Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Co-Occurring Disorders:
Integrated Dual Disorders Treatment
Integrated Dual Disorders Treatment Workbook
Chapter 1: Definitions
INTRODUCTION
This chapter provides definitions for words and phrases commonly used when people talk about substance use. These terms are used throughout this book. Some words that are commonly used together are grouped together below. The words and phrases are presented in alphabetical order.
ABSTINENCE, CLEAN, AND SOBER
Abstinence is when a person does not take any substances of abuse. A person abstains from taking the substance. The term clean usually refers to being abstinent from substances other than alcohol, whereas the term sober usually refers to being abstinent from alcohol. Clean and sober means abstinent from both. When a person is prescribed a medication, such as methadone, and takes it as prescribed, they are considered abstinent from substances of abuse.
ADDICTION
Addiction refers to when a person is physically or psychologically dependent on a substance or a practice (such as gambling) so that using the substance is beyond voluntary control.
DETOXIFICATION
Detoxification is the process whereby an individual who is physically dependent on a substance stops taking that substance and recovers from it's immediate effects. Ideally, people should be monitored by professionals to make sure they are safe. The word detoxification is often used to describe the monitoring, support, and treatments people receive to cope with the withdrawal symptoms and craving for substances that emerge when people cut down or stop using the substance. Because withdrawal symptoms can be extremely uncomfortable and dangerous, monitoring, support, and medical and psychiatric treatments during the process can be helpful and even life-saving. Medications can be used to reduce the severity of symptoms during withdrawal from the substance and to prevent life threatening illnesses. Detoxification alone does not treat substance abuse and dependence. Clients need to be engaged into treatment during and after detoxification.
INTOXICATION
Intoxication (or inebriation) refers to the experience of being under the influence of a substance that causes a person to feel different than normal. Symptoms of intoxication can be physical, such as slurred speech when intoxicated with alcohol, or psychological, such as feeling relaxed when intoxicated with cannabis. Being intoxicated does not in itself suggest that a person has a substance use disorder.
RECOVERY
Recovery is the process by which a person learns new meaning in life beyond the illnesses of substance abuse and mental illness. When a person is "in recovery" it is implied that they are abstinent from substances, but also that they are participating in life activities that are meaningful and fulfilling for them. Recovery also implies that a person is able to function in meaningful activities despite symptoms of mental illness. Integrated dual diagnosis treatment described in this workbook is designed to help people not only become abstinent, but to enter a recovery process.
REMISSION
Remission refers to when a person who once had a substance use disorder has reduced substance use so that they no longer experience distress or impairment in functioning, and therefore no longer meet DSM-IVR criteria for substance abuse or dependence. Remission is used in the same way for reduction in symptoms of mental illness such that impairment is no longer present.
SUBSTANCE
The term substance refers to alcohol, drugs, prescribed medications, over the counter medications, and other substances, such as glue, that people take for recreational purposes to get high or relaxed.
SUBSTANCE ABUSE
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IVR) is a book that mental health clinicians use to define what they mean by any particular disorder. This book defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by at least one of the following in a 12 month period:
- recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home (e.g. poor performance at work, neglect of children)
- recurrent substance use in hazardous situations (e.g. driving while intoxicated)
- recurrent substance related legal problems
- continued substance use despite having recurrent social or interpersonal problems related to substance use(e.g. arguments with spouse about consequences of intoxication)
SUBSTANCE DEPENDENCE
The DSM-IVR defines substance dependence as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 3 or more of the following during a 12 month period:
- tolerance (see below)
- withdrawal (see below)
- the substance is taken in larger amounts or over a longer period of time than intended
- the persons experiences a persistent desire or unsuccessful efforts to cut down or control substance use
- a great deal of time is spent in activities necessary to obtain the substance, use it, or recover from its effects
- important social, occupational, or recreational activities are given up or reduced because of substance use
- the substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance
SUBSTANCE USE DISORDER
Substance Use Disorder refers to when using substances causes distress or impairment in functioning. Substance abuse and substance dependence are substance use disorders (see above).
TOLERANCE, PHYSICAL DEPENDENCE, AND WITHDRAWAL
The concepts of tolerance, physical dependence, and withdrawal are linked together. With repeated use, a person has to use more and more of the substance to get the same pleasurable effect; tolerance occurs. Substance use causes changes in the body and the brain. These changes are probably why tolerance occurs. After regular use of a substance, physical dependence can emerge whereby the body adjusts to the presence of the substance being there. When a person is physically dependent on a substance, they will develop withdrawal symptoms, which cause distress or impairment, when they stop or cut down on the amount of substance they are using. Withdrawal symptoms are caused by rebound hyperactivity of the biological systems that the substance suppressed. Withdrawal symptoms are usually quite uncomfortable, and often lead a person to use substances to get rid of the withdrawal symptoms.
TOC | Previous | Next
|
