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Recovery With Purpose: Occupational Therapy and Drug and Alcohol Abuse

Struggling man surrounded by images of wine glasses

By Ashley Opp

 The idea of substance abuse is not new to most people, but the rehabilitation process can be more difficult to understand. Occupational therapy is uniquely positioned to assist people who are struggling to recover from substance abuse, by helping them to reestablish the roles and identities most meaningful to them.

Use or Abuse?

Defining substance use, substance abuse, and substance dependence can be tricky. According to Ginny Stoffel, PhD, OT, BCMH, associate professor of occupational therapy at the University of Wisconsin–Milwaukee, “Substance abuse occurs when a person is engaged in a pattern of using alcohol or other mood-altering substances—things like alcohol, marijuana, cocaine, street drugs, designer drugs, pain medications, and other pharmaceuticals.”

 Among these, alcohol is the most commonly abused substance. “When someone is abusing, there are negative consequences or there’s a huge potential for them,” Stoffel says. “For example, there’s a potential for organ damage that may or may not yet have occurred.”

Treatment has countless variables, depending on the degree of dependence and type of program. “Typically when someone is in an abuse situation, they are cautioned [by a health professional] about their use and the potential for negative consequences, and given ideas to lessen the risks, such as not driving when under the influence. Treatment is usually indicated for people who clearly have a dependence syndrome,” Stoffel explains. Dependence is marked by having major cravings for a particular substance, experiencing preoccupation with it, or suffering from withdrawal when one doesn’t take it. Tolerance escalates when one is dependent on a drug, meaning that more must be taken to get an effect.

Treatment has changed in the past several decades. Clients are recognizing and dealing with substance abuse earlier. “Thirty years ago, people would enter treatment at the point at which their lives had become unmanageable, having lost their jobs, families, and self-respect,” Stoffel says. “Increasingly we’re finding that people who have drug-related problems have lots of other problems that bring them to the attention of health care and social service workers.”

For example, primary care physicians are increasingly asking broad questions about alcohol and drug use, so a problem might be recognized during an annual checkup. A family receiving counseling might, during a session, reveal a substance abuse problem. Or, as Stoffel explains, studies have suggested that simply giving women good, clear information on the impact of drinking on their health in a physician’s waiting room can result in these women linking that information to their own habits and significantly cutting their alcohol intake. In an occupational therapy context, a practitioner doing hand therapy with a client injured in a fall may learn that repeated injuries occurred from falling while under the influence.

How Can Occupational Therapy Help?

Occupational therapy practitioners are well trained to help clients look critically at everyday routines and examine how they affect their state of health and their ability to carry out what is important to them. “Occupational therapy can help people recognize how their substance use affects those roles that are most meaningful; it helps people explore and make those links, and move toward the occupational roles and patterns they want to achieve,” says Stoffel. For example, if the role of parent is most important to a client, then he or she might learn how to re-parent in a way that boosts his or her parenting skills and simultaneously improves the skills needed to deal with the stresses of parenting without drinking.

Occupational therapy practitioners examine the habits and behaviors of clients that occur each day, throughout the week. They show clients how their behaviors and thoughts revolve around drugs or alcohol and how they lose their identity as they lose the roles most meaningful to them. Practitioners then construct or rebuild those occupational roles by determining what activities bring clients the most joy and sense of well-being—without drugs or alcohol.

The likelihood of someone struggling with substance abuse coming into contact with an occupational therapy practitioner depends entirely on the recovery program. Usually an occupational therapist will work with clients in a short-term rehabilitation program or a partial hospital program. However, an enlightened consumer who has a full understanding of occupational therapy’s benefits and range of services can obtain help from an occupational therapist specializing in drug or alcohol abuse.

Occupational therapy goes beyond helping clients to stop drug use; it prepares clients to fill whatever void the substance leaves behind with productive occupation. According to Stoffel, “We want people to find the activities that are meaningful to them and at just the right level of challenge so that, as they redesign their lifestyle, they tap into those things that allow them to move into a state of well-being. This is where occupational therapy can really make a difference in helping people stay in long-term recovery.”

Find an Occupational Therapy Practitioner

Physicians, case managers, and other medical professionals can refer you to occupational therapy practitioners in your area who specialize in substance abuse. Other sources for locating an occupational therapist include colleagues, family members, and friends who have received occupational therapy services, as well as your local telephone directory.

For More Information

AOTA’s Substance Abuse Tip Sheet
Overcoming Drug and Alcohol Abuse
U.S. Department of Health and Human Services: Drug and Alcohol Information


Ashley Opp
is AOTA’s Senior Staff Writer