Good day everyone! I am a practicing OT, working in mental health & addictions, and am currently completing a Doctor of Science degree in rehabilitation and health leadership. Through conversation with colleagues, friends, and clients, I started to become concerned about the rates of alcohol use in women - and how frequently problem drinking in women goes unnoticed. My dissertation work is primarily focused on this area, but what I'm wondering is what your thoughts - as OTs - are around this issue? Do you currently screen all clients for substance use disorders? Do you feel it falls within your scope? Have you considered the impact of substance use within general practice? You don't have to answer all of those questions... but I'd love to get a dialogue going! I am very interested in your perspectives...
top of page
To see this working, head to your live site.
Edited: Oct 26, 2020
Screening for alcohol use
Screening for alcohol use
9 comments
Like
9 Comments
bottom of page
Hi, very interesting questions indeed. I currently work with service users with Substance Use Disorders ( Alcohol , Heroine , Cannabis , Methamphetamines etc ) and often times there is an under-presentation of women when it comes to treatment seeking behaviour- mostly due to stigma , lack of knowledge , screening and etc . Working in the field of SUD as an Occupational therapist can be quite challenging in a sense that you mostly assume the role of a counsellor as opposed to focusing on Impaired engagement in valued activities. Majority of our patients and fellow colleagues often times overlook the importance of leading a meaningful life through occupational competence. I have discovered through multiple assessment sessions that there is obvious impairment in occupational performance (Patterns , routines etc) which either predisposes , precipitate or continues to perpetuates the use of substances . Another major occupation that is overlooked is the constructive use of leisure time . I believe screening should be considered for all patients, in attempts to correctly identify , place , provide brief interventions and help prevent the escalation of the substance use and long term inpatient care. Some of the screenings tools that are helpful includes: The ASSIST(Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). AND AUDIT and self administered occupational performance questionnaires.
The PROMIS suite of measures (available for free download at healthmeasures.net ) has a set of measures related to alcohol use
Alcohol – Alcohol Use: Drinking patterns, cue-based drinking, cravings to drink, and efforts to control drinking that indicate problematic drinking, particularly at the high end of the severity continuum.
Alcohol – Negative Consequences: Negative personal outcomes of alcohol use over the past 30 days. These items cover physical, mental, and social consequences of drinking.
Alcohol – Negative Expectancies: General attitudes about negative outcomes of alcohol use. These items cover physical, mental, and social negative expectancies of drinking.
Alcohol – Positive Consequences: Positive personal outcomes of alcohol use over the past 30 days. These items cover physical, mental, and social consequences of drinking.
Alcohol – Positive Expectancies: General attitudes about positive outcomes of alcohol use. These items cover physical, mental, and social positive expectancies of drinking.
Not an explicitly OT lens, but definitely has a balanced approach.
There are item banks (where you can pick and choose relevant items for your population) and pre-made questionnaires, where a z score (the score converted to /100) of 50 is equivalent to the population norm.
I haven't used this particular set of measures in practice, but for research I do like the general health questionnaire PROMIS-29 because it taps into a lot of areas (physical functioning, social role participation, anxiety, depression) with 29 simple questions. Also many of the scales have validated translations 😀
I've been doing a lot of work in this area and trying to maintain an intersectional lens within my work. I've put together an infographic that other OTs might find informative (not just for addictions, but more generally as well). I hope you enjoy it!
Thank you for your comments. It is great to see that clinicians are giving thoughtful consideration to the impact that alcohol may be having on their clients. Alcohol use is definitely something that often gets concealed, or swept under the rug, as drinking is so normalized in our society. Areas where I often have concerns are when there might be some overlap in the clients own needs and the alcohol use of a significant other. For example, if we've been referred to do a paediatric consult, and we question if perhaps the mother is experiencing some post-natal depression that is impacting her ability to provide much needed socialization to the infant. Often then we might consider to screen mom for depression as well as for alcohol use - as she may be using alcohol to self-medicate and to cope, and struggling with feelings of shame. Given that there can be such stigma associated with substance use, intertwined with the issue of substance use as a pleasurable occupation for some individuals, it can be challenging to know where to begin to help a client. There are so many complexities to the issue!
I work with a lot of women who use drinking alcohol as a coping strategy to decrease stress/anxiety. I know it is a sensitive subject (shame/guilt) and I wish I had more tools to address it. It definitely impacts productivity/satisfaction/overall quality of life. Using OT models- I have significantly decreased my own drinking habits by better understanding my roles/routines/habits. So I think it Is within OT scope of practice to focus on “drinking” and how much it impacts our clients’ lifestyles.
www.rachelyakar.com
We use the Alcohol Audit tool (AUDIT) as a screening to get a sense of how severe their alcohol use is on admission; I would do educational work on alcohol to ascertain where they are on the cycle of change and I also use the "Tools for Change Workbook" to further the conversation and to identify 3 goals they want to work towards to either change their addiction or to consider harm reduction. Linking in with community addictions team or voluntary addiction groups as required. Also look at the Occupational function; is there any knock off on their cogntition, structure, routine, sleep hygiene, relaxation skills, alternative coping strageties etc.
I would say I screen mostly if I'm the risk assesment, given that it is often used as a negative coping strategy to manage anxiety, low mood or sleep issues. However, you raise a good point given that people may be likely to conceal their use to avoid communicating poor mental health. I have seen it negatively impact on mental health due to the impact on mood/sleep and motivation for occupation. Defiantly omething we should also remember to be screen for given its relevance to our scope of practice! X
Great set of questions @Kimberly! Happy for us to bring this forum to the attention of fellow Members, via our social networks?