Appendix C: Glossary of Terms

Note to the reader: The definitions of many of these terms have been taken verbatim from the Diagnostic and Statistical Manual of Mental Disorders, ( 4th edition, text revision (DSM-IV-TR) ). Such definitions have been presented and properly attributed in the text of this TIP. See appendix B, Acronyms, for acronym definitions.

abstinent—not using substances of abuse at any time.

acculturated—mentally and physically in harmony with and connected to the culture in which one lives.

ACT—see Assertive Community Treatment

acute care—short-term care provided in intensive care units, brief hospital stays, and emergency rooms for those who are severely intoxicated or dangerously ill.

addiction—physical dependence on a substance of abuse. Inability to cease use of a substance without experiencing withdrawal symptoms. Sometimes used interchangeably with the term substance dependence.

AD/HD—see attention deficit/hyperactivity disorder

addiction-only services—programs that by law or regulation, by choice, or for lack of resources cannot accommodate patients who have psychiatric illnesses that require ongoing treatment, however stable the illness and however well-functioning the patient.

advanced program—a treatment program that has the capacity to provide integrated substance abuse and mental health treatment for clients with COD. These programs address COD using an integrated perspective and provide services for both disorders.

agitation—a restless inability to keep still. Agitation is most often psychomotor agitation, that is, having emotional and physical components. Agitation can be caused by anxiety, overstimulation, or withdrawal from depressants and stimulants.

anorexia nervosa—a disorder in which the individual refuses to maintain a minimal normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body.

antiretroviral combination therapy—treatment for HIV/AIDS infection that employs several medications in combination to suppress the HIV virus or delay both the development of resistant viruses and the appearance of AIDS symptoms.

antisocial personality disorder—an illness whose two essential features are: (1) a pervasive disregard for and violation of the rights of others and (2) an inability to form meaningful interpersonal relationships. Deceit and manipulation are important manifestations of antisocial personality disorder.

anxiety disorder—an illness whose essential feature is excessive anxiety and worry. The individual with anxiety disorder finds it difficult to control the worry, and the anxiety and worry are accompanied by additional symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and disturbed sleep, among other signs and symptoms.

Assertive Community Treatment (ACT)—a form of treatment that typically employs intensive outreach activities, continuous 24-hour responsibility for client’s welfare, active and continued engagement with clients, a high intensity of services, as well as the provision of services by multidisciplinary teams. ACT emphasizes shared decisionmaking with the client as essential to the client’s engagement process.

assessment—a basic assessment consists of gathering key information and engaging in a process with the client that enables the counselor to understand the client’s readiness for change, problem areas, COD diagnosis, disabilities, and strengths. An assessment typically involves a clinical examination of the functioning and well-being of the client and includes a number of tests and written and oral exercises. The COD diagnosis is established by referral to a psychiatrist or clinical psychologist. Assessment of the client with COD is an ongoing process that should be repeated over time to capture the changing nature of the client’s status.

attention deficit/hyperactivity disorder (AD/HD)—a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more serious than is typically observed in individuals at a comparable level of development.

basic program—a treatment program with the capacity to provide treatment for one disorder, but that also screens for other disorders and is able to access necessary consultations.

blackout—a blackout is a period of amnesia or memory loss, typically caused by chronic, high-dose substance abuse. The person later cannot remember the blackout period. Blackouts are most often caused by sedative-hypnotics such as alcohol and the benzodiazepines.

borderline personality disorder—an illness whose essential feature is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, along with marked impulsivity that begins by early adulthood and is present in a variety of contexts.

bulimia nervosa—an illness whose essential feature is binge eating and inappropriate compensatory methods to prevent weight gain. In addition, the self-evaluation of individuals with bulimia nervosa is excessively influenced by body shape and weight.

CAGE questionnaire—a brief alcoholism screening tool asking subjects about attempts to Cut down on drinking, Annoyance over others’ criticism of the subject’s drinking, Guilt related to drinking, and use of an alcoholic drink as an Eye opener.

CBT—see cognitive-behavioral therapy

CCISC—see Comprehensive Continuous Integrated System of Care

CM—see contingency management

COD—see co-occurring disorders

coerced—legally forced or compelled.

cognitive—pertaining to the mind’s capacity to understand concepts and ideas.

cognitive-behavioral therapy (CBT)—a therapeutic approach that seeks to modify negative or self-defeating thoughts and behavior. CBT is aimed at both thought and behavior change—that is, coping by thinking differently and coping by acting differently.

coke bugs—slang term for tactile hallucinations (also called formications) that feel like bugs crawling on or under the skin. Chronic and high-dose stimulant abuse can cause these hallucinations.

collaboration—in the context of treatment programs, collaboration is distinguished from consultation by the formal quality of the collaborative agreement, such as a memorandum of understanding or a service contract, which documents the roles and responsibilities each party will assume in a continuing relationship.

combined psychopharmacological intervention—treatment episodes in which a client receives medications both to reduce cravings for substances and to medicate a mental disorder.

comorbid disorders—see co-occurring disorders

competency—an ability, capacity, skill, or set of skills.

Comprehensive Continuous Integrated System of Care (CCISC)—a theoretical method for bringing the mental health and substance abuse treatment systems (and other systems, potentially) into an integrated planning process to develop a comprehensive, integrated system of care. The CCISC is based on an awareness that co-occurring disorders are to be expected in clients throughout the service system.

concomitant treatment—treatment of two or more mental or physical disorders at the same time.

confrontation—a form of interpersonal exchange in which individuals present to each other their observations of, and reactions to, behaviors and attitudes that are matters of concern and should be changed. Confrontation presents “reality” to individuals. The goal of confrontation is feedback on behavior and the compelling appeal to the client for personal honesty, truthfulness in dealing with others, and responsible behavior.

constricted pupils (pinpoint pupils)—pupils that are temporarily narrowed or closed. This is usually a sign of opioid abuse.

consultation—in the context of treatment programs, consultation is a traditional type of informal relationship among treatment providers, such as a referral or a request for exchanging information.

contingency management (CM)—an approach to treatment that maintains that the form or frequency of behavior can be altered through a planned and organized system of positive and negative consequences. CM assumes that neurobiological and environmental factors influence substance use behaviors and that the consistent application of reinforcing environmental consequences can change these behaviors.

continuing care—care that supports a client’s progress, monitors his or her condition, and can respond to a return to substance use or a return of symptoms of mental disorder. It is both a process of post-treatment monitoring and a form of treatment itself. Sometimes referred to as aftercare.

convulsions—a symptom of a seizure, characterized by twitching and jerking of the limbs. A seizure is a sudden episode of uncontrolled electrical activity in the brain. If the abnormal electrical activity spreads throughout the brain, the result may be loss of consciousness and a grand mal seizure. Seizures may occur as the result of head injury, infection, cerebrovascular accidents, withdrawal from sedative-hypnotic drugs, or high doses of stimulants.

co-occurring disorders (COD)—refers to co-occurring substance use (abuse or dependence) and mental disorders. Clients said to have COD have one or more mental disorders as well as one or more disorders relating to the use of alcohol and/or other drugs. See dually disordered.

countertransference—the feelings, reactions, biases, and images from the past that the clinician may project onto the client with COD.

crack—cocaine (cocaine hydrochloride) that has been chemically modified so that it will become a gas vapor when heated at relatively low temperatures. Also called “rock” cocaine.

cross-training—the simultaneous provision of material and training to persons from more than one discipline (for example, to substance abuse and social work counselors or to substance abuse counselors and corrections officers).

cultural competence—the capacity of a service provider or an organization to understand and work effectively in accordance with the cultural beliefs and practices of persons from a given ethnic/racial group. Also includes an ability to examine and understand nuances and exercise full cultural empathy.

cultural destructiveness—practices or actions through which an individual shows that he or she regards other cultures as inferior to the dominant culture, through cultural incapacity and blindness to more positive attitudes and greater levels of skill.

cultural proficiency—the highest level of cultural capacity, which implies an ability to perceive the nuances of a culture in depth and a willingness to work to advance in proficiency through leadership, research, and outreach.

cultural sensitivity—the capacity and willingness of a clinician or other service provider to be open to working with issues of culture and diversity.

culturally competent treatment—biopsychosocial or other treatment that is adapted to suit the special cultural beliefs, practices, and needs of a client.

DDC—see dual diagnosis capable

DDE—see dual diagnosis enhanced

deficit—in the context of substance abuse treatment, disability, or inability to function fully.

detoxification—a clearing of toxins from the body. The medical and biopsychosocial procedure that assists a person who is dependent on one or more substances to withdraw from dependence on all substances of abuse.

dilated pupils—pupils that have become temporarily enlarged.

disorder—an illness or a disruption of some mental or physical process.

domestic violence—the use of emotional, psychological, sexual, or physical force by one family member or intimate partner to control another. Violent acts include verbal, emotional, and physical intimidation; destruction of the victim’s possessions; maiming or killing pets; threats; forced sex; and slapping, punching, kicking, choking, burning, stabbing, shooting, and killing victims. Spouses, parents, stepparents, children, siblings, elderly relatives, and intimate partners may all be targets of domestic violence.

downers—slang term for drugs that exert a depressant effect on the central nervous system. In general, downers are sedative-hypnotic drugs, such as benzodiazepines and barbiturates.

dual diagnosis capable (DDC)—of or pertaining to programs that address co-occurring mental and substance-related disorders in their policies and procedures, assessment, treatment planning, program content, and discharge planning.

dual diagnosis enhanced (DDE)—of or pertaining to programs that have a higher than average level of integration of substance abuse and mental health treatment services. These programs are able to provide primary substance abuse treatment to clients who are, compared with those treatable in DDC programs, more symptomatic and/or functionally impaired as a result of their co-occurring mental disorder.

dually disordered—having been diagnosed with two disorders, for example a substance use disorder and a mental health disorder.

dual recovery groups—therapy groups in which recovery skills for co-occurring disorders are discussed.

DTs—delirium tremens, a state of confusion accompanied by trembling and vivid hallucinations. Symptoms may include restlessness, agitation, trembling, sleeplessness, rapid heartbeat, and possibly convulsions. Delirium tremens often occurs in people with alcohol use disorders after withdrawal or abstinence from alcohol.

ecstasy—slang term for methylenedioxymethamphetamine (MDMA), a member of the amphetamine family (for example, speed). At lower doses, MDMA causes distortions of emotional perceptions. At higher doses, it causes potent stimulation typical of the amphetamines.

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.

formal collaboration—formal collaboration occurs when the nature of the client’s disabilities requires more specific information and more complex and targeted intervention. This level of working relationship ensures that providers give attention to both mental health and substance abuse disorders in the treatment regimen. An example of such collaboration is an interagency staffing conference where representatives of both mental health and substance abuse agencies take part in the development and implementation of a specific treatment program for clients with co-occurring disorders. Focus is placed on the creation of an individualized treatment plan that is implemented under the auspices of one system or the other. (See also collaboration and service integration.)

fully integrated program—a treatment program that actively combines substance abuse and mental health interventions to treat disorders, related problems, and the whole person more effectively.

functional—pertaining to a person’s ability to carry out tasks. Also, working, able to work.

grounding—the use of strategies that soothe and distract the client who is experiencing intense pain or other strong emotions, helping the client anchor in the present and in reality. Grounding techniques direct the mental focus outward to the external world, rather than inward toward the self. Also can be referred to as “centering,” “looking outward,” “distraction,” or “healthy detachment.”

habilitation—initial learning and the acquisition of skills necessary for everyday life.

hallucinogens—a broad group of drugs that cause distortions of sensory perception. The prototype hallucinogen is lysergic acid diethylamide (LSD). LSD can cause potent sensory perceptions, such as visual, auditory, and tactile hallucinations. Related hallucinogens include peyote and mescaline.

hepatitis—an inflammation of the liver, with accompanying liver cell damage and risk of death. Hepatitis may be of limited duration or a chronic condition. It may be caused by viral infection or by chronic exposure to poisons, chemicals, or drugs of abuse, such as alcohol.

ice—slang term for smokeable methamphetamine. Just as cocaine can be modified into a smokeable state (crack cocaine), methamphetamine can be prepared so that it produces a gas vapor when heated at relatively low temperatures. When smoked, ice methamphetamine produces an extremely potent and long-lasting euphoria, an extended period of high energy and possible agitation, followed by an extended period of deep depression.

ICM—see Intensive Case Management

impaired—hampered or held back from being able to do some mental or physical task.

infectious—able to spread by an agent such as a virus or bacterium.

informal collaboration—informal collaboration ensures that both mental illness and substance abuse problems are sufficiently understood by all participating providers to allow effective identification, engagement, prevention, and early intervention. An example of this type of collaboration is a telephone request for information or general advice regarding the origins and clinical course of depression in a person abusing alcohol or drugs. Discussion of a particular client usually does not occur, or occurs at a relatively general level. (See also collaboration, service integration.)

integrated competencies—the possession of specific attitudes, values, knowledge, and skills required to provide appropriate services to individuals with COD in the context of their actual job and program setting.

integrated interventions—specific treatment strategies or therapeutic techniques in which interventions for two or more disorders are combined in a single session or interaction, or in a series of interactions or multiple sessions.

integrated treatment—any mechanism by which treatment interventions for co-occurring disorders are combined within the context of a primary treatment relationship or service setting. It recognizes the need for a unified treatment approach to meet the substance abuse, mental health, and related needs of a client, and is the preferred model of treatment.

integration—as defined by NASMHPD and NASADAD in the context of treatment programs, denotes relationships among mental health and substance abuse providers in which the contributions of professionals in both fields are moved into a single treatment setting and treatment regimen.

Intensive Case Management (ICM)—a thorough, long-term service to assist clients with serious mental illness (particularly those with psychiatric and functional disabilities and a history of not adhering to prescribed outpatient treatment) by establishing and maintaining linkages with community-based service providers. ICM typically provides referrals to treatment programs, maintains advocacy for clients, provides counseling and crisis intervention, and assists in a wide variety of other basic services.

intermediate program—a treatment program that focuses primarily on one disorder without substantial modification to its usual treatment, but also with the capacity to explicitly address specific needs of another disorder.

intersystem linkages—connections between substance abuse treatment and mental health systems that allow collaboration. Necessary because these are the primary care systems for persons with COD.

intervention—encompasses the specific treatment strategies, therapies, or techniques that are used to treat one or more disorders.

legal problems—people who abuse substances are at a higher risk for engaging in behaviors that are high risk and illegal. These behaviors may result in arrest and other problems with the criminal justice system. Examples of such behaviors include driving while intoxicated, writing bad checks to obtain money for drugs, failure to pay bills and credit card debts, possession or sale of drugs, evictions, and drug-related violence.

locus—a place or a setting for some activity.

marijuana—the Indian hemp plant cannabis sativa; also called “pot” and “weed.” The dried leaves and flowering tops can be smoked or prepared in a tea or food. Marijuana has two significant effects. In the person with no tolerance for it, marijuana can produce distortions of sensory perception, sometimes including hallucinations. Marijuana also has depressant effects and is partially cross-tolerant with sedative-hypnotic drugs such as alcohol. Hashish (or “hash”) is a combination of the dried resins and compressed flowers of the female plant.

mental health program—an organized array of services and interventions with a primary focus on treating mental health disorders, whether providing acute stabilization or ongoing treatment.

mental health treatment system—a broad array of services and programs intended to treat a wide range of mental health disorders.

MI—see motivational interviewing

Modified Therapeutic Community (MTC)—a therapeutic community whose approach to treatment adapts the principles and methods of the therapeutic community to the circumstances of the COD client. The MTC employs interventions that have special functions, all of which share community, therapeutic, and educational purposes. All interventions are grouped into four categories: community enhancement, therapeutic/educative, community/clinical management, and vocational.

mood disorders—include the depressive disorders (“unipolar depression”), the bipolar disorders, and two disorders based on etiology—mood disorder due to a general medical condition and substance-induced mood disorder.

motivational interviewing (MI)—a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

MTC—see Modified Therapeutic Community

mutual self-help—an approach to recovery from substance use disorders that emphasizes personal responsibility, self-management, and clients’ helping one another. Such programs apply a broad spectrum of personal responsibility and peer support principles, usually including 12-Step methods that prescribe a planned regimen of change.

nodding out—slang term for the early stages of depressant-induced sleep. Opioids and sedative-hypnotics induce depression of the central nervous system, causing mental and behavioral activity to become sluggish. As the nervous system becomes profoundly depressed, symptoms may range from sleepiness to coma and death. Typically, “nodding out” refers to fading in and out of a sleepy state.

National Mental Health Association (NMHA)—a policymaking and educational association that holds workshops and has an annual conference for clinicians working with persons with mental health problems, including persons with COD. The organization continues to develop resources, documents, publications, and a COD-designated section on its Web site.

neuroleptic medication—a drug used to treat psychosis, especially schizophrenia.

NMHA—see National Mental Health Association

opioid—a type of depressant drug that diminishes pain and central nervous system activity. Prescription opioids include morphine, meperidine (Demerol), methadone, codeine, and various opioid drugs for coughing and pain. Illicit opioids include heroin, also called “smack,” “horse,” and “boy.”

organization—an entity that provides mental health services in two or three service settings (inpatient, residential, or outpatient) and is not classified as a psychiatric or general hospital or as a residential treatment center.

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

paranoia—a type of delusion, or false idea, that is unchanged by reasoned argument or proof to the contrary. Clinical paranoia involves the delusion that people or events are in some way specially related to oneself. People who are paranoid may believe that others are talking about them, plotting devious plans about them, or planning to hurt them. Paranoia often occurs during episodes of high-dose chronic stimulant use and may occur during withdrawal from sedative-hypnotics such as alcohol.

paraphernalia—a broad term that describes objects used during the chemical preparation or use of drugs. These include syringes, syringe needles, roach clips, and marijuana or crack pipes.

pathological gambling—an illness whose essential feature is persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits.

personality disorders—rigid, inflexible, and maladaptive behavior patterns of sufficient severity to cause internal distress or significant impairment in functioning. Personality disorders are enduring and persistent styles of behavior and thought, rather than rare or unusual events in someone’s life.

posttraumatic stress disorder (PTSD)—an illness whose essential feature is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close friend or relative.

Practice Improvement Collaboratives—community-based initiatives that link treatment providers, researchers, and policymakers in order to build a strong foundation to effect action.

Prescribing Onsite Psychiatrist Model—a model for a substance abuse treatment agency that includes on its staff a psychiatrist who works onsite from 4 to 16 hours a week. The onsite psychiatrist brings diagnostic, behavioral, and medication services directly to where the clients are based for the major part of their treatment.

prognosis—a clinician’s judgment or estimate of how well a disorder will respond to treatment.

program—currently, substance abuse treatment programs use the Service Delivery Unit (SDU) as their program definition for the National Survey of Substance Abuse Treatment Services. Mental health treatment programs use facility or organization in reporting for the Survey of Mental Health Organizations, General Hospital Mental Health Services, and Managed Behavioral Health Care Organization (SMHD).

protease inhibitorprotease is an enzyme used by the HIV to process new copies of the virus after it has reproduced. Protease inhibitors are medications used to treat HIV; they interfere with the action of this enzyme, thus interfering with viral reproduction.

psychopharmacological—pertaining to medications used to treat mental illnesses.

psychosis—a mental disorder that is characterized by distinct distortions of a person’s mental capacity, ability to recognize reality, and relationships to others to such a degree that it interferes with that person’s ability to function in everyday life.

psychosocial—involving a person’s psychological well-being, as well as housing, employment, family, and other social aspects of life circumstances.

PTSD—see posttraumatic stress disorder

psychotropic medication—a drug that has an effect on the mind and sometimes affects behavior as well.

quadrants of care—a conceptual framework that classifies clients in four basic groups based on relative symptom severity, rather than by diagnosis.

referral—a process for facilitating client/consumer access to specialized treatments and services through linkage with, or directing clients/consumers to, agencies that can meet their needs. For COD, referrals are frequently made for detoxification, assessment, special treatment, and medications.

relapse—a breakdown or setback in a person’s attempt to change or modify any particular behavior. An unfolding process in which the resumption of substance abuse is the last event in a series of maladaptive responses to internal or external stressors or stimuli.

relapse prevention therapy (RPT)—a variety of interventions designed to teach individuals who are trying to maintain health behavior changes how to anticipate and cope with the problem of relapse. RPT strategies can be placed in five categories: Assessment Procedures, Insight/Awareness Raising Techniques, Coping Skills Training, Cognitive Strategies, and Lifestyle Modification.

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

RPT—see relapse prevention therapy

schizophrenia—a type of psychosis. Persons diagnosed with schizophrenia are subject to hallucinations occurring in the absence of insight into their pathological nature, as well as disorganized speech and grossly disorganized or catatonic behavior. The disorder lasts for at least 6 months and includes at least 1 month of active-phase symptoms including two or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.

screening—a formal process of testing to determine whether a client warrants further attention at the current time for a particular disorder and, in this context, the possibility of a co-occurring substance or mental disorder. The screening process for co-occurring disorders seeks to answer a “yes” or “no” question: Does the substance abuse [or mental health] client being screened show signs of a possible mental health [or substance abuse] problem? Note that the screening process does not necessarily identify what kind of problem the person might have or how serious it might be but determines whether further assessment is warranted.

service integration—no one set of treatment interventions constitutes integrated treatment. The term refers to the availability and delivery of a comprehensive array of appropriate mental health and substance abuse services and interventions that are identified within a single treatment plan, coordinated by a single treatment team, and both effective and responsive to the high degree of severity of both mental illness and substance abuse experienced by the client. Under the “no wrong door” approach, integrated services should be available, as necessary, through both mental health and substance abuse treatment systems. (See also collaboration and informal collaboration.)

Single State Agencies—systems that organize statewide services.

skin abscess—a collection of pus formed as a result of bacterial infection. Abscesses close to the skin usually cause inflammation, with redness, increased skin temperature, and tenderness. Abscesses may be caused by injecting drugs and impurities into the body.

slurred speech—a sign of depressant intoxication. When people consume significant amounts of sedative-hypnotics and opioids, their speech may become garbled, mumbled, and slow.

stigma—a negative association attached to some activity or condition. A cause of shame or embarrassment.

substance abuse—a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. Sometimes used interchangeably with the term substance dependence.

substance abuse treatment program—an organized array of services and interventions with a primary focus on treating substance use disorders, providing both acute stabilization and ongoing treatment.

substance abuse treatment system—a broad array of services organized into programs intended to treat substance use disorders. It also includes services organized in accord with a particular treatment approach or philosophy (e.g., methadone treatment or therapeutic community).

substance dependence—a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by a need for increasing amounts of the substance to achieve intoxication, markedly diminished effect of the substance with continued use, the need to continue to take the substance in order to avoid withdrawal symptoms, and other serious behavioral effects, occurring at any time in the same 12-month period.

substance use disorders—a class of substance-related disorders that includes both substance abuse and substance dependence.

suicidality—a measure or estimate of a person’s likelihood of committing suicide. A high-risk behavior associated with COD, especially (although not limited to) serious mood disorders.

system—an organization of a number of different treatment programs and related services in order to implement a specific mission and common goals.

therapeutic alliance—a type of relationship between client and clinician in which both are working cooperatively toward the same goals, with mutual respect and understanding; also called “helping alliance.” The bond of trust formed between client and clinician during therapeutic work that makes healing possible.

therapeutic community (TC)—a consciously designed social environment or residential treatment setting in which the social and group process is harnessed with therapeutic intent. The TC promotes abstinence from alcohol and illicit drug use, and seeks to decrease antisocial behavior and to effect a global change in lifestyle, including attitudes and values. The TC employs the community itself as the agent of healing. The TC views drug abuse as a disorder of the whole person, reflecting problems in conduct, attitudes, moods, values, and emotional management. Treatment focuses on drug abstinence, coupled with social and psychological change that requires a multidimensional effort involving intensive mutual self-help typically in a residential setting.

toxicity—poisonous nature; poisonous quality.

transference—the feelings, reactions, biases, and images from the past that the client with COD may project onto the clinician.

trauma—violent mental or physical harm to a person, damage to an organ, etc.

treatmentsubstance abuse treatment is an organized array of services and interventions with a primary focus on treating substance abuse disorders. For the Treatment Episode Data Set, the Center for Substance Abuse Treatment defines treatment to include the following general categories: hospital, short- and long-term residential, and outpatient. Mental health treatment is an organized array of services and interventions with a primary focus on treating mental disorders, whether providing acute stabilization or ongoing treatment. These programs may exist in a variety of settings, such as traditional outpatient mental health centers (including outpatient clinics and psychosocial rehabilitation programs) or more intensive inpatient treatment units.

treatment retention—keeping clients involved in treatment activities and receiving required services.

tremor—an involuntary and rhythmic movement in the muscles, most often in the hands, feet, jaw, tongue, or head. Tremors may be caused by stimulants such as amphetamines and caffeine, as well as by withdrawal from depressants.

TC—see therapeutic community

unsteady gait—crooked, meandering, and uncoordinated walk, typical of alcohol-impaired people.

uppers—slang term used to describe drugs that have a stimulating effect on the central nervous system. Examples include cocaine, caffeine, and amphetamines.

wraparound services—aspects of a treatment program that address difficult-to-treat problems, such as finding childcare while in treatment, arranging for proper housing, and finding employment.


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