In this guidance the terms below will be preferred and used for the following reasons:
- Therapists – this term is used to denote the range of different psychological therapists represented by the bodies endorsing this guidance (e.g. counsellors, clinical and counselling psychologists, psychotherapists, psychoanalysts). This term is used simply for the matter of convenience, and its usage in no way intends to minimise or overlook the differences that may exist between different therapeutic professionals and modalities.
- Psychiatric drugs – this term is used throughout to refer to all prescribed psycho-pharmaceuticals including antidepressants, antipsychotics, stimulants, tranquilisers, anxiolytics etc. regardless of who has prescribed them.
- Client: this term is used throughout this guidance to refer to anybody meeting a therapist for therapy.
- Dependence – this term is used throughout this guidance to denote physical dependence on a drug. This is not to deny the relevance of meanings and beliefs and the psychological effects of taking and stopping psychiatric drugs, but only to specify that the research covered in the evidence sections of this guidance predominately relates to dependence in its physical form.
Also, this guidance draws the distinctions between the following terms:
- ‘Dependence’ rather than ‘addiction’ – this distinction is drawn for two reasons: the term ‘addiction’ is generally associated with dependence on non-prescribed substances (such as illicit drugs and alcohol). As such it may be read, rightly or wrongly as having negative connotations. In contrast, ‘dependence’ largely avoids those connotations, which is why the prescribed-harm community, in general, prefers the term, as it better captures the experience of becoming dependent by following a prescriber’s recommendations. Secondly, and following Public Health England’s preferred language, dependence refers to an adaptation to the repeated exposure to a drug. This is usually characterised by tolerance and withdrawal, (though tolerance may not occur with some drugs).2
- Psychiatric ‘drugs’ rather than psychiatric ‘medication’ – this distinction is drawn since the term ‘medication’ is defined as a substance that is used to cure or treat a disease or medical condition, or to alleviate symptoms of an illness.37 As it is contestable as to whether psychiatric drugs either ‘cure’ or ‘treat’ a ‘disease’ or a ‘medical’ condition or ‘illness’, the term ‘drugs’ is preferred, in particular as the definition for drugs (i.e. ‘a substance which has a physiological effect’38), better captures the evidence-base for how psychopharmaceuticals work.
- Drug-Centred vs Disease-Centred model of drug action – this distinction is drawn to clarify how psychiatric drugs work: the disease model assumes psychiatric drugs work by reversing or partially reversing an underlying ‘disease’, while the drug-centred model asserts that psychiatric drugs work by producing physiological and psychological effects, as all psychoactive substances do, which may or may not be experienced as beneficial. This guidance prefers the drug-centred over the disease-centred model, as it better captures the evidence-base as to how psychopharmaceuticals work. This is further expanded on in section 2.
2. Taylor, S., Annand, F., Burkinshaw, P., Greaves, F., Kelleher, M., Knight, J., Perkins, C., Tran, A., White, M. & Marsden, J. (2019). Dependence and withdrawal associated with some prescribed medicines: An evidence review. London: Public Health England.
37. DHHS (2011). What is medication? Available online: https://www.dhhs.nh.gov/dcbcs/bds/nurses/documents/sectionII.pdf. (Accessed February 2019.)
38. English Oxford Dictionary (2019). Available online: https://en.oxforddictionaries.com/definition/drug (Accessed February 2019)