Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment. APPENDIX A: Glossary and Acronyms

03/06/2019

TABLE A.1. Glossary of Terms and Definitions
Term Definition
Acamprosate A prescription medication used to aid individuals who are alcohol dependent; approved by the Federal Drug Administration in July 2004 for post-withdrawal maintenance of alcohol abstinence.a
Addiction Severity Index (ASI) Alcohol, Drug and Legal Composite Scores A semi-structured clinical interview used to generate a diagnostic understanding of individuals' substance use treatment needs. The assessment measures need in 7 problem areas including medical, employment/support, alcohol, drug, legal, family/social, and psychiatric. Composite scores from each problem area represent measures of problem severity to generate deeper understanding of treatment planning and evaluation.b
Affordable Care Act (Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010) The Affordable Care Act collectively refers to the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act that were enacted in March 2010. These legislations expanded access to health insurance for lower-income households by establishing subsidies to offset costs of insurance premiums for households with incomes between 100%-400% of the federal poverty level. The legislations also enabled states to expand Medicaid coverage to adults with incomes below 138% of the federal poverty level. Specific to substance use treatment, the Affordable Care Act requires group health plans, group health insurance, and individual health insurance to provide behavioral health care benefits at parity with medical and surgical benefits.c
Alcohol use disorder A pattern of alcohol use that involves problems controlling drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when rapidly decreasing or stopping drinking.d
Binge drinking A pattern of consuming excessive amounts of alcohol in a short period of time. National guidelines define binge drinking as consuming alcohol in a way that brings blood alcohol concentration levels to 0.08g/dL, which is generally translated to 5 drinks for men and 4 drinks for women during a single drinking episode.e
Buprenorphine Buprenorphine is a medication used in the treatment of opioid dependency. Chemically, buprenorphine is a partial opioid agonist and kappa agonist. The dose-response curve observed from buprenorphine use suggests that, although there is potential for misuse, overdose would not result in significant respiratory depression. Clinical trials have demonstrated significant efficacy for treating opioid dependence.f Buprenorphine was approved for clinical use in October 2002 by the FDA for its use in MAT.g
Buprenorphine-Naloxone A combination medication containing both buprenorphine and naloxone that is used in the treatment of opioid dependency. This medication was developed because of the potential for diversion and misuse of mono-buprenorphine formulations. The naloxone part of the compound precipitates withdrawal in individuals who misuse the combined medication via injection. Combined, this medication decreases the likelihood of diversion and misuse of the combination drug product.f
Care coordination The intentional organization of patient care activities between multiple providers, including primary and behavioral health care providers, to facilitate service delivery in consideration of patients' needs and treatment goals. Care coordination is achieved largely through the managed exchange of information across several aspects of care.h
Case management Process by which multiple aspects of an individual's care is managed, including through phases of assessment, treatment planning, care coordination, clinical monitoring, evaluation, and advocacy with the goal of meeting an individual's unique needs.i
Cognitive behavioral therapy A type of psychotherapy used in the treatment of individuals with SUDs and other psychiatric conditions to help them address harmful thought patterns by learning and practicing alternative ways of thinking and behaving that regulate distressing emotions and harmful behavior.j
Contingency management Giving individuals tangible rewards to reinforce positive behaviors such as abstinence or treatment attendance.k
Co-occurring The presence of more than 1 disorder at the same time, which may include co-occurring behavioral health conditions (mental and SUDs) or co-occurring behavioral health and physical health conditions.
Disulfiram The first medication, approved by the FDA in 1951, to treat chronic alcohol dependence.l
DSM-IV A manual published by the American Psychiatric Association that includes all recognized mental disorders; clinicians and psychiatrists use it to diagnose psychiatric illnesses.m
DSM-V The 2013 update to the American Psychiatric Association's DSM-IV manual that represents the most current version of this classification and diagnostic tool.n
Engagement in treatment Treatment engagement implies continued SUD treatment through additional visits, usually a specified number of encounters occurring within a set time period that may vary depending on the definition. The IET measure defines it generally as "the percentage of members with a diagnosis of AOD dependence who initiated treatment and had 2 or more additional services within 30 days of the initiation visit."o Engagement also may be examined under the rubric of "retention" or "completion."
Enhanced outreach An outreach approach used to engage specific "hard to reach" groups (populations) by using complementary and mutually reinforcing community-based interventions.
Evidence-based practice Treatments that have documented evidence supporting their efficacy. This may refer to treatments for SUDs, mental disorders, or physical health conditions.
Harm reduction Harm reduction is a public health strategy that, among other things, is used for individuals with SUDs for whom abstinence is not feasible. Harm reduction approaches have been effective in reducing morbidity and mortality in those populations.p
HEDIS measures A tool used by health plans to measure performance on dimensions of care and service.
Heavy drinking Defined for men as 15 drinks or more per week and for women as 8 drinks or more per week.q
Illicit drug use The use of illegal drugs and/or the misuse of prescription medications or household substances.
Initiation of use The first use of a substance.
Initiation of treatment Treatment initiation generally indicates that a patient has attended at least 1 treatment or assessment session following his or her identification as someone who needs treatment for alcohol or drug use disorders or following an admissions process. The IET measure defines it generally as "Initiation: the percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, IOP encounter, or partial hospitalization within 14 days of diagnosis."r
Initiation and Engagement of Alcohol and other Drug Dependence Treatment (IET) IET is a widely used performance measure for which NCQA is the steward. This measure contains separate rates for initiation of treatment and engagement in treatment. It is, among other things, part of the HEDIS measure set for health plans and is endorsed by the National Quality Forum.s,t
Inpatient treatment Inpatient treatment is a type of intensive treatment in which a patient is provided 24-hour care at a hospital where medically supervised detoxification can be incorporated if needed. This treatment may take place in a medical or a psychiatric hospital.
Integrated care Care integration and integrated treatment is a model that seeks to integrate treatment of physical, mental, and substance use conditions. Integration may focus on treatment, systems of care, and/or financing.
Intensive outpatient (IOP) treatment IOP treatment is a type of specialized addiction recovery program that provides daily structure and focused treatment activities where a person attends the program on a daily basis that accommodates his or her home and work life.
Medical home model The medical home model is a care delivery model whereby patients' treatment is coordinated through their primary care provider to ensure they receive the necessary care when and where they need it and in a manner that they can understand.
Medication-assisted treatment (MAT) MAT is an evidence-based treatment involving the use of medications with counseling and behavioral therapies to treat either alcohol or OUDs.
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 MHPAEA is a federal law that prevents group health plans and health insurance issuers that provide mental or SUD benefits from imposing less favorable limitations on those benefits than on medical/surgical benefits.
Methadone Methadone is a medication used in MAT to help people reduce or quit their use of heroin or other opiates such as prescription opioid pain medication.
Naloxone Naloxone is a medication that blocks or reverses the effects of opioids, including extreme drowsiness, slowed breathing, or loss of consciousness. It is used to treat opioid or narcotic overdoses in emergency situations. It also is used in the compound medication buprenorphine-naloxone. Naloxone was approved by the FDA to prevent overdose by opioids such as heroin, morphine, and oxycodone.u
Naltrexone Naltrexone is a medication used to treat OUD and alcohol use disorder and is available in oral and injectable forms.
Non-medical drug use The taking of prescription drugs, whether obtained by prescription or otherwise, other than in the manner, for the reasons, or in the time period prescribed. It also includes a person taking a prescription drug that was not prescribed to him or her and is taken for the experience or feeling that the drug causes.
Opioid use disorder (OUD) A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least 2 of the following criteria, occurring within a 12-month period:
  • Taking opioids in larger amounts or over a longer period than was intended.
  • Having a persistent desire or making unsuccessful efforts to cut down or control opioid use.
  • Spending a great deal of time in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
  • Having cravings for or a strong desire or urge to use opioids.
  • Recurrently using opioids that results in a failure to fulfill major role obligations at work, school, or home.
  • Continuing to use opioids despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
  • Reducing or giving up important social, occupational, or recreational activities because of opioid use.
  • Recurrently using opioids in situations in which it is physically hazardous.
  • Continuing to use opioids despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.v
Opioids (heroin, prescription painkillers, synthetic opioids) Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.
Out-of-pocket (OOP) Expenses for medical care that are not reimbursed by insurance. OOP costs include deductibles, co-insurance, and co-payments for covered services plus all costs for services that are not covered.
Outpatient treatment Outpatient treatment, sometimes called ambulatory care, describes medical care or treatment that does not require an overnight stay in a hospital or medical facility. A visit to a doctor or counselor for assessment or treatment in a non-hospital setting is an example of outpatient treatment.
Overdose An excessive and dangerous amount of a drug taken intentionally or by accident that results in negative health consequences or death.
Partial hospitalization (PH) Partial hospitalization provides an intense, structured treatment setting for individuals who have difficulty maintaining current daily routines or who would otherwise require inpatient behavioral health care. It is provided on a daily basis with the person being allowed to reside at home and maintain as much family life and work responsibility as possible. (Also see IOP treatment.)
Pay for performance (P4P) Initiatives aimed at improving the quality, efficiency, and overall value of health care. These arrangements provide financial incentives to hospitals, physicians, and other health care providers to carry out such improvements and achieve optimal outcomes for patients. Performance typically is assessed using a performance or quality measure.
Performance or quality measurement A performance or quality measurement is the regular measurement of outcomes, processes, or other indicators that generate reliable data on the effectiveness and efficiency of programs or interventions.
Performance-based contracting A results-oriented contracting method that focuses on the performance of the contractor to which at least a portion of a contractor's payment may be tied. The contracting parties may be groups consisting of health plan and providers, a state and a health plan, a state and providers, or other entities.
Pharmacotherapy Pharmacotherapy is the treatment of disease and especially mental illness or SUDs with drugs.w
Prescription Drug Monitoring Program (PDMP) PDMPs are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. These programs are designed to monitor this information for suspected abuse or diversion (i.e., channeling drugs into illegal use), providing critical information regarding a patient's controlled substance prescription history to prescribers, pharmacists, or other parties that have been permitted access.
Prevalence The percentage of a population that is affected with a particular disease or condition at a given time.
Recovery support services Recovery support services are non-clinical services provided to people and families during all stages of recovery and may include social supports, transportation, employment services and training, case management, relapse prevention, housing assistance, child care, peer services, life skills, education, and other support services.x
Residential treatment Residential treatment, also called residential or inpatient rehabilitation, describes either a mental health facility or a drug and/or alcohol or other addiction treatment program that is provided to patients who are in residence (living there 24/7) for a period of time.
Retention Treatment retention is the level of commitment or engagement in treatment as indicated by a patient's behavior such as number of treatment sessions attended, completion of prescribed interventions, days of sobriety, or participation in recovery activities.
Single State Authority (SSA) A SSA is a single state agency responsible for coordinating alcohol and drug prevention and treatment activities for the state.y
Substance abuse Prior to the most recent DSM-V edition, the DSM-IV used the term substance abuse to describe the overuse of or dependence on a substance such as alcohol or drugs. Refer to the glossary entry for substance use disorder for further description.
Substance dependence Dependence is a term that was used in the DSM-IV but not the DSM-V. The DSM-IV defined dependence as "a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 3 (or more) of the following, occurring within a 12-month period: Tolerance [defined]…, withdrawal [defined]…. The substance is often taken in larger amounts or over a longer period than was intended. There is 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 the substance, 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 or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance."z
Substance use disorder (SUD) A SUD is present when the recurring use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. A diagnosis of SUD is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.aa
Washington Circle The Washington Circle is a group of national experts in substance use policy, research, and performance management who seek to improve the quality and effectiveness of prevention and treatment services through the use of performance measurement systems. The Washington Circle was convened and supported by the Center for Substance Abuse Treatment since 1998 and was joined by the National Institute of Drug Abuse in 2006.ab This group was instrumental in developing the measure of IET.
42 Code of Federal Regulations (CFR) Part 2 42 CFR Part 2 was established to restrict the disclosure of medical records describing an individual's diagnosis with a SUD or receipt of substance use treatment. The regulation requires individuals to provide consent to share any records pertaining to services received for SUD treatment.
  1. Center for Substance Abuse Treatment. Acamprosate: A new medication for alcohol use disorders. Substance Abuse Treatment Advisory. 2005; 4(1). https://store.samhsa.gov/shin/content/MS974/MS974.pdf.
  2. McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the Addiction Severity Index. J Subst Abuse Treat. 1992; 9(3): 199-213. http://www.journalofsubstanceabusetreatment.com/article/0740-5472(92)90062-S/pdf
  3. Beronio K, Po R, Skopec L, Glied S. Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans. Washington, DC: HHS Office of the Assistant Secretary for Planning and Evaluation; 2013. https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans.
  4. Mayo Clinic Staff. Diseases and conditions: Alcohol use disorder. 2015. http://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/basics/definition/con-20020866.
  5. National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.
  6. Strain EC, Stoller K, Walsh SL, Bigelow GE. Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers. Psychopharmacology. 2000; 148(4): 374-383. https://rd.springer.com/article/10.1007/s002130050066
  7. Substance Abuse and Mental Health Services Administration. Buprenorphine. Updated May 31, 2016. https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine.
  8. McDonald KM, Sundaram V, Bravata DM, et al. Closing the quality gap: A critical analysis of quality improvement strategies (Vol 7: Care Coordination). Technical Reviews, No. 9.7. AHRQ Publication No. 04(07)-0051-7. Rockville, MD: Agency for Healthcare Research and Quality; 2007. https://www.ahrq.gov/downloads/pub/evidence/pdf/caregap/caregap.pdf.
  9. Agency for Healthcare Research and Quality. Comparable Effectiveness of Case Management for Adults With Medical Illness and Complex Care Needs. Rockville, MD: Agency for Healthcare Research and Quality; 2011. https://effectivehealthcare.ahrq.gov/topics/case-management/research-protocol/.
  10. American Addiction Centers. Cognitive Behavioral Therapy and Addiction Treatment. http://americanaddictioncenters.org/cognitive-behavioral-therapy/.
  11. National Institute on Drug Abuse. Principles of drug addiction treatment: A research-based guide (Third Edition). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine). Updated December 2012. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0.
  12. Center for Substance Abuse Treatment. Incorporating alcohol pharmacotherapies into medical practice. Treatment improvement protocol (TIP) series 49. HHS Publication No. (SMA) 09-4380. Rockville, MD; 2009.
  13. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision. Washington, DC; 2000.
  14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth Edition. Washington, DC; 2013.
  15. National Committee for Quality Assurance. HEDIS 2015, Volume 2: Technical Specifications for Health Plans. Washington, DC; October 2014.
  16. Canadian Paediatric Society. Harm reduction: An approach to reducing risky health behaviours in adolescents. Paediatr Child Health. 2008; 13(1): 53-56.
  17. Centers for Disease Control and Prevention. Alcohol and public health: Frequently asked questions. Updated June 8, 2017. https://www.cdc.gov/alcohol/faqs.htm.
  18. National Committee for Quality Assurance. HEDIS 2015, Volume 2: Technical Specifications for Health Plans. Washington, DC; 2014.
  19. National Committee for Quality Assurance. HEDIS® and performance measurement: Measuring performance. http://www.ncqa.org/hedis-quality-measurement
  20. National Quality Forum. Measures, Reports and Tools. http://www.qualityforum.org/Measures_Reports_Tools.aspx.
  21. Substance Abuse and Mental Health Services Administration. Naloxone. March 3, 2016. https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone.
  22. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Washington, DC; 2013.
  23. Merriam-Webster Dictionary. Pharmacotherapy. https://www.merriam-webster.com/dictionary/pharmacotherapy.
  24. Kaplan, L. The role of recovery support services in recovery-oriented systems of care. HHS Publication No. (SMA) 08-4315. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2008. http://www.pacdaa.org/SiteCollectionDocuments/SAMHSA%20White%20Paper%20on%20The%20Role%20of%20Recovery%20Support%20Services.pdf
  25. Rieckmann T, Abraham A, Zwick J, Rasplica C, McCarty D. A longitudinal study of state strategies and policies to accelerate evidence-based practices in the context of systems transformation. Health Serv Res. 2015; 50(4): 1125-1145. doi/10.1111/1475-6773.12273/abstract
  26. Clinical Tools, Inc. DSM-IV-TR Criteria for Substance Abuse and Substance Dependence. Updated September 11, 2017. https://www.buppractice.com/node/1436.
  27. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth Edition. Washington, DC; 2013.
  28. Washington Circle. Performance Measurement for Care of Substance Use Disorders. http://www.washingtoncircle.org/. Accessed September 15, 2017.

 

TABLE A.2. Definitions of Acronyms and Abbreviations
Acronym Definition
42 CFR Part 2 42nd Confidentiality Regulations Part 2 titled Confidentiality of Substance Use Disorder Patient Records
ACO Accountable Care Organization
AOD Alcohol and Other Drug
AQC Alternative Quality Contract
ASAM American Society of Addiction Medicine
ASPE HHS Office of the Assistant Secretary for Planning and Evaluation
BCBSMA Blue Cross Blue Shield of Massachusetts
BHC Behavioral Health Clinic
CCAE Truven Health MarketScan® Commercial Claims and Encounters database
CDC HHS Centers for Disease Control and Prevention
CEO Chief Executive Officer
CFR Code of Federal Regulations
CMO Chief Medical Officer
CMS HHS Centers for Medicare & Medicaid Services
COO Chief Operating Officer
DATA 2000 Drug Addiction Treatment Act of 2000
DEA Drug Enforcement Administration
DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
DSM-V Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
ED Emergency Department
EHR Electronic Health Record
FDA HHS Food and Drug Administration
HEDIS Healthcare Effectiveness Data and Information Set
HFPP Healthcare Fraud Prevention Partnership
HHS U.S. Department of Health and Human Services
HMO Health Maintenance Organization
IESD Index Episode Start Date
IET Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
IMD Institutions for mental diseases
IOP Intensive Outpatient
IP Inpatient
MAT Medication-Assisted Treatment
MHPAEA Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
MIPS Merit-Based Incentive Payment System
MU Meaningful Use
N-SSATS National Survey of Substance Abuse Treatment Services
NCQA National Committee on Quality Assurance
NDH Negative Diagnosis History
NIATx Network for the Improvement of Addiction Treatment
NSDUH National Survey on Drug Use and Health
OOP Out-of-Pocket
OP Outpatient
OTP Opioid Treatment Program
OUD Opioid Use Disorder
P4P Pay For Performance
PCP Primary Care Physician
PDMP Prescription Drug Monitoring Program
PH Partial Hospitalization
PPO Preferred Provider Organization
SAMHSA HHS Substance Abuse and Mental Health Services Administration
SBIRT Screening, Brief Intervention and Referral to Treatment
SSA Single State Authority
STAR-SI Strengthening Treatment Access and Retention--State Initiative
SUD Substance use disorder
VHA Veterans Health Administration