Terms & Definitions

Glossary of commonly used Terms & Definitions
The absence of substance use. However, there are many different types of abstinence. Abstinence is typically interpreted as complete abstinence, as defined:
(a) Continuous abstinence: not consuming the drug of choice during a specified period of time
(b)Essentially abstinent: not consuming more than a specified amount of the drug over a period of time
(c) Minimal abstinence: achieving a minimal period of recovery during a period of time
(d)Point-in-time abstinence: not consuming the drug of choice at a single point in time (e.g., the past 30 days)
(e)Complete abstinence: continuous abstinence from all alcohol and other drugs
(f) Involuntary abstinence: enforced abstinence due to hospitalization or incarceration [Recovery Research Institute].
1) According to the American Society of Addiction Medicine (ASAM), addiction is a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestation. Addiction is characterized by behaviors that include: (a) Impaired control over drug use, (b) Compulsive use, (c) Continued use despite harm, and (d) Cravings.  [Recovery Research Institute]
2) The problematic use of a substance. The harms of substance use can range from mild (e.g., feeling hungover, being late for work) to severs (e.g., homelessness, disease) [CAMH].
3) Elements of addiction derived from a literature search that uncovered 52 studies include: (a) engagement in the behavior to achieve appetitive effects, (b) preoccupation with the behavior, (c) temporary satiation, (d) loss of control, and (e) suffering negative consequences. Differences from compulsions are suggested [Sussman and Sussman 2011].
Behavioural Addictions
A form of addiction that involves a compulsion to engage in a rewarding non-drug-related behavior – sometimes called a natural reward – despite experiencing negative harmful consequences due to the compulsive behavior (e.g., sex, gambling, food, shopping, internet) [Recovery Research Institute].
Co-Occurring Disorders or Concurrent Disorders
This is used most often to describe in with both mental illness & substance use disorder. Personality disorder may also co-exist with psychiatric illness and/or substance use disorders. Also known as comorbidity or dual diagnosis [Recovery Research Institute]. Concurrent disorders are co-occurring addiction and mental health problems. No one symptom or group of symptoms is common to all concurrent disorders. Mental Illness & Addiction Index [CAMH].
Concurrent disorders happens when a person suffers from an addiction and a mental health problem at the same time. For example, people with a concurrent disorder might have schizophrenia and an opioid addiction, or post-traumatic stress disorder and an alcohol addiction. People with this diagnosis often live with other challenges that can further complicate their illness.  This makes recovery even more challenging: (a)An additional mood or personality disorder that makes a client feel particularly anxious, fearful or paranoid, (b) A chronic physical illness, (c)A history of poor health or dental care due to social barriers, (d) Unstable housing and/ or unemployment, (e) Stigma, and (f) history of trauma [BCMHSUS].
Communities of Practice (CoP)
A CoP is a group of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis. The method of interaction does not define the CoP. The members of a CoP can share and build their knowledge by communicating online, in person, through webinars or teleconferences, or through any other means that works for the participants.
Continuum of Services
The continuum of services for Mental Health and Substance Use services is an integrated system of services, spanning all the levels of intensity of care. The levels for each client will vary depending on their unique recovery needs, and individuals ought to be able to move seamlessly back and forth along the continuum.
Systems thinking is an approach to problem solving that views “problems” as a part of a wider, dynamic system.  Through an increased understanding of a system’s fundamental characteristics, systems thinking allows us to see with great precision now systems work.  Systems thinking works to decode the complexity of a health system, then applies this understanding to design and evaluate interventions that maximize health and health equity [AHPSR and WHO, 2009].
To deliver Stepped Care requires a system of delivering and monitoring mental health and addiction treatment so that the most effective, yet least resource intensive treatment, is delivered first, only “stepping up” to intensive / specialist services as required and depending on the level of patient distress or need.
Evidence-informed and Evidence-based Practice
Evidence-informed practice (or policy refers) to scientific evidence and its use; i.e., it implies that many different levels of evidence and types of evidence are needed and used to support decisions. Many people believe that “evidence-informed practice extends beyond the early definitions of evidenced-based practice” [Woodbury 2014].
Client care informed through the integration of clinical expertise and best available clinical evidence from systematic research [Recovery Research Institute].
Fidelity (implementation fidelity
Fidelity (in the context of implementation of an intervention) is the degree to which an intervention or programme is delivered as intended [Carroll C 2007]. Fidelity of intervention means faithful and correct implementation of the key components of a defined intervention [Mihee 2020 in Physical Therapy].
Harm Reduction or Reducing Harms
Policies, programs and practices that aim to reduce the harms associated with the use of alcohol or other drugs. The defining features include a focus on the prevention of harm, rather than on the prevention of substance use itself, with attention and focus on the individual’s active substance use (e.g., a clean needle exchange program can reduce rates of transmission of hepatitis C, HIV, or other infectious disease for individuals suffering from heroin use disorder) [Recovery Research Institute].
Harm Reduction is an evidenced-based, client centered approach that seeks to reduce the health and social harms associated with addiction and substance use. Harm reduction refers to policies, programmes and practices that focus on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using substances as a precondition of support.
Integrated Health Systems / Integrated Treatment Programs
Integrated health systems are ”the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.”  Integration is predominantly about structures and is defined from the perspective of the system [WHO 2017].
Integrated treatment programs that work to treat substance use disorder alongside other co-occurring mental, physical, emotional or social considerations, recognizing how the presence of each can be a risk factor for relapse to either. The term is most often used to indicate the combination of addiction treatment services with mental health treatment services, or on-site pregnancy, parenting, or child-related services [Recovery Research Institute].
Multisectoral collaboration or action involves promoting and protecting mental well-being and preventing and treating mental disorders requires working in partnership across multiple public and private sectors including health care, education, employment, judiciary, housing, social welfare and other relevant sectors [Adapted from WHO, 2019]. 
Integrated Treatment Programs
See Integrated Health Systems
Land Based Healing
Hard work and living off the land – healing can include getting back to our history, hunting, fishing, growing and sharing with each other. Reclamation of our ceremonies and not accommodating our beliefs or explaining our ways. It is everything that helps us remember who we are and be authentic. Getting back to nature to heal ourselves, like swimming in our sacred spots, top of the mountain journey, listening to the creator [Elders, Skwah First Nations- Shxwhá:y Village -members of Stó:lō Nations, Chilliwack BC].
Levels of Care
Various levels of treatment intensity ranging from weekly outpatient therapy to more intensive medically monitored or medically managed hospitalization. The American Society of Addiction Medicine (ASAM) have constructed a detailed assessment process based on specific criteria that can provide clinicians with a holistic approach to individualized assessment and placement to the most appropriate level of care along with outcome-driven treatment plans that focus on individualized needs [Recovery Research Institute].
Measurement-based Practice
Measurement-based practice is a framework in which validated (evidence-based) symptom rating scales and screening tools are routinely used in clinical practice to inform treatment decisions and adjustments. Scales and tools look to screen for and diagnose substance use disorder, measure severity, and monitor disease progression or improvement at every point of care, akin to the management of other chronic diseases such as hypertension and diabetes.
Also known as mutual help organizations, peer support groups are structured non-clinical relationships, in which individuals participate in activities that engage, educate, and support patients recovering from substance use disorder. Peer to peer groups include such organizations as: AA, NA, Smart Recovery, All Recovery groups, LIfeRing, Women for Sobriety, and online forums. As part of a larger treatment plan, peer providers offer valuable guidance and connection to individuals in recovery through the process of sharing their own experiences in recovery from substance use disorder [Recovery Research Institute].
Multisectoral Collaboration
See Integrated Health Systems
Mutual Help Organizations
Also known as self-help groups, peer support groups, and mutual aid, mutual help organizations are for the most part peer run volunteer organizations that focus on socially supportive communication and exchange of addiction and recovery experiences and skills.
Also known as mutual help organizations, peer support groups are structured non-clinical relationships, in which individuals participate in activities that engage, educate, and support patients recovering from substance use disorder. Peer to peer groups include such organizations as: AA, NA, Smart Recovery, All Recovery groups, LIfeRing, Women for Sobriety, and online forums. As part of a larger treatment plan, peer providers offer valuable guidance and connection to individuals in recovery through the process of sharing their own experiences in recovery from substance use disorder [Recovery Research Institute].
Peer Support Groups
See Mutual Help Organizations
Performance Measurement (frameworks / systems) and Accountability
1. Performance measurement is the use of measures or indicators (qualitative or quantitative) to track change attributable to interventions with the aim of effecting positive improvements in meeting the needs of the population. (MHCC 2018).  
2. A performance measurement ‘framework’ is a structure for conceptualizing and categorizing indicators or measures, which will ordinarily have several domains/dimensions; to specify relationships among measures or indicators, to ensure balance across important priority areas, and for planning the measurement process. 
3. A performance measurement ‘system’ includes the capacities and infrastructure for repeated measurement and reporting, continued consultation and engagement, and collaborative action on results”. 
4. Accountability, in the context of health services, refers to a process through which a governing body (e.g., government, regional health authority, healthcare board or professional association) is in a position to mandate providers or organizations to meet certain goals or objectives… and the providers or organizations must account for their achievements in relation to such goals or objectives [Jean-Louis Denis 2014 in Healthcare Policy Vol 10, Special Issue].
Prevention Paradox
A contradictory scenario whereby the majority of cases of substance-related harm come from a population at low or moderate risk of addiction, while only a minority of cases come from the population who are at high risk of substance-related harm.
Taking alcohol use as an example, an alcohol “prevention paradox” would be a case where low-risk drinkers would also require some kind of prevention/intervention to prevent overall harm in the population, despite the fact the incidence of risk is much lower in this group relative to the heavy drinking population [Recovery Research Institute].
Recovery is a sustainable, voluntary, and continual restraint from the compulsive pursuit of reward and/or relief that involves the use of substances and other behaviours; improved physical and mental health, social connection and functioning, and enhanced quality of life. Recovery is the experience through which individuals, families, and communities impacted by substances and other behaviors draw upon recovery capital to willingly resolve these issues, actively manage their continued vulnerability to such difficulties, and develop a healthy, productive, and meaningful life.
Recovery Capital
The resources (social, physical, human and cultural), which are necessary to begin and maintain recovery from substance use disorder [Recovery Research Institute].
Recovery Community Centres
A center or hub that organizes recovery networks regionally and nationally to facilitate supportive relationships between individuals in recovery as well as family and friends of people in recovery. Centers may provide advocacy training, peer support organization meetings, social activities, job linkage, and other community-based services [Recovery Research Institute].
The concept of recovery in mental health refers to living a satisfying, hopeful, and contributing life, even when a person may be experiencing ongoing symptoms of a mental health problem or illness. Recovery journeys build on individual, family, cultural, and community strengths and can be supported by many types of services, supports, and treatments. Recovery principles including hope, dignity, self-determination, and responsibility can be adapted to the realities of different life stages, and to the full range of mental health problems and illnesses. Recovery is not only possible, but it should also be expected. In recovery–oriented practice, service providers engage in shared decision-making with people with lived experience of mental health problems and illnesses, offering a range of services and supports to fully meet a person’s goals and needs.
Recovery-Oriented Systems of Care
A coordinated network of community-based services that involve a strengths-based and personalized approach to recovery and increases in quality of life [Recovery Research Institute].
Shame or Stigma or Discrimination
A painful, negative emotion, which can be caused or exacerbated by conduct that violates personal values. Can also stem from deeply held beliefs that one is somehow flawed and unworthy of love, support, and connection, leading to increased odds of isolation. Stigma is an attribute, behavior or condition that is socially discrediting. Known to decrease treatment seeking behaviours in individuals with substance use disorders [Recovery Research Institute].

Stigma is the negative stereotype and discrimination is the behavior that results from this negative stereotype. Discrimination is unfair treatment due to a person’s identity, which includes race, ancestry, place of origin, color, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability, including mental disorder.
Social Enterprise
Businesses that help solve social problems, improve communities, people’s life chances, or environment. Profits stem from selling goods and services in the open market, but profits are then reinvested back into the business or the local community. This model has started to be used in addiction recovery settings [Recovery Research Institute].
Includes Program and Service standards (operational standards); Quality standards; and Accreditation Standards. 
1. Program and Service Standards (operational standards) define for whom a program is intended; the required services; the type of staff/numbers needed to competently provide the services; and the intended benefits/outcomes for the clients receiving the services. 
2. Quality Standards: Outlines for clinicians and patients what high quality care looks like for a specific condition. Are based on the best available evidence and decided upon by expert advisory committees comprised of patients or caregivers and health care professionals with experience in dealing with the relevant condition. Focus is on where there are large variations in how care is delivered, or where there are gaps between the care provided in and the care patients should receive. 
3. Accreditation Standards: Developed by Health Standards Organization (HSO) and assessed by Accreditation Canada (voluntary). HSO standards focus on providing the highest achievable quality for patients and their families covering a broad spectrum of health services. The global standards are designed in partnership with clinicians and policy makers to ensure they provide for effective health services and overall value.
Stepped Care
See Continuum of Services
Substance Use Disorder
The clinical term describing a syndrome consisting of a coherent set of signs and symptoms that cause significant distress and or impairment during the same 12-month period.
Trauma-informed care
Trauma-informed care recognizes and responds to the impact of adverse experiences on a client or patient.  It has 5 principles (also steps in care): (a) Trauma awareness and acknowledgment, (b) Safety and trustworthiness, (c) Choice, control, and collaboration, (d) Strengths-based and skills-building care, (e)Cultural, historical, and (f) gender issue sensitivity.

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