Skip to main content
NCBI home page
Nordisk Alkohol- & Narkotikatidskrift : NAT logoLink to Nordisk Alkohol- & Narkotikatidskrift : NAT
. 2023 Jan 23;40(4):406–413. doi: 10.1177/14550725221149472

The role of occupational therapy in substance use

Selma Ercan Doğu 1,✉, Esma Özkan 2
PMCID: PMC10472932  PMID: 37663060

Introduction

Substance use disorder is a current serious public health problem that negatively affects the client, the family and the community. Substance use has negative effects on the structure and function of the body, restrictions on daily personal activities and participation in life (O'Day, 2009). In addition, individuals with substance use disorder are socially isolated and exposed to stigmatisation. Therefore, it is essential to integrate them into society. Unfortunately, the rate of drug use has been steadily increasing, and intervention programmes remain inadequate. Many existing substance use programmes showed low success rates; approximately 80%–90% of individuals relapse within the first year of their recovery, and 60% were dissatisfied with the services provided and drop out of treatment (Shaffer et al., 2004; Wasmuth et al., 2015). Therefore, the risk of relapse into substance use and the difficulty quitting nature of the addiction requires a multidisciplinary approach (Cruz, 2019). In addition, substance use affects the individual negatively in many respects; in their occupational and social life, there seems to be a need for holistic approaches in addition to many medical approaches. It may be beneficial to consider occupational therapy approaches in recovery from substance use, as substance use negatively affects occupational participation (Stone, 2017). The aim of the present study was to discuss the role of occupational therapy in substance use and general and occupational therapy (OT) approaches in practice.

Occupational therapy and substance use

OT aims to improve well-being, health and social participation through occupations. OT includes a client-centred process in which the desires and needs of an individual are prioritised (Crouch & Wegner, 2014). According to the American Occupational Therapy Association (AOTA) (2014), occupation refers to the daily activities of individuals, families and communities to make sense of time and add meaning and purpose to life. Occupations include desired and expected things that people need to do. Occupations that are meaningful to someone may not be meaningful to others. The purpose of the activity is determined by individual needs and demands. Therefore, OT interventions must be person-centred in treating substance use disorders.

Occupations have characteristics such as improving health, survival and positive value by culture. When the individual engages in activities that do not conform to socially acceptable norms, this may lead to negative consequences (Scaffa et al., 2014). Drug use can be considered an activity in many aspects for people with substance use. This activity is meaningful and purposeful for them because it can serve many purposes, such as providing a sensation of control, acceptance and peer interaction, and temporarily reducing emotional and physical pain (Herie et al., 2007). Furthermore, drug use can be thought of as raising money for the drugs, making purchases or negotiating agreements, hiding drug use and protecting the supply from others, removing barriers, creating situations for using and seeking persons with whom to use, spending time using and recovering from the effects of using and resuming the drug use process all over again (Moyers, 1997). From the OT perspective, the needs and desires of people are determinant factors when choosing their daily activities. In individuals with drug use, many activities go through the need for seeking substances. More importantly, drug use permits them to express themselves and gives them a sense of who they are in other occupations (Chang, 2008). The occupational perspective of substance use is slightly different from the medical model view. OT aims to enhance the quality of life of people with substance use and prevent them from relapsing (Tsui & Li, 2020). Alternately, the OT view is that substance abuse is unique to each individual, and only that individual can define the meaning of substance use in their life and the impact on activities of daily living (Narain et al., 2018). According to the OT perspective, “recovery” is not a person's quitting substance use and is based on a person's ability to participate in new and healthier occupations (Narain et al., 2018). Thus, restoring and maintaining the roles in the life of the person before substance use may motivate people to stay away from substance use (Bell et al., 2015).

The effect of substance use on occupational performance and participation

OT aims to assess the impact of substance use on occupational performance and participation limitation of the clients. OT addresses the effect of substance use on an individual's major occupational performance areas, such as self-care, productivity (work, education, etc.) and leisure (Stoffel, 1994). Work and education activities of people with substance use are affected, and late for school/work, unexcused absences and meeting declines in productivity are observed. Their leisure activity choices are also different. They choose only activities involving drinking/substance using and uninhibited dangerous behaviour (boating, skiing, etc.) during leisure pursuits. Cognitive and sensory-motor problems as a result of substance use can also be observed, such as the following: rigid thinking; blackouts/memory lapses; sensory, motor and praxis; peripheral neuropathy; and an overall lack of conditioning/fitness. Occupational therapists evaluate whether cognitive processes are affected by substance use. These basic cognitive skills are thinking and processing knowledge, communication, attention span/concentration, memory, problem-solving and judgement. In addition, they have difficulty in communication, social skills and emotional regulation and difficulty establishing and maintaining intimate relationships, are aggressive and hostile, and cope with stress by increasing substance use (Scaffa et al., 2014). As can be seen, the substance use causes problems in all performance skills, sensorimotor, cognitive or psychosocial areas of the individual. In this sense, the multifaceted perspective of OT seems important in addressing these issues. Therefore, improving physical, cognitive and psychosocial skills of individuals with substance use should be among the main therapeutic goals of occupational therapists.

Gutman (2006) emphasised the negative effects of substance use on occupational engagement. Employment, family relationships, financial stability and personal health were among the most affected life areas from substance use. In contrast, Wasmuth et al. (2015) examined the occupational status of 10 people with substance use disorder and found that substance use significantly affected identity, motivation and routines, but did not affect engagement in occupations. Gutman (2006) reported that people with substance use may have difficulty with time management and major life roles. Many participants of recovery programmes reported that the majority of their time was spent in substance-use–related activities and occupied with thoughts related to acquiring substances. In addition, many participants stated that the peer-support programmes supported their shift from substance-related occupations to new, meaningful non-substance related occupations, which they found extremely important in facilitating and maintaining recovery. To initiate recovery, some participants disengaged from activities that were highly associated with substance use (Narain et al., 2018).

The role of OT in substance

From an OT perspective, individuals are addressed in a holistic view. All factors affecting substance use are evaluated together with the client. Environmental factors in particular must be taken into consideration. How are the interpersonal relationships (family, work relationships and friendships) of individuals with substance use? In addition, the environment and people who provide the drug are also other information sources about the client. In a review, Wasmuth et al. (2015) examined what areas of occupation were mostly addressed in addiction interventions and what occupation-based interventions were used to treat addictive disorders. They demonstrated that leisure, work and social participation were mostly addressed. Leisure activities such as yoga, exercise (walking, exercise bike, rowing), psychodrama, systems-releasing action therapy and music therapy were used as OT interventions for addictive disorders. Therefore, these findings emphasised the importance of assessing the occupational patterns and occupational participation of people with substance use.

What can an occupational therapist do?

  • Try to understand and empathise, and use communication techniques.

  • Evaluate whether the client is ready to change and use motivational strategies to encourage the client (Stoffel & Moyers, 2004). Occupational therapists evaluate the daily occupations of the person in three major occupational areas: self-care; productivity; and leisure affected by substance use (Scaffa et al., 2014).

  • Help people develop more satisfying and meaningful patterns of time use and replace unhealthy activities with healthy and meaningful ones.

  • Help the client set short- and long-term goals to enable participation in other activities.

  • Help the client evaluate the risk of relapse and develop a relapse-prevention plan with the client (AOTA (2002), Canadian Association of Occupational Therapists (CAOT)).

When clients want to quit drug use, occupational therapists use the clients’ skills to facilitate occupational change and support their recovery (Stoffel, 1994). Substance use recovery programmes that include OT life skills in particular were found to be effective in occupational performance, self-esteem and quality of life among people with substance use (Martin et al., 2008). A qualitative study was conducted to explore clients’ perceptions of the usefulness of OT after discharge at substance use rehabilitation centres in the Western Cape. Participants perceived skills development, work training, life skills and leisure exploration to be useful. They reported that they needed more practical experiences outside the rehabilitation centre to practise the skills learned during group intervention (Bell et al., 2015). While the majority of the participants participated in leisure activities previously, all stated that they stopped engaging in these activities due to substance use. The participants joined sporting and leisure activities, such as soccer and dancing, during group intervention. They expressed their feelings of satisfaction and health as a result of engagement in leisure and being introduced to new interests. The findings of this study point to the fact that skills development and work training are important. This skills development programme assisted some participants with finding employment after discharge. The study findings revealed that there is a need for community-based therapy for people with substance use, and an important motivator for the participants to stay clean after reintegration into the community was to restore and maintain the roles they had lost (Bell et al., 2015). Therefore, the final purpose is to provide occupational balance and promote quality of life. Helping individuals with substance use regain positive activities and their previous roles could improve their well-being (Hoxmark et al., 2012). Occupational therapists might design client-centred interventions for substance use and they consider the personal traits of clients that contribute to their recovery. Occupational therapists are recommended to take part in interdisciplinary teamwork for clients diagnosed with substance use (Abu Tariah et al., 2015).

Intervention programmes

OT aims to find purposeful and meaningful activities for people with substance use or regain previously meaningful ones. In other words, they use the substance for building their self-esteem, feeling good and defining their identity. Therefore, the aim of OT should be to reactivate the other occupational roles of the individuals, allowing them to be aware of their roles, and develop person-centred programmes that include purposeful activities to meet the needs of the individuals (Lakshmanan, 2014). Evidence-based practices for substance use interventions include brief interventions, motivational strategies, cognitive behavioural therapy and a 12-step recovery programme (O’Day, 2009; Stoffel & Moyers, 2004). These interventions may be effective when used together with occupation-based interventions. Studies have even shown the beneficial effects of the various OT life skills training programmes on individuals with substance use (Amorelli, 2016).

Brief interventions

Brief interventions are designed to reduce risky alcohol/substance use or alcohol/substance-related problems. They are used to investigate a possible problem and motivate the individual to do something about it. Brief interventions include screening, evaluation, feedback, referral and follow-up processes. Implemented short interventions are time-limited and structured. Brief interventions consist of five or fewer sessions, a short process lasting from a few minutes to an hour, and have a special purpose. A specific plan is followed. There is a timetable for the implementation of specific behaviours (Substance Abuse and Mental Health Services Administration [SAMSHA], 1999). The brief intervention consists of five steps: (1) addressing the relationship of substance use with one's health (screening); (2) investigating and evaluating patterns of substance use (evaluation); (3) giving feedback on the evaluation results (feedback); (4) talking about change and goals (referral); and (5) summarising concerns, goals and plans (follow-up) (SAMSHA, 1999). Brief interventions are useful in addressing the client's readiness for change. These interventions were reported to be effective in reducing alcohol use. In applying and synthesising brief interventions to the practice of OT, occupational therapists provide support and encouragement for lifestyle changes to participate in community life (Stoffel & Moyers, 2004).

Motivational approaches

Motivational approaches are based on the transtheoretical model developed in 1982 by Prochaska and DiClemente. This model provides a useful framework for understanding how people change their behaviour and for considering how ready they are to change their substance use or other lifestyle behaviour (DiClemente, 1999; Prochaska et al., 1993). The change model consists of six stages: precontemplation; contemplation (intention to change); decision (preparation); action; maintenance (behavioural actions); and relapse.

Motivational interviewing (MI) is a client-centred and goal-directed technique that helps clients discover and resolve ambivalence. MI focuses on interacting with the client and their strengths. Empathy is used rather than authority and power. Respecting the client's autonomy and decisions is important. Little steps are supported during recovery (Barry, 1999). Another motivational approach, motivational enhancement therapy (MET), is a long-term follow-up to an initial brief intervention strategy. MET consists of four structured sessions and MI, and uses the FRAMES approach for change. These frames are as follows:

  • Feedback: Give feedback about personal risks and discomfort.

  • Responsibility: Give the client responsibility for change.

  • Advice: Suggest a change.

  • Menu of options: Provide alternative self-help or treatment options.

  • Empathy: Be empathic.

  • Self-efficacy: Support your capacity for change and strengthen your hope.

A short intervention consists of three steps covering FRAMES: screening and evaluation; giving feedback; and making suggestions and follow-up (Barry, 1999). Occupational therapists try to understand the client's readiness to change by using motivational strategies. Thus, they motivate the client for further evaluation and intervention plans (Stoffel & Moyers, 2004).

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is an evidence-based psychological approach. CBT is problem-oriented and based on learning theories. CBT helps individuals when they encounter difficulties they cannot overcome in their daily lives (Stoffel & Moyers, 2004). CBT also includes the implementation and monitoring of health behaviours, focusing on physical activity, relaxation and activity pace (Murphy et al., 2018). Cognitive therapies suggest that the cause of behaviours is not the events, but the comments and expectations of people about the events. The goal of CBT is to replace unrealistic beliefs, thought, emotion and negative self-perceptions about substance abuse with realistic ones. For these purposes, CBT techniques can be applied at school, at home, in the business environment and as leisure time activities and can help the individual develop their coping skills (SAMSHA, 2012).

The 12-step recovery programme

Participation in self-help meetings is a long-term treatment in addition to professional treatment. The 12-stage approach consists of a short, structured and guided approach to facilitate getting rid of alcohol use (Crouch & Wegner, 2014; Donovan et al., 2013). The 12-step philosophy refers to a particular view of the recovery process. It emphasises the importance of accepting addiction as a disease that can be stopped but never eliminated, increasing individual maturity and spiritual growth, minimising self-centeredness and providing assistance to others who are dependent (for example, sharing recovery stories at group meetings) (Humphreys et al., 2004). Alcoholics Anonymous (AA) is an international organisation and self-help group that offers emotional support for people who survive alcohol dependence. This approach focuses on being followed in a social network in the recovery process instead of not involving the use of substances for the rest of their lives. The main themes are no drinking or medication, going to meetings, asking for help, getting support, joining groups and being active (Caldwell & Cutter, 1998).

Conclusion

This debate has outlined the literature on OT interventions when working with people experiencing substance use. OT, unlike the many medical approaches, is more person-centred and focuses on the impact of substance use on the activities of daily living and the restoration and maintenance of the roles in life that they had before the addiction, rather than quitting the substance. Limited study findings found that individuals who participated in occupation-based programmes experienced fewer episodes of relapse (Correia et al., 2005) and disengaged from activities that were associated with substance use (Narain et al., 2018). Therefore, occupational therapists can work collaboratively with substance use treatment teams to meet the needs of clients experiencing difficulties in occupational engagement due to substance use. More evidence-based studies are required to understand the role of OT on substance use disorders and addictive behaviours.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: Selma Ercan Doğu https://orcid.org/0000-0003-3276-8041

Contributor Information

Selma Ercan Doğu, Department of Occupational Therapy, Faculty of Hamidiye Health Sciences, University of Health Sciences, Istanbul, Turkey.

Esma Özkan, Department of Occupational Therapy, Faculty of Gulhane Health Sciences, University of Health Sciences, Ankara, Turkey.

References

  1. Abu Tariah H. S., Hamed R. T., Al-Omari H. D. (2015). Jordanian client perspectives of substance abuse: Implications for occupational therapists. International Journal of Therapy and Rehabilitation, 22(12), 566–572. 10.12968/ijtr.2015.22.12.566 [DOI] [Google Scholar]
  2. American Occupational Therapy Association (AOTA) (2002). Overcoming Drug and Alcohol Abuse. www.aota.org
  3. American Occupational Therapy Association (3rd Edition) (2014). Occupational therapy practice framework: Domain & process. American Journal of Occupational Therapy, 68(Supplement-1). 10.5014/ajot.2014.68s1 [DOI] [Google Scholar]
  4. Amorelli C. R. (2016). Psychosocial occupational therapy interventions for substance-use disorders: A narrative review. Occupational Therapy in Mental Health, 32(2), 167–184. 10.1080/0164212X.2015.1134293 [DOI] [Google Scholar]
  5. Barry K. L. (1999). Brief interventions and brief therapies for substance abuse. Center for Substance Abuse Treatment, Substance Abuse and Mental Health Sevices Administration. [PubMed] [Google Scholar]
  6. Bell T., Wegner L., Blake L., Jupp L., Nyabenda F., 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. 10.17159/2310-3833/2015/v45n2a3 [DOI] [Google Scholar]
  7. Caldwell P. E., Cutter H. S. (1998). Alcoholics Anonymous affiliation during early recovery. Journal of Substance Abuse Treatment, 15(3), 221–228. 10.1016/S0740-5472(97)00191-8 [DOI] [PubMed] [Google Scholar]
  8. Canadian Association of Occupational Therapists (CAOT-ACE). Occupational Therapy and Substance Abuse. www.caot.ca
  9. Chang E. (2008). Drug use as an occupation: Reflecting on Insite, Vancouver’s supervised injection site. Occupational Therapy Now, 10(3), 21–23. [Google Scholar]
  10. Correia C. J., Benson T. A., Carey K. B. (2005). Decreased substance use following increases in alternative behaviors: A preliminary investigation. Addictive Behaviors, 30(1), 19–27. 10.1016/j.addbeh.2004.04.006 [DOI] [PubMed] [Google Scholar]
  11. Crouch R., Wegner L. (2014). Substance use and abuse: Intervention by a multidisciplinary approach which includes occupational therapy. In Crouch R., Alers V. (Eds.), Occupational therapy in psychiatry and mental health (5th ed., pp. 446–464). John Wiley & Sons. [Google Scholar]
  12. Cruz, T. (2019). Identifying Occupational Therapy Role for Individuals in Substance Abuse and Addiction Recovery Programs. [Doctoral project, University of St Augustine for Health Sciences]. SOAR @ USA: Student Capstone Projects Collection. 10.46409/sr.FORS9739 [DOI]
  13. DiClemente C. C. (1999). Motivation for change: Implications for substance abuse treatment. Psychological Science, 10(3), 209–213. 10.1111/1467-9280.00137 [DOI] [Google Scholar]
  14. Donovan D. M., Ingalsbe M. H., Benbow J., Daley D. C. (2013). 12-step interventions and mutual support programs for substance use disorders: An overview. Social Work in Public Health, 28(3–4), 313–332. 10.1080/19371918.2013.774663 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gutman S. A. (2006). Why addiction has a chronic, relapsing course. The neurobiology of addiction: Implications for occupational therapy practice. Occupational Therapy in Mental Health, 22(2), 1–29. 10.1300/J004v22n02_01 [DOI] [Google Scholar]
  16. Herie M., Godden T., Shenfeld J., Kelly C. (2007). Addiction: An information guide. https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/drug-use-addiction/Documents/addiction_guide_en.pdf
  17. Hoxmark E., Wynn T. N., Wynn R. (2012). Loss of activities and its effect on the well-being of substance abusers. Scandinavian Journal of Occupational Therapy, 19, 78–83. 10.3109/11038128.2011.552120 [DOI] [PubMed] [Google Scholar]
  18. Humphreys K., Wing S., McCarty D., Chappel J., Gallant L., Haberle B., Weiss R. (2004). Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Journal of Substance Abuse Treatment, 26(3), 151–158. 10.1016/S0740-5472(03)00212-5 [DOI] [PubMed] [Google Scholar]
  19. Lakshmanan S. (2014). Occupational therapy structured activities for substance use recovery. World Federation of Occupational Therapists Bulletin, 70(1), 30–31. 10.1179/otb.2014.70.1.008 [DOI] [Google Scholar]
  20. Martin L. M., Bliven M., Boisvert R. (2008). Occupational performance, self-esteem and quality of life in substance addictions recovery. OTJR: Occupation, Participation and Health, 28(2), 81–88. 10.3928/15394492-20080301-05 [DOI] [Google Scholar]
  21. Moyers P. (1997). Occupational meaning and spirituality. The quest for sobriety. American Journal of Occupational Therapy, 51, 207–214. 10.5014/ajot.51.3.207 [DOI] [PubMed] [Google Scholar]
  22. Murphy S. L., Janevic M. R., Lee P., Williams D. A. (2018). Occupational therapist–delivered cognitive–behavioral therapy for knee osteoarthritis: A randomized pilot study. American Journal of Occupational Therapy, 72(5), 7205205040p1–7205205040p9. 10.5014/ajot.2018.027870 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Narain N., Liu W. N., Mahmood Z., Duncan A. (2018). Women’s perspectives related to occupational performance following participation in substance use recovery programs. Occupational Therapy in Mental Health, 34(1), 61–74. 10.1080/0164212X.2017.1395309 [DOI] [Google Scholar]
  24. O’Day K. (2009). Effectiveness of treatment techniques for substance abuse in occupational therapy. Mental Health CATs: Paper, 1. http://commonc.pacificu.edu/otmh/1
  25. Prochaska J. O., DiClemente C. C., Norcross J. C. (1993). In search of how people change: Applications to addictive behaviors. Addictions Nursing Network, 5(1), 2–16. 10.3109/10884609309149692 [DOI] [PubMed] [Google Scholar]
  26. Scaffa M. E., Riels L. A., Moyers P. A., Stoffel V. C. (2014). Community-based approaches for substance use disorders. In Scaffa M. E., Reitz S. M. (Eds.), Occupational therapy in community-based practice settings (2nd ed., pp. 292–308). F. A. Davis Company. [Google Scholar]
  27. Shaffer H. J., LaPlante D. A., LaBrie R. A., Kidman R. C., Donato A. N., Stanton M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12(6), 367–374. 10.1080/10673220490905705 [DOI] [PubMed] [Google Scholar]
  28. Stoffel V. C. (1994). Occupational therapists’ roles in treating substance abuse. Psychiatric Services, 45(1), 21–22. 10.1176/ps.45.1.21 [DOI] [PubMed] [Google Scholar]
  29. Stoffel V. C., Moyers P. A. (2004). An evidence-based and occupational perspective of intervention for persons with substance-use disorders. American Journal of Occupational Therapy, 58(5), 57–586. 10.5014/ajot.58.5.570 [DOI] [PubMed] [Google Scholar]
  30. Stone, M. (2017). Understanding the impact of substance abuse on occupation using the lifestyle history questionnaire. Occupational Therapy Doctorate Capstone Projects, 25. https://encompass.eku.edu/otdcapstones/25
  31. Substance Abuse and Mental Health Services Administration [SAMSHA] (1999). TIP 34 Brief interventions and brief therapies for substance abuse . https://www.ncbi.nlm.nih.gov/books/NBK64947/
  32. Substance Abuse and Mental Health Services Administration (2012). SAMHSA’s working definition of recovery. http://store.samhsa.gov/shin/content//PEP12-RECDEF/PEP12-RECDEF.pdf
  33. Tsui C. M., Li D. (2020). Substance abuse rehabilitation needs to be guided by well-developed practice model(s). General Psychiatry, 33(3), e100220. 10.1136/gpsych-2020-100220 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Wasmuth S. L., Outcalt J., Buck K., Leonhardt B. L., Vohs J., Lysaker P. H. (2015). Metacognition in persons with substance abuse: Findings and implications for occupational therapists. Canadian Journal of Occupational Therapy, 82(3), 150–159. 10.1177/0008417414564865 [DOI] [PubMed] [Google Scholar]

Articles from Nordisk Alkohol- & Narkotikatidskrift : NAT are provided here courtesy of Nordic Welfare Centre

RESOURCES