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Glossary

abuse:
Excessive use of a substance in a way it was not meant to be used or not as prescribed.

Problem with the term: Although this is a clinical diagnosis in the DSMIV and ICD10, this is a stigmatizing word because

1. it negates the fact that substance use disorders are a medical condition;
2. it blames the illness solely on the individual with the illness, ignoring environmental and genetic factors, as well as the drugs’ abilities to change brain chemistry;
3. it absolves those selling and promoting addictive substances of any wrong doing;
4. it feeds into the stigma experienced not only by individuals with substance use disorders, by also by family members and the treatment/recovery field. See also substance abuse.

Preferred terminology: Misuse, harmful use, inappropriate use, hazardous use, problem use, risky use, substance use disorder

See: The Words We Choose Matters

Addict:
Slang for person with an addictive disorder. This stigmatizing term is demeaning because it labels a person by his/her illness. By making no distinction between the person and the disease, it denies the dignity and humanity of the individual. In addition, this label implies a permanency to the condition, leaving no room for a change in status. see The Words We Choose Matter

Addiction:
A behavioral syndrome characterized by the repeated, compulsive seeking or use of a substance despite adverse social, psychological, and/or physical consequences, and a need for an increased amount of the substance, as time goes on, to achieve the same effect. Addiction is often (but not always) accompanied by physical dependence, a withdrawal syndrome, and tolerance.

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use: see document

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

affinity:
The strength with which a drug binds to its receptor is termed its affinity. The degree to which a drug activates its receptors is termed its intrinsic activity. Affinity for a receptor and activation of the receptor are two different qualities of a drug. A drug can have high affinity for a receptor but not activate the receptor (e.g., an antagonist). Mu opioid agonists, partial agonists, and antagonists can vary in their affinity.

agonist:
Drugs that activate receptors in the brain are termed agonists. Agonists bind to receptors and turn them on. They produce an effect in the organism. Full mu opioid agonists activate mu receptors. Increasing doses of full agonists produce increasing effects until a maximum effect is reached or the receptor is fully activated. Opioids with the greatest abuse potential are full agonists (e.g., morphine, heroin, methadone, oxycodone, hydromorphone).

Alcohol:
Alcohol is a liquid distilled product of fermented fruits, grains and vegetables. Used as solvent, antiseptic and sedative. Moderate potential for abuse. Also know as booze, juice, brew, vino, and sauce.

Alcohol Dependence:
Alcohol Dependence, also known as "alcoholism," is a disease that includes four symptoms:

• Craving: A strong need, or compulsion, to drink.
• Loss of control: The inability to limit one's drinking on any given occasion.
• Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking.
• Tolerance: The need to drink greater amounts of alcohol in order to "get high."

People who are not alcoholic sometimes do not understand why an alcoholic can't just "use a little willpower" to stop drinking. However, alcoholism has little to do with willpower. Alcoholics are in the grip of a powerful "craving," or uncontrollable need, for alcohol that overrides their ability to stop drinking. This need can be as strong as the need for food or water.

Although some people are able to recover from alcoholism without help, the majority of alcoholics need assistance. With treatment and support, many individuals are able to stop drinking and rebuild their lives.
Many people wonder why some individuals can use alcohol without problems but others cannot. One important reason has to do with genetics. Scientists have found that having an alcoholic family member makes it more likely that if you choose to drink you too may develop alcoholism. Genes, however, are not the whole story. In fact, scientists now believe that certain factors in a person's environment influence whether a person with a genetic risk for alcoholism ever develops the disease. A person's risk for developing alcoholism can increase based on the person's environment, including where and how he or she lives; family, friends, and culture; peer pressure; and even how easy it is to get alcohol.

Alcohol Withdrawal:
Alcohol Withdrawal usually occurs in adults, but it may happen in adolescents as well. It occurs when a person who uses alcohol excessively suddenly stops the alcohol use. The withdrawal usually occurs within 5-10 hours after the decrease in alcohol intake, but it may occur up to 7-10 days later.

Excessive alcohol use is generally considered the equivalent of 2-6 pints of beer (or 4 oz of "hard" alcohol) per day for one week or habitual use of alcohol that disrupts a person's life and routines.
The likelihood of developing alcohol withdrawal symptoms increases as the number and frequency of drinks increase. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems.

Alcoholism:
See Alcohol Dependence

alkaloids:
Organic compounds produced by plants. These substances constitute the active ingredients of many drugs.

amygdala:
Located deep within the cerebral hemispheres. It is part of the limbic system and plays an important role in motivation and emotional behavior

analgesic:
Medication to treat pain.

antagonist:
A substance that tends to nullify the effect of another (e.g., a drug that binds to a receptor without eliciting a response).

axon:
Part of the neuron which sends signals to nearby neurons.

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BCT:
Behavioral couples therapy.

benzodiazepine:
Family of depressants used therapeutically to produce sedation, induce sleep, relieve anxiety, muscle spasms, and to prevent seizures. (Xanax®,Valium®,Ativan®,and Restoril® are some examples of benzodiazepines.) Not to be used in combination with Buprenorphine, unless under a doctor's care. In high doses benzodiazepines can cause dangerous respiratory depression. This can have an adding effect when combined with other CNS depressants like alcohol or opioids, and can be fatal. Abrupt cessation of benzodiazepines can cause seizures.

benzos:
see benzodiazepine

Binge Drinking:
For women, 4 or more drinks in a short period of time.
For men, 5 or more drinks in a short period of time.

biopsychosocial:
Combining biological, psychological, and social concerns or effects.

BMT:
Behavioral marital therapy. BMT combines a focus on addiction with efforts to strengthen the marital relationship through shared activities and the teaching of communication and conflict evaluation skills.

Boundary:
An invisible though often effective barrier within a relationship that governs the level of contact. Boundaries can appropriately shape and regulate relationships. Two dysfunctional types of boundaries are those that are (1) so rigid, inhibiting meaningful interaction so that the people in the relationship are said to be “disengaged” from each other, or (2) so loose that individuals lose a sense of independence so that the “enmeshed” relationship stifles individuality and initiative.

brainstem:
Part of the brain responsible for automatic survival behaviors.

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CBT:
Cognitive–behavioral therapy. In (CBT), the therapist helps the patient learn new skills to cope with problems and to change harmful behavior patterns, such as substance abuse.

central nervous system:
CNS. Consists of the brain and the spinal cord.

cerebral cortex:
Brain's outer surface.

cerebral hemisphere:
Either of the two equal halves of the cerebrum. Each hemisphere is connected to functions on the opposite side of the body.

cerebrospinal fluid:
The protective fluid of the brain and spinal cord.

cerebrum:
Part of the brain which is divided into hemispheres. It controls and integrates motor, sensory, and higher mental functions, such as thought, reason, emotion, and memory.

chronic:
Of a long duration: a chronic illness persists for weeks, months, or even for life.

Cirrhosis:
Cirrhosis is the result of chronic liver disease that causes scarring of the liver and liver dysfunction. This often has many complications, including accumulation of fluid in the abdomen, bleeding disorders, increased pressure in the blood vessels, and confusion or a change in the level of consciousness.

Common causes of chronic liver disease in the US include hepatitis C infection and long-term alcohol abuse. Hepatitis C is now the most common reason for liver transplantation in the US. Other causes of cirrhosis include hepatitis B, medications, autoimmune inflammation of the liver, disorders of the drainage system of the liver (the biliary system), and metabolic disorders of iron and copper.

Codependence:
A state of being overly concerned with the problems of another, to the detriment of one’s own wants and needs.

cold turkey:
Term used when quitting drugs on one’s own with no medical help. Abruptly discontinuing drug use in an effort to quit long term. This is only successful in less than 5% of the people who quit opioids “cold turkey”. One of the symptoms of withdrawal is "goose flesh" (horripilation) and looks like a Cold turkey

compulsive:
The type of behavior a person exhibits that is overpowering, repeated, and often irrational.

craving:
Powerful desire for a substance that cannot be ignored. Unnaturally strong desire/urge for a substance. An overpowering urge that people are ill-equipped to control through will. Usually it cannot be suppressed indefinitely and results in taking the substance. Cravings are a symptom of the abnormal brain adaptations of addiction.

Craving (formerly called psychological dependence ) is an intense desire to reexperience the effects of a psychoactive substance. Craving is the cause of relapse after long periods of abstinence.(N Engl J Med 2003;349:975-86.)(see urges)

cross-tolerance:
Normal neurobiological event of tolerance to effects of medication within the same class(Ann Intern Med. 2006;144:127-134)

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D.E.A.:
Drug Enforcement Administration. www.dea.gov

D.O.C. (DOC):
Drug of Choice

dendrite:
The part of the neuron which receives signals. There can be hundreds on a single neuron.

Denial:
A common reaction of people with substance use disorders who, when confronted with the existence of those disorders, deny that they have a substance abuse problem and/or have lost control of it. This is a complex reaction that is the product of psychological and physiological factors, especially those concerned with memory and the influence of euphoria produced by the substance of abuse. It is not a deliberate, willful act on the part of the person who is abusing substances but is rather a set of defenses and distortions in thinking caused by the use of substances.

dependence:
“dependence” by itself has little meaning in the field of addiction treatment. This is because currently the phrase “substance dependence” and “physical dependence” have very different meanings. Which “dependence” is someone referring to when the word is used alone in this context? Confusing the two could lead to a misunderstanding at best and a misdiagnosis at worse. There is some talk within the industry to bring back the word “addiction” to use in place of “substance dependence” in an effort to help with some of the confusion. For the time being we are stuck with two similar phrases with two very different meanings. Understanding the difference is essential. see: physical dependence, substance dependence, craving, and addiction

detox / detoxification:
The metabolic process by which the toxic qualities of a poison or toxin are reduced by the body. Pertaining to addiction it is generally a medically supervised treatment for alcohol or drug addiction designed to purge the body of intoxicating or addictive substances. Such a program is used as a first step in overcoming physiological or psychological addiction.

disease:
a condition that results in medically significant symptoms in a human; a disorder with recognizable signs and often having a known cause; dis-ease, the opposite of ease, when something is wrong with a bodily function.

dopamine:
Dopamine is a chemical naturally produced in the body. In the brain, dopamine functions as a neurotransmitter which provides feelings of euphoria and well being. Endorphins are naturally occurring opioids that activate the dopamine pathway. All addictive substances activate the dopamine pathway. A person takes a drug of abuse, be it marijuana or cocaine or even alcohol, activating the same brain circuits as do behaviors linked to survival, such as eating, bonding and sex. The drug causes a surge in levels of dopamine, which results in feelings of pleasure. The brain remembers this pleasure and wants it repeated. If the brain senses that too much dopamine is being released it will adapt and inhibit dopamine release in an effort to normalize brain function. Once dopamine release is inhibited the external addictive substance is now required to maintain normal levels of dopamine.

DSM-IV:
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States. The DSM has gone though five revisions (II, III, III-R, IV, IV-TR) since it was first published. The next version will be the DSM V, due in approximately 2011. The International Statistical Classification of Diseases and Related Health Problems (ICD) is a commonly-used alternative internationally.

dysphoria:
Opposite of euphoria.

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Enabling:
As it applies to the disease of addiction, can be defined as doing for someone, in an attempt to help, those things they could or should be doing for themselves, thus actually making it easier for them to continue in the progression of the disease.

endorphins:
The name "endorphin", is derived from combining the words "endogenous morphine", which literally means "morphine produced naturally in the body". Endorphins are an opium-like substances produced naturally in the brain, which give a feeling of well-being and are natural painkillers. Production of endorphins is stimulated by many natural circumstances, including profound exercise.

Enmeshment:
The state of being in which two people are so close emotionally that one perceives the other as “smothering” him or her with affection, concern, attention, etc. Enmeshment also can occur without a conscious sense of it.

Ethyl Alcohol:
Ethyl Alcohol or ethanol is the member of the alcohol series of chemicals which is used in alcoholic beverages. It is less toxic than other members of this series, but it is a central nervous system depressant and has a high abuse potential.

euphoria:
Psychological feeling of well being, extreme happiness.

evidence-based treatment:
Scientifically validated approaches are called evidence-based treatment. An array of healthcare initiatives to ensure that patients' medical care is grounded in the best scientific knowledge and is specifically appropriate for them. Evidence-based thinking is a process by which diverse sources of information are synthesized by a clinician, expert, or group of experts in order to identify or choose the optimal clinical approach for a given clinical situation.

excipient:
An inert, inactive or clinically insignificant substance added to a drug usually as a carrier or as a binder of the active ingredient. Excipients may also help deliver the drug to the blood by helping with absorption or osmosis. Examples are corn starch, cellulose, talc, gelatin, polyethylene glycol, and lactose.

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FDA:
Food and Drug Administration. www.FDA.gov

Fetal Alcohol Syndrome:
Fetal Alcohol Syndrome is the manifestation of specific growth, mental, and physical birth defects associated with the mother's high levels of alcohol use during pregnancy.

Alcohol use or abuse by the pregnant woman subjects her to the same range of risks that alcohol has in the general population. However, it poses extreme and unique risks to the fetus and is associated with fetal alcohol syndrome (FAS). Timing of alcohol use during pregnancy is also of importance. Alcohol use during the first trimester is more damaging than during the second trimester, which is, in turn, more damaging than use in the third trimester.

Alcohol ingested by a pregnant woman easily passes across the placental barrier to the fetus. Because of this, drinking alcohol can adversely affect the development of the baby.

A pregnant woman who drinks any amount of alcohol is at risk, since a "safe" level of alcohol ingestion during pregnancy has not been established. However, larger amounts appear to cause increased problems. Multiple birth defects associated with "classical" fetal alcohol syndrome are more commonly associated with heavy alcohol use or alcoholism.

Fetal alcohol syndrome consists of the following abnormalities:

• Intrauterine growth retardation: growth deficiency in the fetus and newborn in all parameters -- head circumference, weight, height)
• Delayed development with decreased mental functioning (mild to severe)
• Facial abnormalities including small head; small upper jaw; short, up-turned nose; groove in upper lip; smooth and thin upper lip; and narrow, small, and unusual-appearing eyes with prominent epicanthal folds
• Heart defects
• Limb abnormalities of joints, hands, feet, fingers, and toes

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gray matter:
Brownish-gray nerve tissue in the brain and spinal cord composed of neuronal cell bodies and dendrites.

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habit:
as in "drug habit". Outdated term for addiction or physical dependence. Calling substance use disorders a habit denies the medical nature of the condition and implies that resolution of the problem is simply a matter of willpower. Cigarette companies prefer this term instead of “addiction”. see The Words We Choose Matter

Hepatitis:
Hepatitus is inflammation of the liver. Hepatitis can be caused by infections with various organisms, including bacteria, viruses (Hepatitis A, B, C, etc.), or parasites. Chemical toxins such as alcohol, drugs, or poisonous mushrooms can also damage the liver and cause it to become inflamed. A rare but extremely dangerous cause of hepatitis results from overdose of acetaminophen (Tylenol), which can be deadly. In addition, immune cells in the body may attack the liver and cause autoimmune hepatitis. Hepatitis may resolve quickly (acute hepatitis), or cause long-term disease (chronic hepatitis). In some instances, progressive liver damage or liver failure may result.

HIPAA:
Health Insurance Portability and Accountability Act www.HIPAA.gov

Hippocratic Oath:
I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of over treatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

hypothalamus:
The part of the brain below the thalamus, forming the major portion of the ventral region of the diencephalon. It is the main control center for all organs and center of the limbic system.

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inhibitory neurotransmitter:
A neurotransmitter that induces electrical changes that make it difficult to generate a new nerve signal in the receiving neuron.

intrinsic activity:
The property of a drug that determines the amount of biological effect produced per unit of drug-receptor complex formed. This is a measure of how much a particular drug “activates” a receptor. The lower the intrinsic activity, the lower the effect.

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LAAM:
Closely related to methadone, the synthetic compound levo -alpha -acetyl -methadol or LAAM (Brand name: ORLAMM), has an even longer duration of action (from 48 to 72 hours) than methadone, permitting a reduction in frequency of use. In 1994, it was approved as a Schedule II treatment drug for narcotic addiction. Both methadone and LAAM have high abuse potential. Their acceptability as narcotic treatment drugs is predicated on their ability to substitute for heroin, the long duration of action, and their mode of oral administration.

limbic system:
Emotional control center of the brain.

Liquor:
Spirits; spirits and liqueurs; or all alcoholic beverages, including wine, sake, beer, and mead

lock-and-key specificity:
Neurotransmitter shape which allows only certain receptors interaction.

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maintenance:
A stabilization period. The patient remains on the lowest effective dose for an indefinite amount of time. This allows the patient to prepare and make the necessary changes that would otherwise make long term abstinence unlikely.

monotherapy:
Therapy using one drug or approach.

motor nerves:
Nerves which send commands from the brain to the body.

mu agonist:
A drug that has affinity for and stimulates physiologic activity at mu opioid cell receptors. See also opioid full agonist.

mu opioid receptor:
A receptor on the surface membrane of nerve cells that mediates opioid analgesia, tolerance, and addiction through drug-induced activation. When an opioid agonist, or partial agonist (e.g., Buprenorphine), binds to a mu opioid receptor, a series of other proteins associated with the mu receptor-signaling pathway becomes activated. Other opioid receptors are the delta and kappa receptors.

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Naltrexone:
(Naltrexone Hydrochloride), an opioid antagonist, is a synthetic congener of oxymorphone with no opioid agonist properties. Naltrexone is used to help people who have alcohol addiction keep their condition in remission. Naltrexone is used after the patient has stopped taking alcohol. It blocks brain opiate receptors, attenuates euphoria associated with alcohol use, makes alcohol use less rewarding, and reduces craving. Naltrexone comes as a tablet to take by mouth, or by monthly extended-release formulation injections. –more-

needle embolization:
Blood clot caused by use of a needle. If dislodged, the clot may cause death.

negative reinforcement:
When people repeat a behavior in order to avoid something unpleasant, such as use drugs to avoid withdrawal.

nerve:
Nerve fibers and blood vessels wrapped in a fibrous sheath.

nerve fiber:
Axon of a single neuron.

neuromodulator:
a neurotransmitter that modulates the effects of other neurotransmitters.

neuron:
A nerve cell. Neurons transmit information throughout the brain and body with electrical signals and chemical impulses.

neurotransmission:
Communication between neurons in the brain or between neurons and other cells in the body.

neurotransmitter:
A molecule secreted by neurons for communicating nerve signal to other neurons, to muscles or to glands.

nuclei:
Cluster of neuron cell bodies.

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OBOT:
Office Based Opioid Treatment.

off-label use:
Once FDA approved, a drug product may be prescribed by a licensed physician for any use that, based on the physician’s professional opinion, is deemed to be appropriate. Any approved product may be used by a licensed practitioner for uses other than those stated in the product label. Off-label use is not illegal, but means that the data to support that use have not been independently reviewed by the FDA. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, (usually as evidenced by peer-reviewed publications addressing the off-label use) and to maintain records of the product's use and effects.(1) The American Medical Association (AMA) has estimated that as many as 40% of all prescriptions are issued for off-label use.(2) It is common practice especially in pediatric and pregnant patients of whom pharmaceutical companies are reluctant to test on. Pharmaceutical companies cannot promote off-label uses of their drugs, and insurance companies may opt to withhold payment if a drug is being prescribed for a disorder that the medication was not indicated for. Malpractice insurance companies may not cover a physician for lawsuits resulting from off-label use of a drug.

One Drink:
12 ounces beer or wine cooler
one 5-ounce glass of wine
1.5 ounces of 80-proof distilled spirits.

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parentera:
Not through the gastrointestinal route; for instance, given via intramuscular or intravenous injection.

PAWS (Post Acute Withdrawal Syndrome):
Withdrawal symptoms that continue after the initial acute withdrawal passes; The symptoms are less severe but can be long lasting. The symptoms are the result of long-term changes to the brain due to addiction. It is these withdrawal symptoms that drive many to relapse even months after drug use ends.

Peer Support:
Structured relationship in which people meet in order to provide or exchange emotional support with others facing similar challenges. The group does not necessarily need to have healthcare providers among its members. Peer to peer groups are those such as AA, NA, smart recovery, and online line forums. Peer support by itself does not constitute treatment, but is one of the many tools that make up a treatment plan. Peer support should be used in conjunction with professional psychosocial therapy and/or medication as part of a comprehensive treatment plan.

peripheral nervous system:
Parts of the nervous system outside of the Central Nervous System which form lines of communication between the CNS and the rest of the body.

pharmacodynamics:
Study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including correlation of these actions and effects with the chemical structure of the drug.

pharmacokinetics:
Study of the action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion.

pharmacotherapy:
Treatment of disease by using medicines.

physical dependence:
Normal physiologic state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal. It is possible to be physically dependent on a substance without being addicted to it. (Ann Intern Med. 2006;144:127-134.)

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use. see document

Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

physiology:
Biological study of the functions of living organisms and their parts.

piloerection:
Goose bumps, also called goose flesh, or the medical term cutis anserina, are the bumps on a person's skin at the base of body hairs which may involuntarily develop when a person is cold or experiences strong emotions such as fear or awe. The reflex of producing goose bumps is known as piloerection.

placebo:
(pla-see'bo) A placebo is an inactive pill, liquid, powder, or other inert compound that has no treatment value. A substance or treatment that has no effect on human beings. In clinical trials, experimental treatments are often compared with placebos to assess the treatment's effectiveness. The participants in the control group will receive a placebo instead of an active drug or treatment. Also referred to as a "sugar pill."

Placebo effect:
An apparently beneficial result of therapy that occurs because of the patient’s expectation that the therapy will help, not due to any medical treatment or substance. A physical or emotional change, occurring after a substance is taken or administered, that is not the result of any special property of the substance. The change may be beneficial, reflecting the expectations of the participant and, often, the expectations of the person giving the substance.

polysubstance abuse:
Concurrent use or abuse of multiple substances (e.g., drinking alcohol as well as smoking tobacco, snorting cocaine, inhaling glue fumes).

post-synaptic neuron:
Neuron receiving a signal.

pre-synaptic neuron:
Neuron sending a signal.

proof:
“Proof” is a measurement of the alcohol content in a beverage. Originating during the 18th century, when payments to sailors included rations of brandy. To ensure that the brandy being used as payment has not been watered down or was of good quality, it was proved by dousing gunpowder in a sample of brandy, and testing to see if it would ignite. If it didn't ignite, the solution had too much water in it and the proof was considered low or "underproof". If it did ignite that was considered “proof” of sufficient alcohol content.

pseudoaddiction:
Behavioral changes in patients that seem similar to those in patients with opioid dependence or addiction but are secondary to inadequate pain control. (Ann Intern Med. 2006;144:127-134.)

psychoactive:
Mind-altering substance.

Psychological dependence:
A compulsion to use a drug for its pleasurable effects. Such dependence may lead to a compulsion to misuse a drug. A craving and compulsion to use a drug that is psychologically rather than physiologically based, eg, compulsive gambling is a purely psychological dependence. Psychological dependence is sometimes called "chronic craving syndrom".

psychosocial:
Combining psychological and social aspects.

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receptor:
A neuron to which a molecule can bind activating the receptor and eliciting a response in the cell.

refractory depression:
Depression that has not responded to other treatments.

reinforcement:
When people repeat a behavior in order to experience something pleasant.

relapse:
A relapse occurs when a person is affected again by a condition that affected them in the past. This could be a medical condition such as depression, bipolar disorder, cancer or an addiction to a drug. A recurrence of symptoms after a period of remission.

remission:
A period of time in which the signs and symptoms of the addiction have disappeared.

replacement therapy:
Opiate Replacement Therapy (ORT) is the medical procedure of replacing an addictive full agonist opiate such as heroin with a longer acting but less euphoric full agonist opiate such as methadone. Some argue buprenorphione treatment is not replacement therapy, because “replacement therapy” implies an equality to street drugs like heroin and treatment medications like buprenorphine. The term suggests a lateral move from illegal addiction to legal addiction and this does not accurately characterize the true nature of the treatment. The essence of addiction is uncontrollable compulsive behavior. The first goal of addiction treatment is to stop this dangerous addictive behavior. With successful buprenorphine therapy, as part of a comprehensive treatment plan, the dangerous addictive behavior is stopped not replaced.

respiratory depression:
the slowing or cessation of one's breathing which is sometimes associated with the use of opioids. This is the actual cuase of death in an opioid overdose.

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Self-help:
The act of helping or improving yourself without relying on anyone else.

Spirits:
Generally refers to distilled beverages low in sugars and containing at least 35% alcohol by volume.

Substance Abuse:
Substance Abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

With SUBSTANCE ABUSE the user has a choice: he/she uses in spite of illegal, unsafe consequences, or inappropriateness of the drinking/drugging experience. Opioid Abuse is a specific type of Substance Abuse.

The use of buprenorphine has been approved for the diagnosis of Opioid Dependence NOT Opioid Abuse. An accurate diagnosis is essential in determining what treatment if any is appropriate.

Substance Dependence:
The American Psychiatric Association uses the term “substance dependence” in place of “addiction” however the two terms are synonymous, or more precisely “substance dependence” = “substance addiction” (since gambling addiction is not substance dependence) and is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress.

1. Tolerance, as defined by either of the following:
   (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
   or
   (b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
   (a) The characteristic withdrawal syndrome for the substance
   or
   (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. 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 (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer
   was made worse by alcohol consumption).

Due to the resulting confusion between the terms "physical dependence" and "substance dependence" there is some talk within the industry of reintroducing the term "addiction" because it is better understood and may pose less chance of confusion.

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Therapeutic dependence:
Patients with adequate pain relief may demonstrate drug-seeking behaviors because they fear not only the reemergence of pain but perhaps also the emergence of withdrawal symptoms. (Ann Intern Med. 2006;144:127-134)

titration:
The progressive stepwise increase (or decrease) in drug dose to determine the optimal dose. To gradually increase (or decrease) the amount of a drug.

tolerance:
Normal neurobiological event characterized by the need to increase the dose over time to obtain the original effect. A state in which a drug produces a diminishing biological or behavioral response; in other words, higher doses are needed to produce the same effect experienced initially.

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definition (see document):

Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

trigger:
A person, place, thing or event that can result in psychological and then physical relapse.

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urges:
Unlike cravings, urges can usually be suppressed by willpower. Urges are less powerful than cravings. Urges are often passing and temporary. Cognitive skills can be learned to effectively suppress urges. Urges can usually be traced back to a source like stress, depression, anxiety, etc. which provides motivation for the escape or comfort of the substance, while cravings may have no external source and the person may have no idea why they are craving and may actually not want to take the drug at all. (see cravings)

user:
As in "drug user". Outdated term describing a person who misuses drugs or alcohol, but not necessarily addicted. The term offers no distinction from chronic addictive behavior or use consistent with medical protocol. A person addicted to heroin and a patient taking pain medicine are both “users.” The term is stigmatizing because it labels a person by his/her behavior. It is also misleading because the term user has come to refer to one who is engaged in risky use of substances, but use alone (e.g. of alcohol or prescription medication) is not necessarily problematic. see The Words We Choose Matter

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withdrawal:
Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from abrupt removal of, or a rapid decrease in, the regular dosage of a psychoactive substance. The syndrome is often characterized by over activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug.

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Xanax®:
Xanax® (generic name: alprazolam) is an anxiolytic benzodiazepine used to treat anxiety disorders, therefore, it provides a calming effect for the prescribed. Side effects range from drowsiness, fatigue, headache and clumsiness to the more severe blurred speech and vision and change in behavior. It is habituating, users build up a tolerance, and physical and psychological dependence is common. Caution should be used in using it in combination with Buprenorphine, or any other CNS depressant.

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