Recovery For ME - Glossary of Recovery-Oriented Language (Based on Connecticut's Practice Guidelines)

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 are intended as a tool for providers to use as they go about making these changes in practice. Not meant to be exhaustive, this material will be further enhanced in the process of implementing recovery-oriented practices across the state.

Given its central role in the remaining definitions, we will start with the term “recovery” itself, followed by a list, in alphabetical order, of other key terms.

A C D E F I J M N P R S T R S T U V W

Recovery:  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, than different from, being in recovery from a heart attack or chronic medical condition. In this case, recovery may be taking place in the presence of an enduring illness or condition, rather than following upon its absence. Many others will recover from serious mental illness over a longer period of time, 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.

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

 

A

Abstinence-Based Recovery:  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).

Affirmative Business:  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 the person’s efforts at community inclusion. A first step is the development of local resource maps (see below). 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.
Asset Mapping:  part of asset-based community development (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 affiliational (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 the person’s local community.

Asset Mapping: part of asset-based community development (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 affiliational (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 the person’s local community.

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C

Choice:  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.

Citizenship:  a strong connection to the rights, resources, roles, responsibilities, and relationships that society offers through public institutions and associational life. 

Community Supports:  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.

Consumer:  literally means someone who purchases services or goods from others. Historically 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 wide-spread use.   

Continuity of Care/Contact:  is a phrase 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 relationships.

Cultural Competence:  is knowledge, data and information from and about individuals and groups that is integrated and transformed into clinical standards, skills, service approaches, techniques, and marketing programs that match the 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.

Culture:  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.

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D

Dignity of risk and right to fail”: a phrase 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. 

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E

Empowerment:  is 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 psycho-active 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 prior to 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 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 defini-tion, 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 him or herself.

Evidence-Based Practices:  are clinical, rehabilitative, and supportive practices that have scientific support for their 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 have the greatest impact on the quality of life of individuals, families, and communities.  

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F

Faith-Based Recovery:  is 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):  is most often viewed as an alternative to, and even antagonistic to, recovery, but 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 the person’s readiness for recovery via the change-encouraging relationships through which harm reduction approaches are delivered.  

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I

Inclusion:  refers to a person’s right to be afforded access to, and to participate in, naturally occurring community activities of his or her choice.

Illness Self-management:  is 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.

Individualized Care:  see Person-Centered Care.  

Indigenous Healers and Institutions:  are 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 through relationships that are culturally-grounded, enduring, and often reciprocal and/or non-commercialized.    

Initiating Factors:  are those factors that spark a commitment to recovery and an entry into the personal experience of recovery. Factors which serve this recovery priming function are often quite different than 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, e.g., 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; or suicidal thoughts. Less well-recognized appreciated, 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; or new opportunities.

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J

Jump Starts:  see Initiating Factors. 

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M

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 socio-cultural values, needs, and preferences.  

Micro Enterprise:  see Social Cooperative/Entrepreneurialism.

Moderated Recovery:  is the resolution of alcohol or other drug problems through reduction of alcohol or other drug consumption to a sub-clinical 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.

Motivational Interventions:  are non-confrontational 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 they 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 intervention strategies.

Multiple Pathways of Recovery:  reflects 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:  are 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 also Indigenous Healers and Institutions).

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N

Natural Recovery:  is 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:  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.

Natural Support:  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, or any other person who plays a positive, but non-professional, role in someone’s recovery. 

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P

Partial Recovery:  is 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 asso-ciated with substance use, or 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 outcome.  

Peer:  within mental health and/or substance use, this term is used to refer to someone else who has experienced first-hand, and is now in recovery from, a mental health and/or substance use condition.  

Peer-Delivered Services:  any service or support provided by a person in recovery from a mental health and/or substance use condition for which their 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 below), encompassing also any conventional health care intervention which 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 psycho-social 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 Programs:  a program that is developed, staffed, and/or managed by people in recovery. In contrast to peer-run businesses (described below) which are self-sustaining and able to generate profits, peer-run programs are typically private-non-profit and oriented to providing health care services and supports such as respite care, transportation to and from health care appointments, recovery education, and advocacy. 

Peer Specialist:  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 multi-disciplinary inpatient, intensive outpatient, or ambulatory team, to roles within peer-run or peer-operated programs (see below).

Peer Support:  while falling along a theoretical continuum, peer support differs both from traditional mutual support groups as well as from consumer-run drop-in centers or businesses. In both mutual support groups and consumer-run programs, the relationships 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 offers 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. 

Person-Centered Care:  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. 

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R

Recovery Capital:  is 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. 

Recovery Celebration:  is 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):  is 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):  is 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 as well as recovery supporters within the community. This concept is based on the belief that there is a well-spring 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.     

Recovery Management:  is 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.  

Recovery-Oriented Practice:  a practice oriented toward promoting and sustaining a person’s recovery from a mental health and/or substance use condition. DMHAS 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:  are 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 may choose.   

Recovery Planning and Recovery Plans:  in contrast to a treatment or service 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.

Recovery Priming:  see Initiating Factors.

Recovery Support Services:  are 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, post-treatment monitoring and support; sober or supported housing; transportation; child care; legal services; educational/vocational supports; and linkage to leisure activities.  

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S

Serial Recovery:  is 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.

Social Cooperative/Entrepreneurialism:  the development and operation of small businesses (“micro enterprises”) 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 means.      
Spirituality:  refers to 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. 

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T

Triggering Mechanisms:  see Initiating Factors.

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U

User/Service Recipient:  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.”  

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V

Valued-Based Practice:  a practice which 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.

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W

Worldview:  is an individual’s perception of his or her relationship with the world; i.e., nature, institutions, people, and things. An individual’s worldview mediates his or her belief systems, assumptions, modes of problem solving, decision making, and conflict resolution style.

WRAP (Wellness Recovery Action Planning):  a self-help approach to illness management and wellness promotion developed by Mary Ellen Copeland.

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