Niki Kiepek

Addictions and Impulse-Control Disorders as Occupation: A Selected Literature Review and Synthesis

Objective. The question addressed in this paper is: “Are activities that are classified as ‘addictions’ and ‘impulse-control disorders’ occupations?” Background. Current conceptualisations of occupation focus on positive contributions to health and well-being. We suggest that occupations are neither inherently healthy nor unhealthy but are associated with positive and/or negative consequences. Methods. Integrative and interpretative literature syntheses were undertaken. Findings. Findings demonstrated that activities classified as addictions and impulse-control disorders meet the criteria of occupation, in that they give meaning to life; are important determinants of health, well-being and justice; organize behaviour; develop and change over a lifetime; shape and are shaped by environments and have therapeutic potential. Conclusion. The findings have implications for the conceptualisation of occupations, including the relationship between occupation and health, the potential risk for negative consequences through occupational engagement, a deeper exploration of occupational patterns and performance and the influence of context. Finally, a potential role for occupational science in the field of addictions and impulse-control disorders is proposed.

Introducing a Critical Analysis of the Figured World of Occupation

This critical analysis of occupational science examines the figured world of occupation. Figured worlds are ‘typical’ representations of a particular construct based on taken-for-granted theories and stories developed through experience and “guided, shaped, and normed” though social interactions (Gee, 2011, p. 76). Drawing on theoretical articles published primarily in the Journal of Occupational Science, a discussion regarding the values and assumptions underlying occupational science is presented. It is proposed that there are tendencies to identify occupations as “positive” and to focus on the relationship of occupational engagement to enhanced health and well-being. At the same time, there may be an implicit exclusion of activities that are considered ‘negative,’ ‘unhealthy’ or ‘deviant’ from the figured world of occupation, which has the potential to stigmatise and marginalise individuals or collectives. It is suggested that occupational science may have a significant role to play in developing critical understandings of the social construction of occupations as moral or immoral, deviant or normal, and healthy or unhealthy. The role of occupational science in (re-)presenting occupations is framed as a social justice issue that contributes to the social construction of ways of acting and ways of being.

Substance Use and Professional Identity

Processes of professional socialization influence types of substances used, patterns of use, and estimation of normalization. This project explores psychoactive substance use among professionals and students in professional programs in Canada, rationales for use, strategies to manage use and potential consequences, and factors within professional education and culture that influence decisions about use. The intent of this study is to uncover social processes through which professional contexts influence substance use. The researchers sought to explore how professionals and professional students described their own decision-making about substance use and their perceptions of professional influences. The mixed methods pilot study involved ecological momentary assessment (EMA), using an app designed for the study, and qualitative interviews. Participants completed a brief survey on the app each time they used a substance during a 4-week period, reporting what substance was used, how much, where, who with, and anticipated or delayed effects. Thirty-four participants were involved in the EMA component, 20 of whom engaged in interviews. The findings suggest a certain amount of substance use is expected, accepted, and even promoted in professional fields. Thematic analysis revealed novel understandings about (i) deliberate decisions, (ii) disclosure and use, (iii) stigmatized substance use, (iv) normative substance use, and (v) the professional context. This study demonstrates potential advantages of undertaking research to explore substance use, as distinct from substance abuse, problematic use, dependence, or addiction. Conceptualizing substance use more broadly can help to identify factors that both encourage use (e.g., performance demands, social norms) and constrain use (e.g., responsibility, role modeling). This can expand approaches to address substance use that look beyond the individual to social and institutional contexts, acknowledging that responsibility is a collective process.

Use of substances among professionals and students of professional programs: a review of the literature

Abstract Background and aims: This literature review investigates the scope of information regarding self-reported substance use by professionals and students in professional programs, with a focus on anticipated and actual effects of substances. Methods: A review of English, peer-reviewed journals and professional journals was conducted. Articles were included if they reported empirical findings of original research and specifically described an aspect of substance use (e.g. type of substance used, patterns of use, reasons for use) by professionals or students. Results: Of the 130 articles ultimately included, 105 involved anonymous self-administered survey methodology. Self-reported data about the effects of substance use or reasons for use were reported in 35 articles. Reasons for use included positive impact on performance and experience, such as fun, pleasure, sleep, enhanced work performance, improved attention and concentration, and relaxation. Predictive associations were analysed regarding demographic factors, mental health, type of profession, and area of specialisation. Conclusions: Little is known about the effects of substance use on the performance or experience of professionals or students in professional programs. Research is required that incorporates qualitative methodologies, elicits anticipated and actual effects of substance use, including controlled and beneficial patterns of use. Minimisation of research bias is key to future study of the effects of substance use by professionals or students in professional programs.

Ecological Momentary Assessment: Enriching Knowledge of Occupation Using App-based Research Methodology

This paper introduces occupational therapists to ecological momentary assessment (EMA) and outlines factors that guide the process of designing a project. EMA methodology is a research methodology that uses electronic devices and specially designed software, or Apps, to collect real-time data. This methodology may enhance the ecological validity of research by collecting data about daily occupations in situated contexts. EMA data collection provides access to highly detailed and specific data and has the potential to reveal longitudinal patterns of change over a short period of time. It is valued as a means to examine events, precursors, and consequences. EMA methodology presents an innovative approach to explore occupation, thus maximizing existing technology and software. It can also be a useful method for evaluative assessment, given its responsiveness to detecting change over time.

Silences around occupations framed as unhealthy, illegal, and deviant

ABSTRACT Occupational science has made tremendous strides in establishing a theoretical and empirical knowledge base grounded in the study of occupation. Yet given its origins in occupational therapy, a health profession aimed at enhancing health and well-being through engagement in meaningful and purposeful occupation, there has been sustained focus on the health-enhancing qualities of occupation. 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. Our intent in this paper is to both explicate why attention to non-sanctioned occupations is an important means to diversify perspectives on occupation, and point to key framing concepts, such as deviance, hegemony, and resistance, for such scholarship. We emphasize that examinations of this nature evoke critical reflection on underlying disciplinary assumptions, enactments of social power, and values and moral standpoints that inform knowledge production in occupational science, helping to diversify understandings of occupation itself.