Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts

Social Support Networks and Care for People Who Use Harmful Drugs

BACKGROUND

The "problem of drugs" is a complex phenomenon with different social dimensions. Thus, the strategy to care for people who use drugs should consider their social support networks, which are defined here as dimensions that compose the social integration of people.

OBJECTIVE

In this paper, we investigate how social support networks are organized, structured, and constituted according to clients of a mental health service dedicated to treat alcohol and drug abuse.

METHODS

Participant observation was employed in a mental health service for three months, and six interviews and three groups of activities were conducted with local clients.

RESULTS

The results demonstrated that the social network of this group is composed of informal and formal social supports: the former includes family, religious institutions, and work, and the latter was represented by a few institutions. However, there are few supports that contribute to the social inclusion and participation of these clients.

CONCLUSIONS

Care actions should expand social networks, helping to create more solid relationships, considering the macro and micro social-life dimensions. Occupational therapists can contribute to this process by driving their action toward social life, building more social participation strategies, and reconfiguring care and social meaning in everyday life.

Substance use and meaning: transforming occupational participation and experience

Abstract Introduction We draw on activity theory of concepts to examine ‘meaning of occupation’ and ‘substance use’ beyond preconceived notions of inherent positive or negative experiences. Objective To explore nuanced meanings of substance use and associated occupations. Method An online survey and semi-structured interviews were used to collect data from professionals about prevalence of substance use, substance effects, and personal experiences. In analyzing the interview data, we attended to substance use as a discrete occupation in itself, substance use co-occurring with other occupations, and substance use altering the performance, participation, and experience of occupations. Results Three broad themes related to meaning: i) complex meanings attributed to substance use, ii) meanings of substance use as shifting and variable, and iii) meanings of substance use in the context of other occupations. Substance use enhances occupations, transforms meaning of occupations, and mitigates less desired aspects of occupations. Work, construed as positively meaningful and valued in occupational therapy literature, was a source of stress, unhappiness, and worry; substance use facilitated relaxation and pleasure. Conclusion This study furthers occupational therapy knowledge with respect to implications for conceptualization that extend beyond dualist framings and implications for occupational therapy education, practice, and policy.

Terapia ocupacional e Paulo Freire: uma revisão de escopo

Resumo Introdução O referencial teórico e o aporte metodológico trazidos pelas obras de Paulo Freire vêm se espraiando por distintas áreas, inclusive na terapia ocupacional. Objetivo Apreender como o referencial freireano vem sendo utilizado em publicações acadêmicas da terapia ocupacional, reunindo e analisando essa literatura, para identificar eixos temáticos e lacunas presentes. Método Revisão de escopo, com levantamento de publicações nas bases de dados CINAHL, Scopus e Web of Science, focalizando artigos acadêmicos que referenciam explicitamente Paulo Freire, num período que, sem recorte inicial, foi até abril de 2020, tendo sido incluídos todos os artigos que referenciavam pelo menos uma obra do autor. Uma planilha desenvolvida no programa Microsoft Excel® reuniu os dados gerais dos artigos, cujos conteúdos foram agrupados, sintetizados e analisados a partir de conjuntos temáticos significativos. Resultados Foram identificados 56 artigos, publicados entre 1993 e abril de 2020. A obra de Freire vem sendo utilizada em publicações acadêmicas da terapia ocupacional, destacando-se o livro “Pedagogia do Oprimido” e as categorias Diálogo/Dialógica e Conscientização/Consciência crítica/política. Foram definidos e discutidos três conjuntos temáticos: 33 (58,9%) artigos que utilizam o referencial freireano para o pensar/fazer da terapia ocupacional; 10 (17,8%) em que ele parametriza a pesquisa na área; 13 (23,2%) cujas análises e proposições envolvendo a formação de terapeutas ocupacionais tomam-no como aporte. Conclusão Paulo Freire informa de diversas maneiras a terapia ocupacional, em prol de uma práxis para a transformação social, embora, em boa parte das vezes, as formulações freireanas não sejam o centro dos esforços de elaboração reflexiva.

A scoping review of occupational therapy interventions in the treatment of people with substance use disorders

Purpose

Diagnosis of substance use disorders and addictive behaviours are growing worldwide. It is timely to examine and collate literature on the nature of occupational therapy intervention in this field, to increase understanding of current practice and inform future directions. The purpose of this paper is to source and synthesise literature on occupational therapy interventions used in the treatment of people experiencing addiction.

Design/methodology/approach

Four databases were searched in August 2019. A total of 597 titles were screened, and 18 studies with varying methods met inclusion criteria. A narrative synthesis of the included literature was arranged into themes to summarise key findings.

Findings

Findings were grouped into three themes about occupational therapy provision to people experiencing addiction: single occupation focused intervention; skills training (including sub-themes on daily living skills and vocational skills); and establishing a community-based sober routine.

Research limitations/implications

Further research on this topic should focus on efficacy of treatments and build on current findings to develop more rigorous research with appropriate sample sizes to support evidence-based practice.

Originality/value

This study presents a synthesis of how occupational therapy interventions have been used to treat people experiencing addiction issues. Findings indicate occupational therapy appears to fit well within addiction treatment and assert that occupational therapy is most supportive when interventions go beyond the teaching of skills alone to prioritise occupational engagement and client centred practice.

Individual and Environmental Factors Associated with Tobacco Smoking, Alcohol Abuse and Illegal Drug Consumption in University Students: A Mediating Analysis

Substance abuse is a major and prevalent public health concern among university students. Tobacco smoking, risky alcohol behavior, and illegal drug consumption may lead to health problems and behavioral and academic issues. Several individual and environmental factors associate with substance abuse in this population, and the mediating effect of alcohol abuse in the relationship between tobacco smoking and drug consumption is yet to be explored. The purposes of this study were to evaluate the association of individual and environmental factors and substance use, and to analyze the relationship between tobacco smoking, alcohol abuse, and drug consumption, considering alcohol abuse as a possible mediator. A total of 550 Spanish undergraduate and postgraduate students completed several questionnaires regarding their smoking status, alcohol use, and drug consumption during the last six months. Bivariate and multivariate analyses were conducted to explore associations between factors. Direct, indirect and mediating effects were tested using a partial least squares approach (PLS-SEM). The results indicated that substance abuse is associated with being male, living with other students, and combined substance consumption. PLS-SEM showed a significant effect of tobacco smoking and alcohol abuse on drug consumption. Alcohol abuse plays a mediating role in the relationship between tobacco smoking and drug use.