Glossary

Citation: a reference to a journal article, conference abstract, dissertation or report of a primary research study, consisting of its title and when and where it was published.

Digital interventions: any interactive programmes and/or devices using digital technology to support behaviour change, for use by services users or individuals (rather than for use by professionals). We define interactive as involving a two-way flow of information; hence interactive digital interventions do not include those that solely provide health information or those that just involve screening.

Outcome measures: measures of the impact the intervention has on the outcomes it aimed to affect e.g. behaviours, knowledge, attitudes.

Primary research: findings from empirical evaluations of digital interventions.

Process measures: measures of the intervention process, including retention, adherence, implementation, satisfaction with or other views about the intervention.

Substance misuse: either unspecified substance misuse, or both drug and alcohol misuse.

Alcohol/drug pathway from prevention to treatment and recovery

Prevention and early intervention

Feedback/tracking/goals: refers to prevention-focused interventions involving normative feedback, tracking consumption and/or setting goals.

Normative feedback: seeks to challenge an individual's misperceptions about the frequency and quantity of their own alcohol or drug use (descriptive norms) and associated behaviours (injunctive norms) by comparing these to actual norms.

Tracking consumption: includes features that allow the user to record, monitor and review their alcohol or drug consumption over time. Tracking functions may also allow users to see their consumption in terms of money (how much it costs) and calories.

Goal setting: allows users to set their own behaviour change objectives, which may be to reduce or to abstain from drug and alcohol use (or another harm reduction goal). Goal setting functions are usually coupled with some form of tracking function, so users can monitor and review progress.

Other prevention strategies: aim to prevent the use or misuse of alcohol or drugs before it becomes problematic or risky. Other prevention strategies include educational interventions, such as educational gaming, and personalised text messaging.

Screening and brief intervention: with or without referral to treatment (SBIRT). This involves the use of a standardised, validated, screening tool to assess the user's level of risk to alcohol and/or drug-related harm. Such screening tests include the alcohol screening tool Alcohol Use Disorders Identification Test (AUDIT) and its shortened forms. The level of risk identified through screening determines whether a brief intervention and/or onward referral is made. A brief intervention typically involves a short (5-10 minute) conversation focused on the score, risks related to current use, benefits of cutting down, tips for cutting down and, where appropriate, onward referral to specialist treatment for diagnostic assessment and brief or structured treatment.

Other early intervention and engagement strategies: include a range of behaviour change approaches focused on intervening early to identify and reduce risky alcohol/drug use or mild alcohol/drug use disorders, such as brief motivational interventions, extended brief interventions (EBI) and brief treatment. Early interventions range from comparatively unstructured to more formal. Structured approaches are often based on (or drawn from) therapeutic models such as motivational interviewing. Early interventions often take place before, or without, a comprehensive specialist assessment for alcohol/drug use disorder. Some of these interventions are focused on referring and initially engaging people into specialist alcohol/drug treatment.

Treatment and recovery

Components of, or adjuncts to, structured treatment: this point in the pathway covers interventions for people who misuse or are dependent on alcohol or drugs.
Structured treatment: consists of a comprehensive package of concurrent or sequential specialist drug or alcohol-focused interventions. It addresses multiple or more severe needs that would not be expected to respond, or have already not responded, to less intensive or non-specialist interventions alone. Structured treatment requires a comprehensive assessment of need and either pharmacological or psychological treatment or both, and may or may not include adjunct interventions. It is delivered according to a recovery care plan, which is regularly reviewed with the client. The plan sets out clear goals which include change to substance use, and how other client needs will be addressed in one or more of the following domains: physical health; psychological health; social well-being; and, when appropriate, criminal involvement and offending. All interventions must be delivered by competent staff, within appropriate supervision and clinical governance structures. Most service users will require interventions to be delivered at least partly in-person[1], especially assessment and reviews, and all service users should have the option of regular in-person keyworking appointments throughout their treatment. Structured treatment provides access to specialist medical assessment and intervention, and works jointly with services for mental and physical health, safeguarding and family support, according to need.
Components of, or adjuncts, to structured treatment include:

Comprehensive Assessment: includes the formal collection of information necessary to make a clinical assessment, and diagnosis, of alcohol and/or drug use and dependence; and to identify and respond to other physical and mental health and social problems. Comprehensive Assessment is essential to establish the needs and strengths of the patient, explore treatment options with the patient to address their needs, build on their strengths and develop a treatment plan. The assessment would typically also include provision of harm reduction advice and identifying a support network. Most people will require in-person interaction to accurately and comprehensively assess their needs and start building rapport with their keyworker.
Pharmacological interventions: prescribing of medicines for alcohol or drug misuse and dependence, including medicines to support stabilisation, maintenance, withdrawal and relapse prevention. This includes prescribing medication to replace illicit opioids with a replacement opioid such as buprenorphine or methadone; manage and treat withdrawal from drugs or alcohol and associated symptoms; prevent and treat Wernicke’s encephalopathy/Wernicke-Korsakoffs; and prevent relapse with medication such as naltrexone.
Psychosocial interventions: psychosocial interventions incorporate psychological approaches and practical support to someone to help them overcome their alcohol or drug use and dependence, and support recovery. These interventions typically help people to build their commitment, motivation and belief in their capacity to reduce or stop their drug/alcohol consumption, and develop a range of cognitive and behavioural skills and techniques to support them in reaching their personal goals.

motivational interventions
family and social network interventions
contingency management
cognitive and behavioural based relapse prevention interventions
evidence-based psychological interventions for co-existing mental health disorders
psychodynamic therapy
12-step work
Counselling

Adjunct interventions: these optional, additional activities are designed to support, encourage, and/or reward engagement with treatment, or foster a strong ‘therapeutic alliance’ between the service provider and patient. Such activities include active monitoring and feedback (including appointment/treatment reminders) and contingency management which incentivises behaviour through rewards.

Sustaining Recovery

Relapse prevention: includes a range of interventions designed to identify and prevent high-risk situations, prevent relapse and maintain recovery. These include interventions which link people into mutual aid groups, help people to identify and track the early warning signs of relapse (e.g. cravings) and develop coping skills to prevent relapse, and interventions that monitor/encourage compliance with relapse prevention medications.

At any stage of the pathway

Peer support: Peer support refers to motivational, emotional, practical or social support offered by people with lived experience of alcohol/drug misuse. It is support given and shared between peers, as opposed to support given by professionals. It may include one-to-one or group peer support.

Overdose prevention: includes interventions which help to prevent overdose and support the management of an overdose situation.