Substance abuse prevention and rehabilitation have become more of a problem in recent years. Our team recently discussed this important topic with an occupational therapist, Johanna Matsetela, and tried to understand the issue in more detail. Our purpose in this discussion was also to see how one can seek help if this is a problem that you or a loved one is struggling with.
Firstly, we need to consider the term “substance use disorders”, which is used in mental health instead of substance abuse. This has been used since the fifth edition of the DSM 5. The DSM 5 is the Diagnostic and Statistical Manual of Mental Disorders. It’s commonly described as an individual who regularly uses substances or drugs as a substance abuser, an addict or an alcoholic. However, research has discovered that all these words can be damaging and stigmatising. So that’s preventing individuals from seeking help and receiving care without prejudice.
So for a long time now, mental health professionals have long argued that labelling an individual as a substance abuser defines a whole person by their condition. However, when an individual is said to have a substance use disorder, it is understood that they have a medical problem that does not define the entire person. According to the DSM five that I mentioned, substance use disorder is a problematic pattern of using substances that often results in impairment in daily life. These patterns of substance use may cause problems with health, and they may cause problems with relationships, work or school. In a nutshell, substance use disorder can also lead to risky behaviours, legal issues, physical harm, or even death. So from an occupational perspective, in a nutshell, substance use disorder presents a dysfunction in occupations.
Substance Abuse Counsellor or Occupational Therapist?
A counsellor or psychologist would be needed for anything related to the prevention and rehabilitation of substance abuse. However, we were not clear on how an occupational therapist would help a patient struggling with substance abuse.
When a client presents with a substance use disorder, you first would want to assess as an occupational therapist to evaluate the extent of impairment in occupation due to substances. This can be done by having an interview with a client to find out about their occupational history, the patterns, what they used to enjoy doing, what kind of occupations have been affected, and what they would like to go back to. And then another one would be another role that we assume would be that of implementing treatment. Now that facilitates engagement in previously valid or enjoyed occupations because, with substance abuse, there is this preoccupation with the substance. All these other occupations that an individual used to enjoy and love doing somehow fall back.
We would help discover new routines and habits that will bring about fulfilment and improve quality of life. And then another role would assume that of an educator. That will facilitate understanding the condition of the client and the family members through psychoeducation. That will be just explaining to the family what the condition is, their role, how they can assist, and so forth, and then also discussing and identifying the adverse effects of substance patterns in a client’s life. Another role as well would be that of advocacy. So now, that will be to advocate for comprehensive substance use disorder programmes or influence policies or legislature to prevent and reduce substance use disorders.
In terms of substance abuse prevention and rehabilitation, since substance use is a chronically relapsing condition, we expect clients to relapse at some point. So once they do relapse, we then come in to reevaluate as well, looking at the behaviour patterns that may have been involved in the person relaxing. So now that we’ll be building on new behaviour patterns and assisting the service user, that’s what we call them; instead of addicts, the service user fills the void with activities which are most likely to produce a feeling of happiness and fulfilment.
Substance Abuse Prevention and Rehabilitation :: Substance Abuse During the Pandemic
People never stopped using substances during the pandemic. Unfortunately, they always had ways of getting it, which is part of the criteria that they have some symptoms of substance use disorders. What we saw during that time was that we had a lot of referrals from shelters who were experiencing withdrawal symptoms because they could not get the substance anymore from the streets and wherever they were. There was a high rate of referrals and a high rate of withdrawal symptoms, and we had to speed up admissions. During the pandemic, we had a highest admission rate than usual. The practitioners were not seeing treatment-seeking behaviour, but the patients often just needed to get rid of the withdrawal symptoms. After they had access to a detoxification unit and the medication, they wanted to leave the hospital. As with any medical treatment, if a client wants to go and if they refuse treatment, the practitioners have to comply with this request.
Substance Abuse Among Youth
South Africa, as with most countries, has a substance abuse problem. There is a need for a lot of awareness and prevention campaigns. People take substances, especially from a young age, but they don’t know the consequences they will face. They discover when there are relationship issues, family issues, you know, schoolwork, when it starts affecting their relationships or participation in community engagements, then that’s when there’s, they start seeing that things have spiralled out of control. Yeah, so we try to educate on know what you are taking, especially with the teens, you know, they just take substances and only realise at the latest age that it had inevitable consequences.
Harm Reduction with Substance Abuse
The ultimate goal is sobriety, especially with our clients who use substances. Some would want to find ways to still use substances, so the concept of harm reduction is essential since it can help patients who are not yet ready to stop using substances. This would allow them to still be functional in life. An example of harm reduction would be to give clean needles to substance service users who inject themselves. This will enable them to try and prevent more harm from transmitting other conditions, other medical conditions, or chronic conditions like HIV. Harm reduction is a safer way of doing it as opposed to just seizing the substance completely because one can experience withdrawal symptoms. This allows the body to adjust and then enables the patient to eventually get to a stage where the patient doesn’t want it anymore.
Substance Abuse Prevention and Rehabilitation :: Overcoming Substance Abuse
You need to first look at why people use substances in the first place, or need substance abuse prevention and rehabilitation in general. Then you can come up with ways to help try and prevent that. For example, some of the factors that play a role in the development of substance use would involve the environment (where the person lives), the availability of drugs, the attitude towards drugs, peer pressure, as well as issues with family neglect, and issues of poverty and so forth.
An occupational therapist can work with clients on constructive occupational patterns, where the patient replaces certain destructive habits with productive activities that give one fulfilment and contentment. Individuals who resort to substance use may often feel lonely, sad, and bored. So the goal is to create a meaningful life for the patient. There is also the issue of the genetic makeup that people tend to underestimate. There is also an issue of mental health and substance-induced psychosis.
Other ways of overcoming substance abuse are prioritising social participation and finding healthier options to induce endorphins, such as going to the gym and socialising with friends. These goals should help the patient to overcome substance abuse, and help them to experience a better quality of life.
Substance Abuse Prevention and Rehabilitation :: Further Resources
In this article, we referenced much of the information from the Moulding Health Episode that we had with Johanna Matsetela, an Occupational Therapist based in South Africa. If you would like to watch the full episode, we included it for you here.
We also had the following amazing Google Review from Johanna, which you can view below.
Substance Abuse Prevention and Rehabilitation :: Looking for Help from a Healthcare Practitioner
Based on working with many healthcare practitioners over many years, we can connect you to a relevant healthcare practitioner if you need assistance with substance abuse prevention and rehabilitation. Enter your details below and you’ll receive confirmation from our team and the relevant healthcare practitioner within one working day.