substance abuse
n.
The use of an illegal or unprescribed drug, or the inappropriate habitual use of another drug or alcohol, especially when resulting in addiction. Also called chemical abuse.
substance abuser n.
According to the World Health Organisation (WHO), substance abuse is defined as:
" the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state." (WHO, 2015)
Substance abuse is a global issue. Not only does the uncontrolled use of substances pose a health hazard to the individual, but poses societal risks as well. According to a 2015 publication by the WHO, between 162 million and 324 million people globally had used some form of illicit drug, with
between 16 million and 39 million people experiencing dependence, or some form of drug-related disorder (WHO, 2015). Drug abuse is a risk factor for various neuropsychiatric disorders, and has been linked to acts of crime, sexual abuse and interpersonal violence (WHO, 2015).
A 2009 study published in the South African Medical Journal analysed the type of substances generally abused throughout the country, and the socio-demographic factors associated with substance use. The findings generally reflected that while prevalence of general drug use is steadily growing, alcohol still remains the most commonly abused substance, followed by tobacco and cannabis. In general, the highest prevalence of drug abuse was found in the White and Coloured populations, followed by the African population, with Indians having the lowest prevalence. In all populations, men tend to have a higher rate of substance abuse than women (Van Heerden, Grimsrud, 2009).
In the South African context, social problems, including poverty, crime and lack of healthy leisure resources, contribute to the high and ever-increasing numbers of people suffering from substance-related disorders (Crouch, Alers, 2014). There is therefore a growing need for healthcare intervention in substance-related disorders, including a need for OT intervention.
According to the WHO, the primary intervention for substance use remains preventative, through educational and legislative approaches (WHO, 2015). By reducing the likelihood of individuals engaging in illicit drug use, through education regarding the dangers, and preventing harmful substances from being easily accessible (except for medical purposes) the prevalence of substance abuse can potentially be reduced.
The unique role Occupational Therapy plays in the rehabilitation of people with substance abuse disorders is in assisting these individuals to regain the roles and patterns of occupation that previously held meaning to them, many of which have been altered by the use or abuse of a substance (AOTA, 2015). This can be done through teaching clients better ways of coping with stressors without resorting to substance use, improving the clients' assertiveness skills to withstand external pressure and improving specific other skills, such as vocational, financial or leisure-related (Crouch, Alers, 2014).
Other interventions would focus on improving the insight of these clients into their condition, so that they can understand the degree of their problem, and the impact it has on themselves, as well as those around them. Goal setting also becomes important, as it allows the client to set a trajectory for improvement, towards an end-state that they are motivated to achieve (Crouch, Alers, 2014). This will also allow them to monitor their own progress.
Especially with substance related disorders, OT handling becomes particularly important, as the therapist must be assertive and aware of any possible manipulation, but at the same time be understanding, consistent and non-judgemental (Crouch, Alers, 2014). As many people with substance dependent disorders have accompanying dependency personality disorders, it is also important that the therapist prevent the client from developing a dependent relationship with the therapist, which can exacerbate manipulative behaviour (Crouch, Alers, 2014).
Substance abuse and dependence is a particularly relevant issue in both the South African and global context. There is a great deal that Occupational Therapy can contribute towards the multi-disciplinary treatment of substance-related disorders, as it plays a significant role in ensuring that these individuals can return to being functional, valued members of society.
WHO (2015).WHO’s role, mandate and activities to counter the world drug problem: A public health perspective. Retrieved from:http://www.who.int/substance_abuse/publications/drug_role_mandate.pdf?ua=1 on 3 October 2015
van Heerden, Margaretha S, Grimsrud, Anna T, Seedat, Soraya, Myer, Landon, Williams, David R, & Stein, Dan J. (2009). Patterns of substance use in South Africa: results from the South African Stress and Health study. SAMJ: South African Medical Journal, 99(5), 358-366. Retrieved October 03, 2015, from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000500025&lng=en&tlng=en. .
American Occupational Therapy Association (2015). Recovery With Purpose: Occupational Therapy and Drug and Alcohol Abuse. Retrieved from http://www.aota.org/about-occupational-therapy/professionals/mh/articles/recoverywithpurpose.aspx on 3 October 2015
Crouch, R, Alers, V (2014). Occupational Therapy in Psychiatry and Mental Health. 5th ed. John Wiley and Sons: West Sussex
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