For debate

Nordic Studies on Alcohol and Drugs

2023, Vol. 40(4) 406–413
The role of occupational therapy © The Author(s) 2023
Article reuse guidelines:
in substance use sagepub.com/journals-permissions
DOI: 10.1177/14550725221149472
journals.sagepub.com/home/nad

Selma Ercan Doğ u

Department of Occupational Therapy, Faculty of Hamidiye Health Sciences,
University of Health Sciences, Istanbul, Turkey

Esma Özkan
Department of Occupational Therapy, Faculty of Gulhane Health Sciences, University
of Health Sciences, Ankara, Turkey

Keywords
addiction, occupational therapy, recovery, substance, substance use

Introduction individuals relapse within the first year of

Substance use disorder is a current serious
public health problem that negatively affects
the client, the family and the community.
Substance use has negative effects on the struc-
ture and function of the body, restrictions on
daily personal activities and participation in
life (O’Day, 2009). In addition, individuals
with substance use disorder are socially isolated
and exposed to stigmatisation. Therefore, it is
essential to integrate them into society.
Unfortunately, the rate of drug use has been
steadily increasing, and intervention pro-
grammes remain inadequate. Many existing
substance use programmes showed low
success rates; approximately 80%–90% of
their recovery, and 60% were dissatisfied with
the services provided and drop out of treatment
(Shaffer et al., 2004; Wasmuth et al., 2015).
Therefore, the risk of relapse into substance
use and the difficulty quitting nature of the
addiction requires a multidisciplinary approach
(Cruz, 2019). In addition, substance use affects
the individual negatively in many respects; in
their occupational and social life, there seems to
be a need for holistic approaches in addition to
many medical approaches. It may be beneficial
to consider occupational therapy approaches in
recovery from substance use, as substance use
negatively affects occupational participation
(Stone, 2017). The aim of the present study was

Submitted December 7, 2022; accepted December 19, 2022

Corresponding author:
Selma Ercan Doğ u, Faculty of Hamidiye Health Sciences, Department of Occupational Therapy, University of Health
Sciences, Selimiye, Tıbbiye Street No: 38, 34668 Uskudar/Istanbul, Turkey.
Email: selmaer@yahoo.com

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Doğ u and Özkan
to discuss the role of occupational therapy in sub-
stance use and general and occupational therapy
(OT) approaches in practice.
Occupational therapy and
substance use
OT aims to improve well-being, health and
social participation through occupations. OT
includes a client-centred process in which the
desires and needs of an individual are prioritised
(Crouch & Wegner, 2014). According to the
American Occupational Therapy Association
(AOTA) (2014), occupation refers to the daily
activities of individuals, families and communi-
ties to make sense of time and add meaning and
purpose to life. Occupations include desired and
expected things that people need to do.
Occupations that are meaningful to someone
may not be meaningful to others. The purpose
of the activity is determined by individual
needs and demands. Therefore, OT interven-
tions must be person-centred in treating sub-
stance use disorders.
Occupations have characteristics such as
improving health, survival and positive value
by culture. When the individual engages in
activities that do not conform to socially accept-
able norms, this may lead to negative conse-
quences (Scaffa et al., 2014). Drug use can be
considered an activity in many aspects for
people with substance use. This activity is
meaningful and purposeful for them because it
can serve many purposes, such as providing a
sensation of control, acceptance and peer inter-
action, and temporarily reducing emotional and
physical pain (Herie et al., 2007). Furthermore,
drug use can be thought of as raising money for
the drugs, making purchases or negotiating
agreements, hiding drug use and protecting
the supply from others, removing barriers, cre-
ating situations for using and seeking persons
with whom to use, spending time using and
recovering from the effects of using and resum-
ing the drug use process all over again (Moyers,
1997). From the OT perspective, the needs and
407
desires of people are determinant factors when
choosing their daily activities. In individuals
with drug use, many activities go through the
need for seeking substances. More importantly,
drug use permits them to express themselves
and gives them a sense of who they are in
other occupations (Chang, 2008). The occupa-
tional perspective of substance use is slightly
different from the medical model view. OT
aims to enhance the quality of life of people
with substance use and prevent them from
relapsing (Tsui & Li, 2020). Alternately, the
OT view is that substance abuse is unique to
each individual, and only that individual can
define the meaning of substance use in their
life and the impact on activities of daily living
(Narain et al., 2018). According to the OT per-
spective, “recovery” is not a person’s quitting
substance use and is based on a person’s
ability to participate in new and healthier occu-
pations (Narain et al., 2018). Thus, restoring
and maintaining the roles in the life of the
person before substance use may motivate
people to stay away from substance use (Bell
et al., 2015).
The effect of substance use on
occupational performance and
participation
OT aims to assess the impact of substance use
on occupational performance and participation
limitation of the clients. OT addresses the
effect of substance use on an individual’s
major occupational performance areas, such as
self-care, productivity (work, education, etc.)
and leisure (Stoffel, 1994). Work and education
activities of people with substance use are
affected, and late for school/work, unexcused
absences and meeting declines in productivity
are observed. Their leisure activity choices are
also different. They choose only activities
involving drinking/substance using and unin-
hibited dangerous behaviour (boating, skiing,
etc.) during leisure pursuits. Cognitive and
sensory-motor problems as a result of substance
408
use can also be observed, such as the following:
rigid thinking; blackouts/memory lapses;
sensory, motor and praxis; peripheral neuropathy;
and an overall lack of conditioning/fitness.
Occupational therapists evaluate whether cogni-
tive processes are affected by substance use.
These basic cognitive skills are thinking and pro-
cessing knowledge, communication, attention
span/concentration, memory, problem-solving
and judgement. In addition, they have difficulty
in communication, social skills and emotional
regulation and difficulty establishing and main-
taining intimate relationships, are aggressive and
hostile, and cope with stress by increasing sub-
stance use (Scaffa et al., 2014). As can be seen,
the substance use causes problems in all perform-
ance skills, sensorimotor, cognitive or psycho-
social areas of the individual. In this sense, the
multifaceted perspective of OT seems important
in addressing these issues. Therefore, improving
physical, cognitive and psychosocial skills of indi-
viduals with substance use should be among the
main therapeutic goals of occupational therapists.
Gutman (2006) emphasised the negative
effects of substance use on occupational
engagement. Employment, family relation-
ships, financial stability and personal health
were among the most affected life areas from
substance use. In contrast, Wasmuth et al.
(2015) examined the occupational status of 10
people with substance use disorder and found
that substance use significantly affected iden-
tity, motivation and routines, but did not affect
engagement in occupations. Gutman (2006)
reported that people with substance use may
have difficulty with time management and
major life roles. Many participants of recovery
programmes reported that the majority of their
time was spent in substance-use–related activ-
ities and occupied with thoughts related to
acquiring substances. In addition, many partici-
pants stated that the peer-support programmes
supported their shift from substance-related
occupations to new, meaningful non-substance
related occupations, which they found
extremely important in facilitating and main-
taining recovery. To initiate recovery, some
Nordic Studies on Alcohol and Drugs 40(4)
participants disengaged from activities that
were highly associated with substance use
(Narain et al., 2018).
The role of OT in substance
From an OT perspective, individuals are
addressed in a holistic view. All factors affect-
ing substance use are evaluated together with
the client. Environmental factors in particular
must be taken into consideration. How are the
interpersonal relationships (family, work rela-
tionships and friendships) of individuals with
substance use? In addition, the environment
and people who provide the drug are also
other information sources about the client. In a
review, Wasmuth et al. (2015) examined what
areas of occupation were mostly addressed in
addiction interventions and what occupation-
based interventions were used to treat addictive
disorders. They demonstrated that leisure, work
and social participation were mostly addressed.
Leisure activities such as yoga, exercise
(walking, exercise bike, rowing), psychodrama,
systems-releasing action therapy and music
therapy were used as OT interventions for
addictive disorders. Therefore, these findings
emphasised the importance of assessing the
occupational patterns and occupational partici-
pation of people with substance use.
What can an occupational
therapist do?
▪ Try to understand and empathise, and use
communication techniques.
▪ Evaluate whether the client is ready to
change and use motivational strategies to
encourage the client (Stoffel & Moyers,
2004). Occupational therapists evaluate
the daily occupations of the person in
three major occupational areas: self-care;
productivity; and leisure affected by sub-
stance use (Scaffa et al., 2014).
▪ Help people develop more satisfying and
meaningful patterns of time use and
Doğ u and Özkan
replace unhealthy activities with healthy
and meaningful ones.
▪ Help the client set short- and long-term
goals to enable participation in other
activities.
▪ Help the client evaluate the risk of relapse
and develop a relapse-prevention plan
with the client (AOTA (2002), Canadian
Association of Occupational Therapists
(CAOT)).
When clients want to quit drug use, occupa-
tional therapists use the clients’ skills to facili-
tate occupational change and support their
recovery (Stoffel, 1994). Substance use recov-
ery programmes that include OT life skills in
particular were found to be effective in occupa-
tional performance, self-esteem and quality of
life among people with substance use (Martin
et al., 2008). A qualitative study was conducted
to explore clients’ perceptions of the usefulness
of OT after discharge at substance use rehabili-
tation centres in the Western Cape. Participants
perceived skills development, work training,
life skills and leisure exploration to be useful.
They reported that they needed more practical
experiences outside the rehabilitation centre to
practise the skills learned during group inter-
vention (Bell et al., 2015). While the majority
of the participants participated in leisure activ-
ities previously, all stated that they stopped
engaging in these activities due to substance
use. The participants joined sporting and
leisure activities, such as soccer and dancing,
during group intervention. They expressed
their feelings of satisfaction and health as a
result of engagement in leisure and being intro-
duced to new interests. The findings of this
study point to the fact that skills development
and work training are important. This skills
development programme assisted some partici-
pants with finding employment after discharge.
The study findings revealed that there is a need
for community-based therapy for people with
substance use, and an important motivator for
the participants to stay clean after reintegration
409
into the community was to restore and maintain
the roles they had lost (Bell et al., 2015).
Therefore, the final purpose is to provide occupa-
tional balance and promote quality of life.
Helping individuals with substance use regain
positive activities and their previous roles could
improve their well-being (Hoxmark et al.,
2012). Occupational therapists might design
client-centred interventions for substance use
and they consider the personal traits of clients
that contribute to their recovery. Occupational
therapists are recommended to take part in inter-
disciplinary teamwork for clients diagnosed with
substance use (Abu Tariah et al., 2015).
Intervention programmes
OT aims to find purposeful and meaningful
activities for people with substance use or
regain previously meaningful ones. In other
words, they use the substance for building
their self-esteem, feeling good and defining
their identity. Therefore, the aim of OT should
be to reactivate the other occupational roles of
the individuals, allowing them to be aware of
their roles, and develop person-centred pro-
grammes that include purposeful activities to
meet the needs of the individuals (Lakshmanan,
2014). Evidence-based practices for substance
use interventions include brief interventions,
motivational strategies, cognitive behavioural
therapy and a 12-step recovery programme
(O’Day, 2009; Stoffel & Moyers, 2004). These
interventions may be effective when used together
with occupation-based interventions. Studies have
even shown the beneficial effects of the various
OT life skills training programmes on individuals
with substance use (Amorelli, 2016).
Brief interventions
Brief interventions are designed to reduce risky
alcohol/substance use or alcohol/substance-related
problems. They are used to investigate a possible
problem and motivate the individual to do some-
thing about it. Brief interventions include screen-
ing, evaluation, feedback, referral and follow-up
410
processes. Implemented short interventions are
time-limited and structured. Brief interventions
consist of five or fewer sessions, a short process
lasting from a few minutes to an hour, and have
a special purpose. A specific plan is followed.
There is a timetable for the implementation of spe-
cific behaviours (Substance Abuse and Mental
Health Services Administration [SAMSHA],
1999). The brief intervention consists of five
steps: (1) addressing the relationship of substance
use with one’s health (screening); (2) investigating
and evaluating patterns of substance use (evalu-
ation); (3) giving feedback on the evaluation
results (feedback); (4) talking about change and
goals (referral); and (5) summarising concerns,
goals and plans (follow-up) (SAMSHA, 1999).
Brief interventions are useful in addressing the
client’s readiness for change. These interventions
were reported to be effective in reducing alcohol
use. In applying and synthesising brief interven-
tions to the practice of OT, occupational therapists
provide support and encouragement for lifestyle
changes to participate in community life (Stoffel
& Moyers, 2004).
Motivational approaches
Motivational approaches are based on the trans-
theoretical model developed in 1982 by
Prochaska and DiClemente. This model provides
a useful framework for understanding how people
change their behaviour and for considering how
ready they are to change their substance use or
other lifestyle behaviour (DiClemente, 1999;
Prochaska et al., 1993). The change model con-
sists of six stages: precontemplation; contempla-
tion (intention to change); decision (preparation);
action; maintenance (behavioural actions); and
relapse.
Motivational interviewing (MI) is a client-
centred and goal-directed technique that helps
clients discover and resolve ambivalence. MI
focuses on interacting with the client and their
strengths. Empathy is used rather than authority
and power. Respecting the client’s autonomy
and decisions is important. Little steps are sup-
ported during recovery (Barry, 1999). Another
Nordic Studies on Alcohol and Drugs 40(4)
motivational approach, motivational enhancement
therapy (MET), is a long-term follow-up to an
initial brief intervention strategy. MET consists
of four structured sessions and MI, and uses the
FRAMES approach for change. These frames
are as follows:
Feedback: Give feedback about personal
risks and discomfort.
Responsibility: Give the client responsibility
for change.
Advice: Suggest a change.
Menu of options: Provide alternative self-
help or treatment options.
Empathy: Be empathic.
Self-efficacy: Support your capacity for
change and strengthen your hope.
A short intervention consists of three steps cover-
ing FRAMES: screening and evaluation; giving
feedback; and making suggestions and follow-up
(Barry, 1999). Occupational therapists try to
understand the client’s readiness to change by
using motivational strategies. Thus, they motivate
the client for further evaluation and intervention
plans (Stoffel & Moyers, 2004).
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is an
evidence-based psychological approach. CBT
is problem-oriented and based on learning theor-
ies. CBT helps individuals when they encounter
difficulties they cannot overcome in their daily
lives (Stoffel & Moyers, 2004). CBT also includes
the implementation and monitoring of health beha-
viours, focusing on physical activity, relaxation
and activity pace (Murphy et al., 2018).
Cognitive therapies suggest that the cause of beha-
viours is not the events, but the comments and
expectations of people about the events. The goal
of CBT is to replace unrealistic beliefs, thought,
emotion and negative self-perceptions about sub-
stance abuse with realistic ones. For these pur-
poses, CBT techniques can be applied at school,
at home, in the business environment and as
leisure time activities and can help the individual
develop their coping skills (SAMSHA, 2012).
Doğ u and Özkan
The 12-step recovery programme
Participation in self-help meetings is a long-
term treatment in addition to professional treat-
ment. The 12-stage approach consists of a short,
structured and guided approach to facilitate
getting rid of alcohol use (Crouch & Wegner,
2014; Donovan et al., 2013). The 12-step phil-
osophy refers to a particular view of the recovery
process. It emphasises the importance of accepting
addiction as a disease that can be stopped but
never eliminated, increasing individual maturity
and spiritual growth, minimising self-centeredness
and providing assistance to others who are depend-
ent (for example, sharing recovery stories at group
meetings) (Humphreys et al., 2004). Alcoholics
Anonymous (AA) is an international organisation
and self-help group that offers emotional support
for people who survive alcohol dependence. This
approach focuses on being followed in a social
network in the recovery process instead of not
involving the use of substances for the rest of
their lives. The main themes are no drinking or
medication, going to meetings, asking for help,
getting support, joining groups and being active
(Caldwell & Cutter, 1998).
Conclusion
This debate has outlined the literature on OT
interventions when working with people experi-
encing substance use. OT, unlike the many
medical approaches, is more person-centred
and focuses on the impact of substance use on
the activities of daily living and the restoration
and maintenance of the roles in life that they had
before the addiction, rather than quitting the sub-
stance. Limited study findings found that indivi-
duals who participated in occupation-based
programmes experienced fewer episodes of
relapse (Correia et al., 2005) and disengaged from
activities that were associated with substance use
(Narain et al., 2018). Therefore, occupational thera-
pists can work collaboratively with substance use
treatment teams to meet the needs of clients experi-
encing difficulties in occupational engagement due
to substance use. More evidence-based studies are
411
required to understand the role of OT on substance
use disorders and addictive behaviours.
Declaration of conflicting interests
The author(s) declared no potential conflicts of inter-
est with respect to the research, authorship, and/or
publication of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this
article.
ORCID iD
Selma Ercan Doğ u https://orcid.org/0000-0003-
3276-8041
References
Abu Tariah, H. S., Hamed, R. T. & Al-Omari, H. D.
(2015). Jordanian client perspectives of substance
abuse: Implications for occupational therapists.
International Journal of Therapy and Rehabilitation,
22(12), 566–572. https://doi.org/10.12968/ijtr.2015.
22.12.566
American Occupational Therapy Association
(AOTA) (2002). Overcoming Drug and Alcohol
Abuse. www.aota.org
American Occupational Therapy Association (3rd
Edition) (2014). Occupational therapy practice
framework: Domain & process. American Journal
of Occupational Therapy, 68(Supplement-1).
https://doi.org/10.5014/ajot.2014.68s1
Amorelli, C. R. (2016). Psychosocial occupational
therapy interventions for substance-use disorders:
A narrative review. Occupational Therapy in
Mental Health, 32(2), 167–184. https://doi.org/
10.1080/0164212X.2015.1134293
Barry, K. L. (1999). Brief interventions and brief
therapies for substance abuse. Center for
Substance Abuse Treatment, Substance Abuse
and Mental Health Sevices Administration.
Bell, T., Wegner, L., Blake, L., Jupp, L., Nyabenda,
F. & Turner, T. (2015). Clients’ perceptions of an
occupational therapy intervention at a substance
use rehabilitation centre in the Western Cape.
South African Journal of Occupational Therapy,
412
45(2), 10–14. https://doi.org/10.17159/2310-
3833/2015/v45n2a3
Caldwell, P. E. & Cutter, H. S. (1998). Alcoholics
Anonymous affiliation during early recovery.
Journal of Substance Abuse Treatment, 15(3),
221–228. https://doi.org/10.1016/S0740-5472(97)
00191-8
Canadian Association of Occupational Therapists
(CAOT-ACE). Occupational Therapy and
Substance Abuse. www.caot.ca
Chang, E. (2008). Drug use as an occupation:
Reflecting on Insite, Vancouver’s supervised
injection site. Occupational Therapy Now,
10(3), 21–23.
Correia, C. J., Benson, T. A. & Carey, K. B. (2005).
Decreased substance use following increases in
alternative behaviors: A preliminary investiga-
tion. Addictive Behaviors, 30(1), 19–27. https://
doi.org/10.1016/j.addbeh.2004.04.006
Crouch, R. & Wegner, L. (2014). Substance use and
abuse: Intervention by a multidisciplinary
approach which includes occupational therapy.
In Crouch, R. & Alers, V. (Eds.), Occupational
therapy in psychiatry and mental health (5th
ed., pp. 446–464). John Wiley & Sons.
Cruz, T. (2019). Identifying Occupational Therapy
Role for Individuals in Substance Abuse and
Addiction Recovery Programs. [Doctoral
project, University of St Augustine for Health
Sciences]. SOAR @ USA: Student Capstone
Projects Collection. https://doi.org/10.46409/sr.
FORS9739
DiClemente, C. C. (1999). Motivation for change:
Implications for substance abuse treatment.
Psychological Science, 10(3), 209–213. https://
doi.org/10.1111/1467-9280.00137
Donovan, D. M., Ingalsbe, M. H., Benbow, J. &
Daley, D. C. (2013). 12-step interventions and
mutual support programs for substance use disor-
ders: An overview. Social Work in Public Health,
28(3–4), 313–332. https://doi.org/10.1080/
19371918.2013.774663
Gutman, S. A. (2006). Why addiction has a chronic,
relapsing course. The neurobiology of addiction:
Implications for occupational therapy practice.
Occupational Therapy in Mental Health, 22(2),
1–29. https://doi.org/10.1300/J004v22n02_01
Nordic Studies on Alcohol and Drugs 40(4)
Herie, M., Godden, T., Shenfeld, J. & Kelly, C. (2007).
Addiction: An information guide. https://www.
camh.ca/en/hospital/health_information/a_z_mental_
health_and_addiction_information/drug-use-
addiction/Documents/addiction_guide_en.pdf
Hoxmark, E., Wynn, T. N. & Wynn, R. (2012). Loss
of activities and its effect on the well-being of
substance abusers. Scandinavian Journal of
Occupational Therapy, 19, 78–83. https://doi.
org/10.3109/11038128.2011.552120
Humphreys, K., Wing, S., McCarty, D., Chappel, J.,
Gallant, L., Haberle, B. & Weiss, R. (2004).
Self-help organizations for alcohol and drug pro-
blems: Toward evidence-based practice and
policy. Journal of Substance Abuse Treatment,
26(3), 151–158. https://doi.org/10.1016/S0740-
5472(03)00212-5
Lakshmanan, S. (2014). Occupational therapy struc-
tured activities for substance use recovery.
World Federation of Occupational Therapists
Bulletin, 70(1), 30–31. https://doi.org/10.1179/
otb.2014.70.1.008
Martin, L. M., Bliven, M. & Boisvert, R. (2008).
Occupational performance, self-esteem and
quality of life in substance addictions recovery.
OTJR: Occupation, Participation and Health,
28(2), 81–88. https://doi.org/10.3928/15394492-
20080301-05
Moyers, P. (1997). Occupational meaning and spir-
ituality. The quest for sobriety. American
Journal of Occupational Therapy, 51, 207–214.
https://doi.org/10.5014/ajot.51.3.207
Murphy, S. L., Janevic, M. R., Lee, P. & Williams,
D. A. (2018). Occupational therapist–delivered
cognitive–behavioral therapy for knee osteoarth-
ritis: A randomized pilot study. American
Journal of Occupational Therapy, 72(5),
7205205040p1–7205205040p9. https://doi.org/
10.5014/ajot.2018.027870
Narain, N., Liu, W. N., Mahmood, Z. & Duncan, A.
(2018). Women’s perspectives related to occupa-
tional performance following participation in sub-
stance use recovery programs. Occupational
Therapy in Mental Health, 34(1), 61–74. https://
doi.org/10.1080/0164212X.2017.1395309
O’Day, K. (2009). Effectiveness of treatment techni-
ques for substance abuse in occupational therapy.
Doğ u and Özkan
Mental Health CATs: Paper, 1. http://commonc.
pacificu.edu/otmh/1
Prochaska, J. O., DiClemente, C. C. & Norcross, J. C.
(1993). In search of how people change:
Applications to addictive behaviors. Addictions
Nursing Network, 5(1), 2–16. https://doi.org/10.
3109/10884609309149692
Scaffa, M. E., Riels, L. A., Moyers, P. A. & Stoffel,
V. C. (2014). Community-based approaches for
substance use disorders. In Scaffa, M. E. &
Reitz, S. M. (Eds.), Occupational therapy in
community-based practice settings (2nd ed.,
pp. 292–308). F. A. Davis Company.
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A.,
Kidman, R. C., Donato, A. N. & Stanton, M. V.
(2004). Toward a syndrome model of addiction:
Multiple expressions, common etiology.
Harvard Review of Psychiatry, 12(6), 367–374.
https://doi.org/10.1080/10673220490905705
Stoffel, V. C. (1994). Occupational therapists’ roles in
treating substance abuse. Psychiatric Services,
45(1), 21–22. https://doi.org/10.1176/ps.45.1.21
Stoffel, V. C. & Moyers, P. A. (2004). An evidence-
based and occupational perspective of intervention
for persons with substance-use disorders.
413
American Journal of Occupational Therapy, 58(5),
57–586. https://doi.org/10.5014/ajot.58.5.570
Stone, M. (2017). Understanding the impact of sub-
stance abuse on occupation using the lifestyle
history questionnaire. Occupational Therapy
Doctorate Capstone Projects, 25. https://encom-
pass.eku.edu/otdcapstones/25
Substance Abuse and Mental Health Services
Administration [SAMSHA] (1999). TIP 34 Brief inter-
ventions and brief therapies for substance abuse.
https://www.ncbi.nlm.nih.gov/books/NBK64947/
Substance Abuse and Mental Health Services
Administration (2012). SAMHSA’s working def-
inition of recovery. http://store.samhsa.gov/shin/
content//PEP12-RECDEF/PEP12-RECDEF.pdf
Tsui, C. M. & Li, D. (2020). Substance abuse rehabili-
tation needs to be guided by well-developed practice
model(s). General Psychiatry, 33(3), e100220.
https://doi.org/10.1136/gpsych-2020-100220
Wasmuth, S. L., Outcalt, J., Buck, K., Leonhardt, B. L.,
Vohs, J. & Lysaker, P. H. (2015). Metacognition in
persons with substance abuse: Findings and implica-
tions for occupational therapists. Canadian Journal
of Occupational Therapy, 82(3), 150–159. https://
doi.org/10.1177/0008417414564865