substance misuse, students, and occupational therapy

Substance misuse and students

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Dark side of occupation

The “dark side of occupation” is a phrase used to describe activities that are not life enhancing but people choose to spend their time doing.1 Substance misuse may be considered within the dark side of occupation, especially in university students.  Substance misuse may also be seen as a maladaptive serious leisure hobby, since the behaviors and activities associated with high risk drinking are oftentimes scheduled and pre-planned, can be rewarding, and provides social interaction.2 However, it is important to recognize substance misuse and intervene if there are problems since there is a strong correlation between high-risk drinking and university attrition.3 Looking at these behaviors as personally meaningful and having similar outcomes as leisure is important for planning intervention.

Historically, students are spending less time studying and more time in leisure and employment activities.4   There are some factors that seem to increase the risk that someone will engage in substance misuse. First, students who have difficulty with self-management to time and poor self-restraint (those who are impulsive and have poor decision making patterns) may be more likely to misuse substances.5 And, students who misuse substances also appear to have lower perceived levels of goal-directed behavior and lower levels of self-efficacy also tend to drink more.5


Assessment of substance use/misuse will be similar to all the other habitual behaviors that have been covered thus far (check out the full list here!). It would be important to look at time use and balance  and also uncover usage patterns (days spent using and amount consumed on days spent using the substance).  Through motivational interviewing, the OT can discover how motivated the student is to change his/her behaviors. Finally, it would be important to consider what secondary gains the substance use provides the student in order to discover equally fulfilling leisure activities.   


  • Psychoeducation2
    • Educate students on the dangers of substance misuse and challenge any denial of the potential for harm. Most misusers report that they were maintaining their ability to perform their occupational roles adequately, although eventually their productivity levels would diminish – this could be a point of conversation since decreasing productivity levels are likely the cause of university attrition.
    • Alternately (depending on the student), gain-framed messages that highlight the benefits of engaging in a health protective behavior (for example, instead of drinking you can go play in a sport and increase your energy levels overall).  Or, you can discuss the positives about not engaging in a risky behavior (for example, by not drinking heavily you can avoid unintended accidents).6
  • Evaluate leisure interests – find something(s) that can be personally meaningful to the student that can replace the substance use activities.
  • Use intention implementations and context modifications (this has been discussed previously here – the most evidenced strategy to address habit change!). Students have to decide that they want to change their behaviors, create goals that support the change in behavior, and make small changes to their routines and environment to encourage habit change.    
  • Assess and address executive function deficits – work on executive functioning skills globally – and self-management and self-restraint in particular.
    • Consider maladaptive habits that have been formed and address time organization and management as a central theme.
  • Group experiences2
    • Emotional, cognitive, physical, and social pleasure can occur within an overt group atmosphere. Any intervention program needs to be designed with the aim to help college students achieve those experiences through less harmful, but equally pleasurable, leisure occupations – and the presence of a group can be very effective.


  1. Twinley, R. (2013) The dark side of occupation: A concept for consideration. Australian Occupational Therapy Journal, 60, 301–303. doi: 10.1111/1440-1630.12026
  2. Maloney, M. (2011) College Student high-risk drinking as a maladaptive serious leisure hobby.  Occupational Therapy in Mental Health, 27, 155–177.  doi: 10.1080/0164212X.2011.567351
  3. Jennison, K. M. (2004). The short-term effects and unintended long-term consequences of binge drinking in college: A10-year follow-up study. American Journal of Drug and Alcohol Abuse, 30, 659–684.
  4. Babcock, P., & Marks, M. (2010). The falling time cost of college: Evidence from half a century of time use data. Review of Economics and Statistics, 93(2), 468-478.
  5. Brunelle, C. & Flood, M. (2016).  Examining the relationship between self-reported executive cogntivie functioning and substance misuse in university students.  J Subst Use, 21(1), 3-8. 
  6. Bernstein, M. H., Wood, M.D., & Erickson, L.R. (2016).  The effectiveness of message framing and temporal context on college student alcohol use and problems: A selective e-mail intervention. Alcohol and Alcoholism, 51(1) 106–116. doi: 10.1093/alcalc/agv091

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