Occupational therapy and substance use
In this blog, I highlight recent literature that supports OTs working with clients who have substance use issues.
A review of OT interventions for substance use
Amorelli (2016) released a review of evidence (from 2000-2015) for OTs working with people with substance use issues. The bottom line:
- Most OTs research supports life skills training for relapse prevention which includes stress and anger management, leisure and relaxation, and cognitive behavior techniques.
- However, the research in this area is not robust, even though they found positive results. The research suffers from small sample sizes, lack of randomization and did not account for bias or confounding variables. Thankfully, there are some new studies that have come out since the review!
Doing, Being, Becoming, BELONGING in substance use treatment
OTs understand the importance of engagement in occupation for health. Blank, Finlay, and Prior (2016) highlight the need for OTs to address the idea of belonging in intervention, especially with people who are dually diagnosed (substance use plus another mental illness).
The authors suggest:
- that OTs can talk about belonging in treatment and explore what belonging means to their clients.
- that connections with people and feelings of belonging may be more important than the act of engagement itself. For OTs, that might mean that treatment can focus on belonging. OTs can help clients work towards better social relationships by using group process in treatment; and help a client achieve a sense of belonging by encouraging participation in new activities. Click here for an article on belonging and horticulture.
- that isolation may be a way to manage stress. This is different than current thinking – that isolation is a sign of distress. OTs can help a client learn to balance social participation with alone time. And, OTs may need to weigh the pros and cons of social engagement at times when a client might need isolation to manage stress.
Adolescents and perceptions of OT INTERVENTION for substance use
Bell, Wegner, Blake, Jupp, Fides & Turner (2016) studied the perceptions of OT treatment by adolescents who were engaged in an inpatient substance abuse program.
The adolescents had difficulty articulating OTs role on the team. Some appeared to dislike the arts and crafts, dismissing them as “boring”. However, activities that built skills and focused on occupation gave them opportunities to avoid the substance.
For the adolescents, leisure exploration and work exploration activities were most valued. They also believed that the communication skills and assertiveness interventions were helpful in staying clean after discharge. If they didn’t have anyone to talk to, they reverted to journaling to get down their thoughts and help with the cravings. Most of the adolescents also felt that by becoming aware of the roles that they lost before treatment helped them in the recovery process.
The adolescents stated that they wanted more community practice with the skilsl they had learned in the rehab program. They also wanted more community based programs after discharge. They really wanted somewhere to go after they were out of the program.
The study suggests:
- Communication skills, including assertiveness training helped the adolescents with sobriety.
- Discussing roles with clients was important in the adolescent’s recovery.
- Other elements of the program that were beneficial: occupation and skills building, including leisure exploration and participation.
- More focus should be on real-life practice of skills and interventions in the community after discharge to facilitate recovery.
Vets with substance abuse and a theater based intervention
Wasmuth & Pritchard (2016) studied a theater based intervention for veterans. The veterans acted scenes from an adaptation of a Greek myth over a six week period. As part of the treatment, they explored the story line: the traits of the
characters, the relationships between characters and the challenges experienced by the characters, and how the story lines fit into their own lives. In the end, they performed the play to the public.
Those who participated in the intervention demonstrated improved social and occupational participation at six weeks after the intervention. They did not have significant improvement at the 6 month follow-up but their scores on the OCAIRS did remain elevated from previous scores. The authors did not find any changes in self-efficacy. Substance use had declined in the group, but this outcome was questionable. The dually diagnosed veterans appeared to derive the most benefit from this treatment.
It looks like from this review that life skills training appears to be most effective for people with a substance abuse problem. The three articles also suggest that belonging might be an important aspect of intervention for substance abuse.
OTs can address belonging in clinical practice by creatively using available resources. For example, is there someone who is a chef that can teach your clientssome skills in the kitchen? Is there someone who is a master gardener that can teach your clients how to grow a wonderful veggie garden in a limited amount of space? Maybe a weekly knitting group to make caps for newborn babies. All of these activities help clients learn a new skill and feel a sense of belonging.
Using groups and the group process can build community with their clients. Remember the stages of group development – forming, norming, storming, performing, and adjourning. Use groups to build a sense of belonging and community.
After discharge, OTs can develop ways to engage their clients with each other through social networks. OTs can also help clients build supports in the community. Apps can provide to provide a connection to a bigger community of people in recovery. Click here to check out an app that connects people who are going through recovery: recoveryBox app
I run groups with young university students. Some groups focus on social participation. One activity that we did was require that the students make “social dates” with each other. We talked about social communication and being open to new activities in order to improve your social circle – ultimately helping with that idea of BELONGING.
I am sure that there are many OTs doing just that – facilitating a sense of belonging in their clients. Do you?
Amorelli, C.R. (2016). Psychosocial occupational therapy interventions for substance-use disorders: A narrative review. Occupational Therapy in Mental Health, 32(2), 167-184. DOI: 10.1080/0164212X.2015.1134293
Bell, T., Wegner, L., Blake, L., Jupp, L., Fides, N., & Turner, T. (2015). Clients’ perceptions of an occupational therapy intervention at a substance use rehabilitation centre in the Western Cape. South African Journal of Occupational Therapy, 45(2), 10-14.
Blank, A., Finlay, L., & Prior, S. (2016). The lived experience of people with mental health substance misuse problems: Dimensions of belonging. British Journal of Occupational Therapy, 79(7). 434-441.
Wasmuth, S. & Pritchard, K. (2016). Theater-based community engagement project for veterans recovering from substance use disorders. American Journal of Occupational Therapy,70 (4), 1-11. Retrieved from http://ajot.aota.org/article.aspx?articleid=2523530