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Licit, Illicit, Prescribed: Substance Use and Occupational Therapy by Niki Kiepek, PhD

by Dominic Lloyd-Randolfi, OTD, OTR/L

substance abuse and occupational therapy coverSubstance abuse and occupational therapy may seem like a non-traditional role.

But what if we told you that OTs have a unique role to play in substance abuse prevention? Now, you might have learned about it briefly in your mental health course during school. However, it's not unlikely that what you learned about substance abuse and occupational therapy got lost in the mix of school and stress.

The fact of the matter is that substance abuse and occupational therapy is an important (and dense) topic that deserves its own course and textbook. I recently had the chance to review Licit, Illicit, Prescribed: Substance Use and Occupational Therapy by Niki Kiepek, PhD, and I’m glad I did. Features of her book include:

  • Presentation of current evidence and best practices
  • Case scenarios to exemplify chapter material
  • Profile of leaders in this emerging field of practice
  • Key resources for further information about topics
  • Discussion questions to support reflection and integration

Occupational therapists bring a unique skill set and knowledge base to help clients overcome substance use issues and attain their goals for optimal health and well-being.

My favorite part of this book is that it provides examples and resources to address substance use and mental health in all areas of practice. Since I work in acute care, I have often seen those admitted to the hospital due to substance abuse or accidents/incidents as a result of substance abuse. Though working in mental health and substance abuse is not the primary objective of my job at the hospital, this book gave me the tools and confidence to address it more in my practice.

To summarize, Dr. Kiepek shares with us her 10 years of experience as an OT practitioner blended with copious amounts of research to support her knowledge and interventions. She begins with an overview of the science of addiction coupled with the appropriate OT theories and frameworks. This book provides the reader with a strong foundation of understanding the important relationship between addiction/substance abuse and meaningful occupation (or lack thereof).

Throughout the text, Dr. Kiepek provides various case studies and clinical scenarios to help OT practitioners learn and identify moments where addressing substance abuse is appropriate. She also educates on the importance of various intervention strategies such as motivational interviewing and cognitive behavioral therapy. You probably learned these in school, but a refresher is always welcome!

Dr. Kiepek concludes the textbook with introspective reflections and further clinical implications of the future of substance abuse and occupational therapy. As healthcare delivery continues to change and service reimbursements are being challenged, occupational therapists need to advocate in their current roles and continue to demonstrate their worth in emerging practice areas.

This book is certainly not the first of its kind, but it stands alone. Not only does it cover the entire spectrum of various substances over the lifespan, but it also gives concrete evidence of assessment tools, interventions, and outcomes. Thinking of, creating, and performing interventions can be one of the most difficult aspects of being a new grad occupational therapist.

Let’s look close at Chapter 9. This entire section of the book is dedicated to real life examples with concrete advice. Box 9.3 in the book address adapting clinical interventions for clients with fetal alcohol spectrum disorders. Followed by bullets for specific advice:

  • Present ideas as concrete ways rather than concepts/metaphors
  • Set boundaries
  • Be encouraging
  • Set goals in to achievable steps

You get the point. Obviously the list in the book is MUCH larger and more resourceful. I also love seeing that they are followed up with how OTs can provide these uniquely and what exactly our role is.

Every aspect as a new grad OT clinician and practitioner requires some sort of mentorship and guidelines. And one would argue (mostly me) that more mentorship is needed in this practice area due to being rather “nontraditional.” That being said, this book does a great job of sharing “vignettes” or personal stories from current OTs practicing in Canada.

substance abuse and occupational therapy excerpt

Not only are they sharing from the frontlines of actual clinicians, but they are sharing the unique experience of a new graduate OT.

What I want to see next:

At the end of this textbook, I would love to see more outcome measures, and more concrete evidence on how substance abuse treatment and occupational therapy can work together. This is not a common working environment for OTs in the US compared to pediatrics, SNFs, or hospitals. If this textbook provided OT outcome measures it could provide evidence and resources to help future OTs promote our role as a unique healthcare discipline.

Even a section on how to communicate with a referring physician or how to get buy-in from social workers/counselors would be extremely helpful.

More concrete tips on practice management would also be beneficial to new grad OTs. Yes, this book is written by a Canadian and published by CAOT, so insurance and payment source is different, but knowing what CPT codes to charge/bill under are crucial factors that help therapists on a individual level to further elevate the profession. As noble as we are, we can’t work for free!

The truth of the matter is, there is no way review every aspect of this textbook. However, what we can say is, if you have any interest in substance abuse and occupational therapy, Licit, Illicit, Prescribed: Substance Use and Occupational Therapy is a fantastic resource.

To learn more you can check out the CAOT website or simply tap the pulldown menu below to skim the 12 chapters offered in this book!


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