Creation of a recovery-oriented system of care requires practitioners to alter the way they look at mental health and substance use conditions, their own roles in facilitating recovery from these conditions, and the language they use in referring to the people they serve. The following glossary is intended as a tool for providers to use as they go about making these changes in practice.* While it is not meant to be exhaustive, this material will be further enhanced in the process of implementing recovery-oriented practices across the country.
Given its central role in the remaining definitions, we will start with the term “recovery” itself, followed by a list, in an alphabetical order, of other key terms.
*Credit for many of the addiction entries goes to William White, with text appreciatively borrowed and adapted from his unpublished manuscript, “The Language of Addiction Recovery: An Annotated Glossary.”
There are several different definitions and uses of this term. In the addiction
self-help recovery community, for example, this term refers to the achievement and
maintenance of abstinence from alcohol, illicit drugs, and other substances (e.g.,
tobacco) or activities (e.g., gambling) to which the person has become addicted,
vigilance and resolve in the face of an ongoing vulnerability to relapse, and pursuit
of a clean and sober lifestyle.
In mental health there are several other forms of recovery. For those fortunate
people, for example, who have only one episode of mental illness and then return
to their previous functioning with little, if any, residual impairment, the usual
sense of recovery used in primary care is probably the most relevant. That is, such
people recover from an episode of psychosis or depression in ways that are more
similar to, rather than different from, recovery from other acute conditions.
Persons who recover from an episode of major affective disorder or psychosis, but
who continue to view themselves as vulnerable to future episodes, may instead consider
themselves to be “in recovery” in ways that are more similar to, rather than different
from, being in recovery from a heart attack or chronic medical condition. In this
case, recovery may take place in the presence of an enduring illness or condition,
rather than following on its absence. Many others will recover from serious mental
illness over a longer period, after perhaps 15 or more years of disability, constituting
an additional sense of recovery found in some other medical conditions such as asthma.
More extended periods of disability are often associated with concerns about the
effects and side effects of having been labeled with a mental illness as well as
with the illness itself, leading some people to consider themselves to be in recovery
also from the trauma of having been treated as mental patients.
Finally, those people who view taking control of their illness and minimizing its
disruptive impact on their lives as the major concentration of their efforts might
find the sense of recovery used in the addiction self-help community to be most
compatible with their own experiences. Such a sense of recovery has been embraced,
for instance, among some people who suffer from co-occurring psychiatric and addictive
disorders who consider themselves to be in “dual recovery.”
For purposes of simplicity and clarity, the Connecticut Department of Mental Health and Addiction Services has adopted the following single definition to capture the common elements of these various forms of recovery:
“Recovery involves a process of restoring or developing a meaningful sense of belonging and positive sense of identity apart from one’s condition while rebuilding a life despite or within the limitations imposed by that condition.”
Other Key Terms
The strategy of complete and enduring cessation of the use of alcohol and other drugs. The achievement of this strategy remains the most common definition of recovery in addiction, but the necessity to include it in this glossary signals new conceptualizations of recovery that are pushing the boundaries of this definition (see partial recovery, moderated recovery, and serial recovery).
See social cooperative/entrepreneurialism
asset-based community development
A technology for identifying and charting the pathways and destinations in the local community most likely to be welcoming and supportive of a person’s efforts at community inclusion. A first step is the development of local resource maps (see asset mapping). A strategy of community preparation is then used to address gaps identified in the resource maps through educational and other community-building activities aimed at decreasing stigma and creating a more welcoming environment in partnership with local communities.
Part of asset-based community development (see above), referring to the process
of identifying opportunities in local communities for people in recovery to take
up and occupy valued social roles in educational, vocational, social, recreational,
and affiliation (e.g., civic, spiritual) life. Although not a literal “map” (i.e.,
as in contained on a piece of paper), asset mapping involves developing and utilizing
virtual or mental landscapes of community life that highlight resources, assets,
and opportunities that already exist in a person’s local community.
A key concept in recovery-oriented care, choice refers to the central role people
in recovery play in their own treatment, rehabilitation, recovery, and life. Within
the health care system, people in recovery need to be able to select services and
supports from among an array of meaningful options (see menu below) based on what
they will find most responsive to their condition and effective in promoting their
recovery. Both inside and outside of the health care system, people in recovery
have the right and responsibility for self-determination and making their own decisions,
except for those rare circumstances in which the impact of the condition contributes
to their posing imminent risks to others or to themselves.
A strong connection to the rights, resources, roles, responsibilities, and relationships
that society offers through public institutions and associational life.
Material and instrumental resources (including other people) and various forms of
prostheses that enable people to compensate for enduring impairments in the process
of pursuing and being actively involved in naturally occurring community activities
of their choice.
Literally, a person who purchases services or goods from others. Historically, this
has been used in mental health advocacy to offer a more active and empowered status
to people who otherwise were being described as “clients” or “mental patients.”
Given the fact that people in recovery have not really viewed themselves as consumers
in the traditional sense of being able to make informed choices, this term has never
really generated or been met with widespread use.
continuity of care/contact
This phrase is used to underscore the importance of sustained, consistent support over
the course of recovery. Such support can come from living within a community of
shared experience and hope but also can refer to the reliable and enduring relationship
between the individual in recovery and his or her recovery coach. Such sustained
continuity is in marked contrast to the transience of relationships experienced
by those who have moved through multiple levels of care or undergone multiple treatment
Knowledge, data, and information from and about individuals and groups that are
integrated and transformed into clinical standards, skills, service approaches,
techniques, and marketing programs that match an individual’s culture and increase
both the quality and appropriateness of health care and health outcomes. As a multidimensional
construct, cultural competence can be conceptualized from provider, program, agency,
and health care system levels.
This includes, but is not limited to, the shared values, norms, traditions, customs,
art, history, folklore, religious, and healing practices and institutions of a racial,
ethnic, religious or social group that are generally transmitted to succeeding generations.
dignity of risk and right to fail
This phrase was coined by Patricia Deegan, an international leader of the mental
health consumer/survivor movement, to emphasize the importance of people in recovery
being able to make their own choices and therefore their own mistakes, as this is
a primary source of learning for all adults, including those with substance use
and/or mental health conditions.
disparities in healthcare
Differences in access, quality, and/or outcomes of health care based on such issues
as race, ethnicity, culture, gender, sexual or religious orientation, social class,
or geographic region.
The experience of acquiring power and control over one’s own life decisions and
destiny. Within the substance use recovery context, there are two different relationships
to power. Among the culturally empowered (those to whom value is ascribed as a birthright),
the erosion of competence often associated with substance use may be countered by
a preoccupation with power and control. It is not surprising then that the transformative
breakthrough of recovery is marked by a deep experience of surrender and an acceptance
of powerlessness. In contrast, the culturally disempowered (those from whom value
has been systematically withheld) are often attracted to psychoactive drugs in their
desire for power, only to discover over time that their power has been further diminished.
Under these conditions, the initiation of recovery may be marked by the assumption
of power and control rather than an abdication of power.
Within the mental health context, empowerment typically refers to a person first
taking back control of his or her own health care decisions before regaining control
of his or her major life decisions and destiny. As such, “empowerment” has been
used most by advocacy groups in their lobbying efforts to make mental health care
more responsive and person centered.
In either community, empowerment is meant to be inspiring, energizing, and galvanizing.
The concept of empowerment applies to communities as well as to individuals. It
posits that the only solution to the problems of substance use and/or mental health
in disempowered communities lies within those very communities. It is important
to note that, by definition, one person cannot “empower” another, as to do so undermines
the very premise of the term, which attributes power over the person’s decisions,
recovery journey, and life to the person himself or herself.
Clinical, rehabilitative, and supportive practice that has scientific support for
its efficacy (under ideal conditions) and effectiveness (in real-world settings).
Advocacy of evidence-based practice is a commitment to use those approaches that
have the best scientific support and, in areas where research is lacking, a commitment
to measure and use outcomes to elevate those practices that make the deepest impact
on the quality of life of individuals, families, and communities.
The resolution of alcohol and other drug problems within the framework of religious
experience, beliefs, and rituals and/or within the mutual support of a faith community.
Faith-based recovery frameworks may serve as adjuncts to traditional recovery support
programs or serve as alternatives to them.
harm reduction (as a stage of recovery)
Most often viewed as an alternative to, and even antagonistic to, recovery, but
harm reduction can also be viewed as a strategy of initiating or enhancing early
recovery. The mechanisms through which this can occur include preventing the further
depletion of recovery capital, increasing recovery capital when it does not exist,
and enhancing a person’s readiness for recovery by way of the change-encouraging
relationships through which harm reduction approaches are delivered.
This refers to a person’s right to be afforded access to, and to participate in,
naturally occurring community activities of his or her choice.
The mastery of knowledge about one’s own illness and assumption of primary responsibility
for alleviating or managing the symptoms and limitations that result from it. Such
self-education and self-management shifts the focal point in disease management
from the expert caregiver to the person with the illness.
See person-centered care.
indigenous healers and institutions
People and organizations in the natural environment of the recovering person who
offer words, ideas, rituals, relationships, and other resources that help initiate
and/or sustain the recovery process. They are distinguished from professional healers
and institutions not only by training and purpose but also through relationships
that are culturally grounded, enduring, and often reciprocal and/or noncommercialized.
Those factors that spark a commitment to recovery and an entry into the personal
experience of recovery. Factors that serve this recovery priming function are often
quite different from those factors that later serve to sustain recovery. Recovery-initiating
factors can exist within the person and/or within the person’s family and social
environment as well as in the health care system. These factors can include pain-based
experiences—for example, anguish, exhaustion, and boredom with addictive lifestyle;
death of someone close; external pressure to stop using; experiences of feeling
humiliated; increased health problems; failures or rejections; and suicidal thoughts.
Less recognized, however, are the hope- and pleasure-based experiences that appear
to be even more effective in promoting recovery: pursuing interests and experiencing
enjoyment and success; exposure to recovery role models; new intimate relationships;
marriage, parenthood, or other major positive life change; a religious experience;
and new opportunities.
See initiating factors.
menu (of services and/or supports)
An array of options from which people can then choose to utilize those services
and/or supports they expect will be most effective in assisting them to achieve
their goals and most responsive to their individual, familial, and sociocultural
values, needs, and preferences.
See social cooperative/entrepreneurialism.
The resolution of alcohol or other drug problems through reduction of alcohol or
other drug consumption to a subclinical level (shifting the frequency, dosage, method
of administration, and contexts of drug use) that no longer produces harm to the
individual or society. The concept takes on added utility within the understanding
that substance use problems exist on a wide continuum of severity and widely varying
patterns of acceleration and deceleration. The prospects of achieving moderated
recovery diminish in the presence of lower age of onset, heightened problem severity,
the presence of co-occurring mental health conditions, and low social support. The
most common example of moderated resolution can be found in people who develop substance
use problems during their transition from youth to adulthood. Most of these individuals
do not go on to develop enduring substance-related problems but instead moderate
their use through the process of maturation.
Nonconfrontational approaches to eliciting recovery-seeking behaviors developed
by Miller and Rollnick. This approach emphasizes relationship-building (expressions
of empathy), heightening discrepancy between an individual’s personal goals and
present circumstances, avoiding argumentation (activation of problem-sustaining
defense structure), rolling with resistance (emphasizing respect for the person
experiencing the problem and his or her sense of necessity and confidence to solve
the problem), and supporting self-efficacy (expressing confidence in the individual’s
ability to recovery and expressing confidence that he or she will recovery). As
a technique of preparing people to change, motivational interventions are an alternative
to waiting for an individual to “hit bottom” and an alternative to confrontation-oriented
multiple pathways of recovery
These reflect the diversity of how people enter into and pursue their recovery journey.
Multiple pathway models contend that there are multiple pathways into mental health
and substance use conditions that unfold in highly variable patterns, courses, and
outcomes; that respond to quite different treatment approaches; and that are resolved
through a wide variety of recovery styles and support structures. This is particularly
true among ethnic minority and religious communities, but diversity is to be found
wherever there are people of different backgrounds.
mutual support/aid groups
Groups of individuals who share their own life experiences, strengths, strategies
for coping, and hope about recovery. Often called “self-help” groups, they more
technically involve an admission that efforts at self-help have failed and that
the help and support of others is needed. Mutual aid groups are based on relationships
that are personal rather than professional, reciprocal rather than fiduciary, free
rather than fee based, and enduring rather than transient (see indigenous healers
A term used to describe those who have initiated and sustained recovery without
professional intervention or involvement in a formal mutual aid group. Since people
in this form of recovery neither access nor utilize formal health care services,
it is difficult to establish the prevalence or nature of this process, but it is
believed to be common.
New Recovery Advocacy Movement
A movement that depicts the collective efforts of grassroots recovery advocacy organizations
whose goals are to 1) provide an unequivocal message of hope about the potential
of long-term recovery from substance use and 2) to advocate for public policies
and programs that help initiate and sustain such recoveries. The core strategies
of the New Recovery Advocacy Movement are 1) recovery representation, 2) recovery
needs assessment, 3) recovery education, 4) recovery resource development, 5) policy
(rights) advocacy, 6) recovery celebration, and 7) recovery research.
A technical term used to refer to people in a variety of roles who are engaged in
supportive relationships with people in recovery outside of health care settings.
Examples of natural supports include family, friends, and other loved ones, landlords,
employers, neighbors, and any other person who plays a positive, but nonprofessional,
role in someone’s recovery.
1. The failure to achieve full symptom remission (abstinence or the reduction of
substance use below problematic levels), but the achievement of a reduced frequency,
duration, and intensity of use and reduction of personal and social costs associated
with substance use. 2. The achievement of complete abstinence from substance use,
but a failure to achieve parallel gains in physical, emotional, relational, and
spiritual health. Partial recovery may precede full recovery or constitute a sustained
within mental health and/or substance use, this term is used to refer to someone
else who has experienced firsthand, and is now in recovery from, a mental health
and/or substance use condition.
Any service or support provided by a person in recovery from a mental health and/or
substance use condition for which his or her personal history of recovery is relevant
and shared. This includes, but is not limited to, the activities of peer specialists
or peer support providers (see peer support), encompassing also any conventional
health care intervention that a person in recovery is qualified to provide. Examples
of these activities range from medication assessment and administration by psychiatrists
and nurses who disclose that they are in recovery to illness management and recovery
education by peers trained in providing this evidence-based psychosocial intervention.
An underlying assumption here is that there is “value added” to any service or support
provided by someone who discloses his or her own recovery journey, as such disclosure
serves to combat stigma and inspire hope.
peer-operated or peer-run program
A program that is developed, staffed, and/or managed by people in recovery. In contrast
to peer-run businesses (described below) that are self-sustaining and able to generate
profits, peer-run programs are typically private–nonprofit and oriented to providing
health care services and supports such as respite care, transportation to and from
health care appointments, recovery education, and advocacy.
A peer (see above) who has been trained and employed to offer peer support to people
in any of a variety of settings. These settings may range from assertive or homeless
outreach in shelters, soup kitchens, or on the streets, to part of a multidisciplinary
inpatient, intensive outpatient, or ambulatory team, to roles within peer-operated
or peer-run programs (see above).
While falling along a theoretical continuum, peer support differs both from traditional
mutual support groups as well as from consumer-run drop-in centers and businesses.
In both mutual support groups and consumer-run programs, the relationships that
peers have with each other are thought to be reciprocal in nature; even though some
peers may be viewed as more skilled or experienced than others, all participants
are expected to benefit. Peer support, in contrast, is conceptualized as involving
one or more persons who have a history of significant improvement in either a mental
health and/or substance use condition and who offer services and/or supports to
other people with mental health and/or substance use conditions who are considered
to be not as far along in their own recovery process.
Care that is based on the person’s and/or family’s self-identified hopes, aspirations,
and goals, which build on the person’s and/or family’s own assets, interests, and
strengths, and which is carried out collaboratively with a broadly defined recovery
management team that includes formal care providers as well as others who support
the person’s or family’s own recovery efforts and processes, such as employers,
landlords, teachers, and neighbors.
person in recovery
A person who has experienced a mental health and/or substance use condition and
who has made progress in learning about and managing his or her condition and in
developing a life outside of, or in addition to, this condition.
The quantity and quality of internal and external resources that one can bring to
bear on the initiation and maintenance of recovery from a life-changing disorder.
In contrast to those achieving natural recovery, most people with mental health
and/or substance use conditions entering treatment have never had much recovery
capital or have dramatically depleted such capital by the time they seek help.
An event in which recovered and recovering people assemble to honor the achievement
of recovery. Such celebrations serve both healing and mutual support functions but
also (to the extent that such celebrations are public) serve to combat stigma attached
to substance use or mental health conditions by putting a human face on these conditions
and by conveying living proof of the possibility of recovery.
recovery coach/guide (recovery support specialist)
A person who helps remove personal and environmental obstacles to recovery, links
the newly recovering person to the recovery community and his or her broader local
community, and, where not available in the natural community, serves as a personal
guide and mentor in the management of personal and family recovery.
recovery community (communities of recovery)
A term used to convey the sense of shared identity and mutual support of those persons
who are part of the social world of recovering people. The recovery community includes
individuals in recovery, their family and friends, and a larger circle of “friends
of recovery” that include both practitioners and recovery supporters within the
community. This concept is based on the belief that there is a wellspring of untapped
hospitality and service within this community that can be mobilized to aid those
seeking recovery for themselves and their families. “Communities of recovery” is
a phrase coined by Kurtz to convey the notion that there is not one but multiple
recovery communities and that people in recovery may need to be introduced into
those communities where the individual and the group will experience a goodness
of “fit.” The growth of these divergent communities reflects the growing varieties
of recovery experiences.
The provision of engagement, education, monitoring, mentoring, support, and intervention
technologies to maximize the health, quality of life, and level of productivity
of persons with severe mental health and/or substance use conditions. Within the
framework of recovery management, the “management” of the condition is the responsibility
of the person with the condition. The primary role of the professional is that of
the recovery consultant, guide, or coach.
A practice oriented toward promoting and sustaining a person's recovery from a mental health and/or substance use condition. Connecticut Department of Mental Health and Addiction Services policy defines recovery-oriented practice as one that “identifies and builds upon each individual’s assets, strengths, and areas of health and competence to support the person in managing his or her condition while regaining a meaningful, constructive, sense of membership in the broader community.”
recovery-oriented systems of care
Systems of health and human services that affirm hope for recovery, exemplify a
strength-based orientation, and offer a wide spectrum of services and supports aimed
at engaging people with mental health and substance use conditions into care and
promoting their resilience and long-term recovery from which they and their families
recovery planning and recovery plans
In contrast to a treatment or service plan, recovery planning and a recovery plan
is developed, implemented, revised, and regularly evaluated by the person receiving
care. Consisting of a master recovery plan and regular implementation/action plans,
the recovery plan covers life domains in addition to mental health and substance
use issues (e.g., physical, finances, employment, legal, family, social life, personal,
education, and spiritual). In mental health settings, recovery planning follows
the principles described above under person-centered care.
See initiating factors
recovery support services
Services designed to 1) remove personal and environmental obstacles to recovery,
2) enhance identification and participation in the recovery community, and 3) enhance
the quality of life of the person in recovery. Services include outreach, engagement,
and intervention services; recovery guiding or coaching, posttreatment monitoring
and support; sober or supported housing; transportation; child care; legal services;
educational/vocational supports; and linkage to leisure activities.
The process through which individuals with multiple concurrent or sequential problems
resolve these problems and move toward optimum level of functioning and quality
of life. Serial recovery refers to the process of sequentially shedding two or more
drugs, or to the overlapping processes involved in recovering from substance use
and co-occurring mental health or other physical conditions.
The development and operation of small businesses (“microenterprises”) by people
in recovery based on their talents and interests and in partnership with their local
community. The resulting businesses offer goods and services to the general public
and may be either for profit or not for profit, but should be at least financially
self-sustaining, although perhaps subsidized through tax breaks or other government
A system of religious beliefs and/or a heightened sense of perception, awareness,
performance, or being that informs, heals, connects, or liberates. For people in
recovery, it is a connection with hidden resources within and outside of the self.
There is a spirituality that derives from pain, a spirituality that springs from
joy or pleasure, and a spirituality that can flow from the simplicity of daily life.
For many people, the spiritual has the power to sustain them through adversity and
inspire them to make efforts toward recovery. For some, this is part of belonging
to a faith community, while for others is may be the spirituality of fully experiencing
the subtlety and depth of the ordinary as depicted in such terms as harmony, balance,
centeredness, or serenity. All of these can be part of the many facets of recovery.
See initiating factors.
A person who receives or uses health services and/or supports for mental health
and/or substance use conditions, preferred by some people as an alternative to “consumer”
or “person in recovery.”
A practice that has not yet accrued a base of evidence demonstrating its effectiveness
in promoting recovery, but for which there are other persuasive reasons to view
it as having been a helpful resource, and as being a helpful resource in the future,
for people with mental health and/or substance use conditions. Examples of value-based
practices include peer-based services that offer hope, role modeling, and mentoring
and culturally specific programs oriented toward cultural subgroups.
An individual’s perception of his or her relationship with the world—that is, nature,
institutions, people, and things. An individual’s worldview mediates his or her
belief systems, assumptions, modes of problem solving, decision-making, and conflict
WRAP (Wellness Recovery Action Planning)
A self-help approach to illness management and wellness promotion developed by Mary Ellen Copeland.