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or has received appropriate evaluation and/or treatment. 9. Relapse – Addictive illness "relapse" is the recurrence of behavior or other ―substantive indicators‖ of active disease after a period of remission, i.e., abstinence from proscribed substances. It is important to note that appropriate treatment of some participants may involve the use of prescription medications known to the PHP. Relapse can involve return to the drug of choice or use of some other substance. There are three levels of relapse behavior having the potential to impact public safety: Level 1 Relapse: Behavior without chemical use that is suggestive of impending relapse Level 2 Relapse: Relapse, with chemical use, that is not in the context of active medical practice Level 3 Relapse: Relapse, with chemical use, in the context of active medical practice. 10. Substantive Non-Compliance Substantive non-compliance is a pattern of non-compliance or dishonesty in PHP continuing care monitoring or an episode of non-compliance which could place patients at risk. 11. Tracks of Referral - a. Voluntary Track – A confidential process of seeking assistance and guidance through a PHP without required personal identification to the state licensure board whereby the potentially impairing illness is addressed. A voluntary track promotes earlier detection of potentially impairing illness before it becomes functionally impairing. The voluntary track participants are in a safe system whereby substantive non-compliance or relapse, depending on each state’s non-compliance reporting requirements, will be promptly reported to the licensure board by name. b. Mandated Track – Mandated licensees are those required by the state medical board to participate in a PHP. A ―mandated‖ referral can be via an informal referral or via a formal disciplinary process that is public. In either instance the board may require quarterly progress reports. It is recommended that boards have a non-disciplinary process for referral to PHPs to encourage early detection and intervention. 12. Mental Disorder – In the DSM-IV nomenclature, the term ―mental disorder‖ has a specific meaning. It includes substance-related disorders, Axis I psychiatric disorders/illnesses, and Axis II behavioral personality disorders. Federation of State Medical Boards 10 According to the DSM-IV, each of the ―mental disorders‖ is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with the following core characteristics: Present distress (e.g., a painful symptom) OR Disability (i.e., impairment in one or more important areas of functioning) OR Significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. Also, the syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. 13. Psychiatric Illness Axis I psychiatric illnesses or clinical conditions include symptom disorders such as mood disorders (for example, bipolar disorders and depressive disorders), anxiety disorders, adjustment disorders, eating disorders, psychotic disorders, and certain other disorders. According to DSM-IV, Axis I psychiatric disorders/illnesses are considered separate and distinct from Axis II personality disorders that involve lifelong maladaptive patterns of behaving. 14. Intervention – An intervention is a strategy orchestrated by an individual or group, in an attempt to persuade a physician to seek professional evaluation and assistance. 15. Treatment – Treatment involves the delivery of care and rehabilitation to licensees experiencing a potentially impairing illness. 16. Continuing care – Care that follows the acute phase of intervention and initial treatment is referred to as continuing care, oftentimes referred to as aftercare. PHPs oversee and monitor the continuity of care to ensure progress and continued compliance. Continuing care includes PHP guidance, support, toxicology collection, and accountability through a formal monitoring contract5 concurrent with or following an evaluation and treatment process. 17. Participant – A participant is a licensee enrolled in a PHP pursuant to an executed contract5