Introduction to the Special Issue on Substance Use and Occupational Therapy

Abstract

Readers of this journal are undoubtedly already aware that substance use disorders (SUDs) are a significant public health problem. More than 2% of the world population is living with a substance abuse disorder, and 1.4% of the global burden of disease is attributable to alcohol and illicit drug use. What readers may have had less opportunity to consider is that occupational therapists are an underutilized resource in our response to the substance use disorder crisis, and that occupational therapy researchers can provide key insights into the nature of substance use in individuals’ lives and in our communities. That is the focus of this special issue.

Introduction

Readers of this journal are undoubtedly already aware that substance use disorders (SUDs) are a significant public health problem. More than 2% of the world population is living with a substance abuse disorder, ¹ and 1.4% of the global burden of disease is attributable to alcohol and illicit drug use. ² What readers may have had less opportunity to consider is that occupational therapists are an underutilized resource in our response to the substance use disorder crisis, and that occupational therapy researchers can provide key insights into the nature of substance use in individuals’ lives and in our communities. That is the focus of this special issue.

What is occupational therapy? Occupational therapy is frequently confused with the field of occupational health, but the 2 are conceptually entirely distinct. The latter is the study of the health and safety of laborers (ie, workers) in all workplaces, employment settings, and occupations. ³ Occupational therapy, in contrast, is a rehabilitation healthcare profession that often focuses on helping individuals perform daily self-care tasks such as bathing, dressing, grooming, toileting, or getting in and out of a bed or chair (ie, “activities of daily living”), or other everyday things such as cooking, working, and leisure activities. ⁴ Occupational therapy practitioners (OTPs) work in hospitals and community health settings, and may also work in schools or private practice. As such, occupational therapists are ideally positioned to be key collaborators in the endeavor to prevent and treat and SUDs. We note here that the definition of SUD used by the US Substance Abuse and Mental Health Services Administration (SAMHSA) is “the recurrent use of alcohol and/or drugs that cause clinically significant impairments, including failure to meet major responsibilities at work, school, or home” which aligns neatly with the scope of practice for OTPs. ⁵ According to the Occupational Therapy Practice Framework (OTPF-4), OTPs should “address barriers that impact participation and performance, including physical, psychological, and environmental barriers.” ⁶ Substance use and related impairments are barriers to participation and performance, and therefore, a logical focus of occupational therapy intervention. As several papers in this special issue demonstrate, OTPs can play a crucial role in identifying and addressing the unique needs of those with SUDs.

Scope of Special Issue

This special issue explores the role of occupational therapy in addressing substance use, or improving the well-being of those living with or recovering from SUDs. The invited articles showcase the experiences and perceived needs of individuals with SUDs, provide case studies of how occupational therapy can meet those needs, and present OTPs’ perspectives on treating clients with SUDs. The studies in this issue can be categorized as pertaining to: (1) the meaning and impact of substance use on daily life, (2) types of occupational therapy interventions to meet SUD-specific needs, and (3) occupational therapy practitioners’ attitudes and perceptions toward treating clients with SUDs.

Specific Studies

Meaning and impact of substance use in daily life

Although addressing SUD is considered a public health priority, it is also true that for some people, some substance use can have benefits. For example, moderate drinking may have a short-term but positive impact on mood, relaxation and disinhibition, ⁷ and thus is widely consumed for recreational purposes. Cannabis may be beneficial for those experiencing chronic pain, lack of appetite, nausea, and, although the evidence is mixed, may alleviate anxiety in some people.^8-11 Emerging research suggest that other illegal drugs, such as psilocybin, may have therapeutic benefits for some people, as well. ¹² There is a growing awareness within the field of occupational therapy that even activities that are illegal, considered unhealthy, or risky may hold meaning and provide positive outcomes for those who engage in them.^13,14 Therefore, understanding the meaning that individuals ascribe to substance use and its impact on their daily life is crucial for occupational therapists to effectively address substance use in therapy.

In this issue, Guyonnet et al ¹⁵ present the results of a 14-paper scoping review that investigated how adults from the US, Canada, UK, Sweden, Nigeria, South Africa, New Zealand, and Australia perceive and describe the significance of cannabis use in their daily lives. Using reflexive thematic analysis, the study found that cannabis can help some adults manage chronic pain, alleviate boredom and stress, facilitate social relationships, and provide spiritual inspiration. Specifically, the review found that adults who participated in the underlying research studies reported that cannabis supported them in navigating daily routines, enhanced their engagement in activities, and contributed positively to their feelings of belonging and sense of identity. The authors encourage occupational therapists to be open to clients who may ascribe positive value to cannabis use.

Kitzinger et al also consider the meaning of substance use to those in recovery from SUD. Specifically, the research team conducted a mixed-methods exploratory study to investigate the habits and routines of adults in early recovery (<1 year) from SUDs. The study found that the recovery process significantly impacted an individual’s daily structure, leaving individuals in need of support in restructuring their free time. Participants in early recovery identified rest as their primary daily activity on both their busiest and least busy days, suggesting that rest is used as a coping mechanism during unstructured time. The study also revealed that boredom and unoccupied time can be a risk for people in the early phase of recovery. This type of daily occupational analysis is crucial for understanding how substance use affects daily routines and habits of subpopulations, so that therapists can help individual clients replace harmful habits with healthier ones. The authors conclude that individuals in recovery from SUDs are most vulnerable during unstructured time and need consistent structure to establish and maintain healthier routines. Occupational therapists can play a role in helping individuals identify and create new patterns of habits and utilize time configuration strategies to benefit clients in recovery.

Types of occupational therapy interventions to meet SUD-specific needs

Shin et al ¹⁷ and Ryan et al provide examples of types of occupational therapy interventions that can meet SUD-specific needs. Shin et al are in the planning phase of a randomized clinical trial. They are preparing to evaluate whether a 10-week occupational therapy group intervention for people living with HIV (PLWH) can reduce falls and fall-related injuries. The fourth week of the 10-week intervention is devoted to substance use, including providing information about substance use treatment options. While the randomized trial has not yet been conducted, what this article highlights is that there is a role—an important one—that occupational therapists can play in injury prevention, in substance use prevention, and on interdisciplinary research teams.

Ryan et al present the results of a one-group pre-and-post evaluation study, involving 16 participants in an occupational therapy intervention that took place in an addiction recovery setting. The intervention was an occupation-focused psychoeducational program comprising 5 topics that were explored once per week for 1 hour. The study explores occupational functioning in people living with SUDs, and uses a well-known and highly regarded occupational therapy assessment instrument, the Canadian Personal Recovery Outcome Measure (C-PROM). The study found that there was a substantial change in C-PROM scores, in the positive and hoped-for direction, from before the intervention to after the intervention. The study is exciting because it is one of the first to explore the impact of providing occupational therapy in a substance abuse treatment inpatient setting, and found promising results.

Occupational therapy practitioners’ attitudes and perceptions toward treating clients with SUDs

The final paper in the special issue is anticipated to become one frequently cited by occupational therapists, innovators in substance abuse treatment and prevention, and public health researchers. Matilla et al ¹⁸ present the results of a cross-sectional, self-report, online survey of N = 116 occupational therapists. Data were collected October-December of 2021 from a convenience sample of occupational therapy professionals who work in settings including acute care, outpatient and inpatient rehabilitation, school systems, community practice, skilled nursing facilities, and home health. Importantly, the research team found that only 27.6% of occupational therapy professional respondents had any formal training on SUDs, including coursework, certification programs, work-related training or continuing education on the topic, and only 51.7% reported feeling like they knew enough about the physical effects of SUDs to carry out their role when working with clients with SUDs. Despite the lack of training, 62% of occupational therapists in their sample reported feeling especially compassionate toward clients with SUDs, and 74.1% saw caring for people with SUDs as an important role of occupational therapists. This is striking, and the implications are clear: occupational therapists need, want, and deserve more and better training on substance use and SUDs, and they will engage in the work of substance abuse treatment in interprofessional teams that include substance abuse treatment specialists.

Together, the articles in this special issue highlight the important role that occupational therapists may play in improving substance abuse treatment outcomes and preventing substance misuse. Future research should continue to investigate the unique contributions that occupational therapists will make, encourage substance abuse researchers to consider additional outcomes—such as occupational performance, and activities of daily living—when investigating the impact of substance use on patient populations and evaluate prevention and treatment strategies. Globally, we are in a time of urgent and tremendous need when it comes to access to health care, treatment options, support, and interprofessional collaboration. Occupational therapists are standing by, capable and clearly willing to assist. As a profession, occupational therapists are ready to stand shoulder to shoulder with recovery specialists and addiction medicine experts to engage in this critically important work, and can be counted upon to do so in a way that is thoughtful about the social determinants of SUDs, addresses inequities, and centers the needs of diverse clients with SUDs, their families, and communities.