Appendix A Glossary

This glossary contains descriptions of key words used in this Technical Assistance Publication. The descriptions of the terms reflect the usage of the terms in this document. The descriptions are not intended as universal or complete definitions of the terms.

Active listening – a counseling skill that enhances rapport and demonstrates interest and understanding through the use of verbal and nonverbal acknowledgment of client statements.

Addiction – a chronic, relapsing disease of the brain with social and behavioral manifestations marked by continued alcohol or drug use despite negative consequences.

Addiction counseling – professional and ethical application of specific competencies that constitute eight practice dimensions, including clinical evaluation; treatment planning; referral; service coordination; individual, group, and family counseling; client, family, and community education; and documentation.

Advocacy – (1) a social or political movement working for changes in legislation, policy, and funding to reflect clients’ concerns and protect their rights (i.e., advocacy for clients);

(2)  a philosophy of substance abuse treatment practice maintaining that clients should be involved actively in their own treatment and have rights in its planning and implementation (i.e., advocacy by clients). Much of advocacy is about shifting the system from the directive model to one in which the client is an empowered, involved participant in treatment decisions.

Biomedical – pertaining to the biological and physiological aspects of clinical medicine.

Biopsychosocial – the biological, psychosocial, and social influences in human development and behavior.

Case management – see “Service coordination.”

Client – individual, significant other, or community agent who presents for alcohol and drug abuse education, prevention, intervention, treatment, and consultation services.

Collateral sources – persons or organizations providing pertinent information about a client (can include family members and legal, educational, and medical personnel).

Competency – specific counselor functions comprising requisite knowledge, skills, and attitudes.

Confidentiality – a client’s right to privacy as defined by applicable Federal and State statutes.

Confidentiality rules and regulations – rules established by Federal and State agencies to limit disclosure of information about a client’s substance use disorder and treatment (described in 42 CFR, Part 2B 16). Programs must notify clients of their rights to confidentiality, provide a written summary of these rights, and establish written procedures regulating access to and use of client records.

Confrontation – a form of interpersonal exchange in which individuals present to one another their observations of, and reactions to, behaviors and attitudes that are matters of concern. Feedback is provided on behavior, and an appeal is made to the client for personal honesty, truthfulness in dealing with others, and responsible behavior.

Content – the subjects discussed in the context of counseling.

Continuing care – care that supports a client’s progress, monitors his or her condition, and responds to a return to substance use or a return of mental disorder symptoms. It is both a process of posttreatment monitoring and a form of treatment itself; sometimes referred to as aftercare.

Continuum of care – the array of services that differ in terms of unique needs of clients throughout the course of treatment and recovery.

Contracting – the process by which the client and the counselor enter into an agreement to address specific problems, issues, or   behaviors.

Co-occurring disorder/coexisting disorder – the presence of concurrent psychiatric or medical disorders in combination with a substance use disorder.

Counseling – a therapeutic process aimed at meeting specific identified needs of the client.

Countertransference – a counselor’s unresolved feelings for significant others that may be transferred to the client.

Craving – an urgent, seemingly overpowering desire to use a substance, which often is associated with tension, anxiety, or other dysphoric, depressive, or negative affective states.

Cultural competency – the capacity of a service provider or organization to understand and work effectively in accord with the beliefs and practices of persons from a given ethnic/racial/ religious/social group or sexual orientation. It includes the holding of knowledge, skills, and attitudes that allow the treatment provider and program to understand the full context of a cli- ent’s current and past socioenvironmental situation.

Cultural diversity – the vast array of different cultural groups based on varying behaviors, attitudes, values, languages, celebrations, rituals, and histories.

Culture – the vast structure of behaviors, ideas, attitudes, values, habits, beliefs, customs, language, rituals, ceremonies, histories, and practices distinctive to a particular group of people.

Diagnosis – classification of the nature and severity of the substance use, medical, mental health, or other problems present. DSM-IV-TR and ICD-10 commonly are used to classify substance use and mental disorders.

Disorder – an affliction that affects the functions of the mind and/or body, disturbing physical and/or mental health.

Duty to warn – the legal obligation of a counselor (healthcare provider) to notify the appropriate authorities as defined by statute and/or the potential victim when there is serious danger of a client’s inflicting injury on an identified individual.

Efficacy – the power to produce a desired effect.

Elements – specific, definable areas found in three of the practice dimensions (clinical evaluation, service coordination, and counseling).

Empirical – relying on observation or experience rather than theoretical principles or theory.

Engagement – a client’s commitment to and maintenance of treatment in all of its forms. A successful engagement program helps clients view the treatment facility as an important resource.

Epidemiology – the study of the incidence, distribution, and consequences of a particular problem in one or more populations.

Etiology – the study of origins (what causes a disorder).

Extrinsic motivator – a rationale for changing substance use that comes from outside the client. Examples include threat of losing a job, legal charges, or a spouse/significant other ending  a relationship.

Harmful use – patterns of alcohol or drug use for nonmedical reasons that result in negative health consequences and some degree of impairment in social, psychological, and occupational functioning for the user.

Helping strategy – an activity employed by the counselor to help the client accomplish his or her therapeutic goals.

Hepatitis C – a viral disease of the liver that is a major cause of liver damage and cirrhosis.

Incidence – the number of new cases of a disorder that occur in a population during a specific period.

Indicated preventive interventions – strategies designed for persons who are identified as having minimal but detectable signs or symptoms or precursors of some illness or condition, but whose condition is below the threshold of a formal diagnosis of the condition.

Individualized treatment plan – a strategy that addresses the identified substance use disorder(s), as well as issues related to treatment progress, including relationships with family and significant others, employment, education, spirituality, health concerns, and legal needs. Plans are developed in collaboration with the client and significant others and tailored to fit the client’s unique biopsychosocial strengths and needs.

Infectious – a contagious illness or disease transmitted by direct or indirect contact.

Initiation – the individual’s introduction to and onset of alcohol or drug use.

Intervention – the specific treatment strategies, therapies, or techniques that are used to treat one or more disorders.

Intoxication – an altered physical and mental state resulting from the overuse of alcohol or drugs.

Intrinsic motivator – an individual’s internal reason for changing substance use behaviors, such as poor health or low self-esteem, resulting from his or her substance use.

Life skills training – activities that include development of job, vocational, life (budgeting, leisure, etc.), anger management, general coping, communication, and social skills; literacy classes and GED preparation; parenting classes; and relationship building.

Managed care – an approach to delivery of health and mental health services that seeks to reduce the cost of care by monitoring the access to and use of medical services and supplies, as well as outcomes of that care.

Modality/treatment modality – any specific treatment method or procedure used to relieve symptoms or motivate behaviors that lead to   recovery.

Model – a collection of beliefs or unifying theory about what is needed to bring about change with a particular client in a particular treatment context.

Motivational interviewing – a direct, client-centered counseling style implemented to elicit behavior change by helping clients resolve their ambivalence to change.

Multiaxial diagnostic criteria – the system used by the DSM-IV-TR that evaluates the acute, longstanding medical conditions as well as stressors and level of functioning (current and past).

Multidisciplinary approach – a planned and coordinated program of care involving two or more health professions for the purpose of improving health care as a result of their joint contributions.

Multidisciplinary assessment approach – an organized process by which professionals of different specialties collaborate to assess the needs of the client.

Mutual help – a process present in many self-help groups by which the members of such groups rely on and receive support from other members who share the same condition.

Outcome monitoring – collection and analysis of data during and following alcohol and drug treatment to determine the effects of treatment, especially in relation to improvements in client functioning.

Outcome statement – an agreement between the client and the counselor that identifies the desired results of treatment.

Outreach strategies – approaches that actively seek out persons in a community who have substance use disorders and engage them in substance abuse treatment.

Patient – see “Client.”

Peer counselor – individuals in recovery from substance use disorders who have been trained to work in substance abuse treatment settings.

Practice dimensions – the eight essential areas of practice that addiction counselors must master to effectively provide treatment activities identified in The Competencies.

Prevalence – the percentage of people in the population that has a specific disorder.

Prevention – the theory and means for reducing the harmful effects of drug use in specific populations. Prevention objectives are to protect individuals before they manifest signs or symptoms of substance use problems, identify persons in the early stages of substance abuse and intervene, and end compulsive use of psychoactive substances through treatment.

Problem statement – a statement that describes a client’s current condition in behavioral terms.

Process – the way in which a client, counselor, or group engages or interacts.

Professionalism – a demonstration of knowledge, skills, and attitudes consistently applied when working with people who use substances and abiding by a code of ethics most commonly held by addiction professionals.

Projective identification – the process by which a person places internal negative feelings or concepts about oneself onto others.

Protective factors – conditions that promote bonding to prosocial values and institutions and can serve to buffer the negative effects of risks.

Psychoactive substance – a pharmacological agent that can change mood, behavior, and cognition process.

Rapport – the degree to which trust and openness are present in the relationship between counselor and client; an essential element of the therapeutic relationship.

Recovery – achieving and sustaining a state of health in which the individual no longer engages in problem behavior or psychoactive substance use and is able to establish a lifestyle that embraces health and positive goals.

Regression – a mechanism whereby an individual retreats to the use of early-life or less mature responses in attempting to cope with stress, fears, pain, or memories.

Relapse – the return to a pattern of substance abuse or the process during which indicators appear before the client’s resumption of substance use.

Relapse prevention – a variety of interventions designed to teach people with substance use disorders to cope more effectively and to overcome the stressors/triggers in their environments that may lead them back into drug use and dependence. The interventions can be placed in five categories: assessment procedures, insight/awareness raising techniques, coping skills training, cognitive  strategies,  and  lifestyle modification.

Reliability – the degree to which a measure is consistent.

Resilience – the ability of an individual to cope with or overcome the negative effects of risk factors or to “bounce back” from a problem. This capability develops and changes over   time,

is enhanced by protective factors, and contributes to the maintenance or enhancement of health.

Risk factors – conditions for a group, individual, or identified geographic area that increase the likelihood of a substance use problem or substance abuse.

Screening – gathering and sorting of information used to determine whether an individual has a problem with substance use and, if so, whether a detailed clinical assessment is appropriate.

Selective preventive interventions – activities targeted to individuals or a subgroup of the population whose risk of developing a disorder is significantly higher than average.

Self-determination – the extent to which individuals control their lives.

Self-help group – a supportive, educational, usually change-oriented mutual-help group that addresses a single life problem or condition shared by all members.

Service coordination – the process of prioritizing, managing, and implementing activities in an individual’s treatment plan.

Significant others – family member, sexual partner, and others on whom an individual is dependent for meeting all or part of his or her needs.

Sobriety – the quality or condition of abstinence from psychoactive substance abuse supported by personal responsibility in recovery.

Special populations – diverse groups of individuals sharing a particular characteristic, circumstance, or problem.

Spirituality – a belief system that acknowledges and appreciates the influence in one’s life of a higher power or state of being.

Stage of change – transtheoretical description of one of several stages through which a person passes in moving from active use to treatment and abstinence.

Stage of readiness – the individual’s awareness of need to change. Can be influenced by external pressure (family, legal system, or employer) or internal pressure (physical health concerns).

Substance abuse – a maladaptive pattern of substance use leading to clinically significant impairment or distress such as failure to fulfill major role responsibilities or use in spite of physical hazards, legal problems, or interpersonal and social problems. (See also DSM-IV-TR for specific criteria.)

Substance dependence – the need for alcohol or a drugs that results from the use of that substance. This need includes both mental and physical changes that make it difficult for individuals to control when they use the substance and how much they use. Psychological dependence occurs when individuals need the substance to feel good or normal or to function. Physical dependence occurs when the body adapts to the substance and needs increasing amounts to achieve the same effect or to function. (See also DSM-IV-TR for specific criteria.)

Substance use – consumption of low and/or infrequent doses of alcohol or drugs, sometimes called “experimental,” “casual,” “recreational,” or “social” use, such that consequences may be rare or minor.

Systems theory – view of behavior as an interactive part of a larger social structure.

Theory – a framework to organize and integrate knowledge to facilitate answering the question, “why?”

Transdisciplinary – knowledge and attitudes that both transcend and are needed by all disciplines working with persons with substance use     disorders.

Transference – the process in which a client’s strong feelings for significant others may be transferred  to  the counselor.

Treatment barriers – anything that hinders treatment. Examples include financial problems, language difficulties, ethnic and social attitudes, logistics (e.g., child care, transportation), and unhelpful patient behaviors (e.g., tardiness, missed appointments).

Treatment goals – objectives based on resolving problems identified during assessment and reasonably achievable in the active treatment phase.

Treatment interventions – strategies the counselor and other professionals use to assist the client in achieving treatment goals.

Treatment objectives – incremental steps a client takes in achieving treatment goals.

Universal prevention – prevention designed for everyone in the eligible population, both the general public and all members of specific eligible groups. Also, activities targeted to the general public or a whole population group that has not been identified on the basis of individual risk.

Validity – the degree to which an instrument or process measures what it is designed to measure.