Standards on Substance Use Disorders and Mental Health Conditions: Definitions

Standards adopted by the Supreme Judicial Court, acting on the advice of the Working Group on Substance Use and Mental Health.

Addiction: The persistent use of substances despite substantial harm and adverse consequences.  The term “addiction” is used interchangeably with the term Substance Use Disorder in these Standards.

Behavioral Health: An umbrella term that includes, but is not limited to, substance use disorders, mental health conditions, and co-occurring disorders.

Co-Occurring Disorder: The co-existence of at least one mental health condition and at least one substance use disorder. Also known as “comorbidity” or “dual diagnosis.”

Evidence-Based Practice: The objective, balanced, and responsible use of current research and the best available data to guide policy and practice decisions to improve outcomes for participants. Empirical research practices, rather than anecdotal or professional experience alone, have been demonstrated to be effective. ⁽¹⁾

Harm Reduction: Evidence-based strategies that aim to reduce the negative effects of the use of alcohol or other drugs. ⁽²⁾

Medications for Substance Use Disorder:  In the treatment of addiction, medications are used to reduce the intensity of withdrawal symptoms, reduce alcohol and other drug cravings, and reduce the likelihood of use or relapse for specific drugs by blocking their effect. Such medications may also be referred to as Medications for Opioid Use Disorder (MOUD). Because medications are an effective treatment strategy, when used alone or in combination with behavioral therapies, the term Medication Assisted Treatment (MAT) is no longer the preferred term. ⁽³⁾ While behavioral therapies are helpful to provide an individualized approach, they are not essential under evidence-based practice.  

Mental Health Condition: A health condition involving changes in emotion, thinking, or behavior (or a combination of these) that is associated with distress or problems functioning in social, work or family activities. ⁽⁴⁾ These Standards use the term Mental Health Condition interchangeably with the term Mental Illness. ⁽⁵⁾ A Serious Mental Illness (SMI) is a mental, behavioral, or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities.

Stigma: Perceptions and attitudes evidenced by derogatory, biased words or behaviors, which, in the context of these Standards, may be directed towards people with a mental health condition, substance use disorder or trauma history. Stigma may take the form of labeling someone as inferior, assigning blame or responsibility to the person for the condition, or portraying the person as a danger or threat to others. Stigma prevents people from seeking treatment and staying in recovery and frequently causes feelings of shame, rejection, and isolation.  

Substance Use Disorder (SUD): The persistent use of substances despite substantial harm and adverse consequences.  Drug classes that are involved in SUD include:  alcohol; opioids; sedatives, hypnotics, or anxiolytics; stimulants; phencyclidine and other hallucinogens; inhalants; cannabis; tobacco; and other unknown substances. The term “substance use disorder” is used interchangeably with the term Addiction in these Standards.

Trauma: Lasting adverse effects on an individual’s functioning and mental, physical, social, or emotional well-being as a result of an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening.

Adverse Childhood Experiences (ACEs): Potentially traumatic events that occur in childhood, including but not limited to being subjected to or living in a home with violence, abuse, or a family member with mental health conditions or substance use disorders. Toxic stress from ACEs can change brain development and affect how the body responds to stress. ACEs are linked to chronic health problems, mental illness, and substance misuse in adulthood. ⁽⁶⁾

Trauma-Informed: A program, organization, or system that recognizes the signs and symptoms of trauma in clients, families, staff, and others, responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks actively to resist re-traumatization. ⁽⁷⁾

1. Crime and Justice Institute at Community Resources for Justice, Evidence-based practices (EBP), U.S. Department of Justice National Institute of Corrections (2009), nicic.gov/projects/evidence-based-practices-ebp.
2. U.S. Department of Health & Human Services, Harm reduction (2023), hhs.gov/overdose-prevention/harm-reduction.
3. Medication Assisted Treatment (MAT) is the use of medication in combination with behavioral health services to provide an individualized approach to the treatment of substance use disorder, including opioid use disorder. 42 C.F.R. § 8.2.
4. American Psychiatric Association, What is mental illness? (2022), psychiatry.org/patients-families/what-is-mental-illness.

5. National Alliance on Mental Illness, Mental health conditions, https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions.

6. Centers for Disease Control and Prevention, Adverse childhood experiences (ACEs) (2021), www.cdc.gov/vitalsigns/aces.

7. SAMHSA’s Trauma and Justice Strategic Initiative, SAMHSA’s concept of trauma and guidance for a trauma-informed approach, Substance Abuse and Mental Health Services Administration, 9 (2014), https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf.