This article is a companion piece to our two-part series in print, "Substance Abuse and OT." The series details both theoretical foundations and intervention strategies for occupational therapy practitioners to address the issue of substance abuse with clients in any practice setting. Part one of the series appeared in the June 25 issue; part two appeared July 9.
It is very likely that on a regular basis, OTs and OTAs will encounter people with active substance abuse or dependence, or people somehow affected by these problems. So regardless of practice arena, OTs and OTAs should be knowledgeable about how to influence an individual's substance use and how to access local resources for assistance, whether those practitioners are working with children whose parents are substance abusers, pre-teens and teens who are substance abusers themselves, or adult substance abusers.
One of the easiest and least invasive forms of brief intervention is the strategic placement of educational materials and pamphlets in waiting rooms and treatment areas. Information left in waiting rooms can prompt the client or the client's family members to request more information or to seek assistance on their own.
Information in treatment areas can be worked into various forms of assessment and treatment. For instance, a pamphlet on substance abuse education may be used as reading material in a visual exam, or looking up self-help groups in the phone book could be used as part of a cognitive assessment.
In addition, therapists may choose to use preparation for attending a twelve-step meeting as part of the therapeutic process by inviting representatives of self-help programs to the clinic in order to introduce clients to the self-help movement. Interaction with people who represent self-help groups can serve as a means for promoting the development of social skills, motivation for self-care training, or community mobility if the site of interaction is outside the clinic.
In order to meet the needs of an individual in the pre-contemplation stage, an OT or OTA who works in a physical rehabilitation unit with people injured while intoxicated can incorporate visual materials into group therapy sessions with guided discussion regarding the causes of injury. Such materials are available from groups such as Trauma Nurses Talk Tough. (http://www.traumarn.com/page6.html)
An OT or OTA who works with infants or children who have parents in the contemplation stage can help the parents resolve ambivalence by clearly identifying with them periods in which they have been more involved with and supportive of their children. They also can explore the possible reasons for differing levels of patience and participation from the parents' during therapy sessions. Patterns of behavior during periods of substance abuse should be noted, and the OT or OTA should help guide the parents to discovery of the relationship between those behaviors and the negative impact they have on the parents' involvement.
Care should be taken not to blame the parents or cause shame. Efforts should be focused on helping parents to develop an awareness of the relationship between substance abuse and functional abilities on their own.
For individuals in the preparation stage, building a sense of personal causation is critical and can be accomplished through the incorporation of recovery activities into treatment sessions. A trip to an AA meeting as part of a community mobility exercise can help build confidence in the individual's ability to get support and reduce anxiety about going to the first meeting. In addition, the client will have an opportunity to practice communication and interpersonal skills that have been learned in therapy sessions.
OTs or OTAs can invite guest speakers in recovery to share personal experiences in order to help individuals overcome much of the fear and trepidation that hinders a strong sense of personal causation, as well as start to build clean and sober social circles. Service to others is a tradition of twelve-step programs, and most groups have people who are eager to do service through personal appearances and sharing their stories.
Individuals in the preparation stage will need to look at the various contexts in which they live and determine the supporting factors and barriers within each context. The OT or OTA can help the client to identify these factors and problem-solve solutions while capitalizing on supporting factors. The client may need to make drastic changes in his/her social circle, as prior relationships may be based on substance abuse. The OT or OTA should assist the client in developing strategies to meet clean and sober people in order to build strong, supportive social networks.
Changes are likely to be needed in other habituated activities, such as shopping or commuting, in order to support an individual in the preparation stage. There may be great benefit to avoiding stores in which alcohol was habitually purchased or changing commuting routes in order to avoid driving by the liquor store or a dealer's home. This may be a terrifying process as the client begins to recognize just how much the substance abuse has infiltrated his/her life.
When working with an individual who is clearly in the action stage, the OT or OTA should make sure there is ample exposure to resources such as such as self-help groups and specialty treatment centers. The OT or OTA also should assist the client in implementing strategies identified above, and going to clean and sober places to meet people (i.e. a coffee shop instead of a bar). Many people may be unsure of how to fund specialty care and may benefit greatly from assistance in exploring health insurance coverage, scholarship opportunities and local resources.
Having these resources readily available can help the individual to focus on the action stage and not get discouraged by the details of trying to arrange assistance. Researching available resources can be a great OT student project and maintaining such records can be an excellent way for OT students to learn about community resources.
A client in the maintenance stage may become complacent about the change, feeling that he does not need to work so hard since he is now abstaining, thus increasing risk for relapse and movement back to an earlier stage. Providing opportunities to continue building resources to sustain change is an important intervention at this stage. Therapists may want to facilitate the development of peer support programs that help to build skills and share resources in order to support clients in the maintenance stage. Learning money management and group leadership skills can provide clients with the abilities they need to take on the role of treasurer or secretary at twelve-step or secular support groups in which they are involved.
In the termination stage, there may be great value in reviewing and/or organizing community resources with a client and ensuring that the client continues to be aware of available supports. Clients who have engaged in the change process with the support of an OT or OTA will likely already have many of these resources, but people who have gone through the process without the assistance of formal treatment may not have resources readily available. Engagement in therapy may occur at the point in which a client is entering the termination stage and the client may benefit from a formal processing into termination with the assistance of an OT or OTA by generating a community resource folder.
Sean Roush, OTR/L, QMHP, works in the Yamhill County Abacus program in McMinnville, OR, a psychosocial, psychoeducational, and vocational treatment program for individuals diagnosed with serious and persistent mental illness. He is a 1997 graduate of Pacific University School of Occupational Therapy and is currently working on his OTD at Creighton University, expecting to graduate in December.