Seeking legitimacy for broad understandings of substance use

Substance Use and Mental Health among Canadian Social Workers

This article reports the findings of an online survey designed to collect information about substance use (licit, illicit, or pharmaceutical) and mental health (depression or anxiety) among social workers. Among the 489 participants, Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) screenings indicated symptoms of depression and anxiety at a higher prevalence than those of the general Canadian population. There were relatively few correlations between mental health scores and substance use. PHQ-9 total score significantly predicted past-year antidepressant use and past-year sleeping medication use. GAD-7 total score significantly predicted past-year benzodiazepine use and past-year melatonin use. Effects of substances (e.g., cannabis, alcohol, benzodiazepines, cocaine, ecstasy) were predominantly beneficial or nonproblematic (e.g., enjoyment/pleasure; socializing enhanced; concentration/focus improved). Subjective experiences of social workers should be sought to understand potential relationships between mental health scores and enhancement effects of substance use. Substances are being used, at least in part, for their performance-enhancing effects to meet the expectations of day-to-day life. Interventions can shift toward root causes, with institutions held more accountable for supporting social workers and promoting "workplace care."

An Occupational Perspective on Psychedelic Therapy: A Scoping Review

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies

Background

The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion.

Objectives

The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients.

Results

Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum.

Conclusion

To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé.

Substance use and meaning: transforming occupational participation and experience

Abstract Introduction We draw on activity theory of concepts to examine ‘meaning of occupation’ and ‘substance use’ beyond preconceived notions of inherent positive or negative experiences. Objective To explore nuanced meanings of substance use and associated occupations. Method An online survey and semi-structured interviews were used to collect data from professionals about prevalence of substance use, substance effects, and personal experiences. In analyzing the interview data, we attended to substance use as a discrete occupation in itself, substance use co-occurring with other occupations, and substance use altering the performance, participation, and experience of occupations. Results Three broad themes related to meaning: i) complex meanings attributed to substance use, ii) meanings of substance use as shifting and variable, and iii) meanings of substance use in the context of other occupations. Substance use enhances occupations, transforms meaning of occupations, and mitigates less desired aspects of occupations. Work, construed as positively meaningful and valued in occupational therapy literature, was a source of stress, unhappiness, and worry; substance use facilitated relaxation and pleasure. Conclusion This study furthers occupational therapy knowledge with respect to implications for conceptualization that extend beyond dualist framings and implications for occupational therapy education, practice, and policy.

Mapping drug epidemiology futures

Epidemiology is a core discipline generating evidence to inform and drive drug policy. In this essay, we speculate on what the future of drug epidemiology might become. We highlight for attention two areas shaping the future of drug epidemiology: nesting epidemiology within a 'syndemic' and 'relational' approach; and innovating in relation to causal inference in the face of complexity. We argue that shifts towards a more relational approach emphasise contingency, including in relation to how drugs might constitute benefit or harm. This leads us to speculate on a 'positive epidemiology'; one that is configured not merely in relation to harm but also in relation to the potential benefits of drugs in relation to well-being. In responding to the complex challenges of delineating contingent causalities, we emphasise the potential of carefully conducted observational study designs that go beyond statistical associations to test causal inference. We acknowledge that each of these developments we describe - a shift towards more relational approaches which emphasise contingent causation, and methodological innovations in relation to establishing causal inference - can be at odds with the other in how they imagine drug epidemiology futures.

Performance and image enhancing drug interventions aimed at increasing knowledge among healthcare professionals (HCP): reflections on the implementation of the Dopinglinkki e-module in Europe and Australia in the HCP workforce

BACKGROUND

Healthcare professionals (HCPs) provide an important point of contact through which people who use performance and image enhancing drugs (PIEDs) could access reliable information, advice, and interventions on a range of PIEDs, their use and related harms. However, HCPs often report difficulties engaging and building rapport with people who use PIEDs, and research suggests that they often lack specialist knowledge on these substances. Providing credible evidence-based resources to support HCPs is thus important. However, educational materials in this area are generally absent and the ones that exist have not been assessed for their utility in the HCP workforce. This paper examines the acceptability and usability of a PIED e-learning module (the Dopinglinkki e-module) targeted at HCPs in three EU Member States and Australia.

METHODS

A standardised two stage, mixed methodology was implemented. Stage 1 involved HCPs completing the e-module and completing an online survey (N = 77). Stage 2 involved conducting individual structured interviews with a subset of survey respondents (N = 37). Normalisation Process Theory and the Theoretical Framework of Acceptability were used as conceptual lenses.

FINDINGS

The e-module provided information that was perceived as useful for HCPs' current and future practice. However, several individual, organisational and societal level barriers were reported as preventing the e-module becoming an accepted and normalised aspect of the HCP workforce, including the need for up to date evidence, the time-consuming nature of completing the e-module, lack of organisational support, the use of over-complex language, and the module's potential to reinforce the stigmatisation of PIEDs.

CONCLUSION

Providing credible evidence-based resources to support HCPs' knowledge development is important. Evidence-based and theory informed interventions are needed to equip HCPs with knowledge that can aid culturally sensitive interactions and effective engagement with people who use PIEDs. Reflecting on our study findings, it is important that the development of interventions should include the voices of both HCP and those using PIEDs, and that careful consideration is given to the various factors that may act as a barrier to effective implementation.