The topic I have chosen to explore and blog about is an occupational perspective of substance use in socially deprived areas. Firstly, I will provide some statistics to link why this is a contemporary issue today and what this means for occupational therapists. This will follow by thoughts around addiction in socially deprived areas. I will consider occupational risk factors, the policy directors and how OT can meet these. Finally acknowledging barriers to recovery and summarising the topic.
Scotland has a major problem with drug use. It is sixth worst country in the world for illicit drug use (University of Glasgow 2010) and gaining over 10,000 new users a year (Scottish Drugs Misuse database 2009/10). Recent NHS, government and Scottish Drugs Forum policy documents link substance abuse and social deprivation. In its Road to Recovery document published in 2008 by the Scottish Government has acknowledged scale of the problem and made tackling substance use a key and contemporary issue directing health and social care services. Social and cultural problems influence health and social care issues. Like other physical and mental health issues, substance use results in occupational disruption. Occupational therapist skills are transferrable and OTs must respond to society and meet its demands by moving into new areas, such as substance use. For the purpose of this blog, I will define addiction as an involvement with drugs, or alcohol, so overwhelming it harms the addict, society, or both (Alexander 2008).
This makes the Road to Recovery a key driving force for addiction services today.
I reflect back to the documentary which was perceived almost as a comedy sketch to many of its viewers – BBC 1’s ‘The Scheme’. For those who haven’t watched the programme, the documentary follows the lives of individuals who live within a housing estate in Kilmarnock (You can find clips on youtube- I want to make you aware there is strong language and images of needles in this. https://www.youtube.com/watch?v=_c9UsSl9bRE). While watching this documentary, I reflected on the social and physical environment, and possible issues affecting the individual and the family.
My reflections led of this led to my following thoughts:
Kilmarnock has gone through deindustrialisation- a decline in industrial industry, in the 1960s was the decline in shipping industry as fierce competition from Germany and Japan- previously had the shipping industry on the river Clyde. This is similar of the fishing industry in Peterhead. This can link into issues surrounding un employment, lack of opportunities etc. They are bored, lack routine and meaningful roles so turn to drugs as a way of meeting the unsatisfied occupational needs.
Following this discussion through conceptualisation of issues using MOHO, I further considered our knowledge of occupational science. Wilcock, 2006, considers occupational risk factors to be – occupational deprivation, alienation and imbalance. Deprivation occurs when external forces prevent engaging in an occupation: in terms of this clientele, these external forces could be reduced employment opportunities, lack of resources and poverty. Occupational alienation results from feelings of loneliness, lack of meaning and disconnection when cut off from normal society routines. For this clientele, alienation could mean using addictions to cope. When individuals are unable to meet occupational needs, imbalance occurs and this clientele may turn to addictions to satisfy unmet need. Addictions become individual’s main role and identity. Their routine of sourcing money for drugs gives a meaning and direction for the day, although not a positive one. Therefore, their life is imbalanced. All these risk factors can inhibit the persons ability to reach occupational competence.
Individuals respond to their immediate bodily need which is why it can be so hard to break the cycle of addiction, preventing them from developing skills to manage in the community and thus not reaching their occupational potential.
As stated early the government has the road to recovery policy which aims to direct services and promote recovery. From reading national and local policies, it is clear that there is a definite role for occupational therapists on the road to recovery.
There are issues however that can present as barriers on the road to recovery and in sustaining recovery in the community. These closely link to social deprivation and environmental factors such as the strong drug culture in the community, drugs are widely available, old social networks are still near and availability of resources remain the same. Moreover, they will still be in poverty which my limit the activities they undertake for enjoyment and housing issues remain the same.
Furthermore, stigma of those with addictions or past addictions is present within society and those trying to get a job may stumble with employers perceptions of those with previous addiction issues- they may also have criminal records which will limit employability opportunities.
The aim of this blog was to identify from an occupational perspective, issues relating to individuals with substance use within socially deprived areas, the role of the occupational therapist in this setting and barriers to recovery.
I believe it is important to state that whether or not addictions are a primary interest for you, you will in your practice come across those whose substance use must be addressed in order to improve their occupational performance.
I would like to leave you with this thought: in 1980s, Bruce Alexander studied two sets of rats from birth – one set in isolated cages and the other in a rat colony environment. Both sets had equal access to tap water and morphine. The rats in isolated cages consumed considerably more morphine than those in the colony, and after 57 days were addicted. Alexander then moved half of them into the colony where they began to choose tap water. The former isolated rats found the morphine inhibited them undertaking their usual rat activities. What does this say about the impact of environment and occupations?!
Looking forward to hearing anyones comments relating to the topic!
Thanks for reading!
NB Views are my own.