#OTalk – 16th February 2021 – Occupational Therapy and Substance Use

This week #OTalk will be hosted by Rachel Rule @_rachelOT.

Opp (2021) states that people who engage in substance use, or are recovering from addictions to substances could benefit from interventions focusing on re-establishing the roles and identities that are most meaningful to them. Occupational therapy considers a person’s identity, hopes and aspirations, their roles in life, their relationships and their individual ability to fulfil these within their physical and social existence (Duncan, 2011). Considering this, Occupational Therapists are in a unique position to work therapeutically with people living with, or recovering from, addiction to substances (Opp, 2021).

When considering Dual Diagnosis, in the United Kingdom, NICE Guidelines (2016) recommend the input of Occupational Therapists as one of the core professions to include in the care planning for people living with a Dual Diagnosis. Further, in exploring the self-identified occupational competencies of people recovering from
addiction, Davies and Cameron (2010) found that three of the four top items that people wanted to change were skills based; particularly focusing on financial management, domestic tasks and personal care.

Occupational Therapists are equipped to meet people ‘where they are at’ and utilise tools in Motivational Interviewing when people remain in the contemplative stage of change (Prochaska, 1983), or to utilise skills in Identity Transformation when people reduce, or stop their substance use (Best et al., 2015). Wasmuth et al., (2014) considered addiction as an occupation, which links to the concept of the Dark Side of Occupation (Twinley, 2013), and considers how addiction is a central component of people’s everyday occupational lives. Addiction can provide routine in daily life and a sense of stability in a person’s identity (Wasmuth et al., 2014), but it can also lead to occupational imbalance (Wanigaratne et al., 1990). Therefore, when people begin their journey of recovery from substance use, they can be left with an occupational deficit. Recovery from addiction is said to involve re-engaging with a person’s meaningful occupations, supporting the development if an identity away from substance use (Stoffel and Moyers, 2004, Strickler et al., 2009).

Working as an Occupational Therapist in an Assertive Outreach Team, I meet many people living with a Dual Diagnosis. I hope to use this #OTalk to discuss the role of Occupational Therapy in working with people living with addictions in other areas of the UK (and the world!) and make connections.


  1. What brings you to this #OTalk about Occupational Therapy and Substance Use today?
  2. In your experience of working with people who use substances, are Occupational Therapists common within your teams?
  3.  Substance use can raise judgements in society and practice, what helps you to keep these judgements in check personally, in your MDT and in wider society?

Best, D. et al. (2015) ‘Overcoming alcohol and other drug addiction as a process of social identity transition: the social identity model of recovery (SIMOR)’, Addiction Research and Theory, (2), pp. 111-123.
Davies, R. and Cameron, J. (2010) ‘Self identified occupational competencies, limitations and priorities for change in the occupational lives of people with drug misuse problems’, British Journal of Occupational Therapy, 73(6), pp. 251-260.
Duncan, E. (2011) Foundations for Practice in Occupational Therapy. (5th ed.) China: Elsevier Ltd.
NICE (2016) ‘Coexisting severe mental illness and substance misuse: community health and social care services’. Available at: https://www.nice.org.uk/guidance/ng58/chapter/Recommendations (Accessed
Opp, A. (2021) ‘Recovery with purpose: Occupational Therapy and Drug and Alcohol Abuse’. Available at: https://www.aota.org/About-OccupationalTherapy/Professionals/MH/Articles/RecoveryWithPurpose.aspx (Accessed: 14.1.2021)

Prochaska, J. O. and DiClemente, C. C. (1983) ‘Stages and processes of self- change of smoking: toward an integrative model of change’, Journal of Consulting and Clinical Psychology, 51(3), pp. 390–395.
Stoffel, V. and Moyers, P. (2004) ‘An evidence based occupational therapy perspective of interventions for people with substance-use disorders’, American Journal of Occupational Therapy, 58(5), pp. 570-586.
Strickler, D. C. et al., (2009) ‘First person accounts of long-term employment activity among people with dual diagnosis’, Psychiatric Rehabilitation Journal, 32(4), pp. 261-68.
Twinley, R. (2013) ‘The dark side of occupation: a concept for consideration’, Australian Occupational Therapy Journal, 60(4), pp. 301-303.Wanigaratne, S. et al., (1990) Relapse prevention for addictive behaviours: a manual
for therapists. Oxford: Blackwell Science.
Wasmuth, S, Crabtree, J. and Scott, P. (2014) ‘Exploring addiction-as-occupation.
British Journal of Occupational Therapy’, 77(12), pp. 605–613.


The Numbers

1.123M Impressions
400 Tweets
71 Participants
8 Avg Tweets/Hour
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