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Young Adults in the Workplace
Glossary of Terms

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Time taken off from work. May be classified separately as employee sick leave, personal days, mental health days, jury duty, vacation, holidays, family illness or bereavement, Family and Medical Leave Act, workers compensation program days, short-term disability, or long-term disability. Substance abuse program theory should be used to determine which of these types of absenteeism are appropriate for analysis of the impact of a substance abuse prevention or early intervention program. Absenteeism does not include telecommuting and working off-site.

The extent to which services are available for individuals who need care. Ease of access depends on several factors, including availability and location of appropriate care and services, transportation, hours of operation, and cultural factors, including languages and cultural appropriateness. For many populations access also includes insurance coverage.

The extent to which an individual who needs care and services is able to receive them. Access is more than having insurance coverage or the ability to pay for services. It is also determined by the availability of services, acceptability of services, cultural appropriateness, location, hours of operation, transportation needs, and cost.

Accessible services
Services that are affordable, located nearby, and open during evenings and weekends. Staff is sensitive to and incorporates individual and cultural values. Staff is also sensitive to barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home than to travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list.

An official decision made by a recognized organization that a health care plan, network, or other delivery system complies with applicable standards.

Activity Therapy
Includes art, dance, music, recreational and occupational therapies, and psychodrama.

Acute Care
Medical treatment rendered to individuals whose illnesses or health problems are life- threatening or debilitating, requiring immediate response, and are short-term or episodic in nature. Acute care facilities are those hospitals that predominantly serve persons requiring these kinds of services.

A chronic, relapsing disease characterized by compulsive drug-seeking and abuse and by long-lasting chemical changes in the brain.

The number of persons admitted, readmitted, or transferred to a specified service during the reporting period.

Adjusted Community Rating (ACR)
A community rating impacted by group- specific demographics and the group's prior experience. Also known as prospective rating.

Administrative Costs
Costs not linked directly to the provision of medical care. Includes marketing, claims processing, billing, and medical record keeping, among others.

Administrative Services Only Organization (ASO)
A healthcare organization that provides administrative support services only for a self-funded plan or startup MCO.

Adverse Selection
A tendency for utilization of health services in a population group to be higher than average. From an insurance perspective, adverse selection occurs when persons with poorer-than-average life expectancy or health status apply for, or continue, insurance coverage to a greater extent than do persons with average or better health expectations.

AIDS (Acquired Immune Deficiency Syndrome)
The final and most serious stage of HIV disease, which causes severe damage to the immune system. The Centers for Disease Control has defined AIDS as beginning when a person with HIV infection has a CD4 cell (also called "t-cell", a type of immune cell) count below 200. It is also defined by numerous opportunistic infections and cancers that occur in the presence of HIV infection. AIDS is the fifth leading cause of death among persons between ages 25 and 44 in the United States. About 47 million people worldwide have been infected with HIV since the start of the epidemic. The Human Immunodeficiency Virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life- threatening illnesses and cancers. Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with fully functional immune systems can cause fatal illnesses in people with AIDS. Most individuals infected with HIV will progress to AIDS, if not treated. However, there is a tiny group of patients who develop AIDS very slowly or never at all. These patients are called non-progressors and many seem to have a genetic difference which prevents the virus from attaching to certain immune receptors. The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called "opportunistic infections." Patients with AIDS have had their immune system depleted by HIV and are very susceptible to such opportunistic infections. Common symptoms are fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.

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 Abuse During Pregnancy
Alcohol Abuse During Pregnancy is dangerous. Alcohol can have a number of harmful effects on the baby. The baby can be born mentally retarded or with learning and behavioral problems that last a lifetime. We don't know exactly how much alcohol is required to cause these problems. We do know, however, that these alcohol-related birth defects are 100- percent preventable, simply by not drinking alcohol during pregnancy. The safest course for women who are pregnant or trying to become pregnant is not to drink alcohol at all.

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
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.

See Alcohol Dependence

Alternative Therapy
An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial.

Alzheimer's Disease (AD)
A slowly progressive form of dementia, which is a progressive, acquired impairment of intellectual functions. Memory impairment is a necessary feature for the diagnosis. Change in one of the following areas must also be present for any form of dementia to be diagnosed: language, decision-making ability, judgment, attention, and other related areas of cognitive function and personality. The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course. The cause of Alzheimer's disease (AD) is not known, but it is not a part of normal aging. Prior theories regarding the accumulation of aluminum, lead, mercury, and other substances in the brain have been disproved. A diagnosis of AD is made based on characteristic symptoms and by excluding other causes of dementia. It can be confirmed by microscopic examination of a sample of brain tissue after death. By causing both structural and chemical problems in the brain, AD appears to disconnect areas of the brain that normally work together. There are two types of AD -- early onset and late onset. In early onset AD, symptoms first appear before age 60. Some early onset disease runs in families and involves autosomal dominant, inherited mutations that may be the cause of the disease. So far, three early onset genes have been identified. Early onset AD is less common, resulting in about 5-10% of cases. Late onset AD, the most common form of the disease, develops in people 60 and older and is thought to be less likely to occur in families. Late onset AD may run in some families, but the role of genes is less direct and definitive. These genes may not cause the problem itself, but simply increase the likelihood of formation of plaques and tangles or other AD-related pathologies in the brain. In the early stages, the symptoms may be very subtle. Symptoms may often include: repeating statements frequently, frequently misplacing items, trouble finding names for familiar objects, getting lost on familiar routes, personality changes, becoming passive and losing interest in things previously enjoyed. AD cannot be cured and the impaired functions cannot be restored. Currently, the progression can be slowed but not stopped. Treatment focuses on attempting to slow the progression; managing the behavior problems, confusion, and agitation; modifying the home environment; and most importantly, supporting the family. As the disease progresses, it may take a greater toll on the family than the patient.

Ambulatory Care
All types of health services provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services that do not require an overnight stay.

American Indian or Alaska Native
A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliations or community attachment.

Stimulant drugs whose effects are very similar to cocaine. Amphetamine, dextroamphetamine, methamphetamine, and their various salts are collectively referred to as amphetamines. In fact, their chemical properties and actions are so similar that even experienced users have difficulty knowing which drug they have taken. Methamphetamine is the most commonly abused.

A group of medications that reduce pain. Some of these medicines are also used just before or during an operation to help the anesthetic work better. Codeine and hydrocodone are also used to relieve coughing. Methadone is also used to help some people control their dependence on heroin or other narcotics. Narcotic analgesics may also be used for other conditions as determined by your doctor. Narcotic analgesics act in the central nervous system (CNS) to relieve pain. Some of their side effects are also caused by actions in the CNS. These medicines are available only with your medical doctor's or dentist's prescription. For some of them, prescriptions cannot be refilled and you must obtain a new prescription from your medical doctor or dentist each time you need the medicine. In addition, other rules and regulations may apply when methadone is used to treat narcotic dependence.

An eating disorder characterized by refusal to maintain a minimally accepted body weight, intense fear of weight gain, and distorted body image. Inadequate calorie intake or excessive energy expenditure results in severe weight loss. The exact cause of this disorder is not known, but social attitudes towards body appearance and family factors are believed to play a role in its development. The condition usually occurs in adolescence or young adulthood. It is more common in women, affecting 1-2% of the female population and only 0.1-0.2% of males. Anorexia is seen mainly in Caucasian women who are high academic achievers and have a goal-oriented family or personality. However, this eating disorder is not more common in higher socioeconomic groups. Some experts have suggested that conflicts within a family may also contribute to anorexia. It is thoughts that anorexia is a way for a child to draw attention away from marital problems, for example, and bring the family back together. Other psychologists have suggested that anorexia may be an attempt by young women to gain control and separate from their mothers. The causes, however, are still not well understood. The purpose of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues. Hospitalization may be indicated in some cases (usually when body weight falls below 30% of expected weight). Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.

Antioxidant vitamins -- E, C and beta carotene (a form of vitamin A) -- have potential health-promoting properties. Much research has recently focused on how antioxidant vitamins may reduce cardiovascular disease risk. Oxidation of low- density lipoprotein (LDL or "bad") cholesterol is important in the development of fatty buildups in the arteries. This process, called atherosclerosis can lead to heart attacks and strokes. Increasing evidence suggests that LDL cholesterol lipoprotein oxidation and its biological effects can be prevented by using antioxidants-both in the diet and in supplements. These data are from various sources: basic science, epidemiology, experiments in animals and clinical investigations, including limited clinical trials. The strongest evidence for using naturally occurring antioxidants to protect against the development of cardiovascular disease is for vitamin E. It's weakest for vitamin C. Data on the role of beta carotene are limited. High intakes of vitamin E have been associated with a lower risk of coronary artery disease (CAD) incidence, based on epidemiological studies. Animal studies also suggest that vitamin E can slow the development of atherosclerosis. Further, vitamin E inhibits LDL cholesterol oxidation in test tube experiments and in human studies. Some epidemiological studies suggest that vitamin C, which also inhibits lipoprotein oxidation, is associated with reduced rates of clinical CAD. Beta carotene doesn't seem to inhibit LDL cholesterol oxidation, but early data suggest that it may reduce further clinical events in people who have CAD. One should not recommend using dietary supplements of antioxidants to prevent cardiovascular disease until their effect is proved in clinical trials that directly test their impact on CVD end points. This caution is because the doses of these antioxidants that inhibited LDL cholesterol oxidation in some studies are much larger than can be achieved by diet alone. Beneficial effects must be demonstrated in randomized, placebo-controlled clinical trials before recommending widespread use to prevent cardiovascular disease.

Anxiety is an emotion that can signal just the right response to a situation. It can spur you on, for example, to add the finishing touches that transform an essay, painting, or important work document from good to excellent. However, if you have an anxiety disorder, exaggerated anxiety can stop you cold and disrupt your life. Like many other illnesses, anxiety disorders often have an underlying biological cause and frequently run in families. Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Symptoms range from chronic, exaggerated worry, tension, and irritability and appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms. Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.

Anxiety Disorders
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.

Any willing provider
A requirement that a health plan contract for the delivery of health care services with any provider in the area who would like to provide such services to the plan's enrollees.

Appropriate services
Designed to meet the specific needs of each individual child and family. For example, one family may need day treatment, while another may need home-based services. Appropriate services for one child and family may not be appropriate for another. Appropriate services usually are provided in the child's community.

The extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a patient's or member's needs. (See also, medically necessary)

A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Assertive Community Treatment
A multi-disciplinary clinical team approach of providing 24-hour, intensive community services in the individual's natural setting that help individuals with serious mental illness live in the community.

A professional review of child and family needs that is done when services are first sought from a caregiver. The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. The assessment identifies the strengths of the child and family. Together, the caregiver and family decide what kind of treatment and supports, if any, are needed.

At Risk
A situation in which a healthcare organization is vulnerable to providing or paying for the delivery of more services than are received through premiums or per capita payments.

Attention Deficit Hyperactivity Disorder(ADD-ADHD)
Attention Deficit Hyperactivity Disorder (ADD-ADHD) is a neurobiological condition characterized by developmentally inappropriate level of attention, concentration, activity, distractability, and impulsivity. The symptoms typically begin by 3 years of age-Attention deficit: does not pay close attention to details; may make careless mistakes at work, school, or other activities; failure to complete tasks; has difficulty maintaining attention in tasks or play activities; does not listen when spoken to directly; has difficulty organizing tasks; is easily distracted; unable to follow more than one instruction at a time. Many different methods of treatment have been used for ADD including psychotropic medications, psychosocial interventions, dietary management, herbal and homeopathic remedies, biofeedback, meditation, and perception stimulation/training. Of these treatment strategies, the most research has been done on stimulant medications and psychosocial interventions. Overall, these studies suggest stimulants to be superior relative to psychosocial interventions. However, there is no long term information comparing the two. The primary medications used to treat attention deficit disorder include: Dexedrine (dextroamphetamine), Ritalin (methylphenidate), Cylert (magnesium pemoline), tranquilizers (such as thioridazine), alpha-adrenergic agonist (clonidine), and others. Psychosocial therapeutic techniques include: contingency management (e.g., point reward systems, time out...), cognitive-behavioral treatment (self monitoring, verbal self instruction, problem solving strategies, self reinforcement), parent counseling, individual psychotherapy.

Autism, also called autistic disorder, is a complex developmental disability that appears in early childhood, usually before age 3. Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.

The automatic assignment of a person to a health insurance plan (typically done under Medicaid plans).

Average Length of Stay
This represents the average time a client receives a specified service during a specified time period. This is generally computed by counting all the days that clients received the service during the time period and dividing by the number of clients that received the service during the same period. (Days a person was on furlough or not receiving are not counted.)

Average Payment Rate
The money that the Center for Medicare and Medicaid Services (CMS) can pay an HMO.

Drugs that fall under the depressant category and are used medicinally to relieve anxiety, irritability, and tension. They have a high potential for abuse and development of tolerance. Depressants produce a state of intoxication similar to that of alcohol. When combined with alcohol, the effects are increased and risks are multiplied. Other drugs that fall under the depressant category include methaqualone, tranquilizers, chloral hydrate, and glutethimide.

Bathtub crank
Poor quality methamphetamine; methamphetamine produced in bathtubs

Smokable methamphetamine


Behavioral Health
A managed care term that applies to the assessment and treatment of problems related to mental health and substance abuse. Substance abuse includes abuse of alcohol and other drugs.

Behavioral Healthcare
A continuum of services to individuals at risk of or suffering from mental, addictive, or other behavioral disorders

Behavioral heath care firm
Specialized (for-profit) managed care organizations focusing on mental health and substance abuse benefits, which they term "behavioral healthcare." These firms offer employers and public agencies a managed mental health and substance abuse benefit.

Behavioral Therapy
As the name implies, behavioral therapy focuses on behavior-changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.

For a particular indicator or performance goal, the industry (healthcare or non- healthcare) measure of best performance. The benchmarking process identifies the best performance in the industry for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance elsewhere.

A person certified as eligible for health care services. A beneficiary may be a dependent or a subscriber.

Benefit-cost Ratio (also known as return on investment ratio)
For workplace prevention programs, the inflation-adjusted, discounted benefits of a program or intervention divided by the inflation-adjusted discounted costs of providing and consuming the program. Values above 1.0 generally denote economically attractive programs that provide more than 1 dollar in benefits for each dollar spent on the program.

Benefit Package
The types of healthcare and other services to be provided by an employer to employees. The employer as primary payor can contract for the healthcare portion of the services. The contractor arranges for delivery of healthcare services that can include substance abuse prevention and early intervention programs.

Bicycle Safety
Bicycle Safety-wear a bike helmet. 1 out of 7 children under age 15 suffers a head injury in a bike crash. Bike helmets can prevent head injuries. Make sure that your bike and your children's bikes are the right size. Your child should be able to straddle the bike with both feet on the ground. Young children should use bikes with coaster brakes- -the kind that brake when you pedal backwards. Before using hand brakes, a child's hands should be large enough and strong enough to use the levers. Avoid riding at night if at all possible. Make sure your bike has reflectors. Obey all traffic laws. Stop at stop signs, check for traffic before turning, and ride on the same side of the road as the automobiles do. Be predictable and ride defensively. Try to ride where drivers of cars can see you. Bicycles are frequently involved in car accidents because the driver of the car did not even know the bike was there. Often, accidents occur when drivers don't pay enough attention to bikers. Many accidents have been avoided because the biker was paying attention to the car. Never ride out into a street without stopping first. Use the proper hand signals for turning or stopping. Yield the right of way to pedestrians. Wear brightly colored clothing so that motorists can easily see you. Use bike paths at all times if possible.

Bike Helmet Safety
Bike Helmet Safety-Kids, especially 11- to 14- year-olds, are sometimes reluctant to wear helmets. They may insist they're good riders who don't need helmets anymore, complain that helmets are uncomfortable, or - an old favorite - point out that none of their friends wear them. Your child may be especially mature for her age; she may be a particularly skilled rider; or it just might feel easier to give in. But we urge you to resist that temptation. Requiring your children to wear a helmet every time, everywhere they go, is the best thing you can do to protect them. If your child rides a bike, then she probably also enjoys skateboards, scooters or inline skates! Make sure that whenever she "wheels" around, she's wearing the right gear. Helmet Tips * Don't negotiate. It's estimated that 75 percent of bicycle-related deaths among children could be prevented with a bicycle helmet. * Buy a helmet that meets or exceeds current safety standards developed by the U.S. Consumer Product Safety Commission. * Correct fit is essential. Helmets should be comfortable and snug, but not too tight. They shouldn't rock back and forth or side to side. * Make sure your child wears her helmet correctly - centered on top of her head and always with the straps buckled. Children who wear their helmets tipped back have a 52 percent greater risk of head injury than those who wear their helmets properly. * If your child is reluctant to wear her helmet, try letting her choose her own. Helmets come in many colors and styles - allowing children to choose a helmet that's "cool" may make them less likely to take it off when you're not around. * Talk to other parents and encourage them to have their kids wear helmets. Let your children see that you wear a helmet, too. Children are more likely to wear helmets when riding with others who wear them.

Bikers coffee
Methamphetamine and coffee

Binge Drinking
The consumption of five or more alcoholic drinks in a row on at least one occasion.

Binge Eating
Binge Eating is an eating disorder characterized by eating more than needed to satisfy hunger. It is a feature of bulimia, a disorder that also includes abnormal perception of body image, constant craving for food and binge eating, followed by self- induced vomiting or laxative use.

Biofeedback is learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature; it can be a path to mastering one's fears. It is used in combination with, or as an alternative to, medication to treat disorders such as anxiety, panic, and phobias.

Biomedical Treatment
Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. Any treatment involving medicine is a biomedical treatment. The kind of medication a psychiatrist prescribes varies with the disorder and the individual being treated.

Bipolar Disorder
A chronic disease affecting over 2 million Americans at some point in their lives. The American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" describes two types of bipolar disorder, type I and type II. In type I (formerly known as manic depressive disorder), there has been at least one full manic episode. However, people with this type may also experience episodes of major depression. In type II disorder, periods of "hypomania" involve more attenuate (less severe) manic symptoms that alternate with at least one major depressive episode. When the patients have an acute exacerbation, they may be in a manic state, depressed state, or mixed state. People who suffer from bipolar disorder, however, have pathological mood swings from mania to depression, with a pattern of exacerbation and remission that are sometimes cyclic. The manic phase is characterized by elevated mood, hyperactivity, over-involvement in activities, inflated self-esteem, a tendency to be easily distracted, and little need for sleep. The manic episodes may last from several days to months. In the depressive phase, there is loss of self-esteem, withdrawal, sadness, and a risk of suicide. While in either phase, patients may abuse alcohol or other substances which worsen the symptoms. The disorder appears between the ages of 15 and 25, and it affects men and women equally. The exact cause is unknown, but it is a disturbance of areas of the brain which regulate mood. There is a strong genetic component. The incidence is higher in relatives of people with bipolar disorder. Hospitalization may be required during an acute phase to control the symptoms and to ensure safety of individuals. Medications to alleviate acute symptoms may include: neuroleptics (antipsychotics), antianxiety agents (such as benzodiazepines), and antidepressant agents. Mood stabilizers, such as lithium carbonate, and anticonvulsants (including carbamazepine and valproic acid) are started as maintenance therapy to relieve symptoms and to prevent relapse.

Marijuana; opium; methamphetamine

Black beauty

Black or African American
A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

Crystal methamphetamine

Blind Sample
The types of healthcare and other services to be provided by an employer to employees. The employer as primary payor can contract for the healthcare portion of the services. The contractor arranges for delivery of healthcare services that can include substance abuse prevention and early intervention programs.

Bling bling

Blue devils

Blue meth

Marijuana; methamphetamine

A process of repeated subsampling, with replacement, from a larger sample, followed by analysis of each repeated subsample. Analyses with the subsample are used to estimate variances or standard errors of variables of interest (Vogt, 1993).

Borderline Personality Disorder
Symptoms of borderline personality disorder, a serious mental illness, include pervasive instability in moods, interpersonal relationships, self-image, and behavior. The instability can affect family and work life, long-term planning, and the individual's sense of self-identity.

Box labs
Small, mobile, clandestine labs used to produce methamphetamine

Break-even Analysis
An analysis designed to determine the dollar cost or the value of benefits that would have to be assigned to make two alternative programs equally attractive (Warner and Luce, 1982).

Marijuana; heroin; methamphetamine

An illness characterized by uncontrolled episodes of overeating usually followed by self-induced vomiting or other purging. In bulimia, eating binges may occur as often as several times a day. Induced vomiting known as purging allows the eating to continue without the weight gain; it may continue until interrupted by sleep, abdominal pain, or the presence of another person. The person is usually aware that their eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. The behavior is usually secretive, although clues to this disorder include overactivity, peculiar eating habits, eating rituals, and frequent weighing. Body weight is usually normal or low, although the person may perceive themselves as overweight. The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, maladaptive behavior, self- identity conflict, and cultural overemphasis on physical appearance. Bulimia may be associated with depression. The disorder is usually not associated with any underlying physical problem although the behavior may be associated with neurological or endocrine diseases. The disorder occurs most often in females of adolescent or young adult age. The incidence is estimated to be 3% in the general population; but 20% of college women suffers from it. Treatment focuses on breaking the binge-purge cycles of behavior since the person is usually aware that the behavior is abnormal. Outpatient treatment may include behavior modification techniques and individual, group, or family counseling. Antidepressant drugs may be indicated for some whether or not they have coincident depression.

Substance that exists naturally in plants. It can also be produced synthetically and used as an additive in certain food products. It is a central nervous system stimulant and a diuretic. Caffeine is absorbed and distributed very quickly. After absorption, it passes into the central nervous system, or the brain. "Caffeine sensitivity" refers to the amount of caffeine that will produce negative side effects. This amount will vary from person to person. Caffeine does not accumulate in the bloodstream nor is it stored in the body. It is excreted in the urine many hours after it has been consumed. Caffeine will not reduce the effects of alcohol, although many people still believe a cup of coffee will "sober up" an intoxicated person. Caffeine may be used as a treatment for migraine headaches and in relieving, for a short time, fatigue or drowsiness. Caffeine is widely consumed. It is found naturally in the leaves, seeds, and fruits of more than 60 plants, including tea leaves, kola nuts, coffee, and cocoa beans. It is in coffee, tea, chocolate, cocoa and many carbonated beverages such as colas. Caffeine is frequently added to over-the-counter medications such as pain relievers, appetite suppressants, and cold medicines. Caffeine has no flavor and can be removed from a food by a chemical process called decaffeination. Excessive caffeine intake can lead to a fast heart rate, diuresis (excessive urination), nausea and vomiting, restlessness, anxiety, depression, tremors, and difficulty sleeping. Abrupt withdrawal of caffeine may cause headaches, drowsiness, irritability, nausea, vomiting, and other symptoms. Reduce caffeine intake gradually to prevent any symptoms of withdrawal.

The NICHD recommends milk and other dairy products as a primary source of calcium. In addition, a variety of other foods are excellent sources of calcium as well. Dark green, leafy vegetables and foods with added calcium can be healthy ways to get enough calcium. By eating a wide variety of foods with calcium, you can help make sure to get the calcium you need each day.

Call Center
A facility set up to handle a large volume of phone calls, often of the customer service variety. However, call centers can be limited to either inbound or outbound calls. For example, some sales operations have inbound- only call centers using 1-800 technology. Call centers can be centralized or distributed. The European Commission has supported distributed, local call centers in order to facilitate access to work sites. Such sites are ideal for telework.

Camping and Hiking Safety
Camping and Hiking Safety-Always bring a first aid kit when camping. Know how to use the contents of the kit. Some situations can be made worse by using first aid supplies incorrectly. Use the buddy-system. It is never a good idea to camp or hike alone. If you were to become immobile because you broke a leg, or you were to fall and get stuck, a partner could go for help. Make sure someone knows where you plan to camp or hike. ( Teach children and remind adults to pick out landmarks at the campsite, and when on hikes to help recognize locations.) Be careful when exploring (always take a compass and map). Take whistles in case you. Whistles can be heard further than your voice will carry. Use caution when chopping wood or building fires. Dress appropriately. Wear long-sleeved shirts and long pants to avoid bites from ticks and other insects. In cold conditions, wear many layers of thin clothing, along with a hat, boots and gloves. When hiking, consider tucking your pants into your socks and boots to help protect against ticks. Take a supply of clean drinking water and drink it. People can become dehydrated very quickly in warm, dry, or windy conditions. Dehydration can lead to other serious complications and should be avoided. Don't drink water unless you know it is clean. Avoid alcoholic beverages which tend to cause dehydration. Don't touch animals out in the wild. Don't eat wild berries and plants. Don't over-do-it when hiking. Never leave a campfire unattended. Before leaving a campsite to return home, make sure all fires are out and the ashes are cold. A single burning ember in a seemingly smothered fire is enough to initiate another full blown fire.

Chemicals that help control mental and physical processes when produced naturally by the body and that produce intoxication and other effects when absorbed from marijuana.

The botanical name for the plant from which marijuana comes.

A method for payment to healthcare providers that is common or targeted in most managed care arenas. Unlike the older fee-for-service arrangement, in which the provider is paid per procedure, capitation involves a prepaid amount per month to the provider per covered member, usually expressed as a PMPM (per member per month) fee. The provider is then responsible for providing all contracted services required by members of that group during that month for the fixed fee, regardless of the actual charges incurred. In such an arrangement, the provider is now at risk, picking up risk that the payor or employer used to have exclusively in fee-for-service or idemnity arrangements.

A person who has special training to help people with mental health problems. Examples include social workers, teachers, psychologists, psychiatrists, and mentors.

A strategy for employers to contract with a single provider of managed healthcare services in which the organization providing general medical services to employees or enrollees also provides more specialized services, such as mental health and addiction services, under one predetermined capitated fee. The term is typically used in reference to behavioral health services provided by the same MCO that is providing medical services.

A strategy for the employer in contracting or providing managed care services in which a portion of the benefit (such as a behavioral health benefit) is separated (carved-out) from the overall medical benefit. A second organization is contracted under a separate agreement to provide these benefits. The term "carve-out" usually refers to a managed behavioral healthcare organization; many HMOs and insurance companies adopt this strategy because they do not have in-house expertise related to behavioral health. Carve-out vendors may be specialized units within larger managed care organizations or they may be independent companies.

Case Management
The monitoring and coordination of treatment rendered to covered persons with a specific diagnosis or requiring high-cost or extensive services. The goal is to achieve optimum patient outcome in the most cost-effective manner.

Case manager
An individual who organizes and coordinates services and supports for children with mental health problems and their families. (Alternate terms: service coordinator, advocate, and facilitator.)

Case Mix
The overall clinical diagnostic profile of a defined population, which influences intensity, cost, and scope of healthcare services typically provided.

Case Rate
A flat fee paid for a patient's treatment based on the diagnosis and/or presenting problem. For this fee the provider covers all of the services the patient requires for a specific period of time. Also referred to as "bundled rate" or "flat fee-per-case." Very often used as an intervening step prior to capitation. Diagnostic Related Groups (DRGs) are an example of a case rate.

Censored Data
Data about an event or phenomenon of interest that are unavailable for periods of time or groups of people. For example, medical expenditures may be unavailable for persons who switch health plans, or for time periods before or after employment or some other event of interest, such as the employer changing the healthcare provider.

Center for Medicare and Medicaid Services (CMS)
The Federal agency that administers the Medicare, Medicaid, and Child Health Insurance Programs. CMS provides health insurance for more than 74 million Americans through Medicare, Medicaid, and Child Health. The majority of these individuals receive their benefits through the fee-for-service delivery system. However, an increasing number are choosing managed care plans. CMS is working to maintain and measure quality of care in managed care through HEDIS measures.

Certificate of Need
A certificate of approval issued by a governmental agency to an organization that proposes to construct or modify a healthcare facility, incur a major capital expenditure, or offer a new or different health service.

Crack Cocaine; amphetamine; methamphetamine

Chicken Feed

Child Dental Health
The care of the child's teeth and gums, including hygiene (brushing and rinsing), examinations by dentists (assessing the current condition of teeth and gums), and treatments (use of fluoride, extractions, fillings, or orthodontics). Healthy teeth and gums are essential to overall good health. Poor dental development, dental disease, and dental trauma can result in poor nutrition, painful and dangerous infections, problems with speech development, and problems with self-image. Current recommendations for dental care during childhood include: Even though newborns and infants do not have teeth, care of the mouth and gums is important, ask your pediatrician if and when your infant needs fluoride added to his diet. Use a damp washcloth to wipe your infant's gums after each meal. Do not put your infant or young child to bed with a bottle of milk, juice, or sugar water. Use only water for bedtime bottles. Begin using a soft toothbrush instead of the washcloth to clean your child's teeth as soon as his first tooth shows (usually between 5-8 months of age). Your child's first visit to the dentist should be between the time his first tooth appears (5-8 months) and the time when all his primary teeth are visible (before 2 1/2 years). Many dentists will recommend a "trial" visit to expose the child to the sights, sounds, smells, and feel of the office before the actual examination. Children who are accustomed to having their gums wipes and teeth brushed will have fewer problems to having the dentist look inside their mouths. Your child should brush his teeth and gums at least twice each day and especially before bed. When permanent teeth are established, flossing his teeth each evening before bed should be encouraged. Additional dental treatments (such as braces or extractions) may be needed during adolescence to prevent long-term problems. Prevent tooth damage by teaching your child to use appropriate protective gear, safe play practices, and actions to take in case of injuries to teeth, gums, or mouth. Regular visits to your dentist (at least every 6 months) will ensure early recognition and treatment of problems. Proper care will give your child healthy teeth and gums for a lifetime. As your child becomes more active, trauma to his teeth may occur. Lost or damaged teeth (chips, change in position) or gums should be treated as a medical emergency to prevent infection, tooth loss, or damage to tooth, root, gums, or mouth. Even damage to primary (first) teeth should be treated to prevent future problems with tooth or gum development. If your child loses a GROWN-UP tooth during a fall or other injury, you should: find the tooth, avoid touching the root, and carefully rinse the tooth in running water (use stopper or strainer to avoid losing the tooth down the drain). Place the clean tooth back into its hole in your child's mouth and have your child hold the tooth in place with his fingers, if you or your child are unable to do this, place the tooth either in saliva (under your tongue), cold milk or saline (such as contact lens solution). Take your child and his tooth for immediate medical or dental assistance.

Child protective services
Designed to safeguard the child when abuse, neglect, or abandonment is suspected, or when there is no family to take care of the child. Examples of help delivered in the home include financial assistance, vocational training, homemaker services, and daycare. If in-home supports are insufficient, the child may be removed from the home on a temporary or permanent basis. Ideally, the goal is to keep the child with the family whenever possible.

Child Safety
Child Safety-the space between crib bars should be no more than 2 1/2 inches. A crib or playpen should have no sharp edges. The distance from the mattress to the top of the rail should be over 2 feet. Use bumper pads on the inside of the crib. Keep plastic wrap or bags away from children. Keep stuffed animals with buttons that can be swallowed away from small children. Avoid putting extra blankets and stuffed animals in a crib with a baby. Child-proof your home: * Place gates at the top and bottom of each stairway. * Cover unused electrical sockets. * Keep toxic substances (such as cleaning fluids, bug poisons, and other chemicals) well out of a child's reach. * Avoid storing toxic substances in unmarked and inappropriate containers (such as food containers). * Keep knives out of reach. * Buy medicines with child-resistant caps. Place all medications out of the reach of children. * Put safety latches on cabinets that a child should not open. * Keep matches out of reach. * Set the hot water heater thermostat to no more than 125 degrees F. * When cooking on the stove, make sure that pot and pan handles are turned to the middle of the stove top. Handles that hang over the edge of the stove top may be reached by a curious toddler. * Keep toys with small parts (and other small objects) out of the reach of toddlers. * In the bathroom, avoid putting dangerous items (such as razor blades) in a waste basket where a young child might have access. * Keep toilet lids down. Never leave an infant unattended in the bathtub. Keep children away from hot beverages and stove tops. Don't leave small children alone in the kitchen. Establish sensible rules for outdoor play and supervise young children constantly. When heating a baby bottle in the microwave oven or on the stove, always test the milk temperature to prevent burning your baby's mouth.

Children need to eat a wide variety of foods for good health. Use the Food Guide Pyramid on page 5 as a starting point for planning family meals and snacks. The Food Guide Pyramid applies to healthy people age 2 years and older. The smaller number of servings in the range is for children age 6 years and under. For 2- to 3-year-old children, the serving size should be smaller, about two- thirds the size of a regular serving (except for milk). When you help children build healthy eating habits early, they will approach eating with a positive attitude-that food is something to enjoy, help them grow, and give them energy. Give your child a snack or two in addition to his or her three daily meals. Offer your child a wide variety of foods, such as grains, vegetables and fruits, low-fat dairy products, and lean meat or beans. Serve snacks like dried fruit, low-fat yogurt, and air-popped popcorn. Let your child decide whether and how much to eat. Keep serving new foods even if your child does not eat them at first. Cook with less fat-bake, roast, or poach foods instead of frying. Limit the amount of added sugar in your child's diet. Choose cereals with low or no added sugar. Serve water or low-fat milk more often than sugar-sweetened sodas and fruit-flavored drinks. Choose and prepare foods with less salt. Keep the saltshaker off the table. Have fruits and vegetables on hand for snacks instead of salty snack foods. Involve your child in planning and preparing meals. Children may be more willing to eat the dishes they help fix. Have family meals together and serve everyone the same thing. Do not be too strict. In small amounts, sweets or food from fast-food restaurants can still have a place in a healthy diet. Make sure your child eats breakfast. Breakfast provides children with the energy they need to listen and learn in school.

Children and adolescents at risk for mental health problems
Children are at greater risk for developing mental health problems when certain factors occur in their lives or environments. Factors include physical abuse, emotional abuse or neglect, harmful stress, discrimination, poverty, loss of a loved one, frequent relocation, alcohol and other drug use, trauma, and exposure to violence.

Children and Exercise
Children should exercise to stay healthy. For children older than 6 years, 20 minutes a day of aerobic exercise at least 3 days a week should be adequate. Encourage your child to build strength, flexibility and aerobic capacity (for example, through running).

A soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and obtained from animal products in the diet. Cholesterol is manufactured in the liver for normal body functions including the production of hormones, bile acid, and Vitamin D. It is transported in the blood to be used by all parts of the body. Dietary cholesterol is present only in foods of animal origin (not in foods of plant origin). Cholesterol is found in eggs, dairy products, meat, poultry, fish, and shellfish. Egg yolks and organ meats (liver, kidney, sweetbread, and brain) are high in dietary cholesterol. Fish generally contains less cholesterol than other meats, but some shellfish is high in cholesterol content. Foods of plant origin (vegetables, fruits, grains, cereals, nuts, and seeds) contain no cholesterol. Fat content is not a good measurement of cholesterol content. For example, liver and other organ meats are low in fat but very high in cholesterol. Excessive cholesterol contributes to atherosclerosis and subsequent heart disease. The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases. Approximately 25% of the adult population in the U.S. has elevated blood cholesterol levels. More than half of the adult population has blood cholesterol levels that are higher than the "desirable" range, as specified by the medical community. Elevated cholesterol levels often begin in childhood. Some children may be at higher risk than others secondary to family history. The level for total cholesterol has been lowered in the past few years. Depending on the laboratory levels either less than 200 or 190 milligrams per deciliter (mg/dl) are considered "desirable" because they carry the least risk of heart disease. When the level is above 200 mg/dl the risk for coronary heart disease increases. It is also important to know the levels for High Density Lipoprotein (HDL, also known as the "good cholesterol") and Low Density Lipoprotein (LDL, or "bad cholesterol"). You must consult your health care provider to measure and discuss your cholesterol profile. To lower high cholesterol levels, eat less than 30% of the total daily calories from fat. Of that 30%, less than one-third should be from saturated fat and not more than one-third should be from polyunsaturated fat. At least one-third of the total fat calories should be from monounsaturated fat. Less than 300 milligrams (mg) of dietary cholesterol per day should be consumed.

Christmas tree
Marijuana; amphetamine; methamphetamine; depressant

Christmas tree meth
Green methamphetamine produced using Drano crystals


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.

A request by an individual (or his or her provider) to that individual's insurance company to pay for services obtained from a health care professional.


Clinical Psychologist
A clinical psychologist is a professional with a doctoral degree in psychology who specializes in therapy.

Clinical Social Worker
Clinical social workers are health professionals trained in client-centered advocacy that assist clients with information, referral, and direct help in dealing with local, State, or Federal government agencies. As a result, they often serve as case managers to help people "navigate the system." Clinical social workers cannot write prescriptions.

Club Drugs
A wide variety of drugs being used by young people at dance clubs, bars, and all-night dance parties ("trances" or "raves"). These parties are usually held in a clandestine location with high-volume music, high-tech entertainment, and easy access to drugs. Club drugs are attractive to today's youth because they are inexpensive and produce increased stamina and intoxicating highs. Because many of these drugs are colorless, tasteless, and odorless, they can be secretly added to beverages by individuals who want to intoxicate or sedate others. The most widely used club drugs are; ecstasy, rohypnol, ketamine, GHB, and LSD. Research has shown that club drugs can have long-lasting negative effects on the brain, especially on memory function and motor skills. When club drugs are combined with alcohol, the effect is intensified, and they become even more dangerous and potentially fatal.

A powerfully addictive stimulant that directly affects the brain. Cocaine has been labeled the drug of the 1980s and '90s, because of its extensive popularity and use during this period. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years. There are basically two chemical forms of cocaine: the hydrochloride salt and the "freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable. Cocaine is generally sold on the street as a fine, white, crystalline powder, known as "coke," "C," "snow," "flake," or "blow." Street dealers generally dilute it with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.

Cognitive/Behavioral Therapy
A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

Cognitive Therapy
Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self- destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior.

Cold Sores
Cold Sores or Herpes labialis is an infection caused by the herpes simplex virus, characterized by an eruption of small and usually painful blisters on the skin of the lips, mouth, gums or the skin around the mouth. These blisters are commonly called cold sores or fever blisters. Most Americans are infected with the type 1 virus by the age of 20. The initial infection may cause no symptoms or mouth ulcers. The virus remains in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious. Herpes virus type 2 usually causes genital herpes and infection of babies at birth but can also cause herpes labialis. Herpes viruses are contagious. Contact can occur directly, or through contact with infected razors, towels, dishes, etc. Occasionally, oral/genital contact can spread oral herpes to the genitals (and vice versa), so people with active herpes lesions on or around their mouths or on their genitals should avoid oral sex. The first symptoms usually appear within 1 or 2 weeks, and as late as 3 weeks, after contact with an infected person. The lesions of herpes labialis usually last for 7 to 10 days, then begin to resolve. The virus may become latent, residing in the nerve cells, with recurrence at or near the original site. Recurrence is usually milder. It may be triggered by menstruation, sun exposure, illness with fever, stress, or other unknown causes. Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear. They include: Skin lesion/rash located around the lips, mouth, and gums; Small blisters (vesicles), filled with clear yellowish fluid, blisters appear on a raised, red, painful skin area. Blisters form, break, and ooze, yellow crusts slough to reveal pink, healing skin, several smaller blisters may merge to form a larger blister, and a mild fever (may occur). Untreated, the symptoms will generally subside in 1 to 2 weeks. Antiviral medications may be given by mouth to may shorten the course of the symptoms and decrease pain. Wash blisters gently with soap and water to minimize the spread of the virus to other areas of skin. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce pain. Take precautions to avoid infecting others. Prevention methods include avoid direct contact with cold sores or other herpes lesions. Minimize the risk of indirect spread by thoroughly washing items in hot (preferably boiling) water before re-use. Do not share items with an infected person, especially when herpes lesions are active. Avoid precipitating causes (especially sun exposure) if prone to oral herpes. Avoid performing oral sex when you have active herpes lesions on or near your mouth and avoid passive oral sex with someone who has active oral or genital herpes lesions. Condoms can help reduce, but do not entirely eliminate, the risk of transmission via oral or genital sex with an infected person. Unfortunately, both oral and genital herpes viruses can sometimes be transmitted even when the person does not have active lesions.

Collateral Services
Services that include contacts with significant others involved in the client's/patient's life for the purpose of discussing the client's/patient's emotional or behavioral problems or the collateral's relationship with the client/patient.

Community Services
Services that are provided in a community setting. Community services refer to all services not provided in an inpatient setting.

Conduct Disorders
Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when these symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools.

Consolidated Omnibus Budget Reconciliation Act (COBRA)
An act that allows workers and their families to continue their employer-sponsored health insurance for a certain amount of time after terminating employment. COBRA imposes different restrictions on individuals who leave their jobs voluntarily versus involuntarily.

Any individual who does or could receive health care or services. Includes other more specialized terms, such as beneficiary, client, customer, eligible member, recipient, or patient.

Consumer Run Services
Mental health treatment or support services that are provided by current or former mental health consumers. Includes social clubs, peer- support groups, and other peer-organized or consumer-run activities.

Continuous quality improvement (CQI)
An approach to health care quality management borrowed from the manufacturing sector. It builds on traditional quality assurance methods by putting in place a management structure that continuously gathers and assesses data that are then used to improve performance and design more efficient systems of care. Also known as total quality management (TQM).

Continuum of care
A term that implies a progression of services that a child moves through, usually one service at a time. More recently, it has come to mean comprehensive services. Also see system of care and wraparound services.

Drug manufacturer; mix heroin with water; heating heroin to prepare it for injection

To inject a drug; person who manufactures methamphetamine

Coordinated services
Child-serving organizations talk with the family and agree upon a plan of care that meets the child's needs. These organizations can include mental health, education, juvenile justice, and child welfare. Case management is necessary to coordinate services. Also see family-centered services and wraparound services.

The portion of the covered healthcare cost for which the person insured has the responsibility to pay, usually as a fixed fee for a specific service type (e.g., $10 per doctor visit).

Corporate Health Management Programs
Health promotion and disease prevention/wellness programs that use health education techniques to promote employee health. These programs usually include components such as exercise regimens, health- risk appraisals, weight control, nutrition information, stress management, disease screening, and smoking cessation.

Cost-based Reimbursement
Method of reimbursement in which third parties pay providers for services provided based upon the documented costs of providing that service.

Cost-benefit Analysis (CBA)
A systematic method for valuing over time the monetary costs and consequences of producing and consuming substance abuse program services. Results from a CBA are often provided in terms of a net present value figure, which shows the difference in inflation-adjusted, discounted costs and benefits of the program in today's dollars or in the dollars of a base year of interest. Results may also be shown in terms of an internal rate of return or a benefit-cost ratio. The data is used in determining the content of a benefit package.

Cost-effectiveness Analysis (CEA)
A systematic method for valuing over time the monetary costs and non-monetary consequences of producing and consuming substance abuse program services. Results from a CEA are often shown in terms of total costs and total levels of effectiveness (e.g., total quality adjusted life-years saved or total numbers of substance abuse cases avoided), or in terms of cost per unit of effectiveness. This data is used by employers to determine contents of a benefits package.

Health insurance practice that requires the insured person to pay some portion of covered expenses (e.g., deductibles, coinsurance, and copayments) in an attempt to control utilization.

Charging one group of patients more in order to make up for underpayment by others. Most commonly, charging some privately insured patients more in order to make up for underpayment by Medicaid or Medicare.

Couples Counseling and Family Therapy
These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist-sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness- such as how to deal with feelings of anger or guilt.

Covered Days
Maximum number of days for which an insurer will reimburse for services rendered. Days may be limited per episode of illness, per year, per lifetime, or per length of policy.

Covered Lives
Individuals having health insurance coverage under a particular contract, payer, or provider group. In the private sector, this refers to employees and family members.


Crack Cocaine
The street name given to the freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. The term "crack" refers to the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride. Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy.

Crack Cocaine; heroin; amphetamine; methamphetamine; methcathinone

Someone who uses or manufatures methamphetamine

The process of reviewing a practitioner's credentials, i.e., training, experience, or demonstrated ability, for the purpose of determining if criteria for clinical privileging are met.

Creditable Coverage
Any prior health insurance coverage that a person has received. Creditable coverage is used to decrease exclusion periods for pre- existing conditions when an individual switches insurance plans. Insurers cannot exclude coverage of pre-existing conditions, but may impose an exclusion period (no more than 12 months) before covering such conditions. (See also, Health Insurance Portability and Accountability Act)



Crisis residential treatment services
Short-term, round-the-clock help provided in a nonhospital setting during a crisis. For example, when a child becomes aggressive and uncontrollable, despite in-home supports, a parent can temporarily place the child in a crisis residential treatment service. The purposes of this care are to avoid inpatient hospitalization, help stabilize the child, and determine the next appropriate step.

Cristina (Spanish)

Smokable methamphetamine

Crack mixed with methamphetamine; methamphetamine


Crush and rush
Method of methamphetamine production in which starch is not filtered out of the ephedrine or pseudoephedrine tablets.


Cocaine; amphetamine; methamphetamine;PCP

Crystal glass
Crystal shards of methamphetamine

Crystal meth

Cultural Competence
Actions that indicate an awareness and acceptance of the importance of addressing cultural factors while providing care; ability to meet the needs of clients and patients from diverse backgrounds.

Cultural competence
Help that is sensitive and responsive to cultural differences. Caregivers are aware of the impact of culture and possess skills to help provide services that respond appropriately to a person's unique cultural differences, including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. They also adapt their skills to fit a family's values and customs.

Data Warehouse
A component of a computer-based patient record that accepts, files, and stores clinical data over time from a variety of intervention systems for the purposes of developing population-based practice guidelines, outcomes management, and research.

Date Rape Drug
See Rohypnol

Day treatment
Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy. It lasts at least 4 hours a day. Day treatment programs work in conjunction with mental health, recreation, and education organizations and may even be provided by them.

The minimum threshold payment that must be made by a health plan enrollee each year before the plan begins to make payments on a shared or total basis. (Source: Rognehaugh R, The Managed Care Dictionary)

The amount an individual must pay for health care expenses before insurance (or a self- insured company) begins to pay its contract share. Often insurance plans are based on yearly deductible amounts.

Delusions are bizarre thoughts that have no basis in reality.

Demand-side Management
Use of employer-provided health education, wellness, and client empowerment programs to assist members to make cost-effective healthcare decisions, thereby decreasing unnecessary utilization and costs. These programs may be part of a carve-out service.

Refers to a group of symptoms involving progressive impairment of all aspects of brain function. Disorders that cause dementia include conditions that impair the vascular (blood vessels) or neurologic (nerve) structures of the brain. A minority of causes of dementia are treatable. These include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes and infections. Unfortunately, most of the disorders associated with dementia are progressive, irreversible, degenerative conditions. The two major degenerative causes of dementia are Alzheimer's disease, which is a progressive loss of nerve cells without a known cause or cure and vascular dementia, which is loss of brain function due to a series of small strokes. Dementia may be diagnosed when there is impairment of two or more brain functions, including language, memory, visual-spatial perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually appears first as forgetfulness. Other symptoms may be apparent only on neurologic examination or cognitive testing. Loss of functioning progresses slowly from decreased problem solving and language skills to difficulty with ordinary daily activities to severe memory loss and complete disorientation with withdrawal from social interaction.

Drugs used medicinally to relieve anxiety, irritability, and tension. They have a high potential for abuse and development of tolerance. Depressants produce a state of intoxication similar to that of alcohol. When combined with alcohol, the effects are increased and risks are multiplied. Drugs that fall under the depressant category include barbiturates, methaqualone, tranquilizers, chloral hydrate, and glutethimide.

A term that people commonly use to refer to states involving sadness, dejection, lack of self-esteem, and lack of energy. Feelings of depression are synonymous with feeling sad, blue, down in the dumps, unhappy, and miserable. Most feelings of depression are a reaction to an unhappy event. It is natural to have some feelings of sadness after a loss such as the death of a relative, or after a major disappointment at home or at work. Depression is more prevalent in women than men and is especially common among adolescents. Mild depression comes and goes and is characterized by downheartedness, sadness, and dejection. Short-term episodes of depression or other mood changes can occur with hormone changes, including those that accompany pregnancy or premenstrual syndrome (PMS), and those occurring shortly after the birth of a baby (postpartum "blues"). Sleep disruption and lack of sunlight during the winter months are other biological factors that can precipitate depressive symptoms. Distorted thought patterns, characterized by feelings of worthlessness, helplessness, and hopelessness are part of the "cognitive triad of depression," and can be a risk factor for depression. It appears that a tendency toward depression is often genetic, but that stressful life circumstances usually play a major role in bringing on depressive episodes. Problems with depression usually begin in adolescence, and are about twice as common in women as in men. Noticeably disturbed thought processes, poor communication and socialization, and sensory dysfunction indicate moderate depression. People with severe depression are withdrawn, indifferent toward their surroundings, and may show signs of delusional thinking and limited physical activity.



Diabetes is a life-long disease marked by elevated levels of sugar in the blood. It can be caused by too little insulin (a chemical produced by the pancreas to regulate blood sugar), resistance to insulin, or both. People with diabetes have high blood glucose. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both. There are three major types of diabetes: * Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are required to sustain life. Without proper daily management, medical emergencies can arise. * Type 2 diabetes is far more common than type 1 and makes up about 90% of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity levels, and widespread failure to exercise. * Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes. High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all. About 40% of type 2 diabetics have no symptoms of the condition.

Diagnostic Evaluation
The aims of a general psychiatric evaluation are 1) to establish a psychiatric diagnosis, 2) to collect data sufficient to permit a case formulation, and 3) to develop an initial treatment plan, with particular consideration of any immediate interventions that may be needed to ensure the patient's safety, or, if the evaluation is a reassessment of a patient in long-term treatment, to revise the plan of treatment in accord with new perspectives gained from the evaluation.

Diagnostic Related Groups (DRGs)
A payment system that reimburses healthcare providers a fixed amount for all care in connection with a standard diagnostic category. The DRG system was instituted by Medicare and is now used by many insurance companies. It is a form of case rate payment system.

Dietary Fiber
Dietary fiber is found in plant foods and humans cannot digest it. It has no calories because the body cannot absorb it. Dietary fiber provides a feeling of fullness and adds bulk in the diet. This assists digestion and elimination. Including fiber in your daily diet helps prevent many problems and brings many benefits. It may be helpful in controlling weight by making you feel full sooner. It helps prevent constipation. It may be helpful in the prevention or treatment of diverticulosis, diabetes, and heart disease (ask your health care provider or registered dietician about recommendations for these conditions). There are two forms of fiber: soluble and insoluble. Soluble fiber attracts water and turns to gel during digestion. This slows digestion and the rate of nutrient absorption from the stomach and intestine. It is found in oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Insoluble fiber is found in foods such as wheat bran, vegetables and whole grains. It appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. The recommendation for older children, adolescents and adults is 20 to 35 grams per day. Younger children will not be able to eat enough calories to achieve this, but introducing whole grains, fresh fruits and other high fiber foods is suggested. To ensure an adequate fiber intake, eat a variety of foods, including more fruits, vegetables, whole grains, cereals, and dried beans and peas.

A discharge is the formal termination of service, generally when treatment has been completed or through administrative authority.

Discount Rate
The rate at which future dollars or future units of effectiveness are devalued, relative to current dollars or units of effectiveness.

The process of devaluing future dollars or units of effectiveness to reflect preferences for dollars or goods or services now, versus in the future.

Disease Management Programs
Comprehensive, integrated programs for managing patients' disease conditions. These programs usually target specific disease conditions for which there are effective, evidence-based practice guidelines, and are designed for diseases such as depression, diabetes, arthritis, hypertension, and heart disease.

A brain chemical, classified as a neurotransmitter, found in regions of the brain that regulate movement, emotion, motivation, and pleasure.

Drop-in Center
A social club offering peer support and flexible schedule of activities: may operate on evenings and/ weekends.

Wrapping methamphetamine in bread and then consuming it

A chemical compound or substance that can alter the structure and function of the body. Psychoactive drugs affect the function of the brain, and some of these may be illegal to use and possess.

Drug abuse
The use of illegal drugs or the inappropriate use of legal drugs. The repeated use of drugs to produce pleasure, to alleviate stress, or to alter or avoid reality (or all three).

Drug Formulary
The list of prescription drugs for which a particular employer or State Medicaid program will pay. Formularies are either "closed," including only certain drugs or "open," including all drugs. Both types of formularies typically impose a cost scale requiring consumers to pay more for certain brands or types of drugs.

Drug Free Workplace Act
The 1988 Federal act that laid the groundwork for subsequent regulation of workplace drug testing.

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
An official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when discussing mental health problems.

Dual Diagnosis
Identification of dual diseases, disorders, or injuries, commonly used to describe individuals diagnosed with both mental disorders and addictive diseases.

A reading disability resulting from a defect in the ability to process graphic symbols. There are about 2 to 8% of elementary-age children that have some degree of reading disability. Developmental reading disorder (DRD) or dyslexia is not attributable to eye problems but instead is a defect of higher cortical (brain) processing of symbols. Children with DRD may have trouble rhyming and separating the sounds in spoken words. These abilities appear critical in the process of learning to read. Initial reading skills are based on word recognition. More developed reading skills require the linking of words into a coherent sentence (thought). DRD children may be unable to form images from the meanings of the words or to process the words into an idea which is understandable. At this level, reading may fail at its primary function, which is to convey information. Dyslexia or developmental reading disorder may appear in combination with developmental writing disorder and developmental arithmetic disorder. All of these processes involve the manipulation of symbols and the conveyance of information by their manipulation. These conditions may appear singly or in any combination. Other causes of learning disability and, in particular, reading disability, must be ruled out before a diagnosis of DRD can be made. Cultural and educational shortfalls, emotional problems, mental retardation, and diseases of the brain (for example AIDS) can all cause learning disabilities. Remedial instruction has remained the best approach to this type of reading disorder.

electronic mail, or written messages that people exchange via computer in ordinary language. It is created, sent, delivered and read using a specific software product that must be bought by the user and loaded onto his or her computer. Microsoft Outlook, Lotus Mail, and Eudora are all e-mail products. E- mail sent from one person to another on the same LAN or WAN is delivered by the network itself. E-mail from one network or computer system to another is delivered via the internet by an INTERNET SERVICE PROVIDER.

Early Intervention
Refers to identifying persons at high risk prior to their having a serious consequence, or persons at high risk who have had limited serious consequences related to substance use on the job, or having a significant personal, economic, legal, or health/mental health consequence, and providing these persons at high risk with appropriate counseling, treatment, education, or other intervention.

Ecstasy (MDMA)
Aa stimulant that combines the effects of amphetamines and hallucinogens. MDMA is a synthetic, psychoactive drug with both stimulant (amphetamine-like) and hallucinogenic (LSD-like) properties. Street names for MDMA include Ecstasy, Adam, XTC, hug, beans, and love drug. Its chemical structure (3-4 methylenedioxymethamphetamine, "MDMA") is similar to methamphetamine, methylenedioxyamphetamine (MDA), and mescaline - other synthetic drugs known to cause brain damage. MDMA also is neurotoxic. In addition, in high doses it can cause a sharp increase in body temperature (malignant hyperthermia) leading to muscle breakdown and kidney and cardiovascular system failure.

Education Services link
Locating or providing a full range of educational services from basic literacy through the General Equivalency Diploma and college courses. Includes special education at the pre-primary, primary, secondary, and adult levels.

Effect Size
The magnitude of a relationship between the dependent and independent variables in the population, or the degree of departure from the null hypothesis. Typical measures of effect size include d, eta, and r.

One pound of methamphetamine

Electroconvulsive Therapy
Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to treat some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life- saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines, and anesthesia have significantly reduced the possibility of side effects.

Eligible Employee
An employee who qualifies to receive health benefits through his/her employer.

A planned program to provide psychiatric care in emergency situations with staff specifically assigned for this purpose. Includes crisis intervention, which enables the individual, family members and friends to cope with the emergency while maintaining the individual's status as a functioning community member to the greatest extent possible.

Emergency and crisis services
A group of services that is available 24 hours a day, 7 days a week, to help during a mental health emergency. Examples include telephone crisis hotlines, suicide hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care.

Emergency Medical Treatment and Labor Act (EMTALA)
EMTALA, also referred to as the Federal Anti- patient Dumping Law link An act pertaining to emergency medical situations. EMTALA requires hospitals to provide emergency treatment to individuals, regardless of insurance status and ability to pay (EMTALA, 2002).

This is a broad category of employment that includes competitive, supported, and sheltered employment.

Employee Assistance Program (EAP)
Programs to assist employees, their family members, and employers in finding solutions for workplace and personal problems. The EAP may be provided directly by the employer or be part of the healthcare contract with a managed care organization or managed behavioral healthcare organization. Components of An EAP program may include some or all of the following components: employee education, supervisor training, drug testing, needs assessments, wellness programs, support for parents, health fairs, peer-to-peer counseling, interactive Web sites, health risk appraisals, newsletters, and employee seminars and information campaigns.

Employee Retirement Income Security Act of 1974 (ERISA)
Also called the Pension Reform Act, this act regulates the majority of private pension and welfare group benefit plans in the United States. It sets forth requirements governing, among many areas, participation, crediting of service, vesting, communication and disclosure, funding, and fiduciary conduct.

Employment/Vocational Rehabilitation Services
A broad range of services designed to address skills necessary for participation in job- related activities.

Something produced by the brain or body.

A person eligible for services from a managed care plan.

The total number of covered persons (employees and their dependents) enrolled in a health plan. Also refers to the process by which a health plan signs up groups and individuals for membership, or to the number of enrollees who sign up in any one group.

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.

Exclusive Provider Organization
A plan in which the patient must remain in the network to receive benefits (out-of- network costs are paid by the patient); a plan regulated under State insurance statute that provides coverage only for contracted providers and does not extend to non- preferred-provider services.

Face Time
Time spent at the employer's offices interacting with colleagues, supervisors, etc. Many employers require regular face time to ensure the teleworker's integration into company culture and practices.

Family-centered services
Help designed to meet the specific needs of each individual child and family. Children and families should not be expected to fit into services that do not meet their needs. Also see appropriate services, coordinated services, wraparound services, and cultural competence.

Family-like arrangements
A broad range of living arrangements that simulate a family situation. This includes foster care and small group homes.

Family support services
Help designed to keep the family together, while coping with mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parenting training, crisis services, and respite care.


Fee for Service
A type of health care plan under which health care providers are paid for individual medical services rendered.

Fetal Alcohol Syndrome
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

Crack and methamphetamine; to inject a drug

Fire Safety
Fire Safety-In the event of a fire, remember time is the biggest enemy and every second counts! Escape first, then call for help. Develop a home fire escape plan and designate a meeting place outside. Make sure everyone in the family knows two ways to escape from every room. Practice feeling your way out with your eyes closed. Never stand up in a fire, always crawl low under the smoke and try to keep your mouth covered. Never return to a burning building for any reason; it may cost you your life. Finally, having a working smoke alarm dramatically increases your chances of surviving a fire. And remember to practice a home escape plan frequently with your family. In less than 30 seconds a small flame can get completely out of control and turn into a major fire. It only takes minutes for thick black smoke to fill a house. In minutes, a house can be engulfed in flames. Most fires occur in the home when people are asleep. If you wake up to a fire, you won't have time to grab valuables because fire spreads too quickly and the smoke is too thick. There is only time to escape. A fire's heat alone can kill. Room temperatures in a fire can be 100 degrees at floor level and rise to 600 degrees at eye level. Inhaling this super hot air will scorch your lungs. This heat can melt clothes to your skin. In five minutes a room can get so hot that everything in it ignites at once: this is called flashover. Fire starts bright, but quickly produces black smoke and complete darkness. If you wake up to a fire you may be blinded, disoriented and unable to find your way around the home you've lived in for years. Fire uses up the oxygen you need and produces smoke and poisonous gases that kill. Breathing even small amounts of smoke and toxic gases can make you drowsy, disoriented and short of breath. The odorless, colorless fumes can lull you into a deep sleep before the flames reach your door. You may not wake up in time to escape.

a secure way of setting up a computer network so that users 'outside' the firewall cannot gain access. For example ABC Company may have an internal information system (sometimes called an intranet) that everyone in the company can use to communicate, but no one outside the company can access it because of the ABC's firewall.

First Aid
First Aid-Know CPR and/or first aid techniques. Post emergency numbers near the telephone. Know how and when to call 911 or other emergency numbers. Keep a first aid kit available.

Combines snorting of heroin, cocaine, methamphetamine, ground up flunitrazepam pills, and drinking alcohol

The five way
Heroin plus cocaine plus methamphetamine plus Rohypnol (flunitrazepam) plus alcohol

Flexible Work
Denotes a range of working practices defined by employers and documented in employment policies. Flexible work policies give employees latitude as to how work will get done. Examples are flexible hours (the policy states a minimum number of hours to be worked and parameters for when those hours can be); flexible work location (various permissible work locations are defined); and flexible work contracts (for example the employee's role may vary within defined parameters).

Folic Acid
Folic Acid is a water-soluble vitamin of the B-complex group (B9). Folic acid acts as a coenzyme (with vitamin B-12 and vitamin C) in the breakdown (metabolism) of proteins and in the synthesis of new proteins. It is necessary for the production of red blood cells and the synthesis of DNA (which controls heredity), as well as tissue growth and cell function. It also increases the appetite and stimulates the formation of digestive acids. Synthetic folic acid supplements may be used in the treatment of disorders associated with folic acid deficiency, and may also be part of the recommended treatment for certain menstrual problems and leg ulcers. Food sources of folic acid include: beans and legumes, citrus fruits and juices, wheat bran and other whole grains, dark green leafy vegetables, poultry, pork, shellfish, and liver.

Food Safety
Refers to the conditions and practices that preserve the quality of food to prevent contamination and food-borne illnesses. Proper handling and preparation of food greatly reduces the risks of getting foodborne illnesses. Food can be contaminated in many different ways -- during the packaging process, by inadequate cooking or storage. Different food products may already have different microorganisms such as bacteria or parasites which may be allowed to multiply and cause disease if food is not appropriately handled. Higher risk foods include red meats and poultry; eggs; cheese and dairy products; raw sprouts; and raw fish or shellfish. The main consequence of improper handling and inadequate food safety is infection (foodborne illness) which may be severe and life-threatening especially in young children, older adults, pregnant women, and persons with weakened immune systems. To safetly handle food wash your hands thoroughly before and after handling any food, and after using the bathroom, changing diapers or after coming into contact with animals; Wash all cutting boards and utensils with hot water and soap after preparing each food item and prior to moving on to the next food item. Wear gloves or avoid preparation if your hands have any cuts or sores; Avoid cross-contaminating food items -- separate meat, poultry and seafood from other food and always wash hands, utensils and boards after coming into contact with these products; Cook to proper temperatures. Cook eggs until both the white and yolk are firm. Fish should be opaque and flake easily. Red meats and poultry should reach an internal temperature of 160 and 180 degrees, respectively. Leftovers must be reheated thoroughly to at least 165 degrees Fahrenheit; Refrigerate promptly -- some items such as meat and poultry must be frozen if not to be used within 1-2 days. Leftovers should be refrigerated within two hours. Keep frozen foods in the freezer until they are ready to be thawed and cooked; Foods can also be contaminated before they are purchased. Watch for and do not use outdated food, packaged food with the seal broken, and cans that have a bulge. Do not use foods that have an unusual odor or a spoiled taste; Prepare home- canned foods in nearly sterile conditions and with extreme caution. Home-canned food is the most common cause of botulism.

Foster Care
Provision of a living arrangement in a household other than that of the client's/patient's family.

Full Service Employee Assistance Program (EAP)
A comprehensive EAP with a human resource management consultation orientation; typically well-funded and well-staffed; most are offered internally.

Gamma Hydroxy Butyrate (GHB)
In the 1980s, GHB was widely available over the counter in health food stores, and bodybuilders used it to lose fat and build muscle. GHB has been given nicknames such as Grievous Bodily Harm, G, Liquid Ecstasy, and Georgia Home Boy. In 1990, the Food and Drug Administration banned the use of GHB except under the supervision of a physician because of reports of severe side effects, including euphoric and sedative effects similar to the effects experienced after taking Rohypnol (the "date rape" drug.) GHB also has been associated with sexual assaults in cities throughout the United States (NIDA, Infofax.) Despite the ban on use, GHB is created in clandestine laboratories, in a variety of forms, including clear liquid, white powder and tablet. Increasing use rates are being reported. In 1998, the Denver Poison Control Center received 33 calls involving GHB, and almost half of these cases were considered life- threatening. (NIDA Infofax-Club Drugs, 2000.) Because it clears from the body relatively quickly, it is often difficult to detect when patients go to emergency rooms and other treatment facilities.

Marijuana; person who uses or manufactures methamphetamine

Primary care physician or local agency responsible for coordinating and managing the health care needs of members. Generally, in order for specialty services such as mental health and hospital care to be covered, the gatekeeper must first approve the referral.

Gatekeeper Model
A situation in which a primary care provider, the "gatekeeper," serves as the consumer's contact for healthcare and referrals. Also called closed access or closed panel.



General Hospital
A hospital that provides mental health services in at least one separate psychiatric unit with specially allocated staff and space for the treatment of persons with mental illness.

General Support
Includes transportation, childcare, homemaker services, day care, and other general services for clients/patients.


Getting glassed
To snort methamphetamine

Heroin; amphetamine; hypodermic needle; methamphetamine

Methcathinone; crank; methamphetamine

A sexually transmitted disease (commonly known as "the clap") caused by the bacterium Neisseria gonorrhea. Gonorrhea is one of the most common infectious bacterial diseases and is most frequently transmitted during sexual activity, including vaginal intercourse and both oral and anal sex. Gonorrhea is a reportable disease and all state governments require that cases of diagnosed gonorrhea be reported to the health authorities (State Board of Health). This allows for adequate follow-up and testing of sexual contacts. Gonorrhea is easily transmitted during oral, vaginal, or anal sex. The bacteria can infect the throat, producing a severe sore throat (gonococcal pharyngitis). It can infect the vagina, causing irritation with drainage (vaginitis), or the anus and rectum, producing a condition called proctitis. In addition, the organisms may spread up the female reproductive tract, through the cervix and uterus, into the fallopian tubes (the tubes that carry the egg from the ovaries to the uterus). On rare occasions gonorrhea can spread through non-sexual contact. An infected woman may transmit the infection to her newborn during childbirth. Infection of the newborn's eyes is called ophthalmia neonatorum (gonococcal conjunctivitis). Young girls who contract gonorrhea either from sexual abuse or intimate contact with recently contaminated objects (such as a damp towel) develop a severe infection called vulvovaginitis. Symptoms in women include: vaginal discharge, pain or burning on urination, urinary hesitancy, sore throat, painful sexual intercourse, and/or mouth sores. Symptoms in men include: increased irinary frequency or urgency, incontinence, urethral dischard, pain on urination, red or sowllen opening of penis, and/or tender testicles. There are two important steps to treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infected person. The second is to locate and test all of the person's other sexual contacts and to treat them to prevent further spread of the disease. That is why mandatory reporting has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the incidence is once again rising. Even though penicillin is effective against gonorrhea, there have been increasing numbers of strains that are resistant to penicillin (they don't respond to penicillin treatment). Because of this, gonorrhea is now treated by a large number of new and very potent antibiotics.

Granulated Orange

Group Model HMO
A healthcare model involving contracts with physicians organized as a partnership, professional corporation, or other association. The health plan compensates the medical group for contracted services at a negotiated rate, and that group is responsible for compensating its physicians and contracting with hospitals for care of their patients.

Group Therapy
This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet regularly with a therapist. The therapist uses the emotional interactions of the group's members to help them get relief from distress and possibly modify their behavior.

Gum Disease
Gum Disease or Periodintis is a dental disorder that results from progression of gingivitis, involving inflammation and infection of the ligaments and bones that support the teeth. Periodontitis is caused when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence. Plaque and tartar (calculus) accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction. Symptoms include: swollen gums, gums appear bright red or red-purple, gums appear shiny, gums bleed easily, gums may be tender when touched but are painless otherwise, breath odor and/or loose teeth. The goal of treatment is to reduce inflammation, and to correct causative conditions. Dental irritants such as rough surfaces of teeth or dental appliances should be repaired. It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. With periodontitis, professional tooth cleaning is often recommended more frequently than the standard twice a year.

Half elbows
1/2 pound of methamphetamine

Hallucinations are experiences of sensations that have no source. Some examples of hallucinations include hearing nonexistent voices, seeing nonexistent things, and experiencing burning or pain sensations with no physical cause.

Drugs that cause hallucinations - profound distortions in a person's perceptions of reality. Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but do not exist. Some hallucinogens also produce rapid, intense emotional swings. Hallucinogens cause their effects by disrupting the interaction of nerve cells and the neurotransmitter serotonin. Distributed throughout the brain and spinal cord, the serotonin system is involved in the control of behavioral, perceptual, and regulatory systems, including mood, hunger, body temperature, sexual behavior, muscle control, and sensory perception. LSD (an abbreviation of the German words for "lysergic acid diethylamide") is the drug most commonly identified with the term "hallucinogen" and the most widely used in this class of drugs. It is considered the typical hallucinogen, and the characteristics of its action and effects described in this Research Report apply to the other hallucinogens, including mescaline, psilocybin, and ibogaine.

Smokable methamphetamine

Health Insurance Organization (HIO)
HIOs act as fiscal intermediaries between State Medicaid agencies and healthcare providers. They receive a per capita payment from a Medicaid agency to finance the care of Medicaid enrollees. As with HMOs, they assume the risk of a loss if the payment is inadequate to cover a beneficiary's healthcare expenses. Unlike HMOs, however, HIOs typically do not deliver care. Since 1985, Congress has subjected HIOs engaged in full-risk contracting to the same regulatory standards as HMOs. HIOs that do not offer a comprehensive set of services, however, face fewer regulatory requirements. States contracting with HIOs for a less-than- comprehensive set of services must only address such issues as the term of the capitation arrangement, renegotiation, and distribution of shared savings.

Health Insurance Portability and Accountability Act (HIPAA)
This 1996 act provides protections for consumers in group health insurance plans. HIPAA prevents health plans from excluding health coverage of pre-existing conditions and discriminating on the basis of health status.

Health Maintenance Organization (HMO)
An organized system of healthcare that provides a comprehensive range of healthcare services to a voluntarily enrolled population in a geographic area on a primarily prepaid and fixed periodic basis. An HMO contracts with healthcare providers, e.g, physicians, hospitals, and other health professionals. Plan members are required to use participating providers for all health services. Model types include staff, group practice, network, and IPA. Under the Federal HMO Act, an entity must have three characteristics in order to call itself an HMO: 1. An organized system for providing people healthcare services, 2. An agreed-upon set of basic supplemental health and treatment services, and 3. A voluntarily enrolled group of people.

Health Plan Employer Data and Information Set (HEDIS)
A set of performance measures designed to standardize the way health plans report data to payers. HEDIS currently measures five major areas of health plan performance: quality, access and patient satisfaction, membership utilization, finance, and descriptive information on health plan management. HEDIS guidelines are published by CMS, which oversees federally funded healthcare.

Health Promotion Program
In the worksite, a program designed to improve employee health and productivity and to save the company money.

Heavy Drinker
Someone who reports having five or more drinks on five or more occasions in the past 30 days. A form of alcohol abuse.

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. The incidence and severity of hepatitis vary depending on many factors, including the cause of the liver damage and any underlying illnesses in a patient. Common risk factors include intravenous drug use, Tylenol overdose (the dose needed to cause damage is quite close to the effective dose so be sure to be careful to take Tylenol only as directed), risky sexual behaviors,

A highly addictive drug, and its use is a serious problem in America. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction. Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for heroin include "smack," "H," "skag," and "junk." Other names may refer to types of heroin produced in a specific geographical area, such as "Mexican black tar."

HHS Certified Laboratory
The term used to describe a laboratory that is certified by the Department of Health and Human Services and that participates in the National Laboratory Certification Program.

Smokable methamphetamine

Smokable methamphetamine

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino."

HIV infection is a viral infection caused by the human immunodeficiency virus (HIV) that gradually destroys the immune system, resulting in infections that are hard for the body to fight. Acute HIV infection may be associated with symptoms resembling mononucleosis or the flu within 2 to 4 weeks of exposure. HIV seroconversion (converting from HIV negative to HIV positive) usually occurs within 3 months of exposure. People who become infected with HIV may have no symptoms for up to 10 years, but they can still transmit the infection to others. Meanwhile, their immune system gradually weakens until they are diagnosed with AIDS. Acute HIV infection progresses over time to asymptomatic HIV infection and then to early symptomatic HIV infection and later, to AIDS (advanced HIV infection): HIV Infection (acute HIV infection) -->early asymptomatic HIV infection -->early symptomatic HIV infection -->AIDS. Most individuals infected with HIV will progress to AIDS if not treated. However, there is a tiny subset of patients who develop AIDS very slowly, or never at all. These patients are called non- progressors. HIV has spread throughout the United States. Higher concentrations of the disease are found in inner city areas. Any symptoms of illness may occur, since infections can occur throughout the body. Special symptoms relating to HIV infection include: sore throat, mouth sores, including candidal infection, muscular stiffness or aching, headache, diarrhea, swollen lymph glands, fever, fatigue, rash of various types, including seborrheic dermatitis, and/or frequent vaginal yeast infections. Drug therapy is often recommended for patients who are committed to taking all their medications and have a CD4 count less than 500 (indicating immune system suppression) or a high viral load (amount of HIV virus in the bloodstream). It is extremely important that patients take all doses of their medications, otherwise the virus will rapidly become resistant to the medications. Therapy is always given with a combination of antiviral drugs. People with HIV infection need to receive education about the disease and treatment so that they can be active partners in decision making with their health care provider.

Holiday meth
Green methamphetamine produced using Drano crystals

Home-based services
Help provided in a family's home either for a defined period of time or for as long as it takes to deal with a mental health problem. Examples include parent training, counseling, and working with family members to identify, find, or provide other necessary help. The goal is to prevent the child from being placed outside of the home. (Alternate term: in-home supports.)

A person who lives on the street or in a shelter for the homeless.

Horizontal consolidation
When local health plans (or local hospitals) merge. This practice was popular in the late 1990s and was used to expand regional business presence.

Horizontal Integration
Merging of two or more firms at the same level of production in some formal, legal relationship. In hospital networks, this may refer to the grouping of several hospitals, the grouping of outpatient clinics within the hospital, or a geographic network of various healthcare services. Integrated systems seek to integrate vertically with some organizations and horizontally with others.

Hot Ice
Smokable methamphetamine

Hot rolling
Liquefying methamphetamine in an eye dropper and then inhaling it

To heat methamphetamine and inhale the vapor through nose using a plastic tube

Household Safety
Household Safety-wear protective footwear and eye wear when mowing the lawn, operating power tools, working with a chisel and hammer or hammering metal on metal. Don't allow children to handle tools until they are old enough to understand and obey instructions regarding their proper use. All stairways should have a sturdy hand rail. All entryways should have lighting that is bright enough to read by. Don't leave objects on stairways and make sure that carpet on stairways is securely fastened. Unplug appliances (such as heating pads and electric blankets) when they are not in use. In the bathroom, use floor mats that don't slip. Put non-slip appliques on the bathtub. Don't use any electrical appliances when you are wet or in the bathtub, shower or pool. Make sure that each fireplace has a fire screen. Keep a fire extinguisher in the kitchen and at least one on every level. Know how to use the extinguishers. Keep the kitchen floor clean from spills that might cause someone to slip and fall. Position pot and pan handles toward the back of the stove or counter. Keep any guns in a locked cabinet and make sure they are unloaded. Firearms and ammunition should be stored separately.

Housing Services
Assistance to clients/patients in finding and maintaining appropriate housing arrangements.

HPV (human papilloma virus)
HPV (human papilloma virus) or genital warts is a viral skin disease characterized by a soft wart-like growth on the genitals. In adults, the disorder is considered a sexually- transmitted disease. Genital warts are caused by the human papilloma virus (HPV). Papilloma viruses cause small growths (warts) on the skin and mucous membranes. Infection of the genital and anal regions with HPV can cause warts (anogenital condyloma) on the penis, vulva, urethra, vagina, cervix, and around the anus (perianal). More than 70 different types of HPV have been classified. Several types, including 6, 11, and 42, are associated with raised, rough, easily visible genital warts (especially in women). Other types are associated with flat warts. More importantly, several types are associated with pre-malignant and malignant changes in the cervix (abnormal Pap smears). These include types 16, 18, 31, 33, 35, 39, 45, 51, and 52. Research also shows that the presence of both HPV and herpes virus together is a good predictor of cervical cancer. Lesions on the external genitalia are easily recognized. On the penis, genital warts tend to be drier and more limited than on the female genitalia or around the anus of either sex. They grow best in the moist genital area. They are raised, rough, flesh-colored "warty" appearing tumors that may occur singly or in clusters. Left untreated, warts around the anus and vulva may rapidly enlarge, taking on a "cauliflower-like" appearance. Keeping the infected area dry may be a problem because the warts are usually damp. In women, HPV can invade the vagina and cervix. These warts are flat and not easily visible without special procedures. Because HPV can lead to premalignant changes in the cervix (cervical dysplasia), it is important that this condition be diagnosed and treated. Regular Pap smears are important for detecting HPV. Infection with HPV is very common, although the majority of people have no symptoms (asymptomatic). In several studies done on college women, nearly half were positive for HPV; although only 1 to 2% had visible warts and less than 10% had ever had any visible genital warts. The incidence of genital warts appears to be increasing rapidly, although this may be a result of increased diagnostic ability and awareness. Risk factors for genital warts include multiple sexual partners, unknown partners, early onset of sexual activity, tobacco use, nutritional status, hormonal conditions, age, stress and concurrent viral infections (such as flu, HIV, Epstein-Barr and herpes). Symptoms include: raised "warty" appearing tumors on the genitals; raised, flesh colored lesions; genital lesions; cauliflower-like appearing growths around the anus or female genitalia; increased dampness or moisture in the area of the growths; itching of the penis, scrotum, anal area, or a vulvar itch; increased vaginal discharge; and/or abnormal vaginal bleeding (not associated with a menstrual period) after sexual intercourse (postcoital).

Hugs and Kisses
Combination of methamphetamine and methylenedioxymethamphetamine (MDMA)

Amphetamine; high quality methamphetamine; marijuana; methylenedioxymethamphetamine (MDMA); marijuana grown in water (hydroponic)

Hypoglycemia occurs when your body's blood sugar, or glucose, is abnormally low. The term insulin shock is used to describe severe hypoglycemia that results in unconsciousness. Hypoglycemia results when your body's glucose is used up too rapidly, when glucose is released into the bloodstream more slowly than is needed by your body, or when excessive insulin is released into the bloodstream. Insulin is a hormone produced by the pancreas in response to increased glucose levels in the blood, which then reduces blood glucose. Hypoglycemia is relatively common in diabetics. It occurs when too much insulin or oral antidiabetic medication is taken, not enough food is eaten, or from a sudden increase in the amount of exercise without an increase in food intake. Relative hypoglycemia, where a newborn's blood glucose is low, is a fairly common occurrence. Severe hypoglycemia may occur in an infant born to a gestational diabetic or a diabetic mother. In these cases the child is referred to as an IDM for "infant of diabetic mother." If, during the pregnancy, the mother's blood sugar is persistently high, the fetus' pancreas assists in controlling the excess blood sugar by producing extra insulin. When the infant is born, it no longer gets the mother's glucose, but still produces increased insulin, and the increased insulin drives the infant's blood sugar down to dangerous levels. This is a medical emergency that may result in seizures and damage to the baby's nervous system if not treated. Sometimes the cause of hypoglycemia is unknown, or idiopathic. In this case, people who are not diabetic and who do not have another known causes of hypoglycemia experience these symptoms. Hypoglycemia can occur because of an insulin-secreting tumor of the pancreas, liver disease, or as a response to the ingestion of alcohol. It can occur in adults, infants, and children. The incidence is approximately 1 out of 1000 people. Symptoms include: fatigue, general discomfort, uneasiness, or ill feeling (malaise), nervousness, Irritability, or even aggression, trembling, headache, hunger, cold sweats, rapid heart rate, blurry or double vision, confusion, convulsions and/or coma.

Cocaine; crack cocaine; smokable methamphetamine; methamphetamine; methylenedioxymethamphetamine (MDMA); phencyclidine (PCP)

The inability to achieve and maintain penile erection sufficient to complete satisfactory intercourse. Between 2 and 30 million men in the United States are affected by impotence problems, according to recent estimates. About 52% of men between 40 and 70 years-old have some degree of erectile dysfunction (ED). Approximately 90% of ED is caused by physical, not psychological, problems. Risk factors for ED include: hypertension (high blood pressure), hyperlipidemia (high cholesterol), diabetes, coronary artery disease, peripheral vascular disease, anemia, medications, smoking, alcohol abuse, surgical procedures (vascular surgeries, abdomino- perineal resection, radical prostatectomy, other pelvic surgeries, etc.), neurological conditions, depression, endocrine disorgers (low testosterone, thyroid disease, hyperprolactinemia, etc.), and/or trauma. Impotence can be classified as primary or secondary. A man with primary impotence has never had an erection sufficient for intercourse. This is rare. The more common condition, secondary impotence, is the loss of erectile function after a period of normal function. Except for impotence caused by injury or sudden illness, secondary impotence usually comes on gradually. Treatment of secondary impotence is usually more successful than that for primary impotence because it is easier to restore function that has been lost than it is to discover why function has never occurred in the first place.

The process of replacing missing data. May be done logically (based on other existing data) or with statistical techniques based on variables that are correlated with the variable and the missing data.

In Home Family Services
Mental health treatment and support services offered to children and adolescents with mental illness and to their family members in their own homes or apartments.

Incremental Cost-Effectiveness Ratio
The difference in the inflation-adjusted, discounted average costs of two programs, divided by the difference in discounted average levels of effectiveness of the two programs.

Incremental Net Benefit Value
The difference in the inflation-adjusted, discounted average benefits and costs of two alternative programs.

Indemnity plan
Indemnity insurance plans are an alternative to managed care plans. These plans charge consumers a set amount for coverage and reimburse (fully or partially) consumers for most medical services.

Independent living services
Support for a young person living on his or her own. These services include therapeutic group homes, supervised apartment living, and job placement. Services teach youth how to handle financial, medical, housing, transportation, and other daily living needs, as well as how to get along with others.

Indicated Prevention
A strategy designed for persons who are identified as having minimal but detectable signs or symptoms or precursors of some illness or condition, but whose condition is below the threshold of a formal diagnosis of the condition.

A defined, measurable variable used to monitor the quality or appropriateness of an important aspect of patient care. Indicators can be activities, events, occurrences, or outcomes for which data can be collected to allow comparison with a threshold, a benchmark, or prior performance.

Individual Practice Association (IPA) Model HMO
A healthcare model that contracts with an entity, which in turn contracts with physicians to provide healthcare services in return for a negotiated fee. Physicians continue in their existing individual or group practices and are compensated on a per capita, fee schedule, or fee-for-service basis.

Individual Therapy
Therapy tailored for a patient/client that is administered one-on-one.

Individualized services
Services designed to meet the unique needs of each child and family. Services are individualized when the caregivers pay attention to the needs and strengths, ages, and stages of development of the child and individual family members. Also see appropriate services and family-centered services.

Information and Referral Services
Information services are those designed to impart information on the availability of clinical resources and how to access them. Referral services are those that direct, guide, or a client/patient with appropriate services provided outside of your organization.

Breathable chemical vapors that produce psychoactive (mind-altering) effects. Although people are exposed to volatile solvents and other inhalants in the home and in the workplace, many do not think of inhalable substances as drugs because most of them were never meant to be used in that way. Young people are likely to abuse inhalants, in part because inhalants are readily available and inexpensive. Sometimes children unintentionally misuse inhalant products that are found in household products. Parents should see that these substances are monitored closely so that they are not inhaled by young children. Inhalants fall into the following categories: Solvents: Industrial or household solvents or solvent-containing products, including paint thinners or solvents, degreasers (dry- cleaning fluids), gasoline, and glues Art or office supply solvents, including correction fluids, felt-tip-marker fluid, and electronic contact cleaners Gases - Gases used in household or commercial products, including butane lighters and propane tanks, whipping cream aerosols or dispensers (whippets), and refrigerant gases - Household aerosol propellants and as sociated solvents in items such as spray paints, hair or deodorant sprays, and fabric protector sprays - Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide (laughing gas) Nitrites - aliphatic nitrites, including cyclohexyl nitrite, which is available to the general public; amyl nitrite, which is available only by prescription; and butyl nitrite, which is now an illegal substance.

The act of administering a drug or combination of drugs by nasal or oral respiration. Also, the act of drawing air or other substances into the lungs. Nicotine in tobacco smoke enters the body by inhalation. [5]

A method of administering a substance such as a drug into the skin, subcutaneous tissue, muscle, blood vessels, or body cavities, usually by means of a needle.

Inpatient hospitalization
Mental health treatment provided in a hospital setting 24 hours a day. Inpatient hospitalization provides: (1) short-term treatment in cases where a child is in crisis and possibly a danger to his/herself or others, and (2) diagnosis and treatment when the patient cannot be evaluated or treated appropriately in an outpatient setting.

Services designed to briefly assess the type and degree of a client's/patient's mental health condition to determine whether services are needed and to link him/her to the most appropriate and available service. Services may include interviews, psychological testing, physical examinations including speech/hearing, and laboratory studies.

Integrated Delivery System
A system of providers and diverse organizations working collaboratively to coordinate a full range of care and services within a community.

Integrated Health Plan
A single entity serving as an integrated delivery network that is fully responsible for obtaining and managing payer contracts, assuming healthcare risk, collecting revenue, and asset control by lease or ownership.

Integrated Service Delivery (ISD)
A generic term referring to a joint effort of physician/hospital integration for a variety of purposes.

A concept describing how previously separate organizations, functions, and/or caregivers are blending their services and operations to function more efficiently and effectively in offering a seamless system of care within which consumers can easily move.

Intensive case management
Intensive community services for individuals with severe and persistent mental illness that are designed to improve planning for their service needs. Services include outreach, evaluation, and support.

Intensive Residential Services
Intensively staffed housing arrangements for clients/patients. May include medical, psychosocial, vocational, recreational or other support services.

Intent-to-treat Design
An evaluation design in which analyses are conducted upon the basis of a treatment or comparison group assigned or chosen at baseline, regardless of how long observations remained in that group.

Internal Rate of Return
The discount rate associated with a net present value figure of $0. Programs with higher internal rates of return are more economically attractive.

Internal Validity
Refers to the ability to make statements about causal relationships between variables. Internal validity threats may diminish the truthfulness of those statements.

The International Classification of Diseases, Ninth Revision (ICD- 9)
The ICD-9 system is a classification system that groups related disease entities and procedures for the reporting of statistical information. Responsibility for maintenance of the classification system is shared between the National Center for Health Statistics (NCHS), which handles diagnosis classification, and the Center for Medicare and Medicaid Services (CMS), which handles procedure classification.

The worldwide networking of separate computer systems and networks into one "information superhighway". To get around, "browse," or "surf" this complex interconnection of networks, special software and hardware are needed. The cost of such equipment would be prohibitive for individuals, or even most companies. However, a user can gain access to the internet via an Internet Service Provider(ISP). One cannot get onto the internet simply by buying a computer, but must also contract with an ISP, usually for a monthly fee. Compuserve, AOL, Worldnet, MSN, and Mindspring are just a few of the hundreds of ISP's available.

Interpersonal Psychotherapy
Through one-on-one conversations, this approach focuses on the patient's current life and relationships within the family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on strengths.

Jet fuel
PCP; methamphetamine; methamphetamine combined with PCP (phencyclidine)

Smokable methamphetamine

a central nervous system depressant that produces a rapid-acting dissociative effect. It was developed in the 1970s as a medical anesthetic for both humans and animals. Ketamine is often mistaken for cocaine or crystal methamphetamine because of a similarity in appearance (NCADI, 2000). Also known as K, Special K, Vitamin K, Kit Kat, Keller, Super Acid, and Super C, Ketamine is available in tablet, powder, and liquid form. So powerful is the drug that, when injected, there is a risk of losing motor control before the injection is completed. In powder form, the drug can be snorted or sprinkled on tobacco or marijuana and smoked (Partnership for a Drug-Free America, 2000). The effects of Ketamine last from 1 to 6 hours, and it is usually 24-48 hours before the user feels completely "normal" again.

L.A. glass
Smokable methamphetamine

L.A. ice
Smokable methamphetamine

LAN (Local Area Network)
A group of computers hooked up to operate as a network within a specific building or on a floor of a building. The largest LAN's can operate among a few neighboring buildings.

An inflammation of the larynx generally associated with hoarseness or loss of voice. The voice box (larynx) is located at the top of the airway to the lungs (windpipe, trachea) and contains the vocal cords. When they become inflamed or infected, they swell. This can cause hoarseness, and may occasionally cause obstruction of the airway. The most common form of laryngitis is an infectious illness usually caused by a virus which results in hoarseness. It may also be part of a bacterial infection or part of a common cold, bronchitis, flu, or pneumonia. Laryngitis often follows or occurs during an upper respiratory infection and is a self- limiting condition. Common laryngitis is not normally associated with any breathing difficulty (respiratory distress). Several forms of laryngitis occur in children and can lead to significant or fatal respiratory obstruction. These are croup and epiglottitis (discussed under their respective headings). Other causes of laryngitis include laryngeal polyps, laryngeal paralysis (such as Horner syndrome), premalignant changes of the vocal mucosa, malignant tumors, allergies, and trauma. Symptoms include: recent or current upper respiratory infection, hoarseness, fever, swollen lymph nodes or glands in the neck and/or drooping eyelid on one side (Horner syndrome). Since most common laryngitis is viral, treatment with antibiotics is generally not indicated. Your health care provider will make this decision. Voice rest helps both the voice and to reduce inflammation of the vocal cords. A humidifier may provide comfort for the scratchy feeling sometimes associated with laryngitis. Decongestants and analgesics may provide some symptomatic relief from the accompanying upper respiratory infection.

Legal Advocacy
Legal services provided to ensure the protection and maintenance of a client's/patient's rights.

Lemon drop
Methamphetamine with a dull yellow tint

Length of Stay
The duration of an episode of care for a covered person. The number of days an individual stays in a hospital or inpatient facility.

Better grade methamphetamine

Lithium scabs
Open scabs and skin lesions due to methamphetamine abuse

Living Independently
A client who lives in a private residence and requires no assistance in activities of daily living.

Load of Laundry

Local Mental Health Authority
Local organizational entity (usually with some statutory authority) that centrally maintains administrative, clinical, and fiscal authority for a geographically specific and organized system of health care.

Long-term Disability Expenditures
Includes salary continuation payments for those covered by insured, self-administered, or trust plans (Source: U.S. Chamber of Commerce definition, 1995).

Lysergic Acid Diethylamide (LSD)
An hallucinogenic drug that acts on the serotonin receptor. LSD was discovered in 1938 and is one of the most potent mood- changing chemicals. It is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. LSD, commonly referred to as "acid," is sold on the street in tablets, capsules, and, occasionally, liquid form. It is odorless, colorless, and has a slightly bitter taste and is usually taken by mouth. Often LSD is added to absorbent paper, such as blotter paper, and divided into small decorated squares, with each square representing one dose. The Drug Enforcement Administration reports that the strength of LSD samples obtained currently from illicit sources ranges from 20 to 80 micrograms of LSD per dose. This is considerably less than the levels reported during the 1960s and early 1970s, when the dosage ranged from 100 to 200 micrograms, or higher, per unit.

Managed Behavioral Healthcare
Any of a variety of strategies to control behavioral health (i.e., mental health and substance abuse) costs while ensuring quality care and appropriate utilization. Cost-containment and quality assurance methods include the formation of preferred provider networks, gatekeeping (or precertification), case management, relapse prevention, retrospective review, claims payment, and others. In many employer-negotiated health plans, behavioral healthcare is separated from care available in the rest of the health plan for the separate management of costs and quality of care.

Managed Behavioral Healthcare Organizations (MBHO)
An organized system of behavioral healthcare delivery, usually to defined population or members of HMOs, PPOs, and other managed care structures; also known as a behavioral health carve-out.

Managed Care
For Workplace Managed Care definitional purposes, managed care includes the following four characteristics: (1) a network of healthcare providers operating within some degree of management control; (2) assumption of financial risk by the provider network or health benefit intermediary; (3) management of service utilization through guidelines, protocols, and case management techniques; and (4) provision of preventive care.

Managed Care Organization (MCO)
A generic term applied to a managed care plan; may be in the form of an HMO, PHO, PPO, EPO, or other structure.

Managed Healthcare Plan
A healthcare plan that integrates financing and management with the delivery of healthcare services to an enrolled population; employs or contracts with an organized provider network that delivers services and which (as a network or individual provider) either shares financial risk or has some incentive to deliver quality, cost-effective services; and uses an information system capable of monitoring and evaluating patterns of covered persons' use of healthcare services and the cost of those services.

Management Services Organization (MSO)
An organization that provides practice management, administration, and support services to individual physicians or group practices. MSOs are typically owned by hospital(s) or investors.

Mandatory Guidelines
In drug testing, the term used to refer to the Mandatory Guidelines for Federal Workplace Drug Testing Programs initially published in the Federal Register on April 11, 1988, and revised on June 9, 1994, to establish the scientific and technical guidelines for Federal drug testing programs.

A green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and flowers of a plant. You may hear marijuana called by street names such as pot, herb, weed, grass, boom, Mary Jane, gangster, or chronic. There are more than 200 slang terms for marijuana. Sinsemilla (sin-seh-me-yah; it's a Spanish word), hashish ("hash" for short), and hash oil are stronger forms of marijuana. All forms of marijuana are mind-altering. In other words, they change how the brain works. They all contain THC (delta-9- tetrahydrocannabinol), the main active chemical in marijuana. They also contain more than 400 other chemicals. Marijuana's effects on the user depend on the strength or potency of the THC it contains. THC potency of marijuana has increased since the 1970s but has been about the same since the mid-1980s.

Maternal and Child Health Programs (MCHP)
A State service organization to assist children under 21 years of age who have conditions leading to health problems

Marijuana; methamphetamine

A term that describes a third variable's relationship to a dependent and an independent variable, in which the third variable represents the generative mechanism through which the independent variable is able to influence the dependent variable of interest. A variable functions as a mediator when it meets the following criteria: (1) variations in the levels of the independent variable significantly account for variations in the presumed mediator; (2) variations in the mediator significantly account for variations in the dependent variable; and (3) a previously significant relationship between the independent and the dependent variable is lost or greatly attenuated when the variance accounted for by the independent/mediator relationship is removed.

Medicaid is a health insurance assistance program funded by Federal, State, and local monies. It is run by State guidelines and assists low-income persons by paying for most medical expenses.

Medicaid client
Mental health clients to whom some services were reimbursable through Medicaid.

Medical group practice
A number of physicians working in a systematic association with the joint use of equipment and technical personnel and with centralized administration and financial organization.

Medical Necessity
The evaluation of healthcare services to determine if they are medically appropriate and necessary to meet basic health needs, consistent with the diagnosis or condition and rendered in a cost-effective manner, and consistent with national medical practice guidelines regarding type, frequency, and duration of treatment.

Medical review criteria
Screening criteria used by third-party payers and review organizations as the underlying basis for reviewing the quality and appropriateness of care provided to selected cases.

Medical Review Officer
In drug testing, a licensed medical doctor specially trained in substance abuse who is responsible for receiving, interpreting, and evaluating drug test results.

Medically necessary
Health insurers often specify that, in order to be covered, a treatment or drug must be medically necessary for the consumer. Anything that falls outside of the realm of medical necessity is usually not covered. The plan will use prior authorization and utilization management procedures to determine whether or not the term "medically necessary" is applicable.

Medicare is a Federal insurance program serving the disabled and persons over the age of 65. Most costs are paid via trust funds that beneficiaries have paid into throughout the courses of their lives; small deductibles and some co-payments are required.

A drug that is used to treat an illness or disease according to established medical guidelines.

Medication Therapy
Prescription, administration, assessment of drug effectiveness, and monitoring of potential side effects of psycho-tropic medications.

MediGap plans are supplements to Medicare insurance. MediGap plans vary from State to State; standardized MediGap plans also may be known as Medicare Select plans.

Used synonymously with the terms enrollee and insured. A member is any individual or dependent who is enrolled in and covered by a managed health care plan.

Member Assistance Program
A human risk management program that focuses on lowering behavioral and healthcare costs by proactively reducing demand for treatment. Also known as "demand reduction" or "demand management program."

Memorandum for Record (MFR)
In drug testing, a statement prepared by an individual that provides or corrects information on any documents associated with a drug test.

Mental disorders
Another term used for mental health problems.

Mental Health
Refers to how a person thinks, feels, and acts when faced with life's situations. It is how people look at themselves, their lives, and the other people in their lives; evaluate the challenges and the problems; and explore choices. This includes handling stress, relating to other people, and making decisions.

Mental health
How a person thinks, feels, and acts when faced with life's situations. Mental health is how people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explore choices. This includes handling stress, relating to other people, and making decisions.

Mental Health Parity (Act)
Mental health parity refers to providing the same insurance coverage for mental health treatment as that offered for medical and surgical treatments. The Mental Health Parity Act was passed in 1996 and established parity in lifetime benefit limits and annual limits.

Mental health problems
Mental health problems are real. They affect one's thoughts, body, feelings, and behavior. Mental health problems are not just a passing phase. They can be severe, seriously interfere with a person's life, and even cause a person to become disabled. Mental health problems include depression, bipolar disorder (manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia, and conduct disorder.

Mental illnesses
This term is usually used to refer to severe mental health problems in adults.


Meth head
Methamphetamine regular user

Meth monster
One who has a violent reaction to methamphetamine

Meth speed ball
Methamphetamine combined with heroin

A powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpensive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse. Methamphetamine is commonly known as "speed," "meth," and "chalk." In its smoked form, it is often referred to as "ice," "crystal," "crank," and "glass." It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. The drug was developed early in this century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Methamphetamine's chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. The effects of methamphetamine can last 6 to 8 hours. After the initial "rush," there is typically a state of high agitation that in some individuals can lead to violent behavior.

Methlies Quik

Mexican crack
Methamphetamine with the appearance of crack; methamphetamine

Mexican speedballs
Crack and methamphetamine

MHA Administration
Activities related to the planning, organization, management, funding, and oversight of direct services.

MHA Data collection/reporting
These are activities to obtain, analyze, and report data for planning, management or evaluation purposes.

MHA Other Activities
Other specific non-direct service activities of State MHAs that further the provision of mental health services in the State.

MHA Planning Council Activities
All activities that comply with the mandate of State MHAs to form and operate a planning council to support the development of a strategic plan for mental health services and assess ongoing operations.

MHA Technical Assistance
Provision or sponsorship of training, education, or technical support in the planning, operation or management of public mental health programs in the State.

MI and MR/DD services
Services designed to address the needs of people with both psychiatric illness and mental retardation or developmental disabilities.

Mobile Treatment Team
Provides assertive outreach, crisis intervention, and independent-living assistance with linkage to necessary support services in the client's/patient's own environment. This includes PACT, CTTP, or other continuous treatment team programs.

A device that allows a computer to communicate with another computer by dialing over telephone lines. Modems may be built into compUters or added onto them as separate equipment. To get onto the INTERNET, one's computer must dial an ISP's computer using a modem

A term that describes a third variable's relationship to a dependent and an independent variable, in which the third variable partitions the independent variable into subgroups that establish its domains of maximal effectiveness in regard to the dependent variable. The moderator may be qualitative or quantitative, and it affects the direction and/or strength of the relation between the independent and the dependent variable. Within an ANOVA framework, the moderator effect can be represented as an interaction between an independent variable and a factor that specifies particular conditions for its effect.

An actuarial determination of the incidence and severity of sicknesses and accidents in a well-defined class or classes of persons.

More Than One Race
A category of racial grouping for a person who reports multiple racial origins.

An actuarial determination of the death rate at each age as determined from prior experience.

Motor Vehicle
Motor Vehicle-more than 41,000 people lose their lives in motor vehicle crashes each year and over two million more suffer disabling injuries, according to the National Safety Council. The triple threat of high speeds, impaired or careless driving and not using occupant restraints threatens every driver -- regardless of how careful or how skilled. Driving defensively means not only taking responsibility for yourself and your actions but also keeping an eye on "the other guy." The National Safety Council suggests the following guidelines to help reduce your risks on the road: Don't start the engine without securing each passenger in the car, including children and pets. Safety belts save thousands of lives each year! Lock all doors. Remember that driving too fast or too slow can increase the likelihood of collisions. Don't kid yourself. If you plan to drink, designate a driver who won't drink. Alcohol is a factor in almost half of all fatal motor vehicle crashes. Be alert! If you notice that a car is straddling the center line, weaving, making wide turns, stopping abruptly or responding slowly to traffic signals, the driver may be impaired. Avoid an impaired driver by turning right at the nearest corner or exiting at the nearest exit. If it appears that an oncoming car is crossing into your lane, pull over to the roadside, sound the horn and flash your lights. Notify the police immediately after seeing a motorist who is driving suspiciously. Follow the rules of the road. Don't contest the "right of way" or try to race another car during a merge. Be respectful of other motorists. While driving, be cautious, aware and responsible.

Motorcycle crack

National Committee for Quality Assurance (NCQA)
A national organization founded in 1979 and composed of 14 directors representing consumers, purchasers, and providers of managed healthcare. It accredits quality assurance programs in prepaid managed healthcare organizations, and develops and coordinates programs for assessing the quality of care and service in the managed care industry.

Native Hawaiian or Other Pacific Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.


Net Present Value
The inflation-adjusted, discounted benefits of a program or intervention, minus the inflation-adjusted, discounted costs of producing and consuming it, expressed in today's dollars or the dollars of a base year of interest.

The rules of behavior for the Internet and e- mail communications.

The system of participating providers and institutions in a managed care plan.

Network adequacy
Many States have laws defining network adequacy, the number and distribution of health care providers required to operate a health plan. Also known as provider adequacy of a network.

Network Model HMO
An HMO type in which the HMO contracts with more than one physician group, and may contract with single- and multi-specialty groups. The physician works out of his/her own office. The physician works out of share in utilization savings, but does not necessarily provide care exclusively for HMO members.

New Generation Medications
Anti-psychotic medications which are new and atypical.

One of the most heavily used addictive drugs in the United States. Cigarette smoking has been the most popular method of taking nicotine since the beginning of the 20th century. In 1998, 60 million Americans were current cigarette smokers (28 percent of all Americans aged 12 and older), and 4.1 million were between the ages of 12 and 17 (18 percent of youth in this age bracket). In 1989, the U.S. Surgeon General issued a report that concluded that cigarettes and other forms of tobacco, such as cigars, pipe tobacco, and chewing tobacco, are addictive and that nicotine is the drug in tobacco that causes addiction. In addition, the report determined that smoking was a major cause of stroke and the third leading cause of death in the United States.

Non-Institutional Services
A facility that provides mental health services, but not on a residential basis, other than an inpatient facility or nursing home.

Non-Medicaid Services
Services other than those funded by Medicaid.

Nurse Practitioner (NP)
A nurse practitioner is a registered nurse who works in an expanded role and manages patients' medical conditions.

Nursing Home
An establishment that provides living quarters and care for the elderly and the chronically ill. This includes assisted living outside a nursing home.

Nutrition for Seniors
Nutrition for Seniors-As you grow older, you may need less energy from what you eat. But, you still need just as many of the nutrients in food. Nutrition experts can recommend what the average older person needs to eat, but you should also check with your doctor or a registered dietitian, a specialist trained in nutrition. This is especially true if you have a health problem that limits what you should eat. They can help you plan meals that will include the healthy foods you need without the foods you should avoid. Choose many different healthy foods. Pick those that are lower in fat, especially saturated fat (mostly in foods that come from animals), and cholesterol. Eat or drink only small amounts of sugary or salty foods, and alcoholic drinks, if you drink them at all. Avoid "empty calories" as much as you can. These are foods like sodas, potato chips, and cookies that have a lot of calories, but not many nutrients. The U.S. Department of Agriculture (USDA) has developed the Food Guide Pyramid to help you make healthy food choices. There are five major food groups. Every day you should try to eat the suggested number of servings from each group. If you can't do that, at least try to eat something from each group each day. Lower fat choices are best. Make sure you eat vegetables, fruits, and whole-grain foods.

Obesity is defined as a BMI (body mass index) over 30 kg/m2. Patients with a BMI between 25 and 29.9 are considered overweight, but not obese. An individual is considered obese when weight is 20% (25% in women) or more over the maximum desirable for their height. When an adult is more than 100 pounds overweight, it is considered morbid obesity. More than half of the U.S. population is overweight. But being obese is different from being overweight. Obesity increases a person's risk of illness and death due to diabetes, stroke, coronary artery disease, hypertension, high cholesterol, and kidney and gallbladder disorders. Obesity may increase the risk for some types of cancer. It is also a risk factor for the development of osteoarthritis and sleep apnea. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight. To help prevent an increase in weight: Avoid excess alcohol consumption; Stress; Depression; Boredom and frustration; Poor eating habits; and avoid a sedentary lifestyle. Perform aerobic exercise for at least 30 minutes a day, 3 times a week and try to increase physical activity in general by walking rather than driving, and climbing stairs rather than using an elevator or escalator. In addition reduce consumption of food that is high in fat and sugar.

In drug testing, the individual who watches the donor urinate into a collection container or specimen bottle when a direct-observed collection is required.

Obsessive-Compulsive Disorder (OCD)
One of the anxiety disorders, OCD is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home. Obsessions are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness. In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Mental problems, such as mentally repeating phrases, listmaking, or checking are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary. People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity. OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.

Occupational Illness
Occupational illness is any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to factors associated with employment. It includes acute and chronic illnesses or disease which may be caused by inhalation, absorption, ingestion, or direct contact.

Occupational Injury
Occupational injury is any injury such as a cut, fracture, sprain, amputation, etc., which results from a work-related event or from a single instantaneous exposure in the work environment.

Also known as "narcotic analgesics". Concern about the abuse of prescription painkillers has risen dramatically in the U.S. Of particular concern is the abuse of pain medications containing opiates, marketed under such brand names as Vicodin, OxyContin, Percocet, Demerol, and Darvon. According to the Drug Abuse Warning Network (DAWN), the incidence of emergency department (ED) visits related to narcotic analgesic abuse has been increasing in the U.S. since the mid-1990s, and more than doubled between 1994 and 2001.

Opportunity Cost
The value of resources used to produce or consume goods or services in their next best alternative use.

Organized Delivery Systems
Proposed networks of providers and payors that would provide care and compete with other systems for enrollees in their region. Systems could include any providers and/or sites that offer a full range of preventive and treatment services.

Information on outbreaks of concern to international travelers.

Outcome Measures
Assessments that gauge the effect or results of services provided to a defined population. Outcomes measures include the consumers' perception of restoration of function, quality of life, and functional status, as well as objective measures of mortality, morbidity, and health status.

The results of a specific health care service or benefit package.

Outcomes research
Studies that measure the effects of care or services.

Outlier Data
Extremely high or low values of a variable of interest.


P and P
Methamphetamine used in combination with MDMA (methylenedioxymethamphetamine) and Viagra

Panic Disorder
Panic Disorder is when people experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep. The good news is that proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks. Symptoms include pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy. Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam can be used to treat panic disorders. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered "gold standards" for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms.

A dosage unit of heroin; one-tenth of a gram or less of the drug ice or methamphetamine

Party and play
Methamphetamine used in combination with MDMA (methylenedioxymethamphetamine) and Viagra

Passive Inhalation
The exposure of non-smoking subjects to side- stream smoke from active smokers, thereby raising the possibility that a non-user may test positive.

A code known only to a specific user, thanks to which he or she can access a computer network, program, system or file. Usually a word or phrase.

Pastoral Counseling
Pastoral counselors are counselors working within traditional faith communities to incorporate psychotherapy, and/or medication, with prayer and spirituality to effectively help some people with mental disorders. Some people prefer to seek help for mental health problems from their pastor, rabbi, or priest, rather than from therapists who are not affiliated with a religious community.

The party, including employers, government agencies, and insurance companies, that purchases the health services provided to consumers.

Peanut butter
Methamphetamine; PCP mixed with peanut butter

Performance Goals
The desired level of achievement of standards of care or service. These may be expressed as desired minimum performance levels (thresholds), industry best performance (benchmarks), or the permitted variance from the standard. Performance goals usually are not static but change as performance improves and/or the standard of care is refined.

Performance Measure(s)
Methods or instruments to estimate or monitor the extent to which the actions of a healthcare practitioner or provider conform to practice guidelines, medical review criteria, or standards of quality.

Pharmacy Benefit Manager (PBM)
PBMs are third party administrators of prescription drug benefits.

Phencyclidine (PCP)
Also known as "angel dust" and is a hallucinogen. It is difficult to estimate the current use of phencyclidine in the United States because many individuals do not recognize that they have taken it. PCP is frequently laced with other illicit substances (such as marijuana) and the buyer not made aware of its presence. PCP use in the U.S. dates back to 1967 when it was sold as the "Peace Pill" in the Haight-Ashbury district of San Francisco. Its use never became very popular because it had a reputation for causing "bad trips." PCP use grew during the mid-1970s primarily because of different packaging (sprinkling on leaves that are smoked) and marketing strategies. During the 1980s it was established as the most commonly used hallucinogen, with the majority of users 15 to 25 years old. Although phencyclidine was initially developed by a pharmaceutical company searching for a new anesthetic, it was not suitable for human use because of its psychotropic side effects. PCP is no longer manufactured for legitimate, legal purposes. Unfortunately it can be made rather easily and without great expense by anyone with a basic knowledge of organic chemistry, making it a prime drug for the illicit drug industry. It is available illegally as a white, crystalline powder that can be dissolved in either alcohol or water.

Irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms. Specific phobia is an unfounded fear of a particular object or situation-such as being afraid of dogs, yet loving to ride horses, or avoiding highway driving, yet being able to drive on city and country roads. Virtually an unlimited number of objects or situations- such as being afraid of flying, heights, or spiders-can be the target of a specific phobia. Agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Many people who have agoraphobia become housebound. Others avoid open spaces, standing in line, or being in a crowd. Many of the physical symptoms that accompany panic attacks - such as sweating, racing heart, and trembling - also occur with phobias. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking. Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.

Physical Activity
Physical activity is defined as the state of being active, or as energetic action or movement. Physical activity can increase the basal metabolic rate by approximately 10%. This increase can last for up to 48 hours after the completion of the activity. Physical activity helps in the utilization of calories. The number of calories used is dependent on the type and intensity of the activity, and on the body weight of the person performing the physical activity. Physical activity assists in reducing the appetite. For the purpose of weight loss, physical activity can reduce body fat and is more beneficial in combination with reduced intake of calories. Physical activity also helps in the maintenance and control of weight. Physical activity contributes to health by reducing the heart rate, decreasing the risk for cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis. Physical activity also helps the body use calories more efficiently, thereby helping in weight loss and maintenance. It can increase basal metabolic rate, reduces appetite, and helps in the reduction of body fat.

Physical dependence
An adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped; usually occurs with tolerance.

Physician Assistant
A physician assistant is a trained professional who provides health care services under the supervision of a licensed physician.

Physician-Hospital Community Organization
Similar to a physician-hospital organization, with the addition of community governance representation.

Physician-Hospital Organization (PHO)
An IPA (individual practice association) associated with and often initiated by a hospital which provides management services; features a contracting mechanism for obtaining "covered lives," generally with 50:50 physician and hospital control and hospital financing.


Pink elephants

Pink hearts
Amphetamine; methamphetamine

Plan of care
A treatment plan especially designed for each child and family, based on individual strengths and needs. The caregiver(s) develop(s) the plan with input from the family. The plan establishes goals and details appropriate treatment and services to meet the special needs of the child and family.

Play Therapy
Geared toward young children, play therapy uses a variety of activities-such as painting, puppets, and dioramas-to establish communication with the therapist and resolve problems. Play allows the child to express emotions and problems that would be too difficult to discuss with another person.

Stands for "per member per month," a fixed rate paid per enrolled member under a managed care contract for the provision of healthcare. This is the form that a capitated payment usually takes.

Po coke

Point-of-Service (POS)
A type of healthcare benefit plan in which the insured person can choose to use a nonparticipating provider at a reduced coverage level and with more out-of-pocket cost. Such POS plans combine HMO-like systems with indemnity systems. Often known as open- ended HMOs or PPOs, these plans permit the insured to choose providers outside the plan, yet are designed to encourage the use of network providers. One of the most popular plans with consumers and employers, POS services represent the area of greatest HMO growth.

Poor man's coke

Isobutyl nitrite; amyl nitrite; methamphetamine

Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) affects people of all ages if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person's ability to hold a job or to develop intimate relationships with others. The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. In addition, people with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks. A rape victim with PTSD, for example, might avoid all contact with men and refuse to go out alone at night. Many people with PTSD also develop depression and may, at times, abuse alcohol or other drugs as "self-medication" to dull their emotional pain and to forget about the trauma. Psychotherapy can help people who have PTSD regain a sense of control over their lives. Many people who have this disorder need to confront what has happened to them and, by repeating this confrontation, learn to accept the trauma as part of their past. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Another focus of psychotherapy is to help people who have PTSD resolve any conflicts that may have occurred as a result of the difference between their personal values and how behaviors and experiences during the traumatic event violated them. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti- anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.

Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder is an anxiety disorder that develops as a result of witnessing or experiencing a traumatic occurrence, especially life threatening events. PTSD can cause can interfere with a person's ability to hold a job or to develop intimate relationships with others.

In statistics, the probability of rejecting the null hypothesis. In a statistical comparison of two groups, the power of a statistical test is the probability of correctly identifying a difference between the groups, given that the difference does in fact exist. Power = 1-beta, where beta is type II error.

Practical Significance
A result or value of sufficient magnitude that it is important to program providers, clients, employers, policy makers, or other stakeholders.

Practice Guidelines
Systematically developed statements on healthcare practice that assist healthcare providers and consumers in making decisions about appropriate healthcare for specific situations or conditions. Managed care organizations frequently use these guidelines to evaluate appropriateness and medical necessity of care.

Prader-Willi Syndrome
A congenital (present from birth) disease characterized by obesity, decreased muscle tone, decreased mental capacity, and hypogonadism. Prader-Willi is caused by the deletion of a gene on chromosome 15. For unkown reasons, only the copy of this gene on chromosome 15 that is received from the father is active. The maternal copy of this gene is turned off in all people. When there is a deletion of this gene on the copy received from the father, the disease occurs. This is because the patient is left with only the maternal copy -- which is inactive in all people. Signs of Prader-Willi may be seen at birth. New infants with the condition are often small and very floppy (hypotonic). Male infants may have undescended testicles. The growing child exhibits slow mental and delayed motor development, increasing obesity, and characteristically small hands and feet. Rapid weight gain may occur during the first few years because the patient develops uncontrollable hunger which leads to morbid obesity. Mental development is slow, and the IQ seldom exceeds 80. However, children with Prader-Willi generally are very happy, smile frequently, and are pleasant to be around. Affected children have an intense craving for food and will do almost anything to get it. This results in uncontrollable weight gain. Morbid obesity (the degree of obesity that seriously affects health) may lead to respiratory failure with hypoxia (low blood oxygen levels), cor pulmonale (right- sided heart failure), and death.

Pre-existing condition
A medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining a policy from the insurance company. Many insurance companies now impose waiting periods for coverage of pre-existing conditions. Insurers will cover the condition after the waiting period (of no more than 12 months) has expired. (See also, HIPAA)

Preferred Provider Organization (PPO)
A network discount, fee-for-service provider arrangement with incentives to stay inside the network; allows healthcare services outside of the PPO network at an increased copayment and/or deductible; has structured quality and utilization management.

Prescription Drugs
Make complex surgery possible, relieve pain for millions of people, and enable many individuals with chronic medical conditions to control their symptoms and lead productive lives. Most people who take prescription medications use them responsibly. However, the non-medical use of prescription drugs is a serious public health concern. Nonmedical use of prescription drugs like opioids, central nervous system (CNS) depressants, and stimulants can lead to abuse and addiction, characterized by compulsive drug seeking and use. Addiction rarely occurs among people who use a pain reliever, CNS depressant, or stimulant as prescribed; however, inappropriate use of prescription drugs can lead to addiction in some cases. Patients, healthcare professionals, and pharmacists all have roles in preventing misuse and addiction. For example, if a doctor prescribes a pain medication, CNS depressant, or stimulant, the patient should follow the directions for use carefully, and also learn what effects the drug could have and potential interactions with other drugs by reading all information provided by the pharmacist. Physicians and other health care providers should screen for any type of substance abuse during routine history-taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why.

The public health model of prevention includes primary, secondary, and tertiary prevention (defined elsewhere in this glossary). An Institute of Medicine (IOM) committee (1994) set forth another definition in which prevention refers to those interventions that take place before the onset of a disorder. IOM classifies preventive interventions as: -Universal preventive interventions: -Target the general public or an entire population not identified on the basis of individual risk -Selective preventive interventions: -Target populations whose risk of a disorder is significantly higher than average at present or over a lifetime -Indicated preventive interventions: -Target high risk individuals who have minimal but detectable signs or symptoms which may lead to a mental disorder.

Prevention Research
The U.S. Public Health Service definition defines prevention research as research designed to show results directly applicable to interventions to prevent occurrences of disease or disability.

Preventive Care
Comprehensive healthcare emphasizing priorities for prevention, early detection, and early treatment of conditions, generally including risk assessment appraisals, routine physical examinations, immunizations, and well-baby care.

Primary Care
Basic or general healthcare, traditionally provided by family practice, pediatrics, and internal medicine.

Primary Care Case Management (PCCM)
Case management that requires a gatekeeper to coordinate and manage primary care services, referrals, pre-admission certification, and other medical or rehabilitative services. The primary advantage of PCCM for Medicaid eligibles is increased access to PCP while reducing use of hospital outpatient departments and emergency rooms. (There is encouragement within Medicare Choices to provide PCP coordination for patients being treated by a wide variety of specialists but who no longer have a PCP for oversight.)

Primary Care Provider (PCP)
A term used to denote the health care provider who typically delivers health care services to the patient, such as a family practitioner, general internist, pediatrician, and sometimes an ob/gyn. Generally, under managed care, a PCP supervises, coordinates, and provides initial ambulatory medical care, acting as a "gatekeeper" for the initiation of all referrals for non-urgent specialty care.

Primary Prevention
Strategies designed to decrease the number of new cases of a disorder or illness.

Prior authorization
The approval a provider must obtain from an insurer or other entity before furnishing certain health services, particularly inpatient hospital care, in order for the service to be covered under the plan.

Productivity Correlates
Defined generally by economists as the amount of output of a good or service produced per unit of input needed to produce it. May be measured more easily in manufacturing processes in terms of goods or units produced per staff member or machine. More difficult to measure for services, because the boundaries that define services may be less well understood or the quality of services produced may be more difficult to measure. Factors related to productivity, such as various forms of absenteeism, restricted activity days, employee morale, production delays, job tenure, etc.

Propensity Score
In the context of performing adjustments for selection bias, the propensity score is the predicted probability that each client participates in a substance abuse program.

Proteins are complex organic compounds. The basic structure of protein is a chain of amino acids that contain carbon, hydrogen, oxygen, and nitrogen. The presence of nitrogen differentiates protein from carbohydrate and fat. Protein is the main component of muscles, organs, and glands. Every living cell and all body fluids, except bile and urine, contain protein. The cells of muscles, tendons, and ligaments are maintained with protein. Children and adolescents require protein for growth and development. Proteins are described as essential and nonessential proteins or amino acids. The human body requires approximately 20 amino acids for the synthesis of its proteins. The body can make only 13 of the amino acids -- these are known as the nonessential amino acids. They are called non- essential because the body can make them and does not need to get them from the diet. There are 9 essential amino acids that are obtained only from food, and not made in the body. If the protein in a food supplies enough of the essential amino acids, it is called a complete protein. If the protein of a food does not supply all the essential amino acids, it is called an incomplete protein. All meat and other animal products are sources of complete proteins. These include beef, lamb, pork, poultry, fish, shellfish, eggs, milk, and milk products. Protein in foods (such as grains, fruits, and vegetables) are either low, incomplete protein or lack one of the essential amino acids. These food sources are considered incomplete proteins. Plant proteins can be combined to include all of the essential amino acids and form a complete protein. Examples of combined, complete plant proteins are rice and beans, milk and wheat cereal, and corn and beans.

Provider (Participating Provider)
Individuals and/or organizations that directly deliver prevention, treatment, and maintenance services to consumers within the defined plan. Depending upon the arrangement, usually involves contracts.

Providers Service Organization/Provider Sponsored Network (PSN)
A formal affiliation of healthcare providers organized and operated to provide a full range of healthcare services; a term used in draft language of the 1996 budget discussions of House and Senate proposals that would allow Medicare to contract directly with PSNs on a full-risk capitated basis in a way that would "cut some HMOs out of the middle" depending on the ultimate language. The degree to which PSNs must be subject to licensing, financing, and insurance considerations, as regulated by State insurance commissioners, will determine the number of providers to qualify, as compared to the more rigid HMO standards under which provider networks must currently qualify.

Psychedelic drug
A drug that distorts perception, thought, and feeling. This term is typically used to refer to drugs with actions like those of LSD.

Psychiatric Emergency Walk- in
A planned program to provide psychiatric care in emergency situations with staff specifically assigned for this purpose. Includes crisis intervention, which enables the individual, family members and friends to cope with the emergency while maintaining the individual's status as a functioning community member to the greatest extent possible and is open for a patient to walk-in.

A psychiatrist is a professional who completed both medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness.

Psychoactive drug
A drug that changes the way the brain works.

Psychoanalysis focuses on past conflicts as the underpinnings to current emotional and behavioral problems. In this long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week, using "free association" to explore unconscious motivations and earlier, unproductive patterns of resolving issues.

Psychodynamic Psychotherapy
Based on the principles of psychoanalysis, this therapy is less intense, tends to occur once or twice a week, and spans a shorter time. It is based on the premise that human behavior is determined by one's past experiences, genetic factors, and current situation. This approach recognizes the significant influence that emotions and unconscious motivation can have on human behavior.

Psychosocial Rehabilitation
Therapeutic activities or interventions provided individually or in groups that may include development and maintenance of daily and community-living skills, self-care, skills training includes grooming, bodily care, feeding, social skills training, and development of basic language skills.

Quality-Adjusted Life- Year
Measurement unit to define health outcomes that result from medical or surgical care, expressed in terms of the number of years of life in a less-desirable health condition as compared to years of full health; if the quality of life for a bedridden patient is 50 percent with a life expectancy of 10 years, the measurement would be 5 quality-adjusted life-years. As the U.S. system of medicine becomes more focused on how to allocate limited healthcare resources, more attention will be given to this and other measures of intervention benefits.

Quality Assurance (QA)
A formal set of measures, requirements, and tasks to monitor the level of care being provided. Such programs include peer or utilization review components to identify and remedy deficiencies in quality. The program must have a mechanism for assessing effectiveness and may measure care against preestablished standards.

Quality of Care
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Smokable methamphetamine

Cocaine; heroin; methamphetamine

Randomization Test
A process of repeated testing used to eliminate P-values for statistical tests with small samples.

A large molecule that recognizes specific chemicals (normally neurotransmitters, hormones, and similar endogenous substances) and transmits the message carried by the chemical into the cell on which the receptor resides. [5]

Under the influence of drugs; methamphetamine

Redneck cocaine

Registered Nurse (RN)
A registered nurse is a trained professional with a nursing degree who provides patient care and administers medicine.

In drug abuse, relapse is the resumption of drug use after trying to stop taking drugs. Relapse is a common occurrence in many chronic disorders, including addiction, that require behavioral adjustments to treat effectively.

Remote Employees
A term generally used from the management point of view, meaning workers who are based at a location or locations different from management's location. For example a plant in Singapore might have remote Purchasing employees in Hong Kong. This is often the case when the remote employees serve more than one organizational unit. The Hong Kong Purchasing group might service all of an American company's Far East operation.

Report Card
An accounting of the quality of services, compared among providers over time. The report card grades providers on predetermined, measurable quality and outcome indicators. Generally, consumers use report cards to choose a health plan or provider, while policy makers may use report card results to determine overall program effectiveness, efficiency, and financial stability.

Report Card on Healthcare
An emerging tool that can be used by policymakers and healthcare purchasers such as employers, government bodies, employer coalitions, and consumers to compare and understand the actual performance of health plans. The tool provides health plan performance data in major areas of accountability, such as healthcare quality and utilization, consumer satisfaction, administrative efficiencies and financial stability, and cost control.

Reproductive Health
Reproductive Health is the many factors can contribute to producing healthy children. It is well known that the health of an unborn child can suffer if a woman fails to eat right, smokes, or drinks alcohol during pregnancy. It is not well known, however, that a man's exposure to substances in the workplace can affect his ability to have healthy children. Radiation, many chemicals, drugs (legal and illegal), cigarettes, and heat are examples of reproductive hazards.

Residential Services
Services provided over a 24-hour period or any portion of the day which a patient resided, on an on-going basis, in a State facility or other facility and received treatment.

Residential treatment centers
Facilities that provide treatment 24 hours a day and can usually serve more than 12 young people at a time. Children with serious emotional disturbances receive constant supervision and care. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long- term than inpatient hospitalization. Centers are also known as therapeutic group homes.

Respite care
A service that provides a break for parents who have a child with a serious emotional disturbance. Trained parents or counselors take care of the child for a brief period of time to give families relief from the strain of caring for the child. This type of care can be provided in the home or in another location. Some parents may need this help every week.

Respite Residential Services
Provision of periodic relief to the usual family members and friends who care for the clients/patients.

Clients who are of legal age, stopped working and have withdrawn from one's occupation.

The process by which neurotransmitters are removed from the synapse by being "pumped" through transporters back into the axon terminals that first released them.

The process that reinforces behavior. It is mediated at least in part by the release of dopamine into the nucleus accumbens. Human subjects report that reward is associated with feelings of pleasure.

Possibility that revenues of the insurer will not be sufficient to cover expenditures incurred in the delivery of contractual services. A managed care provider is at risk if actual expenses exceed the payment amount.

Risk adjustment
The adjustment of premiums to compensate health plans for the risks associated with individuals who are more likely to require costly treatment. Risk adjustment takes into account the health status and risk profile of patients.

Risk Analysis
The process of evaluating expected healthcare costs for a prospective group and determining what product, benefit level, and price to offer in order to best meet the needs of the group and the carrier.

Risk Sharing
The distribution of financial risk among parties furnishing a service. For example, if a hospital and a group of physicians from a corporation provide healthcare at a fixed price, a risk-sharing arrangement would entail both the hospital and the physician group being held liable if expenses exceed revenues.


Trade name for flunitrazepam, has been a concern for the last few years because of its abuse as a "date rape" drug. People may unknowingly be given the drug which, when mixed with alcohol, can incapacitate a victim and prevent them from resisting sexual assault. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants. Rohypnol produces sedative-hypnotic effects including muscle relaxation and amnesia; it can also produce physical and psychological dependence. In Miami, one of the first sites of Rohypnol abuse, poison control centers report an increase in withdrawal seizures among people addicted to Rohypnol. Rohypnol is not approved for use in the United States and its importation is banned. Illicit use of Rohypnol began in Europe in the 1970s and started appearing in the United States in the early 1990s, where it became known as "rophies," "roofies," "roach," "rope," and the "date rape" drug. Another very similar drug is now being sold as "roofies" in Miami, Minnesota, and Texas. This is clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril. It is sometimes abused to enhance the effects of heroin and other opiates. Based on emergency room admission information, Boston, San Francisco, Phoenix, and Seattle appear to have the highest use rates of clonazepam.

Route of administration
The way a drug is put into the body. Drugs can enter the body by eating, drinking, inhaling, injecting, snorting, smoking, or absorbing a drug through mucous membranes.

A serious brain disorder. It is a disease that makes it difficult for a person to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses to others, and to behave normally in social situations. Schizophrenia is a complex and puzzling illness. Even the experts in the field are not exactly sure what causes it. Some doctors think that the brain may not be able to process information correctly. Genetic factors appear to play a role, as people who have family members with schizophrenia may be more likely to get the disease themselves. Some researchers believe that events in a person's environment may trigger schizophrenia. For example, problems during intrauterine development (infection) and birth may increase the risk for developing schizophrenia later in life. Psychological and social factors may also play some role in its development. However, the level of social and familial support appears to influence the course of illness and may be protective against relapse. There are five recognized types of schizophrenia: catatonic, paranoid, disorganized, undifferentiated, and residual. Features of schizophrenia include its typical onset before the age of 45, continuous presence of symptoms for six months or more, and deterioration from a prior level of social and occupational functioning. People with schizophrenia can have a variety of symptoms. Usually the illness develops slowly over months or even years. At first, the symptoms may not be noticed. For example, people may feel tense, may have trouble sleeping, or have trouble concentrating. They become isolated and withdrawn, and they do not make or keep friends. No single characteristic is present in all types of schizophrenia. The risk factors include a family history of schizophrenia. Schizophrenia is thought to affect about 1% of the population worldwide. Schizophrenia appears to occur in equal rates among men and women, but women have a later onset. For this reason, males tend to account for more than half of clients in services with high proportions of young adults. Although the onset of schizophrenia is typically in young adulthood, cases of the disorder with a late onset (over 45 years) are known. Childhood- onset schizophrenia begins after five years of age and, in most cases, after relatively normal development. Childhood schizophrenia is rare and can be difficult to differentiate from other pervasive developmental disorders of childhood, such as autism.


School attendance
Physical presence of a child in a school setting during scheduled class hours. "Regular" school attendance is attendance at least 75% of scheduled hours.

School Based Services
School-based treatment and support interventions designed to identify emotional disturbances and/or assist parents, teachers, and counselors in developing comprehensive strategies for addressing these disturbances. School-based services also include counseling or other school-based programs for emotionally disturbed children, adolescents, and their families within the school, home and community environment.


Seasonal affective disorder (SAD)
Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box."

Secondary Prevention
Prevention strategies designed to lower the rate of established cases of a disorder or illness in the population (prevalence).

Section 1115 Waiver
A statutory provision that allows a State to operate its system of care for Medicaid enrollees in a manner different from that proscribed by the Centers for Medicare and Medicaid Services (CMS), in an attempt to demonstrate the efficacy and cost- effectiveness of an alternative delivery system through research and evaluation.

Section 1915(b) Waiver
A statutory provision that allows a State to partially limit the choice of providers for Medicaid enrollees; for example, under the waiver, a State can limit the number of times per year that enrollees can choose to drop out of an HMO.

Selection Bias
A bias in the estimate of a program effect that arises from the inability to separate the impact of the program on an outcome of interest from the impact of other factors that are correlated with program participation and outcome measures. Such bias often occurs in nonrandomized or poorly randomized settings, resulting in treatment and comparison groups that differ on measurable and unmeasurable factors. For example, self-referral to (or self-selection into) a substance abuse program may result in substantial differences between substance abusers who participate in the program and those who do not. These differences, along with participation status, may influence observed outcomes.

Selective Prevention
Strategy designed for individuals who are members of population subgroups whose risk of developing an imminent or lifetime disease or disability is significantly above average.

Self-help generally refers to groups or meetings that: involve people who have similar needs; are facilitated by a consumer, survivor, or other layperson; assist people to deal with a "life-disrupting" event, such as a death, abuse, serious accident, addiction, or diagnosis of a physical, emotional, or mental disability, for oneself or a relative; are operated on an informal, free-of-charge, and nonprofit basis; provide support and education; and are voluntary, anonymous, and confidential. Many people with mental illnesses find that self-help groups are an invaluable resource for recovery and for empowerment.

In the context of the accuracy of diagnosis coding, sensitivity refers to the ability to identify persons with a particular disorder using claims data or survey data among persons who really have that disorder.

Sensitivity Analysis
A process of repeating the CBA or CEA several times, each time varying one or more assumptions necessary to carry out the analysis, to see how robust the results are to these changing assumptions.

Serious emotional disturbances
Diagnosable disorders in children and adolescents that severely disrupt their daily functioning in the home, school, or community. Serious emotional disturbances affect one in 10 young people. These disorders include depression, attention- deficit/hyperactivity, anxiety disorders, conduct disorder, and eating disorders. Pursuant to section 1912(c) of the Public Health Service Act "children with a serious emotional disturbance" are persons: (1) from birth up to age 18 and (2) who currently have, or at any time during the last year, had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM- III-R. Federal Register Volume 58 No. 96 published Thursday May 20, 1993 pages 29422 through 29425.

Serious Mental Illness
Pursuant to section 1912(c) of the Public Health Service Act, adults with serious mental illness SMI are persons: (1) age 18 and over and (2) who currently have, or at any time during the past year had a diagnosable mental behavioral or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-IV or their ICD-9-CM equivalent (and subsequent revisions) with the exception of DSM-IV "V" codes, substance use disorders, and developmental disorders, which are excluded, unless they co-occur with another diagnosable serious mental illness. (3) That has resulted in functional impairment, which substantially interferes with or limits one or more major life activities. Federal Register Volume 58 No. 96 published Thursday May 20, 1993 pages 29422 through 29425.

A type of support or clinical intervention designed to address the specific mental health needs of a child and his or her family. A service could be provided only one time or repeated over a course of time, as determined by the child, family, and service provider.

Service Utilization
A description, usually statistical, of the level, frequency, and necessity of services actually used by consumers. Generally aggregated into population measures, rather than individual consumer measures.

Sexually transmitted diseases (STDs)
Sexually transmitted diseases (STDs), once called venereal diseases, are among the most common infectious diseases in the U.S. today. More than 20 STDs have now been identified and they affect more than 13 million men and women in this country each year. The annual comprehensive cost of STDs in the United States is estimated to be well in excess of $10 billion. STDs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly two-thirds of all STDs occur in people younger than 25 years of age. The incidence of STDs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. In addition, divorce is more common. The net result is that sexually active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing STDs. Most of the time, STDs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STD causes no symptoms, however, a person who is infected may be able to pass the disease on to a sex partner. That is why many doctors recommend periodic testing or screening for people who have more than one sex partner. Health problems caused by STDs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed. * Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. The latter can be fatal. * STDs in women also may be associated with cervical cancer. One STD, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers. * STDs can be passed from a mother to her baby before, during, or immediately after birth; some of these infections of the newborn can be cured easily, but others may cause a baby to be permanently disabled or even die. When diagnosed and treated early, many STDs can be treated effectively. Some infections have become resistant to the drugs used to treat them and now require newer types of antibiotics. Experts believe that having STDs other than AIDS increases one's risk for becoming infected with the AIDS virus.

Combination of powder cocaine and methamphetamine; crack cocaine; methamphetamine; methylenedioxymethamphetamine (MDMA)

Short-term Disability Expenditures
Includes company payments for sickness and accident benefits beyond any sick leave or other days not included in the short-term disability program. For example, many companies do not pay for the first five consecutive absence days under a short-term disability program.

Single-stream funding
The consolidation of multiple sources of funding into a single stream. This is a key approach used in progressive mental health systems to ensure that "funds follow consumers."


Smokeless Tobacco
Like cigarettes, comes from the tobacco plant. Unfortunately, most of the publicity focused only on the health hazards associated with cigarette smoking. While the number of cigarette smokers in the United States has continually decreased over recent years, the number of smokeless tobacco users has steadily increased. Since the 1970s, a 15-fold increase in smokeless tobacco has been noted in adolescents aged 17 to 19. This has most likely been related to the emphasis on smoke- free environments; availability of tobacco products; increased advertising of smokeless products; macho, athletic role models who use and advertise for smokeless products; and the false belief that smokeless tobacco is a safe alternative for those convinced they should stop smoking but who still want (are addicted to) the nicotine effects of tobacco.

Smoking Cessation
Means to quit or stop smoking. Some tips to help people quit smoking include: -Enroll in a smoking cessation program (hospitals, health departments, community centers, and work sites frequently offer programs). -Ask your health care provider for help, including whether prescription medications (such as Zyban) might help. -Find out about nicotine patches, gum, and sprays. -Hypnosis may help some people. -Ask your family, friends, and people you work with for help. -Avoid smoke-filled settings and situations in which you are more likely to smoke. -Start reducing your cigarette use, including decreasing the number and strength of the cigarettes. -Set a quit date. -Quit completely--cold turkey. -Exercise to relieve urges to smoke. -Get rid of all your cigarettes. -Make a plan about what you will do instead of smoking when you are stressed

Smoking During Pregnancy
Can lead to increased fetal death, premature labor, low birthweight infants, and SIDS (sudden infant death syndrome), which are all specific health risks associated with tobacco use.

Gamma hydroxybutyrate (GHB); crack cocaine; methamphetamine

Soap dope
Methamphetamine with a pinkish tint

Social Health Maintenance Organization
Federally funded Medicare demonstration project for the elderly; provides comprehensive health and long-term care benefits to Medicare beneficiaries. Unlike other Medicare-enrolling HMOs, care in a social HMO is reimbursed at 100 percent.


Methamphetamine that has a somewhat shiny appearance

In the context of the accuracy of diagnosis coding, specificity refers to the ability to identify those who do not have a disorder of interest using claims data or survey data among those who really do not have that disorder.

In drug testing, urine that has been provided by a donor for a drug test. The entire sample is contained in a single specimen bottle.

Speckled birds

Crack Cocaine; amphetamine; methamphetamine

Speed freak
Habitual user of methamphetamine

To shoot up or smoke a mixture of cocaine and heroin; ecstasy mixed with ketamine; the simultaneous use of a stimulant with a depressant

Split Specimen
In drug testing, a single specimen that is split into two separate specimen bottles. Split specimens are never collected from two different voids by the donor.


Sports injuries
Sports injuries like Raoul's may be inevitable, but there are some things you can do to help prevent them: Enroll your child in organized sports through schools, community clubs, and recreation areas where there may be adults who are certified athletic trainers (ATC). An ATC is also trained in the prevention, recognition and immediate care of athletic injuries. Make sure your child uses the proper protective gear for a particular sport. This may lessen the chances of being injured. Warmup exercises, such as stretching and light jogging, can help minimize the chance of muscle strain or other soft tissue injury during sports. Warmup exercises make the body's tissues warmer and more flexible. Cooling down exercises loosen the body's muscles that have tightened during exercise. Make warmups and cool downs part of your child's routine before and after sports participation. And don't forget to include sunscreen and a hat (where possible) to reduce the chance of sunburn, which is actually an injury to the skin. Sun protection may also decrease the chances of malignant melanoma--a potentially deadly skin cancer--or other skin cancers that can occur later in life. It is also very important that your child has access to water or a sports drink to stay properly hydrated while playing. Treat Injuries With "RICE" If your child receives a soft tissue injury, commonly known as a sprain or a strain, or a bone injury, the best immediate treatment is easy to remember. "RICE" (Rest, Ice, Compression, and Elevation) the injury. Get professional treatment if any injury is severe. A severe injury means having an obvious fracture or dislocation of a joint, prolonged swelling, or prolonged or severe pain. RICE: * Rest: Reduce or stop using the injured area for 48 hours. If you have a leg injury, you may need to stay off of it completely. * Ice: Put an ice pack on the injured area for 20 minutes at a time, 4 to 8 times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice that has been wrapped in a towel. * Compression: Compression of an injured ankle, knee, or wrist may help reduce the swelling. These include bandages such as elastic wraps, special boots, air casts and splints. Ask your doctor which one is best. * Elevation: Keep the injured area elevated above the level of the heart. Use a pillow to help elevate an injured limb.

Staff Model HMO
A healthcare model that employs physicians to provide healthcare to its members. All premiums and other revenues accrue to the HMO, which compensates physicians by salary and incentive programs.

Persons or groups who have strong interest about the design, function, or outcomes of a healthcare program or intervention.

State Children's Health Insurance Plan (SCHIP)
Under Title XXI of the Balanced Budget Act of 1997, the availability of health insurance for children with no insurance or for children from low-income families was expanded by the creation of SCHIP. SCHIPs operate as part of a State's Medicaid program (Centers for Medicare and Medicaid Services, 2002).

State Coverage
The total unduplicated count of mental health patients/clients served through State programs, exclusive of Medicaid and Other Coverage.

State Hospital
A publicly funded inpatient facility for persons with mental illness.

State Mental Health Authority or Agency
State government agency charged with administering and funding its State's public mental health services.

Statistical Power
The ability to accurately detect differences between groups or relationships between variables.

A class of drugs that elevates mood, increases feelings of well-being, and increases energy and alertness. These drugs produce euphoria and are powerfully rewarding. Stimulants include cocaine, methamphetamine, and methylphenidate (Ritalin).

Stove top
Crystal methamphetamine; methamphetamine

Defined as a feeling of tension that can be both emotional and physical. Emotional stress usually occurs when situations are considered difficult or unmanageable. Therefore, different people consider different situations as stressful. Physical stress refers to a physiological reaction of the body to various triggers. The pain experienced after surgery is an example of physical stress. Physical stress often leads to emotional stress, and emotional stress is frequently experienced as physical discomfort (e.g., stomach cramps). Stress management refers to various efforts used to control and reduce the tension that occurs in these situations. The attitude of an individual can influence whether a situation or emotion is stressful or not. Negative attitude can be a predictor of stress, because this type of person will often report more stress than a person with a more positive attitude. Stress is not a disease and is a normal part of everyone's life. Stress in small quantities is good: it makes us more productive. For example, the fear of a bad grade can make the a student study more attentively. However, too much stress is unhealthy and counterproductive. The same student, if he was recently mugged and or is getting over the sudden death of a friend will not be able to study as well. Persistent and unrelenting stress is called anxiety.

An arrangement whereby a capitated health plan pays its contracted providers on a capitated basis.

Employment group or individual that contracts with an insurer for medical services.

Substance Abuse
Refers to the abuse of alcohol and/or drugs. There are many definitions. The DSM-IV definition is: The 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: * recurrent substance use resulting in a failure to fulfill major role obligations; * recurrent substance use in situations in which it is physically hazardous; * recurrent substance-related legal problems; and * substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance.

Substance Abuse Prevention and Early Intervention Program (components of)
here are six key components: (1) Written company/managed care policy that includes prevention and early intervention; (2) Substance abuse education for covered lives; (3) A clearly identified locus (e.g., managed care corporation, personnel, human resources, EAP, etc.) for prevention and early intervention activities; (4) Program with all covered lives having access to prevention/early intervention programs and activities; (5) Capacity for prevention and early intervention; and (6) Trained medical/behavioral interventionists for prevention and early intervention.

A successful or unsuccessful attempt to intentionally kill oneself. Suicidal behaviors indicate that a person wishes to, intends to, or actually attempts to commit suicide. Suicidal behaviors can accompany many emotional disturbances, including depression, schizophrenia, and other psychotic illnesses. In fact, more than 90% of all suicides are related to an emotional or psychiatric illness. Suicidal behaviors occur as a response to a situation that the person views as overwhelming, such as social isolation, death of a loved one, emotional trauma, serious physical illness, growing old, unemployment or financial problems, guilt feelings, drug abuse, and alcohol abuse. In the U.S., suicide accounts for about 1% of all deaths each year. The highest rate is among the elderly, but there has been a steady increase in the rate among young people (particularly adolescents). Suicide is now the third leading cause of death for those 15 to 19 years old (after accidents and homicide). The incidence of reported suicides varies widely from country to country in the world; however, this may be in part related to reporting (especially in cultures where suicide is considered sinful or shameful). Suicide attempts (where the person tries to harm him- or herself but the attempt does not result in death) far outnumber actual suicides. The method of suicide attempt varies from relatively nonviolent methods (such as poisoning, overdose, or inhaling car exhaust) to violent methods (such as shooting or cutting oneself). Males are more likely to choose violent methods, which probably accounts for the fact that suicide attempts by males are more likely to be successful. Many unsuccessful suicide attempts are carried out in a manner or setting that makes rescue possible. They must be viewed as a cry for help.

Super ice
Smokable methamphetamine

Super X
Combination of methamphetamine and methylenedioxymethamphetamine (MDMA)

Clandestine laboratories capable of producing 10 pounds of methamphetamine in 24 hours

Supported Employment
Supportive services that include assisting individuals in finding work; assessing individuals' skills, attitudes, behaviors, and interest relevant to work; providing vocational rehabilitation and/or other training; and providing work opportunities. Includes transitional and supported employment services.

Supported Housing
Services to assist individuals in finding and maintaining appropriate housing arrangements.

Supportive Residential Services
Moderately staffed housing arrangements for clients/patients. Includes supervised apartments, satellite facilities, group homes, halfway houses, mental health shelter- care facilities, and other facilities.

Suppressor or Masking Variable
A variable that may have a low correlation with a dependent variable, but which, when entered in a multiple regression analysis, leads to improvement in the predictive power of another predictor in the equation. The inclusion of the variable is thought to control for irrelevant variance, that is, variance that it shares with the predictors but which may not be shared with the dependent variable.

A sexually transmitted or congenital infection caused by the bacterium Treponema pallidum. Syphilis is an infectious disease caused by the spirochete Treponema pallidum, which penetrates broken skin or mucous membranes. Transmission occurs most frequently by sexual contact. Syphilis can also be transmitted to the fetus during any stage in pregnancy. Syphilis is widespread in the United States and primarily involves sexually active adults between 20-29 years of age. Syphilis has several stages. In the primary stage, painless sores, called chancres, appear approximately 2-3 weeks after initial exposure. Some individuals with primary syphilis may not notice chancres nor have symptoms associated with them, in particular if the chancres are located in the rectum or cervix. In about 4 to 6 weeks chancres will usually disappear. Approximately one-third of untreated individuals will progress to the second stage: secondary syphilis. This usually occurs at about 2 to 8 weeks after the appearance of the original chancre in some cases the chancre may still be present. Secondary syphilis is the stage where the bacteria have spread in the bloodstream and have reached their highest numbers. The most common symptoms include: skin rash which can be varied in appearance, yet frequently involves the palms and soles, in addition to lesions in the mouth, vagina, penis (mucous patches), swollen lymph nodes, and fever. This stage is the most contagious stage of syphilis. It usually resolves within weeks to a year. A latent phase follows, which may last for years and is characterized by the absence of symptoms. The final stage of syphilis is called tertiary syphilis (syphilis; tertiary) and is characterized by brain or central nervous system involvement (neurosyphilis), cardiovascular involvement with inflammation of the aorta (aortitis or aneurysms), and gummatous syphilis (destructive lesions of the skin and bones). The symptoms of syphilis depend on the stage of the disease. In addition, a significant proportion of individuals may remain without symptoms. Symptoms include: Syphilis; primary: chancres -- (usually single yet may be multiple) painless sores on genitals, rectum, or mouth and/or enlarged lymph nodes in the area adjacent to the chancre. Syphilis; secondary: skin rash -- usually throughout the body with both flat and raised patches which may involve the palms and soles of the feet; extensive lymph node enlargement; mucous patches (painless silvery ulcerations of mucous membranes -- seen mostly in the mouth and on the genitals); condyloma lata: coalescing papules which form a grey-white plaque frequently in folds such as groin, genital areas, axilla, and under the breasts; hair loss (alopecia); general symptoms such as fever, fatigue, loss of appetite, and aches and pains in bones. Syphilis; tertiary: infiltrative, destructive lesions of skin, bones, or liver (gummatous syphilis); cardiovascular syphilis, which leads to inflammation of the aorta (aortitis) and can be associated with aortic aneurysms; central nervous system disorders with involvement of the meninges, brain, spinal cord, eye, or auditory system.

System of Care
A system of care is a method of addressing children's mental health needs. It is developed on the premise that the mental health needs of children, adolescents, and their families can be met within their home, school, and community environments. These systems are also developed around the principles of being child-centered, family- driven, strength-based, and culturally competent and involving interagency collaboration.

Tamper-evident Label/Seal
In drug testing, the label that is used to seal a urine specimen bottle. In addition to sealing the specimen bottle, it also provides an appropriate specimen number and space for the donor to initial and date the label.

A facility set up for the support of teleworkers; includes both single-company centers and multi- company facilities. Sometimes set up as a satellite office by a company, a partnership of companies, or an independent vendor of telework support.

A meeting held among people at different loca- tions using telecommunications software that allows meeting attendees to all dial a single number, then talk among themselves.

Telephone Hotline
A dedicated telephone line that is advertised and may be operated as a crisis hotline for emergency counseling, or as a referral resource for callers with mental health problems.

Tertiary Prevention
Strategies designed to decrease the amount of disability associated with an existing disorder or illness.

THC (Tetrahydrocannabinol)
Delta-9-tetrahydrocannabinol; the main active ingredient in marijuana, which acts on the brain to produce its effects.

Therapeutic Foster Care
A service which provides treatment for troubled children within private homes of trained families. The approach combines the normalizing influence of family-based care with specialized treatment interventions, thereby creating a therapeutic environment in the context of a nurturant family home.

Third-party Administrator (TPA)
Usually an out-of-house professional firm providing healthcare administrative services, such as paying claims, collecting premiums, and carrying out other administrative support services, for employee benefit plans. (Synonyms: administrative agent, carrier, insurer, underwriter).

Third party payer
A public or private organization that is responsible for the health care expenses of another entity.

PCP in powder form; methamphetamine

Tick tick

Methamphetamine; crystal methamphetamine; methamphetamine used with Viagra

A plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects. It is considered an addictive substance because it contains the chemical nicotine. The tobacco plant is believed to have originated in the Western Hemisphere. The leaves of the plant are prepared for smoking, chewing, or sniffing. In addition to nicotine, tobacco contains over 19 known carcinogens (most are collectively known as "tar") and more than 4,000 chemicals. Prior to European influence in the Americas, tobacco was used by the Indians of Mexico and Peru for ceremonies, medicinal purposes, and to alleviate hunger pangs during famines. Columbus is credited with introducing tobacco into Europe. Tobacco use became widely accepted by the Portuguese, Spanish, French, British, and Scandinavians. Explorers and sailors who became dependent upon tobacco began planting seeds at their ports of call, introducing the product into other parts of Europe and Asia. The colonists introduced tobacco on the American continent in the early 1600s. It became a major crop and trading commodity of the Jamestown colony. Over the years, tobacco has been claimed as a cure for a wide range of ailments with varying forms of administration (for example, used in poultices, pastes, smoked, chewed, sniffed, or placed in any body cavity). Its social importance also grew over the years, even to the point of denoting the "modern or liberated woman" during the first part of the twentieth century. It was not until the 1960s, with the introduction of medical research related to cigarette smoking, that the adverse health effects of tobacco became widely publicized.

A condition in which higher doses of a drug are required to produce the same effect as during initial use; often leads to physical dependence.

Tonsil glands serve as agents against infections. However, in some people, particularly in children with larger tonsils, these glands can perform less efficiently and cause frequent throat and ear infections or obstruct breathing. In these cases, surgery to remove the tonsils is of benefit. Under general anesthesia, the ear-nose-throat (ENT) surgeon holds the mouth open using a mouth gag to expose the tonsils. The tonsils are then removed by being cut away with an instrument or a cautery (burning instrument). Bleeding is controlled, and the cut heals naturally without stitches. Tonsillectomy is advisable when tonsillitis attacks are so frequent or severe that they affect a child's general health or interfere with school, hearing, or breathing. However, some physicians believe tonsillectomies are done more often than necessary, so a second opinion should be obtained when there is any doubt. Specifically, the guidelines for surgery are: * 7 or more episodes of tonsillitis in one year * 5 or more episodes per year over a 2- year period * Severe tonsillitis * Tonsillitis that is not responding to antibiotics * An abscess in the tonsils * Grossly asymmetric tonsils Tonsillectomy is advised if the tonsils are enlarged and obstructing access to the adenoid during an adenoidectomy operation, or the physician suspects the presence of a tonsil tumor. Tonsillectomy is usually done on an outpatient basis, with the patient returning home the same day as the surgery. Only rarely are patients observed overnight in the hospital and return home the day after the surgery. Complete recovery can take 2 weeks. Expect some throat and ear pain in the first days following surgery. The use of ice packs to relieve pain may be used, although sucking on an ice cube or ice cream may provide adequate comfort. In addition, pain- relief medication may be prescribed. During recovery, it is recommended to eat soft, easy- to-swallow food and to drink a lot of cold fluids. The use of humidifier at home can also bring some comfort. Your child may experience alternating "good and bad" days for 2 weeks after surgery. It is a good idea to keep your child away from crowds or ill people for 7 days, since the throat is highly susceptible to infections during this period.


Turnover Rate
Includes all permanent separations, whether voluntary or involuntary. Monthly turnover rates are calculated by employers and collected as part of the Bureau of National Affairs' Quarterly Employment Survey. BNA then calculates the monthly median rates and the average of monthly median rates for the year. Monthly rates are calculated as (number of separations during month / average number of employees on payroll during the month) * 100. (Source: Bureau of National Affairs' definition, 1995). SAMHSA grantees may wish to calculate separate turnover rates for voluntary and involuntary separations if their programs are more likely to affect one type of turnover than another.

Methamphetamine-like substance

Crack and methamphetamine

Type I Error
The error committed when a true null hypothesis is rejected.

Type II Error
The error committed when a false null hypothesis is accepted.

Unable to Work
This on-line forum was created especially for the nation's jobless and underemployed workers. This resource is available to help the unemployed learn more about the unemployment system, to share their experiences and concerns, and to participate in the national debate over aid to the jobless.

The review of prospective or renewing cases to determine their risk and their potential costs.

Unduplicated Counts
Counting a client/patient and their services uniquely. Unduplicated counts can exist at different levels: a program, a local system of care, or at the State level.

Not currently employed. This could include people looking for work, or people engaged in other activities such as homemakers, students or volunteers.

Universal Prevention
Prevention designed for everyone in the eligible population, both the general public and all members of specific eligible groups.

Unmet Needs
Identified treatment needs of the people that are not being met as well as those receiving treatment that is inappropriate or not optimal.

The level of use of a particular service over time.

Utilization Management (UM)
The process of evaluating the necessity, appropriateness, and efficiency of healthcare service. A review coordinator or medical director gathers information about the proposed hospitalization, service, or procedure from the patient and/or providers, then determines whether it meets established guidelines and criteria, which may be written or automated protocols approved by the organization. A provider or integrated delivery network that proves it is skilled in UM may negotiate more advantageous pricing, if UM is normally performed by the HMO but could be more effectively passed downward at a savings to the HMO.

Utilization Review (UR)
The evaluation of the medical necessity and the efficiency of healthcare services, either prospectively, concurrently, or retrospectively; contrasted with utilization management in that UR is more limited to the physician's diagnosis, treatment, and billing amount, whereas UM addresses the wider program requirements.

Utilization risk
The risk that actual service utilization might differ from utilization projections.

Vegetarian diets excluding all or some animal products. Vegan is a diet that consists of only foods of plant origin. Lacto-vegetarian is a diet that consists of plant foods plus some or all dairy products. Lacto- ovovegetarian is a diet that consists of plant foods, milk, dairy products and eggs. Semi or Partial Vegetarian is a diet that consists individuals that do not eat red meat, but may eat chicken or fish with plant foods, dairy products, and eggs. The diet may be adopted for a variety of reasons, including religious or political beliefs, economics, or the desire to consume a more healthful diet. The American Dietetic Association states that a well-planned vegetarian diet can be consistent with good nutritional intake. Dietary recommendations vary with the type of vegetarian diet. For children and adolescents these diets require special planning, because it may be difficult to obtain all the nutrients required for growth and development. Nutrients that may be lacking in a vegetarian's diet are Protein, Vitamin B12, Vitamin D, Riboflavin, Calcium, Zinc, and Iron. Eating protein, which is made up of smaller chemicals called amino acids, is necessary for good health. You don't have to eat animal products to get complete proteins in the diet. Integrating the vegetarian style of eating into a non- vegetarian diet is recommended for individuals wishing to choose a healthier diet. For example, a person may choose to eat meat once a day or as little as twice a week.

Vertical disintegration
A practice of selling off health plan subsidiaries or provider activities. Vertical disintegration was a trend in the late 1990s.

Vertical Integration
An organization of production whereby one business entity controls or owns all stages of the production and distribution of goods or services. In healthcare, vertical integration can take many forms, but generally implies that physicians, hospitals, and health plans have combined their organizations or processes in some manner to increase efficiencies, increase competitive strength, or to improve quality of care. Integrated delivery systems or healthcare networks are generally vertically integrated.

A meeting held among people at different loca-tions wherein attendees can both hear and see one another. It involves a set of hardware and software linked together, including cameras, microphones, scanners, and television screens at each attendee location.

Virtual Organization
Workers who belong to separate organizations, and/or operate as independent contractors, but sometimes work together to accomplish a specific, defined result. For example, an Environment Engineering firm might create a virtual orga- nization of engineers, financial analysts, scientists, and information technologists, all of whom work for other companies or universities, but who cooperate to deliver specific work to the Environmental Engineering firm on an as needed basis.

Virtual Team (Distributed Team or Dispsersed Team)
employees from the same or different departments in the same company who work as a structured team under a designated team leader to accomplish a specific, defined result. For example, Product Development Managers often pick individuals from around the company to bring a new idea to market. Those individuals work on the new product until it is delivered, at which time they return to their separate department structures, where they have a permanent organizational home.

Vitamin Supplements
The Dietary Supplement Health and Education Act defines dietary supplements as a: product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; a dietary substance for use to supplement the diet by increasing the total dietary intake; a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet. Dietary supplements are available widely through many commercial sources including health food stores, grocery stores, pharmacies, and by mail.

Vocational Rehabilitation Services
Services that include job finding/development, assessment and enhancement of work-related skills, attitudes, and behaviors as well as provision of job experience to clients/patients. Includes transitional employment.


A combination of hydrogen and oxygen; it is the basis for the fluids of the body. Water makes up more than two thirds of the weight of the human body. Without water, humans would die in a few days. All the cell and organ functions depend on water for functioning. It serves as a lubricant and forms the base for saliva and the fluids that surround the joints. Water regulates the body temperature, as the cooling and heating is distributed through perspiration. Water helps to alleviate constipation by moving food through the intestinal tract and thereby eliminating waste. Water is obtained from some of the foods we eat. These are foods that are 85 to 95% water. Some water is obtained from the by-products of metabolism. But our main source of water is our drinking water, which is the best source. Water is also obtained from soup, milk, and juices. Alcoholic beverages and beverages with caffeine (such as coffee, tea, and colas) are not the best choices because they have a diuretic (water-excreting) effect. Six to eight 8-ounce glasses of water, or half of the body weight in ounces, are recommended on a daily basis. For example, if you weight 140 lbs, you will need 70 ounces of water. Milk, juice, and soup can not be substituted for the entire water requirement. Caffeinated and alcoholic beverages (due to their diuretic effect) would not be appropriate substitutes at all. Carrying a water bottle and drinking at regular intervals will help you to obtain the required amount of water your body needs.

Blunts; methamphetamine; PCP; a mixture of marijuana and other substances within a cigar; Gamma hydroxybutyrate (GHB)

Water Safety
Learn to swim. The best thing anyone can do to stay safe in and around the water is to learn to swim. Always swim with a buddy; never swim alone. The American Red Cross has swimming courses for people of any age and swimming ability. Swim in supervised areas only. Obey all rules and posted signs. Watch out for the "dangerous too's"--too tired, too cold, too far from safety, too much sun, too much strenuous activity. Don't mix alcohol and swimming. Alcohol impairs your judgement, balance, and coordination, affects your swimming and diving skills, and reduces your body's ability to stay warm. Pay attention to local weather conditions and forecasts. Stop swimming at the first indication of bad weather. Know how to prevent, recognize, and respond to emergencies.

Wellness Program
Programs, typically oriented toward healthy lifestyle and preventive care, that may decrease health-care utilization and costs. From an employer perspective the emphasis is on keeping employees healthy.

Blunts mixed with marijuana and PCP; methamphetamine; marijuana cigarettes soaked in PCP ("embalming fluid") and dried

A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

White Cross
Amphetamine; methamphetamine

Symptoms that occur after chronic use of a drug is reduced or stopped.


Workers Compensation Payments
Includes actual disbursements for injuries and illnesses covered under Workers Compensation program rules.

Working man's cocaine

Workplace Injuries and Illnesses
Nonfatal occupational illnesses or injuries that involve one or more of the following: loss of consciousness, restriction of work or motion, lost worktime, transfer to another job, or medical treatment (other than first aid).

Workplace Managed Care (WMC)
In WMC, workplaces integrate their substance- abuse prevention and early-intervention programs, strategies, and activities for employees and their families (covered lives). Integrated activities frequently include internal and external workplace and workplace- related components: employee assistance programs (EAPs), human resources, security, management, and managed care organizations and providers (primary and behavioral health care). Services may be received in various locations and through face-to-face encounters (e.g., at the workplace, physician's office, health fairs, etc.) or multi-media (e.g., video, telephone, Internet, publications, etc.). It is the strategy of integrating these elements and agents that constitutes the WMC approach to providing substance abuse prevention and early intervention to employees and their families.

Wraparound Services
Services that address consumers' total healthcare needs in order to achieve health or wellness. These services "wrap around" core clinical interventions, usually medical. Typical examples include such services as financial support, transportation, housing, job training, specialized treatment, or educational support.

Ya Ba
A pure and powerful form of methamphetamine from Thailand; "crazy drug"

Yellow bam

Yellow jackets
Depressants; methamphetamine

Yellow powder