Substance use to enhance occupational performance and experience: a critical interpretive synthesis

Abstract

Introduction: Substance use, as an occupation, is typically portrayed as problematic and the target of occupational therapy intervention and remediation. At the same time, psychoactive substances may be used to enhance mood, cognition, occupational performance, and/or experience, a perspective that is largely absent from occupation scholarship. Objective: We examine substance use in relation to the enhancement of occupation, drawing on the theoretical notion of agential realism. This theory suggests that in the social world 'reality' is not so much objective fact, stable and predictable, but rather continuously produced and reproduced, through doing and intra-active becoming. Method: A selected integrative, critical interpretive synthesis of the literature was conducted. The analysis is focused on synthesizing literature about substance use and enhancement of occupation. Results: Occupation does not exist independent of the doing, but also in 'becoming'. Sometimes using a substance is in itself an occupation-having a drink, or going out for coffee. Sometimes using a substance is a means to enhance another occupation-taking erectile dysfunction medication to improve sex, or amphetamines to improve studying. Sometimes using a substance simply alters the experience of an occupation-using cannabis or psychedelics to enhance the experience of listening to music. Conclusion: Adopting a focus on occupation may encourage novel ways of understanding substance use and what constitutes optimal quality of life and meaningful experiences. It may also facilitate better understandings of how people employ alternative, non-substance means to achieve desired occupational outcomes.

Substance use and meaning: transforming occupational participation and experience

“…Despite this hegemonic approach to understanding substance use, it too is an occupation with multiple, nuanced, complex and even contradictory meanings. Psychoactive substances -whether legal or illegal, prescribed or widely available -may be used as part of spiritual ceremony and ritual (Boiteux et al, 2014;Labate, 2014) or to enhance mood, cognition, occupations (Kiepek et al, 2019b). Such substances may be used to alter the experience of other occupations, such as taking psychedelics to increase the pleasure of listening to music, or using cannabis to make housework more enjoyable.…”

“…Elsewhere we propose alternative ways of conceptualizing 'meaning of occupation' (Kiepek et al, unpublished data) and 'substance use' (Kiepek et al, 2019b), but here we take up the challenge of the activity theory of concepts: to uncover values that inform dominant concepts. We have drawn on Engestrom's work on activity theory.…”

Use of Marijuana to Promote Well-Being: Effects of Use and Prohibition in the Daily Lives of Brazilian Adults

“…Kiepek et al 43 identified occupations as discursively “positive” and focused on how the relationship between occupational engagement and improved health and well-being can result in the implicit exclusion of activities considered “negative,” “unhealthy,” or “deviant,” with the potential to stigmatize and marginalize individuals or groups. “This has effectively silenced a significant realm of human experience, namely, occupations that are considered within dominant worldviews and societal groups to be unhealthy, illegal, and/or deviant.” 45 Some authors have argued that drug use 46 - 50 or addiction 46 , 51 , 52 is an occupation. Looking critically at the realm of healthcare, drug use and drug abuse have been deemed undesirable behaviors by society, 46 and typically labeled as problematic.…”

“…Looking critically at the realm of healthcare, drug use and drug abuse have been deemed undesirable behaviors by society, 46 and typically labeled as problematic. 49 Thus, they are almost always viewed as an object of intervention and remediation in occupational therapy, with healthcare professionals eager to help clients abandon it. 46…”

“…In the occupational science field, studies have pointed out that viewing drug use as distinct from substance abuse, problematic use, dependence, or addiction, focusing on occupation can (a) stimulate new ways of understanding substance use and its relationship with the quality of life and meaningful experiences 50 ; (b) facilitate a better understanding of how people employ alternatives to achieve desired occupational outcomes 49 ; and (c) help identify factors that encourage and constrain use, expanding approaches to addressing substance use that go beyond the individual to social and institutional contexts. 48 Attention to non-sanctioned occupations may be vital to diversify perspectives on occupation, emphasizing a critical reflection on underlying disciplinary assumptions, decrees of social power and values, and moral viewpoints that inform the production of knowledge in science.…”