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The abuse of oxycodone in Northwestern Ontario, Canada, has escalated at alarming rates raising concerns that opiate use has reached epidemic proportions, particularly among the First Nations communities. The authors were involved in establishing Ontario's first rural inpatient medical withdrawal unit to serve patients seeking abstinence. Issues: The development of the medical withdrawal support services (MWSS) required creative and adaptive strategies to respond to the geographical, cultural and institutional circumstances. Lessons learned: Key factors to support program efficacy and successful outcomes for clients during the inaugural eight months of operation are interprofessional and collaborative approaches with a cultural awareness.

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.

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.

Introduction: Substance use, as an occupation, is typically portrayed as problematic and the target of occupational therapy intervention and remediation. At the same time, psychoactive substances may be used to enhance mood, cognition, occupational performance, and/or experience, a perspective that is largely absent from occupation scholarship. Objective: We examine substance use in relation to the enhancement of occupation, drawing on the theoretical notion of agential realism. This theory suggests that in the social world 'reality' is not so much objective fact, stable and predictable, but rather continuously produced and reproduced, through doing and intra-active becoming. Method: A selected integrative, critical interpretive synthesis of the literature was conducted. The analysis is focused on synthesizing literature about substance use and enhancement of occupation. Results: Occupation does not exist independent of the doing, but also in 'becoming'. Sometimes using a substance is in itself an occupation-having a drink, or going out for coffee. Sometimes using a substance is a means to enhance another occupation-taking erectile dysfunction medication to improve sex, or amphetamines to improve studying. Sometimes using a substance simply alters the experience of an occupation-using cannabis or psychedelics to enhance the experience of listening to music. Conclusion: Adopting a focus on occupation may encourage novel ways of understanding substance use and what constitutes optimal quality of life and meaningful experiences. It may also facilitate better understandings of how people employ alternative, non-substance means to achieve desired occupational outcomes.

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