Glossary of Legal and Clinical Terms

One of the persistent challenges in fiduciary management of behavioral health situations is the gap between legal and clinical vocabularies. This glossary provides clear, precise definitions for terms that fiduciaries, estate attorneys, and trust officers encounter when their practice intersects with addiction medicine and behavioral health.

Clinical Terms

Substance Use Disorder (SUD)

A clinical diagnosis defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characterized by a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues using a substance despite significant substance-related problems. The DSM-5 classifies SUDs on a spectrum from mild (2-3 symptoms) to moderate (4-5 symptoms) to severe (6 or more symptoms). The term "substance use disorder" has replaced older terminology such as "substance abuse" and "substance dependence" in clinical practice.

Medication-Assisted Treatment (MAT)

The use of FDA-approved medications, in combination with counseling and behavioral therapies, to treat substance use disorders. For opioid use disorders, MAT includes methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol). MAT is considered the gold standard of care for opioid use disorders by the National Institute on Drug Abuse and the World Health Organization. Trust provisions that condition distributions on "sobriety" or "clean drug tests" may inadvertently penalize beneficiaries engaged in MAT, which is an evidence-based medical treatment rather than continued substance use.

Continuum of Care

The range of treatment settings and intensity levels through which a patient may progress during addiction treatment. The American Society of Addiction Medicine (ASAM) defines six levels of care: Level 0.5 (early intervention), Level 1 (outpatient), Level 2.1 (intensive outpatient), Level 2.5 (partial hospitalization), Level 3 (residential/inpatient), and Level 4 (medically managed intensive inpatient). Movement between levels should be based on clinical need as determined by the ASAM Criteria assessment.

Co-Occurring Disorders

The simultaneous presence of a substance use disorder and one or more mental health disorders (depression, anxiety, bipolar disorder, PTSD, personality disorders). Co-occurring disorders are common: SAMHSA estimates that approximately 9.2 million adults in the United States have co-occurring mental health and substance use disorders. Treatment of co-occurring disorders requires integrated approaches that address both conditions simultaneously.

Detoxification (Detox)

The medically supervised process of managing acute withdrawal symptoms when an individual stops using a substance. Detoxification is a medical procedure, not treatment in itself — it stabilizes the patient physiologically and prepares them for therapeutic treatment. Duration varies by substance: alcohol detoxification typically requires 3-7 days; opioid detoxification may last 5-14 days; benzodiazepine detoxification may require weeks to months of gradual tapering.

Relapse

The return to substance use after a period of abstinence. The National Institute on Drug Abuse characterizes relapse as a common feature of substance use disorders, noting that relapse rates for addiction (40-60%) are similar to those for other chronic medical conditions such as hypertension and asthma. In the fiduciary context, relapse should be understood as a clinical event requiring response rather than a moral failing justifying punitive action.

Sober Companion

A trained professional who provides one-on-one support to an individual in early recovery, typically residing with or accompanying the client 24/7 for a defined period. Sober companions are distinct from recovery coaches (who provide ongoing support without constant presence) and from sponsors (who provide peer support through mutual-aid programs). The sober companion role may include relapse prevention support, accompaniment to therapeutic appointments, lifestyle structure, and communication with the clinical team.

Legal Terms

42 CFR Part 2

The federal regulation governing the confidentiality of substance use disorder treatment records. Part 2 imposes stricter protections than HIPAA for SUD-specific records, prohibiting disclosure of treatment information without the patient's written consent, a court order, or a limited statutory exception. The 2024 amendments aligned Part 2 more closely with HIPAA but preserved the core consent requirement. Fiduciaries seeking information about a beneficiary's SUD treatment must navigate Part 2's requirements to obtain treatment status information.

Discretionary Distribution

A trust distribution that is within the trustee's discretion to make or withhold, as opposed to a mandatory distribution that the trust terms require. Discretionary distribution authority gives the trustee flexibility to respond to a beneficiary's behavioral health condition by adjusting the timing, amount, and form of distributions. The trustee's exercise of discretion is subject to judicial review under a standard that varies by state (from "abuse of discretion" to "good faith" to "reasonableness").

Incentive Trust

A trust that conditions distributions on the beneficiary meeting specified behavioral criteria. In the addiction context, incentive provisions may require sobriety, treatment compliance, or engagement with recovery support as conditions for receiving distributions. The enforceability and wisdom of incentive trust provisions in behavioral health contexts are subjects of ongoing professional debate.

Spendthrift Provision

A trust provision that prevents the beneficiary from assigning their interest in the trust and protects trust assets from the claims of the beneficiary's creditors. Spendthrift provisions are particularly important when a beneficiary has a substance use disorder, as they prevent the beneficiary from pledging or assigning trust distributions to drug suppliers or other inappropriate parties.

Trust Protector

An independent party designated in the trust instrument with authority to modify trust provisions, change trustees, or adjust distribution standards. In the behavioral health context, a trust protector can adapt trust provisions to respond to changes in the beneficiary's condition, the clinical landscape, or the legal environment without the need for judicial modification proceedings.

Guardianship

A court-supervised arrangement in which a guardian is appointed to make personal decisions (healthcare, living arrangements, personal care) for an individual who has been found to lack capacity. Guardianship is the most restrictive form of legal protection and represents a significant limitation on the individual's autonomy. In most jurisdictions, a finding of incapacity is required before a guardian can be appointed.

Conservatorship

A court-supervised arrangement in which a conservator is appointed to manage the financial affairs and property of an individual who has been found to lack capacity to manage their own finances. Some jurisdictions use "conservatorship" to encompass both personal and financial decision-making authority. The terminology varies by state.

Marchman Act (Florida)

Florida Statute Chapter 397, which provides a statutory framework for involuntary assessment, stabilization, and treatment of individuals with substance use disorders. The Marchman Act is distinct from guardianship in that it does not require a finding of general incapacity — it permits involuntary intervention when an individual has lost the power of self-control with respect to substance use and meets specified risk criteria.