Authors (including presenting author) :
Lam CK(1), Louie TM(1)
Affiliation :
(1) Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital
Introduction :
Substance abuse refers to the harmful or hazardous use of psychoactive substance such as illicit drugs. Repeated psychoactive substance use can lead to dependence syndrome and psychiatric disorders - a cluster of behavioral, cognitive, and physiological phenomena that develop and typically include a strong desire to take the drug. Clients with substance abuse always have difficulties in resisting the craving and persisting in its use despite harmful consequences. They would give a higher priority to drug use than to other daily and healthy activities. As a result, they showed a marked deterioration in occupational life-functioning. To facilitate people with substance abuse to cease addictive behavior and resume normal daily occupations, a multi-disciplinary community service model has been adopted in the substance abuse service in a local community of Hong Kong. The service team consists of a specialized psychiatrist and experienced occupational therapist from the medical sector (i.e., Public Hospital) and social workers and nurses from the social sector (i.e., non-government organization). Within the team, the goals of Occupational Therapy (OT) are to help the abusers to resist the craving, cease the drug-taking behavior, and re-engage into meaningful daytime occupations/activities. To achieve these goals, a novel approach was adopted by incorporating a new wave of psychotherapy - Metacognitive Therapy (MCT) into the OT process. MCT targets to eliminate a problematic pattern of thinking style and cognitive processing called the Cognitive Attentional Syndrome (CAS). A review of the research evidence indicates that CAS configurations and metacognitive beliefs are present in addictive behavior. CAS influences deliberate volition and the self-regulation system, which plays a core role in restraining or maintaining addictive behaviors. The volition system of a human involves thoughts and feelings about what one holds important (values), perceives as personal capacity and effectiveness (personal causation), and finds enjoyable (interests). One of the important dimensions under personal causation is self-efficacy – refers to one’s sense of effectiveness in using personal capacities to achieve desired outcomes in life. When the client continues to adopt CAS in response to intrusive urges to take drugs or negative emotions, one’s self-efficacy to avoid drug would be largely affected. Metacognitive-Focused Occupational Therapy (MFOT) program has been established to help clients resolve the negative influence of CAS on the process of ceasing substance abuse through MCT techniques in addition to Occupational Life-style Redesign (OLSR).
Objectives :
This case study aims at illustrating the processes of the intervention in MFOT applied to addictive behaviors.
Methodology :
The client Mr. Y presenting substance abuse behavior undergoing MFOT program is drawn from an RCT study that investigated the treatment effectiveness of the MFOT program under a community-based multi-disciplinary service model for people with substance abuse.
Result & Outcome :
Mr. Y showed not only improvement in resisting the craving, but also capable of resuming a worker role and life. For other successful cases, they resumed a new and meaningful life and also abstained from substance abuse totally.
