Substance use and meaning: transforming occupational participation and experience

Abstract

Introduction We draw on activity theory of concepts to examine ‘meaning of occupation’ and ‘substance use’ beyond preconceived notions of inherent positive or negative experiences. Objective To explore nuanced meanings of substance use and associated occupations. Method An online survey and semi-structured interviews were used to collect data from professionals about prevalence of substance use, substance effects, and personal experiences. In analyzing the interview data, we attended to substance use as a discrete occupation in itself, substance use co-occurring with other occupations, and substance use altering the performance, participation, and experience of occupations. Results Three broad themes related to meaning: i) complex meanings attributed to substance use, ii) meanings of substance use as shifting and variable, and iii) meanings of substance use in the context of other occupations. Substance use enhances occupations, transforms meaning of occupations, and mitigates less desired aspects of occupations. Work, construed as positively meaningful and valued in occupational therapy literature, was a source of stress, unhappiness, and worry; substance use facilitated relaxation and pleasure. Conclusion This study furthers occupational therapy knowledge with respect to implications for conceptualization that extend beyond dualist framings and implications for occupational therapy education, practice, and policy.

“You Are You, But You Are Also Your Profession”: Nebulous Boundaries of Personal Substance Use

“…The 2017 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) involved n = 16,349 telephone interviews conducted with residents aged 15 years and older ( Government of Canada, 2019a ). Our research about substance use among professionals has consistently found rates of past-year prevalence of substance use that well exceed what is reported in the CTADS study ( Kiepek, Ausman, et al, 2022 ; Kiepek et al, 2019 ). This may, in part, be accounted for by the anonymized nature of our online survey compared to phone interviews conducted by the federal government.…”

“…This, compounded by certain erroneous beliefs around substances, can be problematic. Reported separately, our study found that cocaine was used by 7% of Canadian professionals in the past-year and 19.8% ever ( Kiepek, Ausman, et al., 2022 ). Commonly reported effects included socializing enhanced, awake/alert, confidence, and energy increased, with no reports of work performance or missing work obligations.…”

“…This may, in part, be accounted for by the anonymized nature of our online survey compared to phone interviews conducted by the federal government. In these studies ( Kiepek, Ausman, et al, 2022 ; Kiepek et al, 2019 ), the most commonly reported substance use effects are positive or non-problematic (i.e., enjoyment, pleasure, relaxation).…”

“…Each interviewee completed 3-weeks of EMA data entry, which included two interviews; one during the first week EMA data collection and one within a week of completion. Findings from the broader study are published elsewhere: one focused on meanings of substance use and associated activities ( Kiepek, Ausman, et al, 2022 ) and one focused on gendered experiences ( Kiepek, Beagan, et al, 2022 ).…”

Social Support Networks and Care for People Who Use Harmful Drugs

“…Here, emphasis is placed on the aspects that compose a social perspective of drug use, going beyond understanding the specific effects of substances, and highlighting political and sociocultural contexts. The approach to drug use from a social point of view understands that there is not one substance or individual with similar elements, but rather different social and cultural contexts permeated by the use of different substances, and that without due attention to such differences, it is not possible to understand the theme in its entirety [ 2 , 3 , 4 ].…”