Combating substance abuse from a public health perspective: through an occupational therapy lens

Abstract

Introduction Substance abuse has become one of the most pressing public health problems in South Africa. Persons who suffer from substance abuse often have limited or severely decreased participation in the different categories of occupations (CoOs), including instrumental activities of daily living (IADL) and activities daily activities of living (ADL), and ultimately a decrease in quality of life. Research suggests that occupational therapists have a unique skillset, and practices that are evidence-based and have been proven to be beneficial in the treatment of substance use disorders. There is however limited literature to promote and motivate for the inclusion of occupational therapy in the management of substance use disorders on a public health care platform. The study aimed to gain an in-depth understanding of the current state of the management of substance use disorders from a public health perspective in noninstitutional settings. Furthermore, the study aimed to provide a perspective to-base the management of substance use disorders through the lens of occupational therapy. Methodology The study was a mixed-method study using an explanatory sequential design where the quantitative study (strand1) informed the qualitative study (strand 2), but with equal emphasis placed on both strands. In strand 1 quantitative data were collected from occupational therapists using a questionnaire. In strand 2 the qualitative data were gathered in key informant interviews which explored perceived service gaps and the contribution of occupational therapy to the intervention to persons who suffer from SUDs on a primary health care level. Results The quantitative results indicated that occupational therapists are contributing to the management of persons who suffer from substance use disorders however these services were mostly rendered at the level of specialist psychiatric care, within tertiary hospitals. Intervention is mainly in groups directed at the person with a substance use disorder and not their family members. Interventions are mainly task focused and medium intensity groups using a number of approaches and frames of reference. The qualitative findings suggested that approaches to deal with the rising problem of substance use and abuse in South Africa should be community-based and more family-orientated especially after a person with a substance use disorder is discharged from the hospital. These services should be based on an interprofessional collaborative approach and should be available at a community level and provide ongoing support for the vulnerable recovering addict and his/her family. The approach should also reflect the understanding of the complexity of the services needed based, on the multifaceted nature of substance abuse in our country. A wide range of challenges was experienced by the MDT participants in the management of persons who suffer from substance use disorders at the primary care level: a lack of appropriate human and financial resources, poor inter-sectorial collaboration which is crippling the ability of professionals to render services in view of the many socio-financial and political factors which exacerbate substance use such as poverty, high unemployment rates, gender-based violence and violence against women and children, occupational injustice, stigmatisation as well as the cultural acceptance of substance use. Conclusion Persons who suffer from substance use disorders experience disruptions within their occupational lives and are characterised by the maladaptive engagement of a person, their environment, and occupations. There is an urgent need for the occupational therapy profession to conduct further research and document evidence-based practice in order to motivate for the inclusion of these services within the management of substance use disorders with the implementation of the re-engineered Universal Health Care System.