The concept of alcoholism (no longer used in ICD): The belief that alcoholism is a condition of primary biological causation and predictable natural history, conforming to accepted definitions of a disease. The 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 (From the WHO Lexicon of alcohol and drug terms).

Dependence: A condition that can occur with the regular use of illicit or some prescription drugs, even if taken as prescribed. Dependence is characterized by withdrawal symptoms when drug use is stopped. A person can be dependent on a substance without being addicted, but dependence sometimes leads to addiction (NIDA glossary).

WHO ICD-11

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-induced pancreatitis

Acute pancreatitis is inflammation of the pancreas with sudden onset. Pathological changes range from oedema to necrosis. While mild cases often recover without complications, severe cases have high mortality due to systemic complications despite intensive treatment. 

DC31.1 Acute alcohol-induced pancreatitis - Acute pancreatitis associated with alcohol consumption. Although alcohol consumption is a major cause of this disease, the diagnosis should be made after exclusion of other etiologies. 

DC32.3 Chronic alcohol-induced pancreatitis [No further information given]

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). (WHO Lexicon of alcohol and drug terms)

WHO ICD-11

Alcohol-related brain damage

Alcohol-related brain damage (ARBD), or alcohol-related brain injury (ARBI), is an umbrella term for the damage that can happen to the brain as a result of long-term heavy drinking. ARBD is sometimes referred to as ‘wet brain’ or by the name of one of the most well-known forms of the condition, Wernicke-Korsakoff Syndrome. ARBD occurs because, over time, drinking too much alcohol can change the physical shape and structure of the brain. These changes are the result of the toxic effects of alcohol and a lack of Vitamin B1 (thiamine). Vitamin deficiency is a common problem for long-term heavy drinkers, as alcohol stops the body absorbing some vitamins properly.

See Alcohol Change UK website Alcohol-related brain damage
See also: Glossary entry for Alcohol-related neurological disorders

Alcohol Change UK - Alcohol and the brain factsheet

Alcohol-related neurological disorders

ICD-11 uses this term to describe a number of conditions

  8D44.0 Alcoholic polyneuropathy  

  8D44.1 Alcoholic myopathy   

  6D84.0 Dementia due to use of alcohol  

Dementia due to use of alcohol is characterised by the development of persistent cognitive impairments (e.g., memory problems, language impairment, and an inability to perform complex motor tasks) that meet the definitional requirements of Dementia that are judged to be a direct consequence of alcohol use and that persist beyond the usual duration of alcohol intoxication or acute withdrawal. The intensity and duration of alcohol use must have been sufficient to produce the cognitive impairment. The cognitive impairment is not better accounted for by a disorder or disease that is not induced by alcohol such as a dementia due to another disorder or disease classified elsewhere.

  8D44.Y Other specified alcohol-related neurological disorders   

  8D44.Z Alcohol-related neurological disorders, unspecified  

See also, 

·         Wernicke-Korsakoff Syndrome (5B5A.1)

·         Korsakoff syndrome (5B5A.11)

WHO ICD-11

Alcoholic gastritis

DA42.80 Alcoholic gastritis - Inflammation of the gastric mucosa due to excessive alcohol use

DA42.83 Drug-induced gastritis - Acute or chronic gastritis induced by taking some known gastric mucosal damaged agents such as NSAIDs, aspirin and antibiotics.

WHO ICD-11

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

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

Analgesic: A drug that relieves pain.

Analgesic drug: A drug designed to control pain. Analgesic comes from the Greek an-, without + algesis, sense of pain = without a sense of pain.

See also: opioid

WebMD RxList

Antidepressant

Antidepressant: Anything, and especially a drug, used to prevent or treat depression. The available antidepressant drugs include the SSRIs or selective serotonin reuptake inhibitors, MAOIs or monoamine oxidase inhibitors, tricyclic antidepressants, tetracyclic antidepressants, and others.

Antidepressant, MAOI: Monoamine oxidase inhibitor (MAOI), a potent class of medications used to treat depression. This group of antidepressants have many serious drug interactions, which may limit their use. Examples include, phenelzine (Nardil), tranylcypromine (Parnate).

Antidepressant, SSRI: A selective serotonin reuptake inhibitor (SSRI), one of the commonly prescribed drugs for treating depression. SSRIs affect the chemicals that nerves in the brain use to send messages to one another. These chemical messengers, called neurotransmitters, are released by one nerve and taken up by other nerves. Neurotransmitters that are not taken up by other nerves are taken up by the same nerves that released them. This process is termed "reuptake." SSRIs work by inhibiting the reuptake of serotonin, an action which allows more serotonin to be available to be taken up by other nerves. Examples include, citalopram (Celexa, Cipramil), escitalopram oxalate (Cipralex, Lexapro), fluvoxamine maleate (Luvox), paroxetine (Paxil, Seroxat, Aropax), fluoxetine (Prozac), sertraline (Zoloft, Lustral)

Antidepressant, tricyclic: One of a class of medications used to treat depression. The tricyclic antidepressants (TCAs) are also used for some forms of anxiety, fibromyalgia, and the control of chronic pain. "Tricyclic" refers to the presence of three rings in the chemical structure of these drugs. Examples include, amitriptyline (Elavil, Endep), clomipramine (Anafranil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortryptyline (Pamelor), protriptyline (Vivactil), trimipramine (Surmontil).

See the antidepressant section in ICD-11, for information on specific drugs for this category including Monoamine oxidase-inhibitors, Monoamine oxidase A inhibitors, Selective serotonin reuptake inhibitors, Serotonin-norepinephrine reuptake inhibitors, Non-selective monoamine reuptake inhibitors, and other antidepressants.

WebMD RxList

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.

NICE glossary

B
Bad trip

In 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

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.

NICE glossary

Benzodiazepines

A type of CNS depressant sometimes prescribed to relieve anxiety, panic, or acute stress reactions. Some benzodiazepines are prescribed short-term to promote sleep. Diazepam (Valium®) and alprazolam (Xanax®) are among the most widely prescribed benzodiazepine medications.

__________________________

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. (WHO Lexicon of alcohol and drug terms)

NIDA glossary

Best practice(s)

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

The EMCDDA Best practice portal is designed to help you find practical and reliable information on what works (and what doesn’t) in the areas of prevention, treatment, harm reduction and social reintegration. It will help you identify tried and tested interventions quickly, allocate resources to what's effective, and improve interventions applying tools, standards and guidelines.

EMCDDA

Bias

Systematic (as opposed to random) deviation of the results of a study from the 'true' results, which is caused by the way the study is designed or conducted.

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.

Bias may be defined as any systematic error in an epidemiological study that results in an incorrect estimate of the true effect of an exposure on the outcome of interest.

Bias results from systematic errors in the research methodology - The effect of bias will be an estimate either above or below the true value, depending on the direction of the systematic error. The magnitude of bias is generally difficult to quantify, and limited scope exists for the adjustment of most forms of bias at the analysis stage. As a result, careful consideration and control of the ways in which bias may be introduced during the design and conduct of the study is essential in order to limit the effects on the validity of the study results (Healthknowledge.org.uk).

NICE glossary

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. 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.

For information on blood alcohol levels and driving in Ireland see citizensinformation.ie-drink driving offences

WHO Lexicon of alcohol and drug terms

Brief Intervention

A brief intervention (such as brief advice) involves discussion, negotiation or encouragement, with or without written or other support or follow up. But it may also involve a referral for further help. It is often carried out when the opportunity arises, typically taking no more than a few minutes for basic advice.

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. (NICE Clinical guideline, Drug misuse in over 16s: psychosocial interventions)

NICE glossary

Buprenorphine

Buprenorphine: A prescription medication for people addicted to heroin or other opiates that acts by relieving the symptoms of opiate withdrawal such as agitation, nausea and insomnia. Buprenorphine is more weakly addictive and has a lower risk of overdose than methadone. The effects last for about three days.

Buprenorphine is sold under the brand name of Subutex and, in combination with naloxone, as Suboxone. Subutex is intended for use at the beginning of treatment while Suboxone is intended for the maintenance treatment of opiate addiction. (Naloxone was added to guard against intravenous abuse of buprenorphine by individuals physically dependent on opiates.)

The side effects of buprenorphine include cold or flu-like symptoms, headaches, sweating, sleeping difficulties, nausea, and mood swings. Buprenorphine can cause dangerously diminished breathing, especially when used in combination with alcohol or other central nervous system depressants.

Buprenorphine: An opioid partial agonist medication prescribed for the treatment of opioid addiction that relieves drug cravings without producing the high or dangerous side effects of other opioids (NIDA glossary)

WebMD RxList

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 stimulant compound found naturally in coffee, tea, cocoa (chocolate), and kola nuts (cola) and added to soft drinks, foods, and medicines. Caffeine can cause anxiety, insomnia, nervousness, and hypertension. Caffeine is a diuretic and increases urination. It can decrease a person's ability to lose weight because it stimulates insulin secretion, which reduces blood sugar, which increases hunger. Caffeine can help to relieve headaches, so a number of over-the-counter and prescription pain relievers include it as an ingredient, usually with aspirin or another analgesic.

Caffeine is a Xanthine derivative.

6C48 Disorders due to use of caffeine - Disorders due to use of caffeine are characterised by the pattern and consequences of caffeine use. Caffeine is a mild psychostimulant and diuretic that is found in the beans of the coffee plant (Coffea species) and is a constituent of coffee, cola drinks, chocolate, a range of proprietary 'energy drinks' and weight-loss aids. It is the most commonly used psychoactive substance worldwide and several clinical conditions related to its use are described, although severe disorders are comparatively rare considering its ubiquity. Caffeine Intoxication related to consumption of relatively higher doses (i.e., > 1 g per day) is described. Caffeine Withdrawal is common upon cessation of use among individuals who have used caffeine for a prolonged period or in large amounts. Caffeine-Induced Anxiety Disorder has been described, often following intoxication or heavy use (WHO ICD-11).

WebMD RxList

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

Cardiomyopathy

Cardiomyopathy are myocardial disorders in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease sufficient to cause the observed myocardial abnormality. 

ICD-11 BC43.4 Cardiomyopathy due to drugs or other external agents - This is one type of cardiomyopathy due to drugs and other external agents. Causing agents are alcohol, cocaine chemotherapeutic agents, psychotherapeutic agents and chemical toxins. 

ICD-11 BC43.01 Nonfamilial dilated cardiomyopathy - Nonfamilial dilated cardiomyopathy is dilated cardiomyopathy secondary to an acquired systemic disorder that is known to be associated with dilated or inflammatory cardiomyopathy such as infectious myocarditis, exposure to toxins such as alcohol or anthracycline therapy, nutritional disorders, autoimmune disease, and many others.

Cardiomyopathy, Alcoholic - Disease of cardiac muscle resulting from chronic excessive alcohol consumption. Myocardial damage can be caused by: (1) a toxic effect of alcohol; (2) malnutrition in alcoholics such as thiamine deficiency; or (3) toxic effect of additives in alcoholic beverages such as cobalt. This disease is usually manifested by dyspnea and palpitations with cardiomegaly and congestive heart failure (heart failure) (Pubmed MESH).

Alcoholic cardiomyopathy is 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-11 BC43.0) 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).

WHO ICD-11

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

Case-control studies start with the identification of a group of cases (individuals with a particular health outcome) in a given population and a group of controls (individuals without the health outcome) to be included in the study. In a case-control study the prevalence of exposure to a potential risk factor(s) is compared between cases and controls. If the prevalence of exposure is more common among cases than controls, it may be a risk factor for the outcome under investigation. A major characteristic of case-control studies is that data on potential risk factors are collected retrospectively and as a result may give rise to bias. This is a particular problem associated with case-control studies and therefore needs to be carefully considered during the design and conduct of the study.


For more information see: 

Principles of Epidemiology in Public Health Practice, 3rd Ed. US Department of Health and Human Services, Centers for Disease Control and Prevention.

Chapter 8. Case-control and cross sectional studies from BMJ Epidemiology for the uninitiated

CASP: Case control study checklist

Health knowledge - Epidemiology for practitioners

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, Disorders due to substance use (DSM / ICD)

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.

 •   Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) Classification

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders. It also provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions. 

Substance-related disorders: The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. The diagnosis of a substance use disorder can be applied to all 10 classes included except caffeine. For certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for phencyclidine use disorder, other hallucinogen use disorder, or inhalant use disorder). An important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioral effects of these brain changes may be exhibited in the repeated relapses and intense drug craving when the individuals are exposed to drug-related stimuli. These persistent drug effects may benefit from long-term approaches to treatment. 

DSM-5 provides information on conditions including diagnostic criteria and diagnostic features for substance-related disorders including: alcohol, caffeine, cannabis, hallucinogen (including phencyclidine and other Hallucinogens), inhalants, opioids, Sedative-, hypnotic-, or anxiolytics, stimulants, tobacco and other substances. There is also a section for non-substance-related disorders (gambling disorder)

 •   World Health Organisation: International Classification of Diseases 11th edition (ICD-11) Classification

ICD–11 is the international standard for systematic recording, reporting, analysis, interpretation and comparison of mortality and morbidity data.

Disorders due to substance use (listed under ICD-11 06 Mental, behavioural or neurodevelopmental disorders) include disorders that result from a single occasion or repeated use of substances that have psychoactive properties, including certain medications. Disorders related to fourteen classes or groups of psychoactive substances are included. Typically, initial use of these substances produces pleasant or appealing psychoactive effects that are rewarding and reinforcing with repeated use. With continued use, many of the included substances have the capacity to produce dependence. They also have the potential to cause numerous forms of harm, both to mental and physical health. Disorders due to harmful non-medical use of non-psychoactive substances are also included in this grouping.

See WHO ICD-11

WHO ICD-11

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

Cochrane 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. The main purpose of The Cochrane Collaboration is to develop systematic reviews of the strongest evidence available about healthcare interventions. Consumers and health practitioners can then work together to make the best possible decisions about health care. The reviews are published electronically within The Cochrane Library and are freely accessible in shortened versions

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

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

Cochrane Library

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

An observational study in which a group of people with a particular exposure (e.g. a putative risk factor or protective factor) and a group of people without this exposure are followed over time. The outcomes of the people in the exposed group are compared to the outcomes of the people in the unexposed group to see if the exposure is associated with particular outcomes (e.g. getting cancer or length of life).

See, Healthknowledge.org.uk Introduction to study designs - cohort studies

And CASP cohort study checklist tool

CASP glossary

Community-based prevention

From: European Prevention Curriculum (EUPC): a handbook for decision-makers, opinion-makers and policy-makers in science-based prevention of substance use. Chapter 9: Community-based prevention

In the curriculum presented, we look at ‘community’ as a place where effective prevention systems can be developed and implemented. Most prevention professionals work at various levels of the community. This can include the broader society, which involves the macrolevel environment — for example regional selective interventions targeting people with a migration background — as well as many micro-level settings, such as youth organisations and sports clubs. The chapter defines basic concepts that are key to understanding how to build prevention systems with evidence-based interventions and policies involving several actors, stakeholders and available resources. Evidence-based interventions, such as the Stockholm against drugs (STAD) project, Project Northland, Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER) and CTC, are presented as examples.

EMCDDA

Comparison / control 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 (or a different intervention).

Random assignment — making a comparison group as similar as possible to the intervention group, to rule out external influences; randomly allocating individuals to either the intervention group or the control group.

Controls in a randomised control trial (RCT) are people in a comparison group. They receive the usual treatment (or a placebo) while the experimental group receive the treatment being tested. (CASP)

EMCDDA

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 and DSM. 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).

NICE glossary

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.

NICE glossary

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.

Ireland (from An Garda Siochana):

A controlled drug is an illegal drug where the substance, product or preparation is specified in the Schedule of the Misuse of Drugs Act 1977.  The Act has been amended on several occasions by subsequent legislation.   The main objective of the Act is to ensure the availability of controlled drugs for medical and scientific purposes only and to prevent the non-medical use of those drugs. The Misuse of Drugs Act 1977, as amended, for example, by the Misuse of Drugs Act 1984, prohibits the import, export, production, possession, sale and supply of controlled drugs unless carried out in accordance with the terms outlined in regulations made under the Act. To see the most recent up to date list of controlled substances please refer to Statutory Instrument 173/2017 – Misuse of Drugs Regulations 2017.

Since September 2005, the Health Products Regulatory Authority (HPRA) has managed the application and issue process for controlled drug licenses on behalf of the Department of Health. The HPRA carries out inspections of manufacturers and distributors of controlled drugs, as well as some other operators as required, ensuring compliance with the relevant requirements. Controlled drugs include certain tablets and other medicines that can be purchased on prescription. However if a person is in possession of a controlled drug without a prescription for either personal use or to sell or supply they are committing an offence under the Misuse Use of Drugs Act 1977 as amended. To see the most recent up to date list of controlled substances please refer to Statutory Instrument 173/2017 – Misuse of Drugs Regulations 2017. The following are the most common type of controlled drugs seized in Ireland: cannabis herb and resin, cocaine/ crack cocaine, ecstasy, heroin (Diamorphine), ketamine, amphetamines, GHB (gammahydroxbutyrate), LSD (lysergic acid), new psychoactive substances (Includes 950 substances), tablets (Controlled).

The Health Products Regulatory Authority (HPRA) have a role in regulating controlled drugs and precursor chemicals in Ireland.

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

See also, information from the International Narcotics Control Board (INCB), the independent and quasi-judicial monitoring body for the implementation of the United Nations international drug control conventions.

WHO Lexicon of alcohol and drug terms

Conventions, international drug

The framework for the international control of psychotropic substances is established by the Convention on Psychotropic Substances of 1971 signed in Vienna, Austria. Following the establishment of the Convention on Psychotropic Substances of 1971, a commentary was prepared providing detailed explanation of the various articles and provisions of the convention. The UN Treaty Collection provides information related to the signature, accession, acceptance, approval, formal confirmation and succession by Governments to the United Nations Convention on Psychotropic Substances, 1971 (INCB).

The 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances Convention provides comprehensive measures against drug trafficking, including provisions against money laundering and the diversion of precursor chemicals. It provides for international cooperation through, for example, extradition of drug traffickers, controlled deliveries and transfer of proceedings.

Historical information: 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 (WHO Lexicon of alcohol and drug terms).

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

INCB

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).

NICE glossary

Craving

Craving is usually associated with a craving for cigarettes and drugs such as cocaine or heroin, but can also be a craving for food, a loved one or even a place or ritual. In many instances, a craving for a drug can be enforced by a physical urge – where the body needs the drug to maintain a desired state or avoid an unwanted one. In the case of heroin addiction or alcoholism, a craving for the drug is usually strengthened by a strong desire to avoid withdrawal symptoms.

The psychological element of craving is more complex and often more powerful and difficult to negotiate if it becomes problematic. Much of our learned behaviour is established by associating an act, place, sight or smell with a desired outcome. In the case of an enjoyable effect, such as having a cigarette or a whisky to calm you down or make you more sociable, a feeling or place can trigger a craving. Hence many people crave a cigarette or a drink when in a social situation such as in a pub. In the case of addiction, a craving can be almost constant, particularly if the drug is being used to avoid withdrawal or is acting as an aid for social situations and for coping. This is made worse if people in the places where the user socialises take the same drugs or use them for similar reasons. 

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 (WHO Lexicon of alcohol and drug terms).
See also: compulsion; control, impaired; dependence syndrome; withdrawal

In WHO ICD-11, craving returns the following category: VV00 Energy and drive functions - General mental functions of physiological and psychological mechanisms that cause the individual to move towards satisfy specific needs and general goals in a persistent manner.

Drugwise

Critical appraisal

Reviewing a study to judge the quality of the method used and the reliability of the conclusions.

Critical Appraisal is the process of assessing and interpreting evidence, by systematically considering its validity, results and relevance to your own context. (CASP glossary)

NICE glossary

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.

NICE glossary

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 drug profiles 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).

Irish drug-related deaths data

National Drug-Related Deaths Index, Ireland

Decriminalisation versus Legalisation

Decriminalisation: When drug use and possession are decriminalised, criminal charges are not applied.

Legalisation: Drug legalisation removes all penalties for possession and personal use of a drug.

Decriminalisation may replace criminal penalties with civil penalties. These could include referral to an education or treatment program, or a fine. Civil cases do not have to go through the court system and may be dealt with by tribunals. While records may be kept by a tribunal, these are not criminal records and will not affect employment, housing, or travel opportunities. The key difference to a criminal model is that in a decriminalised model, while penalties still apply for use and possession of drugs, they are no longer criminal charges. Put simply, if a drug or drug use is decriminalised, people are not criminalised for personal use. Decriminalisation is not legalisation. If drug possession and personal use are decriminalised, it is still illegal to possess and use drugs. Selling and manufacturing drugs still carry criminal penalties.

See also, for Ireland, CityWide Decriminalisation evidence base

And, EMCDDA 3 minute Youtube video

Alcohol and Drug Foundation

Delirium

Delirium is characterized by a disturbance of attention, orientation, and awareness that develops within a short period of time, with transient symptoms that may fluctuate depending on the underlying causal condition or etiology. Delirium often includes disturbance of behavior and emotion, and may include impairment in multiple cognitive domains. A disturbance of the sleep-wake cycle, including reduced arousal of acute onset or total sleep loss with reversal of the sleep-wake cycle, may also be present. Delirium may be caused by the direct physiological effects of a medical condition not classified under mental, behavioural, or neurodevelopmental disorders, or of a substance or medication, including withdrawal, or by multiple or unknown etiological factors.

6D70.1 Delirium due to psychoactive substances including medications - All definitional requirements for delirium are met. There is evidence from history, physical examination, or laboratory findings that the delirium is caused by the direct physiological effects of a substance or medication (including withdrawal). If the specific substance inducing the delirium has been identified, it should be classified using the appropriate subcategory (e.g., alcohol-induced delirium).

Alcohol-induced delirium (6C40.5)
Cannabis-induced delirium (6C41.5)
Synthetic cannabinoid-induced delirium (6C42.5)
Opioid-induced delirium (6C43.5)
Sedative, hypnotic or anxiolytic-induced delirium (6C44.5)
Cocaine-induced delirium (6C45.5)
Stimulant-induced delirium including amphetamines, methamphetamine or methcathinone (6C46.5)
Synthetic cathinone-induced delirium (6C47.5)
Hallucinogen-induced delirium (6C49.4)
Volatile inhalant-induced delirium (6C4B.5)
MDMA or related drug-induced delirium, including MDA (6C4C.5)
Dissociative drug-induced delirium including ketamine or PCP (6C4D.4)
Delirium induced by other specified psychoactive substance including medications (6C4E.5)
Delirium induced by unknown or unspecified psychoactive substance (6C4G.5)
Delirium induced by multiple specified psychoactive substances including medications (6C4F.5)

WHO ICD-11

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.

NICE glossary

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

Dementia due to use of alcohol

Dementia due to use of alcohol is characterised by the development of persistent cognitive impairments (e.g., memory problems, language impairment, and an inability to perform complex motor tasks) that meet the definitional requirements of Dementia that are judged to be a direct consequence of alcohol use and that persist beyond the usual duration of alcohol intoxication or acute withdrawal. The intensity and duration of alcohol use must have been sufficient to produce the cognitive impairment. The cognitive impairment is not better accounted for by a disorder or disease that is not induced by alcohol such as a dementia due to another disorder or disease classified elsewhere. (ICD-11 6D84)

WHO ICD-11

Demography

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

NICE glossary

Dependence

Dependency describes a compulsion to continue taking a drug in order to feel good or to avoid feeling bad. When this is done to avoid physical discomfort or withdrawal, it is known as physical dependence; when it has a psychological aspect (the need for stimulation or pleasure, or to escape reality) then it is known as psychological dependence.

Physical dependence is when someone has taken drugs in quantity for a time and comes to rely on the use of them in order to feel well and for their body to function ‘normally’. It usually happens when the body has built up a tolerance to the drug and in its absence, physical withdrawal symptoms appear. It mainly happens with depressant drugs like alcohol, barbiturates, heroin or tranquillisers. However, the deep depressions and even suicidal feelings that can follow cocaine and ecstasy use could be counted as physical dependence, because users will take more of the drug to escape these feelings.

Psychological dependence is when the user experiences an overwhelming desire to continue with the drug experience. This can be because of the pleasurable effects and the desire to keep experiencing them. It can, however, also represent some sort of psychological crutch. The drug experience can become a way of blocking out reality, making life bearable, and a way of facing the world. Without the crutch life seems worthless. It can happen with any drug or any activity which takes over a person’s life including eating, sex, work, or jogging.

From NIDA glossary: A condition that can occur with the regular use of illicit or some prescription drugs, even if taken as prescribed. Dependence is characterized by withdrawal symptoms when drug use is stopped. A person can be dependent on a substance without being addicted, but dependence sometimes leads to addiction.

Drugwise

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

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.

NICE glossary

Detoxification

A process in which the body rids itself of a drug, or its metabolites. Medically-assisted detoxification may be needed to help manage a person’s withdrawal symptoms. Detoxification alone is not a treatment for substance use disorders, but this is often the first step in a drug treatment program.

From WHO lexicton: (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.)

NIDA glossary

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.

NICE glossary

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: 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

Disorders due to substance use

Disorders due to substance use include disorders that result from a single occasion or repeated use of substances that have psychoactive properties, including certain medications. Disorders related to fourteen classes or groups of psychoactive substances are included. Typically, initial use of these substances produces pleasant or appealing psychoactive effects that are rewarding and reinforcing with repeated use. With continued use, many of the included substances have the capacity to produce dependence. They also have the potential to cause numerous forms of harm, both to mental and physical health. Disorders due to harmful non-medical use of non-psychoactive substances are also included in this grouping.

Classified under this heading in ICD-11 are:

6C40 Disorders due to use of alcohol 

6C41 Disorders due to use of cannabis 

6C42 Disorders due to use of synthetic cannabinoids 

6C43 Disorders due to use of opioids 

6C44 Disorders due to use of sedatives, hypnotics or anxiolytics 

6C45 Disorders due to use of cocaine 

6C46 Disorders due to use of stimulants including amphetamines, methamphetamine or methcathinone 

6C47 Disorders due to use of synthetic cathinones 

6C48 Disorders due to use of caffeine 

6C49 Disorders due to use of hallucinogens 

6C4A Disorders due to use of nicotine 

6C4B Disorders due to use of volatile inhalants 

6C4C Disorders due to use of MDMA or related drugs, including MDA 

6C4D Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP] 

6C4E Disorders due to use of other specified psychoactive substances, including medications 

6C4F Disorders due to use of multiple specified psychoactive substances, including medications 

6C4G Disorders due to use of unknown or unspecified psychoactive substances 

6C4H Disorders due to use of non-psychoactive substances 

6A41 Catatonia induced by substances or medications 

6C4Y Other specified disorders due to substance use 

6C4Z Disorders due to substance use, unspecified 

Disorders due to addictive behaviours 

[For DSM notes see also, article from 2013, DSM-5 Criteria for substance use disorders: recommendations and rationale, and from the 2016 online book Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health]

See also, What is a substance use disorder? by the American Psyciatric Association

WHO ICD-11

Disulfiram (Antabuse)

Antabuse is a prescription medicine used to treat the symptoms of Alcoholism. Antabuse may be used alone or with other medications. Antabuse belongs to a class of drugs called Psychiatry Agents, Other. Disulfiram (brand name for Antabuse) is an alcohol antagonist drug.

WebMD RxList

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 drug profiles 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, 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.

The National Drug Treatment Reporting System in Ireland use the following categories:

Hazardous: a pattern of alcohol use that increases the risk of harmful consequences for the user. The term describes drinking over the recommended limits by a person who has no apparent alcohol-related health problems. Includes experimental drinking. [AUDIT score 8 – 15: Increasing risk]
Harmful: a pattern of use that results in damage to physical or mental health; can include negative social consequences. [AUDIT score 16 – 19: High risk]
Dependent: a cluster of behavioural, cognitive, and physiological symptoms. Typically, includes a strong desire to consume alcohol, impaired control over its use, persistent drinking despite harmful consequences, a higher priority given to drinking than to other activities and obligations, increased alcohol tolerance. Also, notably a physical withdrawal reaction when alcohol use is discontinued. [AUDIT score 20+: Possible dependence] (NDTRS treatment page)

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.

See The drugs wheel web-resource for categories of drugs in a number of countries

WHO Lexicon of alcohol and drug terms

Drug consumption facilities

Drug consumption facilities are places in which drug users can use illicit drugs under the supervision of medically trained staff. They exist in several European countries and are usually located in areas where there is an open drug scene and injecting in public places is common. Their primary goal is to reduce morbidity and mortality by providing a safer environment for drug use and training clients in safer forms of drug use.

For more details see the EMCDDA consumption room webpage.

EMCDDA

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 Drug and Alcohol Task Forces, 12 in Dublin, one in Cork and one in Bray. There are also 10 Regional Drug and Alcohol Task Forces. Task Forces include representatives from statutory agencies, the voluntary sector, local communities and public representatives.

Drug and Alcohol Task Force areas:

  • Ballymun Local Drugs Taskforce
  • Ballyfermot Local Drug and Alcohol Task Force
  • Blanchardstown Local Drug & Alcohol Task Force
  • Bray Local Drug and Alcohol Task Force
  • Clondalkin Drug and Alcohol Task Force
  • Cork Local Drug & Alcohol Task Force
  • Dublin 12 Local Drugs & Alcohol Task Force
  • Dublin North East Drugs & Alcohol Task Force
  • Dun Laoghaire Rathdown Drugs Taskforce
  • ECRDATF East Coast Regional Drugs Task Force – Wicklow and South Dublin
  • Finglas/Cabra Local Drug and Alcohol Task force
  • Mid-West Regional Drugs and Alcohol Task Force - Counties Clare and Limerick, and North Tipperary
  • Midland Regional Drug and Alcohol Task Force - Counties Laois, Longford, Offaly and Westmeath
  • North Dublin Regional Drug and Alcohol Task Force - North Dublin city and county, including the five LDTF areas within these boundaries
  • North Eastern Regional Drug and Alcohol Taskforce - Counties Cavan, Louth, Meath and Monaghan
  • North Inner City Drugs and Alcohol Task Force
  • Northwest Regional Drug and Alcohol Task Force - Counties Donegal, Leitrim and Sligo, and north-west Cavan
  • South East Regional Drug and Alcohol Task Force - Counties Carlow, Kilkenny, Waterford and Wexford, and South Tipperary,
  • South Western Regional Drugs and Alcohol Task Force - South-west Dublin, west Wicklow and County Kildare, including the six LDTF areas within these boundaries
  • Southern Regional Drug and Alcohol Task Force - Counties Cork and Kerry, including the Cork LDTF area
  • Tallaght Drug and Alcohol Task Force
  • Western Region Drugs & Alcohol Task Force - 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-related problem

Any of the range of adverse accompaniments of drug use, particularly illicit 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.

Drug abuse or misuse by Drugwise:

Drugs can be used either by swallowing, smoking, injecting or any other way of getting the drug into the blood stream, such as inserting into the anus (often done by heavy cocaine snorters to avoid further damaging their noses) or insufflation – inhaling the drug contained in a fine spray. The terms have different connotations, varying usually on ideas of harm or inappropriate purpose. Abuse and misuse imply that the use is harmful or done in the wrong way. Misuse, as harm, refers to use that is dependent or part of a problematic or harmful behaviour. Those who believe drug taking is wrong, except within a medical context, will tend to use the term misuse to refer to illicit drug taking. The Government, for example, still uses this term, in keeping with their policies that aim to prevent non-medical drug taking. Use by children is regarded as inappropriate and again the terms abuse and misuse often apply, such as in the case of volatile substance abuse which is often harmful and particular to young teenagers. Drug use is used to refer to drug taking that, although it has some risk, is not necessarily wrong or dangerous. The term does not imply that drug taking is wrong and is therefore preferred by many not wishing to value-judge the taking of drugs (Drugwise).

WHO Lexicon of alcohol and drug terms

Dual diagnosis (Co-morbidity)

The co-occurrence of psychiatric illness and substance disorders, commonly termed co-morbidity or dual diagnosis, is not a new phenomenon. However, in recent years the issue has gained momentum in the political and professional discussion as it has become apparent that a large and probably growing number of people are affected. 

Comorbidity: When two disorders or illnesses occur in the same person. Drug addiction and other mental illnesses or viral infections (HIV, hepatitis) are often comorbid. Also referred to as co-occurring disorders (NIDA glossary).

EMCDDA

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).

NICE glossary

Effectiveness

How beneficial a test or treatment is under usual or everyday conditions, compared with doing nothing or opting for another type of care.

See also efficacy

NICE glossary

Efficacy

How beneficial a test, treatment or public health intervention is under ideal conditions (for example, in a laboratory), compared with doing nothing or opting for another type of care.

See also the definition for effectiveness

NICE glossary

Electronic cigarette (e-cigarettes)

Electronic cigarette (e-cigarettes) are devices that enable the user to inhale nicotine. They work by heating and vaporising a solution that contains nicotine, glycerine and sometimes flavourings. Inhaling nicotine from an e-cigarette is referred to as vaping. Since there is no burning involved with e-cigarettes there is no smoke produced and hence no tar or carbon monoxide, which are two of the most toxic products of smoking. The vapour from e-cigarettes has been found to contain some potentially harmful chemicals but these are at much lower levels than they are in conventional tobacco smoke. However, some recent studies have linked the flavourings in some e-cigarettes to lung damage.

See also, Smoking: how e-cigarettes and vaping affect your body and Vaping: e-cigarette and marijuana vape risks from WebMD RxList

Drugwise

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.

Healthknowledge.org.uk has an online public health textbook with a detailed chapter on epidemiology

NICE 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.

Most program managers assess the value and impact of their work all the time when they ask questions, consult partners, make assessments, and obtain feedback. They then use the information collected to improve the program. Indeed, such informal assessments fit nicely into a broad definition of evaluation as the “examination of the worth, merit, or significance of an object.” And the term “program” is defined as “any set of organized activities supported by a set of resources to achieve a specific and intended result.” This definition is intentionally broad so that almost any organized public health action can be seen as a candidate for program evaluation. What distinguishes program evaluation from ongoing informal assessment is that program evaluation is conducted according to a set of guidelines.

In general, evaluation questions fall into these groups:

Implementation: Were your program’s activities put into place as originally intended?
Effectiveness: Is your program achieving the goals and objectives it was intended to accomplish?
Efficiency: Are your program’s activities being produced with appropriate use of resources such as budget and staff time?
Cost-Effectiveness: Does the value or benefit of achieving your program’s goals and objectives exceed the cost of producing them?
Attribution: Can progress on goals and objectives be shown to be related to your program, as opposed to other things that are going on at the same time?

CDC: Introduction to program evaluation for public health programs: a self-study guide

Evidence

Information on which a decision or guidance is based. Evidence can be obtained from a range of sources, including randomised controlled trials, observational studies and expert opinion (for example, healthcare and other professionals, people using services, family members and carers).

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

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

NICE 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).

Evidence based medicine (EBM) has been defined as the a process of turning clinical problems into questions and then systematically locating, appraising, and using contemporaneous research findings as the basis for clinical decisions.' The phrase ‘evidence-based’  was coined by David Eddy, an American healthcare analyst, in the 1980s, and the term ‘evidence-based medicine’ was first used by Gordon Guyatt, a professor in the Department of Epidemiology at McMaster Medical School in Canada, in 1990 to label this clinical learning strategy.

The practice of evidence-based medicine means integrating clinical expertise and the best available evidence from systematic research with the ideas, concerns and expectations of individual patients. This includes clinically relevant research into the accuracy and precision of diagnostic tests, the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventative regimens. EBM is not restricted to randomised controlled trials and meta-analyses, but should involve appraising the best evidence available with which to answer clinical questions...

Health knowledge - Epidemiology for practitioners

Evidence-based practices

A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC").

See also, Evidence-based practice: a practice manual by the HSE South East

Sicily statement on evidence-based practice

Experimental study

A study in which the people taking part are sorted into 2 or more groups. At least 1 will be a control group. All groups are then followed up under carefully controlled conditions to investigate whether or not a test or treatment affects the course or outcome of a condition or disease. A controlled clinical trial and randomised controlled trial are examples of experimental studies.

Experimental treatment: A new treatment (for example, a new drug) that is being studied to see whether it has an effect on the course or outcome of a condition or disease.

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 2 criteria: manipulation of a variable factor between 2 or more groups, and random assignment of patients to those groups. A quasi-experimental study uses the first criterion but patients are not randomly assigned to groups. This means a researcher cannot 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. 

NICE 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

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).

Drug misuse: psychosocial interventions 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

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

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

WHO ICD-11 LD2F.00 Fetal alcohol syndrome - Fetal alcohol syndrome is a malformation syndrome caused by maternal consumption of alcohol during pregnancy. It is characterised by prenatal and/or postnatal growth deficiency (weight and/or height <10th percentile); a unique cluster of minor facial anomalies (short palpebral fissures, flat and smooth philtrum, and thin upper lip) that presents across all ethnic groups, is identifiable at birth, and does not diminish with age. Affected children present severe central nervous system abnormalities including: microcephaly, cognitive and behavioural impairment (intellectual disability, deficit in general cognition, learning and language, executive function, visual-spatial processing, memory, and attention).

Fetal alcohol syndrome is one of a spectrum of disorders under the umbrella term of fetal alcohol spectrum disorder (FASD). There is a total of five disorders that comprise fetal alcohol spectrum disorders. They are fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), a neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE), and alcohol-related birth defects (ARBD). All of these fetal alcohol spectrum disorders are used to classify the wide-ranging physical and neurological effects that prenatal alcohol exposure can inflict on a fetus (StatPearls)

WHO ICD-11

Fidelity of implementation

Fidelity measures the degree to which an intervention is implemented as it is prescribed in the original protocol. Fidelity is commonly measured by comparing the original evidence-based intervention and the disseminated and implemented intervention in terms of (1) adherence to the program protocol, (2) dose or amount of program delivered, (3) quality of program delivery, and (4) participant reaction and acceptance. In case of complex interventions, the measurement of fidelity focuses more on the function and process of the intervention rather than on the individual components.

A glossary for dissemination and implementation research in health

Flashback

Flashback: A sudden but temporary recurrence of aspects of a drug experience (including sights, sounds, and feelings) that may occur days, weeks, or even more than a year after using drugs that cause hallucinations.

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-V) of the American Psychiatric Association, it is named ‘Hallucinogen Persisting Perception Disorder’ (EMCDDA Drug profiles glossary).

NIDA glossary

Focus group

Used for some types of qualitative research. Usually, between 6 and 12 people have a group interview or discussion on a particular topic. It is a good way to find out how people feel or think about an issue, or to come with possible solutions to a problem.

For more information, see How to conduct research for service improvement: a guidebook for health and social care professionals

NICE glossary

Follow-up

Observation over a period of time of a person, group or defined population to observe changes in health status, or health- and social care-related variables.

NICE glossary

Formative evaluation

Formative evaluation ensures that a program or program activity is feasible, appropriate, and acceptable before it is fully implemented. It is usually conducted when a new program or activity is being developed or when an existing one is being adapted or modified.

For more information see Building our understanding: key concepts of evaluation from the CDC Healthy Communities Program

Also, EMCDDA Evaluation Instruments Bank

CDC website

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 Drug profiles 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

Gray/grey literature

Literature that has not been formally published in sources such as books or journal articles.

Literature that is unpublished or has limited distribution and is not included in bibliographic retrieval systems. Examples include conference proceedings, academic or policy reports, newsletters and industry and technical reports.

NICE glossary

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

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

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

Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. A core principle of harm reduction is the development of pragmatic responses to dealing with drug use through a hierarchy of intervention goals that place primary emphasis on reducing the health-related harms of continued drug use.

Harm reduction: Measures aiming to prevent or reduce negative health or other consequences associated with drug misuse, whether to the drug-using individual or to society. Attempts are not necessarily made to reduce the drug use itself (Drug misuse: psychosocial interventions glossary).

EMCDDA

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. 

• 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-I1 (WHO Lexicon of alcohol and drug terms).

WHO ICD-11:

6C44.1 Harmful pattern of use of sedatives, hypnotics or anxiolytics - A pattern of sedative, hypnotic, or anxiolytic use that has caused clinically significant harm to a person’s physical or mental health or in which behaviour induced by sedatives, hypnotics or anxiolytics has caused clinically significant harm to the health of other people. The pattern of sedative, hypnotic, or anxiolytic use is evident over a period of at least 12 months if use is episodic and at least one month if use is continuous (i.e., daily or almost daily). Harm may be caused by the intoxicating effects of sedatives, hypnotics or anxiolytics, the direct or secondary toxic effects on body organs and systems, or a harmful route of administration. 

6C40.0 Episode of harmful use of alcohol - An episode of use of alcohol that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to alcohol intoxication on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of alcohol use. 

6C40.1 Harmful pattern of use of alcohol - A pattern of alcohol use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of alcohol use is evident over a period of at least 12 months if substance use is episodic or at least one month if use is continuous. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to alcohol intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of alcohol applies. 

6C41.0 Episode of harmful use of cannabis – An episode of use of cannabis that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to cannabis intoxication on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of cannabis use. 

6C41.1 Harmful pattern of use of cannabis - A pattern of cannabis use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of cannabis use is evident over a period of at least 12 months if substance use is episodic or at least one month if use is continuous (i.e., daily or almost daily). Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to cannabis intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of cannabis applies. 

6C43.0 Episode of harmful use of opioids - An episode of opioid use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to opioid intoxication on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of opioid use. 

6C43.1 Harmful pattern of use of opioids - A pattern of use of opioids that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of opioid use is evident over a period of at least 12 months if substance use is episodic or at least one month if use is continuous (i.e., daily or almost daily). Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to opioid intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of opioids applies. 

6C45.0 Episode of harmful use of cocaine - An episode of use of cocaine that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to cocaine intoxication on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of cocaine use. 

6C45.1 Harmful pattern of use of cocaine - A pattern of use of cocaine that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of cocaine use is evident over a period of at least 12 months if substance use is episodic or at least one month if use is continuous (i.e., daily or almost daily). Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to cocaine intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of cocaine applies.

See also, from ICD-11

6C48.10 Harmful pattern of use of caffeine, episodic

6C48.11 Harmful pattern of use of caffeine, continuous

6C49.0 Episode of harmful use of hallucinogens

6C49.1 Harmful pattern of use of hallucinogens

6C4A.1 Harmful pattern of use of nicotine

6C4B.0 Episode of harmful use of volatile inhalants

6C4B.1 Harmful pattern of use of volatile inhalants

6C42.0 Episode of harmful use of synthetic cannabinoids

6C42.1 Harmful pattern of use of synthetic cannabinoids

6C47.0 Episode of harmful use of synthetic cathinones

6C47.1 Harmful pattern of use of synthetic cathinones

6C4C.1Z Harmful pattern of use of MDMA or related drugs, including MDA, unspecified

6C4H.0 Episode of harmful use of non-psychoactive substances

6C4H.1 Harmful pattern of use of non-psychoactive substances

WHO ICD-11

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 library 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.

NICE glossary

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.

NICE glossary

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.

NICE glossary

Health Service Executive (HSE)

The Health Service Executive provides all of the public health services in Ireland. 

The National Social Inclusion office supports equal access to Health Services for people from vulnerable groups, including those affected by addiction and homelessness.

There are 32 local health offices which act as an entry point to community health and personal social services. The wide range of services that are provided through these Offices and from Health Centres include general practitioner services, public health nursing, child health services, community welfare, chiropody, ophthalmic, speech therapy, social work, addiction counselling and treatment, physiotherapy, occupational therapy, psychiatric services and home help.

In order to implement Slaintecare, the Department of Health have introduced six regional health area.

The HSE also has an alcohol and drugs freephone helpline on 1800 459 459 from Monday to Friday between 9:30am and 5:30pm or email helpline@hse.ie

Health Service Executive

Heavy episodic drinking (binge)

In Ireland acute intoxication or heavy episodic drinking (HED) is often referred to as ‘binge drinking’ and is defined for both males and females as consuming at least six standard drinks on a single drinking occasion. Even in a person who does not have a long-standing drinking problem, this can result in alcohol poisoning and injuries (Alcohol consumption, alcohol-related harm and alcohol policy in Ireland). Irish standard drink: a drink that contains 10 grams of alcohol; this is the equivalent of one glass of beer, one pub measure of spirits, or 100 mL of wine. (2019–20 Irish National Drug and Alcohol Survey)

WHO ICD-11 6C40.3 Alcohol intoxication: Alcohol intoxication is a clinically significant transient condition that develops during or shortly after the consumption of alcohol that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of alcohol and their intensity is closely related to the amount of alcohol consumed. They are time-limited and abate as alcohol is cleared from the body. Presenting features may include impaired attention, inappropriate or aggressive behaviour, lability of mood and emotions, impaired judgment, poor coordination, unsteady gait, fine nystagmus and slurred speech. At more severe levels of intoxication, stupor or coma may occur. Alcohol intoxication may facilitate suicidal ideation or behaviour. 

WHO ICD-11 6C40.0 Episode of harmful use of alcohol: An episode of use of alcohol that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxication; (2) direct or secondary toxic effects on body organs and systems; or (3) a harmful route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour due to alcohol intoxication on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of alcohol use.

WHO ICD-11

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 Heroin hub

Heterogeneity / Homogeneity

Heterogenity 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.

NICE glossary

HIV (Human Immunodeficiency Virus)

Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells. HIV destroys these CD4 cells, weakening a person’s immunity against infections such as tuberculosis and some cancers. WHO recommends that every person who may be at risk of HIV should access testing. People diagnosed with HIV should be offered and linked to antiretroviral treatment as soon as possible following diagnosis. If taken consistently, this treatment also prevents HIV transmission to others.

If the person’s CD4 cell count falls below 200, their immunity is severely compromised, leaving them more susceptible to infections. Someone with a CD4 count below 200 is described as having AIDS (acquired immunodeficiency syndrome). HIV can be diagnosed using simple and affordable rapid diagnostic tests, as well as self-tests. It is important that HIV testing services follow the 5Cs: consent, confidentiality, counselling, correct results and connection with treatment and other services.

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 eHealth Ireland site

eHealth Ireland

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 legally sanctioned channels.

An illicit drug is defined as any drug which is illegal to possess or use or any legal drug used in an illegal manner, for example: a drug obtained on prescription but given or sold to another person to use; glue or petrol which is sold legally, but is used in a manner that is not intended, such as inhaling fumes; stolen pharmaceuticals sold on the black market (e.g. Pethidine) (Australian Government).

WHO Lexicon of alcohol and drug terms

Impulse control disorders

Impulse control disorders are characterised by the repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite consequences such as longer-term harm either to the individual or to others, marked distress about the behaviour pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Impulse Control Disorders involve a range of specific behaviours, including fire-setting, stealing, sexual behaviour, and explosive outbursts.

WHO ICD-11

Impulse control syndrome induced by multiple specified psychoactive substances

Impulse control disorder induced by multiple specified psychoactive substances is characterised by persistently repeated behaviours in which there is recurrent failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite longer-term harm either to the individual or to others (e.g., fire setting or stealing without apparent motive, repetitive sexual behaviour, aggressive outbursts) that develop during or soon after intoxication with or withdrawal from multiple specified psychoactive substances. The intensity or duration of the symptoms is substantially in excess of disturbances of impulse control that are characteristic of intoxication with or withdrawal from the multiple specified psychoactive substances. The amount and duration of the multiple specified psychoactive substances use must be capable of producing disturbances of impulse control. The symptoms are not better explained by a primary mental disorder (e.g., an Impulse control disorder, a Disorder due to addictive behaviours), as might be the case if the impulse control disturbances preceded the onset of the use of multiple specified psychoactive substances, if the symptoms persist for a substantial period of time after cessation of the multiple specified psychoactive substance use or withdrawal, or if there is other evidence of a pre-existing primary mental disorder with impulse control symptoms (e.g., a history of prior episodes not associated with multiple specified psychoactive substances use). (ICD-11 6C4F.73)

WHO ICD-11

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.

NICE glossary

Indicated prevention

Indicated prevention can be seen as the third part of a ‘prevention chain’ leading from universal prevention and selective prevention to indicated prevention with numerous overlapping borders. 

For more details see the EMCDDA 2009 review on indicated prevention

EMCDDA

Indicator

A statistic or marker that has been chosen to monitor health or service activity. For example, an indicator might be the number of women attending for breast cancer screening or the number of deaths from coronary heart disease in a defined population.


For more details see the EMCDDA resource PERK.

NICE 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).

In medical terms this could be a drug treatment, surgical procedure, diagnostic test or psychological therapy. Examples of public health interventions could include action to help someone to be physically active or to eat a more healthy diet. Examples of social care interventions could include safeguarding or support for carers.

NICE glossary

Intervention-specific instruments

The Evaluation Instruments Bank (EIB) is an online archive of freely available instruments for evaluating drug-related interventions. Details regarding copyright and/or possible use restrictions are specified for each instrument. An evaluation instrument is typically a questionnaire, an interview script, or a set of observation guidelines, used to evaluate one or more aspects of an intervention in the drugs field.

EMCDDA

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.

Interviews are the most commonly used data collection method in qualitative research, whereby the researcher conducts a dialogue with selected participants, often on a one-to-one basis, on a chosen topic of research interest. The difference between an interview and a normal conversation is that the direction of dialogue is mindfully guided by the investigator in accordance with specific research objectives, either with explicit, ordered questions, as in a structured interview; or with assurances and prompts, as in an unstructured interview....

For more information on interviews see How to conduct research for service improvement: a guidebook for health and social care professionals. on our Doing research webpage

How to conduct research for service improvement

Interviewer bias

The influence of the interviewer on the interviewee. This may result from several factors, including the physical and psychological characteristics of the interviewer, which may affect the interviewees and cause differential responses among them.

CDC evaluation glossary

Intoxication

The WHO Lexicon of alcohol and drug terms defines intoxication as 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.

The WHO ICD-11 has several entries for substance related intoxication:

6C40.3 Alcohol intoxication

Alcohol intoxication is a clinically significant transient condition that develops during or shortly after the consumption of alcohol that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of alcohol and their intensity is closely related to the amount of alcohol consumed. They are time-limited and abate as alcohol is cleared from the body. Presenting features may include impaired attention, inappropriate or aggressive behaviour, lability of mood and emotions, impaired judgment, poor coordination, unsteady gait, fine nystagmus and slurred speech. At more severe levels of intoxication, stupor or coma may occur. Alcohol intoxication may facilitate suicidal ideation or behaviour. 

See also,

6C43.3 Opioid intoxication

6C45.3 Cocaine intoxication

6C46.3 Stimulant intoxication

6C49.3 Hallucinogen intoxication

6C4F.3 Intoxication due to multiple specified psychoactive substances

WHO ICD-11

K
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

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

Life skills are abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life (WHO definition). In particular, life skills are a group of psychosocial competencies and interpersonal skills that help people make informed decisions, solve problems, think critically and creatively, communicate effectively, build healthy relationships, empathise with others, and cope with and manage their lives in a healthy and productive manner. Life skills may be directed toward personal actions or actions toward others, as well as toward actions to change the surrounding environment to make it conducive to health.

Skills-based health education is an approach to creating or maintaining healthy lifestyles and conditions through the development of knowledge, attitudes, and especially skills, using a variety of learning experiences, with an emphasis on participatory methods.

WHO Skills for health

Literature review

Not to be confused with a book review, a literature review surveys scholarly articles, books and other sources (e.g. dissertations, conference proceedings) relevant to a particular issue, area of research, or theory, providing a description, summary, and critical evaluation of each work. The purpose is to offer an overview of significant literature published on a topic.

Similar to primary research, development of the literature review requires four stages:

  • Problem formulation—which topic or field is being examined and what are its component issues?
  • Literature search—finding materials relevant to the subject being explored
  • Data evaluation—determining which literature makes a significant contribution to the understanding of the topic
  • Analysis and interpretation—discussing the findings and conclusions of pertinent literature...

Literature search: A data collection method that involves an identification and examination of research reports, published papers, and books. (CDC Evaluation glossary)

UC Santa Cruz library

Liver-disease

DB94 Alcoholic liver disease - Alcoholic liver disease is damage to the liver and its function due to excessive intake of alcohol over a prolonged period of time. The diagnosis is made by a history of excessive intake of alcohol and exclusion of other causes of liver disease. However, it is important to note that excessive alcohol intake interacts with other causes of chronic liver disease to worsen the pathological severity and clinical outcome; important (relatively common) examples are with chronic hepatitis C, obesity and diabetes-related fatty liver, and haemochromatosis. 

DB95 Drug-induced or toxic liver disease - Drug-induced and toxic liver disease is hepatotoxicity as injury to the liver that is associated with impaired liver function caused by exposure to a drug or another noninfectious agent. 

DB95.5 Drug-induced or toxic liver disease with fibrosis or cirrhosis of liver - This is a drug-induced hepatic fibrosis as the end result of chronic hepatitis, chronic hepatotoxicity, steatohepatitis, or chronic cholestasis with bile duct injury. (See WHO ICD-11 for further definitions) 

DB94.3 Alcoholic cirrhosis of liver without hepatitis - Alcoholic cirrhosis is an advanced pathological stage of alcoholic liver disease characterised by diffuse fibrosis that links portal tracts and central veins, distortion of the hepatic architecture and the formation of regenerative nodules. It often occurs with alcoholic hepatitis. 

DB94.2 Alcoholic liver fibrosis - Alcoholic fibrosis of liver is defined as an excess deposition of the collagens and extracellular matrix within the liver as evident histologically, caused by excessive intake of alcohol.

WHO ICD-11

Logic model

A systematic and visual way to present the perceived relationships among the resources you have to operate the program, the activities you plan to do, and the changes or results you hope to achieve.

CDC evaluation 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.

NICE glossary

Low threshold services

The term ‘low threshold’ refers to the accessibility and pre-requisites to obtaining a service, and within the substance use field, low threshold provision is often underpinned by principles of harm reduction. Client work typically focuses on ensuring that the basic needs of the client are being met (housing, food, medical) and on collaboratively supporting the client to implement harm reduction strategies in their lives, according to the pattern and type of substances they are using. This type of service is generally provided on a drop-in basis during specific time periods, does not require service users to be abstinent or substance free and may work with service users if they are intoxicated.

BYAP Community based low threshold substance use services

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

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).

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

WHO Lexicon of alcohol and drug terms

Mass media interventions

Mass-media interventions use a range of methods to communicate a message as widely as possible. This can include local, regional or national television, radio and newspapers, and leaflets and booklets. It can also include digital media.

NICE 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

Mean or Median

An average can be described as a summary of a group of numbers as a single number. There are different types of averages; the most common used in official statistics are mean and median.

Mean

The mean (also called arithmetic mean), in everyday language called the average, is the sum of the values of a group of numbers divided by the amount of numbers in the group.

Example of mean:

We have 9 numbers in a group: 10, 12, 11, 15, 13, 35, 41, 23, 20. The sum of these 9 numbers is 180. Then the sum of 180 is divided by 9 in order to get the average. The average is 180/9 = 20. 

In official statistics, the most common type of average is the weighted average or weighted mean, as it is rare that all items have the same importance. In a weighted average, each item taken into account is multiplied by a number (weight), which reflects the item's relative importance, then the result is added up before being divided by the number of items. 

Example of weighted mean:

Population          % not owning a car

Country A            20 million             5%

Country B            500 thousand    30%

Country C            1 million               16%

Total A+B+C       21.5 million         This is a weighted average – how is it calculated?

The average of those not owning a car in these 3 countries is NOT calculated by adding 5% + 30% + 16%=51% and then 51%/3=17% since the different size of the 3 countries has to be taken into consideration. The weighting factor in this example is the population. 

The way to calculate the weighted average is:

5 % of 20 million = 1 million

30 % of 500 thousand = 150 thousand

16 % of 1 million =160 thousand

Total: 1 million + 150 thousand + 160 thousand = 1.31 million

The weighted average is [(1.31 million/21.5 million) -1] x100 = 6 % (rounded)

 

Median

The median is the middle value in a group of numbers ranked by size. It is the number which is exactly in the middle so that 50% of the ranked numbers are above and 50% are below the median. 

Example of median:

In order to find the median of the same 9 numbers: 10, 12, 11, 15, 13, 35, 41, 23, 20, first put them in ascending order, i.e. 10, 11, 12, 13, 15, 20, 23, 35, 41 - the middle number is 15: the median is 15 as 4 numbers are below 15 and 4 numbers are above 15. 

If there is an even amount of numbers: 10, 11, 12, 13, 15, 20, 23, 35 - the two in the middle (13 and 15) are added together (13+15=28) and then divided by 2 (28/2= 14), which means the median in this case is 14.

Eurostat Statistics Explained

Meta-analysis

A method often used in systematic reviews to combine results from several studies of the same test, treatment or other intervention to estimate the overall effect of the treatment.

NICE glossary

Methadone

Methadone Hydrochloride Oral Concentrate is a mu-agonist, a synthetic opioid analgesic, indicated for detoxification treatment of opioid addiction (heroin or other morphine-like drugs), and for maintenance treatment of opioid addiction (heroin or other morphine-like drugs), in conjunction with appropriate social and medical services.

Methadone oral concentrate is available in generic form. 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 (WHO Lexicon of alcohol and drug terms).

See also: maintenance therapy; opioid

WebMD RxList

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

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.

NICE glossary

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

NICE glossary

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 library 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-11 6C4F.3) is one of the ''Intoxication due to multiple specified psychoactive substances" in ICD-I1, 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

8C80 Drug-induced myopathy - Myopathy caused by drugs that ranges from mild myalgias with or without mild weakness to chronic myopathy with severe weakness, to massive rhabdomyolysis with acute renal failure. It could be due to several different mechanisms including direct myotoxicity, immune mediated and indirect muscle damage through drug-induced coma, drug-induced hypokalaemia, drug-induced hyperkinetic states or dystonic states.

8D44.1 Alcoholic myopathy - Myopathy secondary to alcohol use and includes acute and chronic alcoholic myopathy. Several forms have been described: acute necrotizing myopathy, acute hypokalaemic myopathy, chronic alcoholic myopathy, asymptomatic alcoholic myopathy, and alcoholic cardiomyopathy.

WHO ICD-11

N
Naloxone

Naloxone is used worldwide in medical emergencies to reverse respiratory depression caused by opioid overdose. It has no effect on non-opioid drug overdoses, no dependency potential and a high safety margin.

EMCDDA Drug profiles

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

Narcotic: 1. A drug that causes insensibility or stupor. A narcotic induces narcosis, from the Greek "narke" for "numbness or torpor."
2. A drug such as marijuana which is subject to regulatory restrictions comparable to those for addictive narcotics.

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) (WHO Lexicon of alcohol and drug terms).

• 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)

WebMD RxList

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.

Link: Latest NDRDI publications

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 the library collection.

NICE

Needle and syringe exchange

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

Pubmed 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 is the collection and analysis of information that relates to the needs of affected populations and that will help determine gaps between an agreed standard and the current situation.

The Inter-Agency Standing Committee (IASC) defines people in need as those members [of a population]:
• whose physical security, basic rights, dignity, living conditions or livelihoods are threatened or have been disrupted, and
• whose current level of access to basic services, goods and social protection is inadequate to re-establish normal living conditions with their accustomed means in a timely manner without additional assistance.

The primary purpose of needs assessment is to identify which people are in need, disaggregated by different categories of people (for example, all affected persons, pregnant women, children) and different types of needs; determine the severity of their needs; and pinpoint the type of assistance they require to ensure prioritized, focused, response planning. It is triggered by a need to better assess and monitor a particular situation and the conditions faced by populations of concern, whether in the context of a response to a sudden crisis or as an ongoing planning effort during a protracted crisis.

WHO

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

New psychoactive substances (NPS)

New psychoactive substances (NPS) are drugs which were designed to replicate the effects of illegal substances like cannabis, cocaine and ecstasy whilst remaining legal – hence their previous name ‘legal highs’.

NPS fall into four main categories:

Synthetic cannabinoids – these drugs mimic cannabis and are traded under such names as Clockwork Orange, Black Mamba, Spice and Exodus Damnation. They bear no relation to the cannabis plant except that the chemicals which are blended into the base plant matter act on the brain in a similar way to cannabis.

Stimulant-type drugs – these drugs mimic substances such as amphetamine, cocaine and ecstasy and include BZP, mephedrone, MPDV, NRG-1, Benzo Fury, MDAI, ethylphenidate.

‘Downer’/tranquiliser-type drugs – these drugs mimic tranquiliser or anti-anxiety drugs, in particular from the benzodiazepine family and include Etizolam, Pyrazolam and Flubromazepam.

Hallucinogenic drugs – these drugs mimic substances like LSD and include 25i-NBOMe, Bromo-Dragonfly and the more ketamine-like methoxetamine.

The effects of NPS vary significantly from drug to drug and, compared to more traditional drugs, we have relatively little information on them. However, there is a growing body of evidence to demonstrate the potential short and long-term harms associated with their use. There have been hospitalisations and deaths linked to NPS...

For Ireland, see the 2017, Country report on new psychoactive substances in Ireland and the Criminal Justice (Psychoactive Substances) Act 2010

Drugwise

Nicotine

Nicotine: An alkaloid (a nitrogen-containing chemical) made by the tobacco plant or produced synthetically. Nicotine has powerful pharmacologic effects (including increased heart rate, heart stroke volume, and oxygen consumption by the heart muscle), as well as powerful psychodynamic effects (such as euphoria, increased alertness, and a sense of relaxation). Nicotine is also powerfully addictive.

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 (WHO Lexicon of alcohol and drug terms).

WHO ICD-11 6C4A Disorders due to use of nicotine - Disorders due to use of nicotine are characterised by the pattern and consequences of nicotine use. Nicotine is the active dependence-producing constituent of the tobacco plant, Nicotiana tabacum. Nicotine is used overwhelmingly through smoking cigarettes. Increasingly, it is also used in electronic cigarettes that vaporize nicotine dissolved in a carrier solvent for inhalation (i.e., “vaping”). Pipe smoking, chewing tobacco and inhaling snuff are minor forms of use. Nicotine is a highly potent addictive compound and is the third most common psychoactive substance used worldwide after caffeine and alcohol. Nicotine Dependence and Nicotine Withdrawal are well described and Nicotine-Induced Mental Disorders are recognized. 

WHO ICD-11 6C4A.3 Nicotine intoxication - Nicotine intoxication is a clinically significant transient condition that develops during or shortly after the consumption of nicotine that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of nicotine and their intensity is closely related to the amount of nicotine consumed. They are time-limited and abate as nicotine is cleared from the body. Presenting features may include restlessness, psychomotor agitation, anxiety, cold sweats, headache, insomnia, palpitations, paresthesias, nausea or vomiting, abdominal cramps, confusion, bizarre dreams, burning sensations in the mouth, and salivation. In rare instances, paranoid ideation, perceptual disturbances, convulsions or coma may occur. Nicotine intoxication occurs more commonly in naïve (non-tolerant) users or among those taking higher than accustomed doses.

WHO ICD-11 QE12 Hazardous nicotine use - A pattern of nicotine use that appreciably increases the risk of harmful physical or mental health consequences to the user or to others to an extent that warrants attention and advice from health professionals. Most often nicotine is consumed in the form of tobacco, but there are also other forms of nicotine delivery (e.g., nicotine vapour). Hazardous nicotine use has not yet reached the level of having caused harm to physical or mental health of the user or others around the user. The pattern of nicotine use often persists in spite of awareness of increased risk of harm to the user or to others. This category is not intended to include the use of nicotine replacement therapies under medical supervision when these are used as part of attempts to stop or reduce smoking.

WebMD RxList

Nitrites (poppers)

Poppers, amyls, amyl nitrite, butyl nitrite, isobutyl nitrite, isopropyl nitrite, hardware, liquid gold, locker room, ram, rock hard, rush, snapper, stag, stud, thrust, TNT

Nitrites or poppers are yellow liquids which are inhaled for their intoxicating effects. In the UK they are usually sold in a small bottle. They may be inhaled directly from the bottle or from a cloth or cigarette dipped into the liquid. Nitrites tend to have a sweet odour when fresh but this tends to turn to a ‘dirty socks’ smell when stale. The drug will go stale quickly once the bottle has been opened. Effects start almost immediately after inhalation but only last a few minutes. Poppers work by increasing blood flow to the heart (hence their original medical use in the treatment of angina). This causes the user to experience a ‘high’ as their heartbeat quickens and blood rushes to their head.

Drugwise

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-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

Program goals and objectives establish criteria and standards against which you can determine program performance.

Objectives are statements describing the results to be achieved, and the manner in which they will be achieved. You usually need multiple objectives to address a single goal. SMART attributes are used to develop a clearly-defined objective. 

CDC website

Objectivity

Evidence and conclusions that can be verified by someone other than the original authors.

Objectivity is, along with reliability and validity, an important indicator for the quality of an instrument. 

Objective data: Observations that do not involve personal feelings and are based on observable facts. Objective data can be measured quantitatively or qualitatively.

CDC evaluation glossary

Observational study

A retrospective or prospective study in which the investigator observes the natural course of events with or without control groups (for example, cohort studies and case–control 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).

NICE glossary

Odds ratio

Odds ratio compares the odds (probability) of something happening in 1 group with the odds of it happening in another. An odds ratio of 1 shows that the odds of the event happening (for example, a person developing a disease or a treatment working) is the same for both groups. An odds ratio of greater than 1 means that the event is more likely in the first group than the second. An odds ratio of less than 1 means that the event is less likely in the first group than in the second group. See also confidence interval, relative risk, risk ratio.

NICE glossary

Opiate

A medication or an illegal drug that is derived from the opium poppy. Opiates are narcotic sedatives that depress activity of the central nervous system, reduce pain, and induce sleep. Codeine, morphine, and heroin are examples of opiates. In contrast, the term opioid is a broader term that originally was used to refer to any substance, natural (such as opiates) or synthetic, that bind to the opioid receptors in the brain and cause sedative and pain relief effects. Some examples of synthetic opioids include the prescription painkillers hydrocodone (Vicodin) and oxycodone (OxyContin), as well as fentanyl and methadone. In recent years, the term opioid has been used more broadly and is often used to refer to the entire class of drugs that consists of both opium derivatives (opiates) and synthetic opioids. Side effects of all opioids may include oversedation, nausea, and constipation. Long-term use can produce addiction, and overuse can cause overdose and potentially death.

See also: opioid

WebMD RxList

Opioid

Opioid: 1. A synthetic narcotic that resembles the naturally occurring opiates. 2. Any substance that binds to or otherwise affects the opiate receptors on the surface of the cell.

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. (WHO Lexicon of alcohol and drug terms)

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.

WebMD RxList

Opium

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

See also opioid

Opium: An addictive narcotic drug that is derived from the unripe seedpods of the opium poppy. Preparations of opium were called laudanum. Derivatives of opium include paregoric (a drug used to treat diarrhea), morphine, and heroin. For centuries, opium was used as a painkiller in the Middle East and Asia. It gained great popularity in Europe and the European colonies in the 18th century and became a main ingredient in patent medicines that patients could easily obtain without prescriptions. Many people became addicted to opium. Wounded Civil War soldiers who were in pain often received morphine. By 1900, it is estimated that more than 200,000 people in the US were addicted to opium and its derivatives. In 1909, the US Congress passed a law prohibiting the manufacture and sale of opium (WebMd RxList).

EMCDDA Drug profiles glossary

Outcome

The impact that a test, treatment, policy, programme or other intervention has on a person, group or population. Depending on the intervention, outcomes could include changes in knowledge and behaviour related to health or in people's health and wellbeing, 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, symptoms or situation.

Outcomes: The results of program operations or activities; the effects triggered by the program. (For example, increased knowledge, changed attitudes or beliefs, reduced tobacco use, reduced TB morbidity and mortality.) (CDC evaluation glossary)

Outputs: The direct products of program activities; immediate measures of what the program did. (CDC evaluation glossary)

NICE glossary

Outcome evaluation

The systematic collection of information to assess the impact of a program, present conclusions about the merit or worth of a program, and make recommendations about future program direction or improvement.

See, CDC evaluation resources; WHO/UNDCP/EMCDDA Workbooks on evaluation, 2000); EMCDDA Evaluation Instruments Bank

CDC evaluation glossary

Outreach

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

PubMed glossary

Overdose

An overdose occurs when a person uses enough of a drug to produce a life-threatening reaction or death.

See also: intoxication; and death.

NICE glossary

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 2 treatments found that 1 seems to be 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 0.1% probability that the results occurred by chance), the result is seen as highly significant. 

However, a statistically significant difference is not necessarily clinically significant. For example, drug A might relieve pain and stiffness statistically significantly more than drug B. But, if the difference in average time taken is only a few minutes, it may not be clinically significant. See Minimal clinically important difference. 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.

NICE glossary

Passive smoking / Environmental smoke

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. Peer reviewers can include both professionals and 'lay' experts. Lay experts are people whose expertise derives from their personal experience rather than formal training.

NICE glossary

Performance and image enhancing drugs (PIEDs)

Performance and image enhancing drugs (PIEDs) are taken by people who wish to improve their physical appearance and/or enhance their strength and sporting performance.

Possible benefits include increasing the size and definition of muscles, reducing body fat, increasing strength/endurance and helping the body recover from injury. These benefits can increase a user’s confidence and self-esteem which may lead to them becoming psychologically dependent on these drugs. The most widely used type of PIED are anabolic steroids however this group also includes peptides and hormones such as androstenedione, human growth hormone, erythropoietin, diuretics, and various stimulants...

See also, steroid

Drugwise

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 responsiveness 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-11, PCP-related disorders are classed with hallucinogens (XM5M84).


WHO ICD-11: 6C4D Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP] - Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP] are characterised by the pattern and consequences of dissociative drug use. Dissociative drugs include ketamine and phencyclidine (PCP) and their (comparatively rare) chemical analogues. Ketamine is an intravenous anaesthetic widely used in low- and middle-income countries, particularly in Africa, and in emergency situations. Ketamine is also undergoing evaluation for treatment of some mental disorders (e.g., treatment resistant Depressive Disorders). It is also a widespread drug of nonmedical use in many countries and may be taken by the oral or nasal routes or injected. It produces a sense of euphoria but depending on the dose, emergent hallucinations and dissociation are recognised as unpleasant side effects. Phencyclidine has a more restricted worldwide distribution and also has euphoric and dissociative effects. Its use may result in bizarre behaviour uncharacteristic for the individual, including self-harm. Dissociative Drug Dependence is described but a withdrawal syndrome is not recognized by most authorities. Several Dissociative Drug-Induced Mental Disorders are recognised (WHO ICD-11).

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.

NICE glossary

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.

NICE glossary

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.

NICE glossary

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

A pre-post clinical trial/cross-over trial is one in which the subjects are first assigned to the treatment group and, after a brief interval for cessation of residual effect of the drug, are shifted into the placebo /alternative group. Thus, the subjects act as their own control at the end of the study. However, such studies are not feasible if there is mortality, or if the disease is easily cured by one of the interventions.

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

Health knowledge - Epidemiology for practitioners

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 (Healthknowledge.org.uk).

In drug prevalence surveys the following terms are often 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.  (The 2019–20 Irish National Drug and Alcohol Survey: main findings)

Related terms: incidence

See our Irish prevalence resource page for national, school and other surveys that report the prevalence of drug use in Ireland.

NICE

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

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

Primary research

Primary research is any type of research that you collect yourself. Examples include surveys, interviews, observations, and ethnographic research.

Interviews: Interviews are one-on-one or small group question and answer sessions. Interviews will provide a lot of information from a small number of people and are useful when you want to get an expert or knowledgeable opinion on a subject.

Surveys: Surveys are a form of questioning that is more rigid than interviews and that involve larger groups of people. Surveys will provide a limited amount of information from a large group of people and are useful when you want to learn what a larger population thinks.

Observations: Observations involve taking organized notes about occurrences in the world. Observations provide you insight about specific people, events, or locales and are useful when you want to learn more about an event without the biased viewpoint of an interview.

Analysis: Analysis involves collecting data and organizing it in some fashion based on criteria you develop. They are useful when you want to find some trend or pattern. A type of analysis would be to record commercials on three major television networks and analyze gender roles.

Primary data: Data collected specifically for a study.

Purdue online writing guide

Probability

A probability gives the likelihood that a defined event will occur. It is quantified as a positive number between 0 (the event is impossible) and 1 (the event is certain). Thus, the higher the probability of a given event, the more likely it is to occur.  See also odds ratio.

Probability sampling: The selection of units from a population based on the principle of randomization. Every unit of the population has a calculable (non-zero) probability of being selected.

Health knowledge - Epidemiology for practitioners

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

Prospective study

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

Prospective cohort study - An observational study with 2 or more groups (cohorts) of people with similar characteristics. One group has 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.

NICE glossary

Pseudo-Cushing syndrome, alcohol-induced

An endocrine disorder (ICD-11 5A70.2), 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 ICD-11 5A70.2 Pseudo-Cushing syndrome - This is a condition in which patients display the signs, symptoms, and abnormal hormone levels seen in Cushing's syndrome. However, pseudo-Cushing's syndrome is not caused by a problem with the hypothalamic-pituitary-adrenal axis as Cushing's is; it is an idiopathic condition.

WHO Lexicon of alcohol and drug terms

Psilocybin (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. Psilocybin (PY, 4-phosphoryloxy-N,N-dimethyltryptamine) is the main psychoactive principle of hallucinogenic mushrooms.

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 (WHO Lexicon of alcohol and drug terms).

See also: hallucinogen

EMCDDA

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

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

PubMed Health 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-11 (Alcohol-induced psychotic disorder 6C40.6 and drug-induced psychotic disorders 6C41.9-6C45.6) 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-11

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 to potency, 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%.

See also the Drugwise site for information on purity and related concepts

EMCDDA Drug profiles glossary

Q
Qualitative research

Qualitative research explores people's beliefs, experiences, attitudes, behaviour and interactions. It asks questions about how and why. For example, why people want to stop smoking, rather than asking how many people have tried to stop. It generates non-numerical data, such as a person's description of their pain rather than a measure of pain. Qualitative research techniques such as focus groups and in depth interviews may be used to find out more about the views and experiences of the target population or practitioners.

See Introduction to qualitative research by Healthknowledge.org.uk

Qualitative data: Observations that are categorical rather than numerical, and often involve knowledge, attitudes, perceptions, and intentions. (CDC evaluation glossary)

See also, quantitative research

NICE 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.

NICE quality standards are a set of specific, concise statements and associated measures. They set out aspirational, but achievable, markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions. 

NICE 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 quality-adjusted life year (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 0 to 1 scale). It is often measured in terms of the person’s ability to carry out the activities of daily life, and freedom from pain and mental disturbance.

NICE glossary

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?'.

Quantitative and qualitative research are contrasting methodologies, based upon different epistemiological positions: qualitative research has its routes in interpretivism, which assumes that there is no “true reality” that exists independently from observation but that all reality is in fact socially constructed (subjectively interpreted) and therefore fluid. This position is in contrast to the positivist paradigm, within which quantitative research is usually based, which holds that there is a single, observable, and measurable reality that can be quantified and objectively interpreted. Broadly speaking, qualitative research tends to answer the “why?” and “how?” questions surrounding public health topics, in contrast to quantitative methodologies which tend to focus on epidemiological estimates of prevalence and strength of associations between variables. (Healthknowledge epidemiology)

Quantitative data: Observations that are numerical.

See also, qualitative research

NICE glossary

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).

See Randomised Control Trials video course by Healthknowledge.org.uk

Randomization: Use of a probability scheme for choosing a sample. This can be done using random number tables, computers, dice, cards, and so forth (CDC evaluation glossary).

NICE glossary

Rapid Alcohol Problems Screen

The Rapid Alcohol Problems 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

Journal of Studies on Alcohol and Drugs

Recovery

Recovery can mean different things to different people and may depend upon a multitude of factors such as the causes and extent of a person’s problematic drug use, the resources available to help them and their personal priorities. Despite this, it is helpful to have a broad consensus on the meaning of the term. For this reason, in 2008, the UK Drug Policy Commission Recovery Consensus Group brought together experts in the field to discuss the topic in depth. In the report of this meeting they provided a vision statement for recovery as follows: The process of recovery from problematic substance use is characterised by voluntarily-sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society.... (Drugwise)

Individuals may have differing definitions for what recovery from substance use disorder means for them. For some, this term is used to describe the voluntary process of improving health and quality of life by pursuing treatment for substance use disorder and/or controlling problematic substance use (NIDA glossary). 

Recovery-oriented care and recovery support systems help people with mental and substance use disorders manage their conditions successfully. Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. There are four major dimensions that support recovery:

Health—overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
Home—having a stable and safe place to live.
Purpose—conducting meaningful daily activities and having the independence, income, and resources to participate in society.
Community—having relationships and social networks that provide support, friendship, love, and hope… (SAMHSA)

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

See also, (2017) Recovery, reintegration, abstinence, harm reduction: the role of different goals within the drug treatment in the European context. Lisbon: European Monitoring Centre for Drugs and Drug Addiction 

Drugwise

Recreational use

Recreational drug use is the use of drugs for pleasure or leisure.

The term is often used to denote the use of ecstasy and other ‘dance drugs’, and implies that drug use has become part of someone’s lifestyle, even though they may only take drugs occasionally.

Drugwise

Rehabilitation

The broad definition of rehabilitation encompasses a structured development process focused on individuals, involving a continuum of care and aimed at maximising their quality of life and enabling their re-integration into communities (HSE).

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).

HSE Rehabilitation framework

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-11.

WHO Lexicon of alcohol and drug terms

Relapse

In drug addiction, relapse is the return to drug use after an attempt to stop. Relapse is a common occurrence in many chronic health disorders, including addiction, that requires frequent behavioral and/or pharmacologic adjustments to be treated effectively (NIDA glossary).

• 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).

NIDA glossary

Relative risk (risk ratio)

The probability of an event occurring in the study group compared with the probability of the same event occurring in the control group, described as a ratio. 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 1 means the outcome is less likely in the first group. Relative risk is sometimes referred to as risk ratio. It will be very similar to the odds ratio when events are rare.

NICE glossary

Reliability

The ability to get the same or similar result each time a study is repeated with a different population or group (NICE).

The extent to which a measurement, when repeatedly applied to a given situation consistently produces the same results if the situation does not change between the applications. Reliability can refer to the stability of the measurement over time or to the consistency of the measurement from place to place. (CDC evaluation glossary). (CDC evaluation glossary)

Reliability is the overall consistency of a measure. A highly reliable measure produces similar results under similar conditions so, all things being equal, repeated testing should produce similar results. Reliability is also known as reproducibility or repeatability. There are different means for testing the reliability of an instrument:

  • Inter-rater (or inter-observer) reliability - The degree of agreement between the results when two or more observers administer the instrument on the same subject under the same conditions. 
  • Intra-rater (or intra-observer) reliability - Also known as test-retest reliability, this describes the agreement between results when the instrument is used by the same observer on two or more occasions (under the same conditions and in the same test population). 
  • Inter-method reliability - This is the degree to which two or more instruments, that are used to measure the same thing, agree on the result. This is also known as equivalence
  • Internal consistency reliability - This is the degree of agreement, or consistency, between different parts of a single instrument. (Healthknowledge.org.uk
NICE glossary

Remission

 A medical term meaning that major disease symptoms are eliminated or diminished below a pre-determined harmful level.

NIDA 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.

Residential or day care settings - Examples of residential and day care settings include: day care centres for older people and adults or children with physical or learning disabilities; children’s homes; residential and nursing care homes (including those for adults and children with physical or learning disabilities); prisons, and young offender institutes. (NICE glossary)

UNODC, Demand reduction, Glossary of terms

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.

NICE glossary

Review

Review is any summary of the literature. Ideally literature reviews should be systematic and unbiased.

Systematic review is a review in which evidence on a topic has been systematically identified, appraised and summarised according to predetermined criteria.

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).

Review of the literature: A summary of the evidence in a number of different individual studies, with conclusions about their findings. A review may or may not be systematically researched and developed. (NICE glossary)

Review protocol: A document that outlines the background, objectives and planned methods for a systematic review. (NICE glossary)

CASP 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.

NICE glossary

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. 

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: People in 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.

Sample size: The number of units to be sampled.

Sample size formula: An equation that varies with the type of estimate to be made, the desired precision of the sample and the sampling method, and which is used to determine the required minimum sample size.

Sampling error: The error attributed to sampling and measuring a portion of the population rather than carrying out a census under the same general conditions.

Sampling frame: Complete list of all people or households in the target population.

Sampling method: The method by which the sampling units are selected (such as systematic or stratified sampling). (CDC evaluation glossary)

See also, Methods of sampling from a population by Healthknowledge.org.uk

NICE glossary

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
• Johns Hopkins University - Substance use screening and risk assessment in adults.
• NICE Alcohol-use disorder pathway
• NICE Drug-misuse disorder pathway
• HSE, Ireland - Quick question (alcohol use leaftlet)
• Library collection subject - screening method

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 study

A study of studies: a review of individual studies (each of which is called a primary study). A systematic review is a secondary study.

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

CASP glossary

Sedative / hypnotic

Sedative: A drug that calms a patient, easing agitation and permitting sleep. Sedatives generally work by modulating signals within the central nervous system. If sedatives are misused or accidentally combined, as in the case of combining prescription sedatives with alcohol, they can dangerously depress important signals that are needed to maintain heart and lung function. Most sedatives also have addictive potential. For these reasons, sedatives should be used under supervision and only as necessary... (WebMD RxList). 

Hypnotics are used for the treatment of insomnia which is characterized by difficulties with falling asleep or maintaining sleep. Specific hypnotics such as Intermezzo (zolpidem tartrate) can be used for insomnia involving middle of the night waking followed by difficulty returning to sleep. There are a variety of hypnotics that are used for treating insomnia. The main difference among the various hypnotics is their half-life, that is, how long the drug is active in the body……(WebMD RxList)

From WHO: Sedatives/hypnotics: 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 (6C44) in ICD-11 (WHO Lexicon of alcohol and drug terms).

WHO ICD-11 6C44 Disorders due to use of sedatives, hypnotics or anxiolytics - Disorders due to use of sedatives, hypnotics or anxiolytics are characterised by the pattern and consequences of use of these substances. Sedatives, hypnotics, and anxiolytics are typically prescribed for the short-term treatment of anxiety or insomnia and are also employed to provide sedation for medical procedures. They include the benzodiazepines and the non-benzodiazepine positive allosteric modulators of GABA receptors (i.e., ‘Z-drugs’) as well as many other compounds. Sedatives, hypnotics, and anxiolytics include barbiturates, which are available much less commonly now than in previous decades. Sedatives, hypnotics, and anxiolytics have dependence-inducing properties that are related to the dose and duration of their use. They may cause intoxication, dependence and withdrawal. Several other mental disorders induced by sedatives, hypnotics, or anxiolytics are recognized.

WebMD RxList

Selective prevention

Selective prevention measures target subsets of the total population that are considered at risk for substance abuse by virtue of their membership in a particular segment of the population. Selective prevention targets the entire subgroup, regardless of the degree of risk of any individual within the group.

Preventive interventions that are targeted to individuals or to a subgroup of the population whose risk of developing mental, emotional, or behavioral disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a disorder. Those risk factors may be at the individual level for nonbehavioral characteristics (e.g., biological characteristics such as low birth weight), at the family level (e.g., children with a family history of substance abuse but who do not have any history of use), or at the community/population level (e.g., schools or neighborhoods in high-poverty areas).

Selective prevention refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. Indicated prevention includes strategies that are targeted to individuals who are identified (or individually screened) as having an increased vulnerability for a disorder based on some individual assessment but who are currently asymptomatic. Selective and indicated prevention strategies might involve more intensive interventions and thus involve greater cost to the participants, since their risk and thus potential benefit from participation would be greater. (Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities.)

Institute of Medicine (IOM) Classification System

Self-help group

A term that refers to two types of therapeutic groups but is more commonly used for what is properly called a  mutual-help group

WHO Lexicon of alcohol and drug terms

Sensitivity

How well a test detects what it is testing for. It is the proportion of people with the disease or condition that are correctly identified by the study test. For example, a test with a sensitivity of 96% will, on average, correctly identify 96 people in every 100 who truly have the condition, but incorrectly identify as not having the condition 4 people in every 100 who truly have it. It is different from positive predictive value.

Sensitivity analysis: A means of exploring uncertainty in the results of economic evaluations. There may be uncertainty because data are missing, estimates are imprecise or there is controversy about methodology. Sensitivity analysis can also be used to see how applicable results are to other settings. The analysis is repeated using different assumptions to examine the effect of these assumptions on the results.

NICE glossary

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 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.

NICE glossary

Social reintegration

Social reintegration is not a term that is used or defined consistently across EU Member States but it is a key aspect of full recovery from drug dependence. Its scope is wider than the traditional treatment focus on pharmacological and psychosocial outcomes. The EMCDDA defines it 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. More recently the EMCDDA has introduced the concept of employability to account for the complexity of the issue (e.g. interlinkage between interventions, contextual factors, distinguishing between different needs). Furthermore, as employment is acknowledged in the EU Member States and beyond as important for social integration, supportive measures to overcome personal and structural-level barriers to obtain employment and to increase personal employability are seen as a key to social reintegration....

EMCDDA

Socioeconomic status

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

NICE 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 of the spread, scatter or variability of a set of measurements. Usually used with the mean (average) to describe numerical data.

NICE glossary

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.

Irish standard drink: Standard drink – a drink that contains 10 grams of alcohol; this is the equivalent of one glass of beer, one pub measure of spirits, or 100 mL of wine. (2019–20 Irish National Drug and Alcohol Survey)

WHO Lexicon of alcohol and drug terms

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

NICE glossary

Steroid

Anabolic steroids are one type of performance-enhancing drug or medication. They mimic testosterone in the body to enhance performance by making muscle cells larger and by allowing the body to recover more quickly from the stress of exercise. Slang for anabolic steroids is roids. 

There are two types of steroids that the body naturally produces: Catabolic steroids or glucocorticoids are part of the body's response to stress. Anabolic androgenic steroids are steroids that mimic testosterone in the body. 

Though most anabolic steroids need to be injected into the body to be effective, some may be taken by mouth and others used as a cream or gel and applied to the skin. The user will try to take enough anabolic steroid to increase the ability to exercise and allow muscles to grow while minimizing the risk of side effects and the potential of being caught. Usually people take steroids in cycles with regular injections followed by periods of rest. Numerous books and web sites discuss the benefits and risks of different techniques to maximize the effect of a variety of steroids on the body. There is a large underground illegal industry that has grown to meet the demand for anabolic steroids and provides methods to try to avoid detection…

WebMD RxList

Stimulant

A stimulant is a drug which speeds up the central nervous system to increase neural activity in the brain. Examples include amphetamines, cocaine and crack, caffeine, nicotine and ecstasy. Stimulant drugs tend to make people feel more alert and focused and are sometimes called ‘uppers’. Stimulants raise blood pressure, heart rate, and respiration and reduce the desire to eat. After the effects wear off people may feel tired, hungry and depressed.

Historically, stimulant drugs like ephedrine were used to treat asthma and other respiratory problems as well as obesity, insomnia and certain neurological disorders. Amphetamines were also used throughout the Second World War to increase the alertness and focus of soldiers – see our page on amphetamines for more about their history. During the 1960s, as their potential for abuse and addiction became apparent, authorities began to control stimulants like amphetamines and their medical use was restricted. Now, stimulants are only used for a small number of medical conditions such as ADHD, narcolepsy, and occasionally depression. The mild stimulant caffeine, however, remains one of our most popular drugs; being found in tea, coffee and chocolate.

In ICD-I1, Psychostimulants are subdivided into those due to the use of cocaine (ICD-11 6C45) and those due to the use of other stimulants listed under Methylenedioxymethamphetamine, including amphetamines, ecstasy, methamphetamine or methcathinone (ICD-11 6C46). Prominent among them are amphetamine psychosis and cocaine psychosis. See also: psychotic disorder, alcohol- or drug-induced

Drugwise

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.

NICE glossary

Substance use disorders

A medical illness caused by disordered use of a substance or substances. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SUDs are characterized by clinically significant impairments in health, social function, and impaired control over substance use and are diagnosed through assessing cognitive, behavioral, and psychological symptoms. An SUD can range from mild to severe.

See also, Disorders due to substance use

NIDA glossary

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

Summative evaluation

Outcome and impact evaluations are common components of ex post evaluations (i.e. evaluations conducted at the end of a programme or strategy). These are types of summative evaluation, which look at the extent to which a policy or programme has met its goals and had any other consequences, and draw lessons based on these assessments. The main focus at this stage is often on effectiveness, added value and efficiency, that is whether or not the objectives of the policy or programme were achieved and represented a good use of resources. Nevertheless, in addition they usually seek to identify other lessons for future policy development, such as issues that have acted as barriers and key factors for success, so they often also include process evaluations or implementation reviews.

EMCDDA

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.)

NICE glossary

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

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.

EMCDDA Drug profiles

Systematic review

Systematic review is a review in which evidence on a topic has been systematically identified, appraised and summarised according to predetermined criteria.

See also, Cochrane Collaboration and CASP tools checklist for systematic reviews

Meta-analysis is a statistical technique which summarises the results of several studies into a single estimate, giving more weight to results from larger studies.

CASP 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

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

Tobacco

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

When people are addicted, they have a compulsive need to seek out and use a substance, even when they understand the harm it can cause. Tobacco products -- cigarettes, cigars, pipes, and smokeless tobacco -- can all be addictive. It is actually the nicotine in tobacco that is addictive. Each cigarette contains about 10 milligrams of nicotine. Because the smoker inhales only some of the smoke from a cigarette, and not all of each puff is absorbed in the lungs, a smoker gets about 1 to 2 milligrams of the drug from each cigarette.

Nicotine is only one of more than 4,000 chemicals, many of which are poisonous, found in the smoke from tobacco products. Smokeless tobacco products also contain many toxins, as well as high levels of nicotine. Many of these other ingredients are things we would never consider putting in our bodies, like tar, carbon monoxide, acetaldehyde, and nitrosamines. Tar causes lung cancer, emphysema, and bronchial diseases. Carbon monoxide causes heart problems, which is one reason why smokers are at high risk for heart disease.

See also: nicotine for WHO ICD-11 categories & passive smoking

WebMD RxList

Tolerance

The effects of tolerance mean that increasingly higher doses of a drug are needed to maintain the same effect. The body learns to tolerate the drug in the system. Alcohol, barbiturates, heroin and amphetamine are all drugs to which the body can build up tolerance (Drugwise).

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).

Drugwise

Tranquillizer

In pharmacology, a drug that calms and relieves anxiety. The first tranquilizer, chlordiazepoxidehydrochloride (brand name: Librium), received FDA approval in 1960. Tranquilizers range in potency from mild to major, with increasing levels of drowsiness occurring as potency increases. They are prescribed for a wide variety of conditions but are used primarily to treat anxiety and insomnia. Most tranquilizers are potentially addictive, particularly those in the benzodiazepine family (WebMD).

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).

WebMD RxList

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

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.

Universal interventions target the general population and are not directed at a specific risk group. Universal prevention measures address an entire population (national, local, community, school, or neighborhood) with messages and programs aimed at preventing or delaying the use of alcohol, tobacco, and other drugs. The mission of universal prevention is to deter the onset of substance abuse by providing all individuals with the information and skills necessary to prevent the problem. The entire population is considered at risk and able to benefit from prevention programs.

Institute of Medicine (IOM) Classification System

V
Validity

Whether a test or study actually measures what it aims to measure. Internal validity shows whether a study or test is appropriate for the question, for example, whether a study of exercise among gym members measures the amount of exercise people do at the gym, not simply whether people join. External validity is the degree to which the results of a study hold true in non-study situations, for example, in routine NHS practice. It may also be referred to as the generalisability of study results to non-study populations. For example, the external validity of a study that took place in Spain may be questioned if the results were to be applied to people in Australia.

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.

See also, Validity, reliability and generalisability from Healthknowledge.org.uk

NICE glossary

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’ shops.

EMCDDA Drug profiles

W
Wernicke encephalopathy

WHO ICD-11 5B5A.1 Wernicke-Korsakoff Syndrome - A thiamine-deficiency syndrome characterised by symmetric hyperaemic lesions of the brainstem, hypothalamus, thalamus, and mammillary bodies with glial proliferation, capillary dilatation, and perivascular haemorrhage. The syndrome is manifested by a confusional state, disorientation, ophthalmoplegia, nystagmus, diplopia, and ataxia (Wernicke encephalopathy), with severe loss of memory for recent events and confabulation (the invention of accounts of events to cover the loss of memory) (Korsakov psychosis) occurring following recovery. Defective binding of thiamine diphosphate by transketolase has been found. It appears that the disorder is of autosomal recessive inheritance but is expressed as clinical disease only in the event of thiamine deficiency.

5B5A.10 Wernicke encephalopathy - Wernicke's encephalopathy is an acute neuropsychiatric syndrome characterised by nystagmus, ophthalmoplegia, changes in the mental status, an uncoordinated gait and truncal ataxia. Wernicke's encephalopathy is usually accompanied or followed by Korsakoff's syndrome/Korsakoff's dementia (a continuum of Wernicke's encephalopathy characterised by severe memory defects, ataxia, apathy, disorientation, confabulations, hallucinations, paralysis of muscles controlling the eye and coma). The disorder results from a deficiency in vitamin B1, and mostly occurs in adults with a history of alcohol abuse or in patients with AIDS.

WHO ICD-11

Withdrawal

Symptoms that can occur after long-term use of a drug is reduced or stopped; these symptoms occur if tolerance to a substance has occurred, and vary according to substance. Withdrawal symptoms can include negative emotions such as stress, anxiety, or depression, as well as physical effects such as nausea, vomiting, muscle aches, and cramping, among others. Withdrawal symptoms often lead a person to use the substance again (NIDA glossary).

From WHO ICD-11:

WHO ICD-11 6C40.4 Alcohol withdrawal - Alcohol withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of alcohol in individuals who have developed Alcohol dependence or have used alcohol for a prolonged period or in large amounts. Presenting features of Alcohol withdrawal may include autonomic hyperactivity (e.g. tachycardia, hypertension, perspiration), increased hand tremor, nausea, retching or vomiting, insomnia, anxiety, psychomotor agitation, depressed or dysphoric mood, transient visual, tactile or auditory illusions or hallucinations, and distractability. Less commonly, the withdrawal state is complicated by generalised tonic-clonic seizures. The withdrawal state may progress to a very severe form of delirium characterised by confusion and disorientation, delusions, and prolonged visual, tactile or auditory hallucinations. In such cases, a separate diagnosis of Alcohol-induced delirium should also be assigned.

6C41.4 Cannabis withdrawal - Cannabis withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of cannabis in individuals who have developed Cannabis dependence or have used cannabis for a prolonged period or in large amounts. Presenting features of Cannabis withdrawal may include irritability, anger or aggressive behaviour, shakiness, insomnia, restlessness, anxiety, depressed or dysphoric mood, decreased appetite and weight loss, headache, sweating or chills, abdominal cramps and muscle aches.

6C43.4 Opioid withdrawal - Opioid withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of opioids in individuals who have developed Opioid dependence or have used opioids for a prolonged period or in large amounts. Opioid withdrawal can also occur when prescribed opioids have been used in standard therapeutic doses. Presenting features of Opioid withdrawal may include dysphoric mood, craving for an opioid, anxiety, nausea or vomiting, abdominal cramps, muscle aches, yawning, perspiration, hot and cold flushes, lacrimation, rhinorrhea, hypersomnia (typically in the initial phase) or insomnia, diarrhea, piloerection, and pupillary dilatation.

6C45.4 Cocaine withdrawal - Cocaine withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of cocaine in individuals who have developed Cocaine dependence or have used cocaine for a prolonged period or in large amounts. Presenting features of Cocaine withdrawal may include dysphoric mood, irritability, fatigue, psychomotor retardation, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, anxiety, psychomotor agitation or retardation, and craving for cocaine.

6C4A.4 Nicotine withdrawal - Nicotine withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of nicotine (typically used as a constituent of tobacco) in individuals who have developed Nicotine dependence or have used nicotine for a prolonged period or in large amounts. Presenting features of Nicotine withdrawal may include dysphoric or depressed mood, insomnia, irritability, anger, anxiety, difficulty concentrating, restlessness, bradycardia, increased appetite, and craving for tobacco (or other nicotine-containing products. Other physical symptoms may include increased cough and mouth ulceration.

6C4G.4 Withdrawal due to unknown or unspecified psychoactive substance - Withdrawal due to unknown or unspecified psychoactive substance is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of an unknown or unspecified substance in individuals who have developed dependence or have used the unknown or unspecified substance for a prolonged period or in large amounts. Withdrawal due to unknown or unspecified psychoactive substance can also occur when prescribed psychoactive medications have been used in standard therapeutic doses. The specific features of the withdrawal state depend on the pharmacological properties of the unknown or unspecified substance.

6C42.4 Synthetic cannabinoid withdrawal - Synthetic cannabinoid withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of synthetic cannabinoids in individuals who have developed Synthetic cannabinoid dependence or have used synthetic cannabinoids for a prolonged period or in large amounts. Presenting features of Synthetic cannabinoid withdrawal may include irritability, anger, aggression, shakiness, insomnia and disturbing dreams, restlessness, anxiety, depressed mood and appetite disturbance. In the early phase, Synthetic cannabinoid withdrawal may be accompanied by residual features of intoxication from the drug, such as paranoid ideation and auditory and visual hallucinations.

6C47.4 Synthetic cathinone withdrawal - Synthetic cathinone withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of synthetic cathinones in individuals who have developed Synthetic cathinone dependence or have used synthetic cathinones for a prolonged period or in large amounts. Presenting features of Synthetic cathinone withdrawal may include dysphoric mood, irritability, fatigue, insomnia or (more commonly) hypersomnia, vivid and unpleasant dreams, increased appetite, psychomotor agitation or retardation, and craving for stimulants, including synthetic cathinones.

6C4B.4 Volatile inhalant withdrawal - Volatile inhalant withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of volatile inhalants in individuals who have developed Volatile inhalant dependence or have used volatile inhalants for a prolonged period or in large amounts. Presenting features of Volatile inhalant withdrawal may include insomnia, anxiety, irritability, dysphoric mood, shakiness, perspiration, nausea, and transient illusions.

6C44.4 Sedative, hypnotic or anxiolytic withdrawal - Sedative, hypnotic or anxiolytic withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of sedatives, hypnotics or anxiolytics in individuals who have developed dependence or have used sedatives, hypnotics or anxiolytics for a prolonged period or in large amounts. Sedative, hypnotic or anxiolytic withdrawal can also occur when prescribed sedatives, hypnotics or anxiolytics have been used in standard therapeutic doses. Presenting features of Sedative, hypnotic or anxiolytic withdrawal may include anxiety, psychomotor agitation, insomnia, increased hand tremor, nausea or vomiting, and transient visual, tactile or auditory illusions or hallucinations. There may be signs of autonomic hyperactivity (e.g., tachycardia, hypertension, sweating), or postural hypotension. The withdrawal state may be complicated by seizures. Less commonly, there may be progression to a more severe withdrawal state characterised by confusion and disorientation, delusions, and more prolonged visual, tactile or auditory hallucinations. In such cases, a separate diagnosis of Sedative, hypnotic, or anxiolytic-induced delirium should be assigned.

6C4C.4 MDMA or related drug withdrawal, including MDA - MDMA or related drug withdrawal, including MDA is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of MDMA or related drugs in individuals who have developed MDMA or related drug dependence or have used MDMA or related drugs for a prolonged period or in large amounts. Presenting features of MDMA or related drug withdrawal may include fatigue, lethargy, hypersomnia or insomnia, depressed mood, anxiety, irritability, craving, difficulty in concentrating, and appetite disturbance.

KD35 Neonatal withdrawal syndrome from maternal use of drugs of addiction - Intrauterine exposure to addictive drugs can lead to neonatal withdrawal symptoms. Withdrawal symptoms are usually neurological, preventing normal autonomic function. The clinical presentation of drug withdrawal is variable and dependent on several factors, such as, the type and dose of drug used, and rate of metabolism and excretion of the mother and infant.

NIDA glossary