Introduction: Despite advances in addiction research and practice, addiction remains a significant public health problem with strikingly high relapse rates and low treatment retention rates. This study explored whether the concept of addictionas-occupation aligned with the experiences of ten persons with addiction(s), and suggests that further development of a model based on this concept may help to elucidate and address some barriers to addiction recovery services.Methods: Semi-structured interviews were performed to gain descriptions of the occupational lives and first-hand experiences of ten persons with addiction(s). Transcripts were analysed using a qualitative thematic analysis methodology.Results: Seven themes were identified in the data: connection, locus of control, penetration, habituation, identity, motivation, and coping/escape. Participants in this study described their addictions using occupational terms, and addressed both the gains and harms of performing their addictions.Conclusion: Further investigation of experiences of addiction-as-occupation could be useful for informing occupational therapy interventions for substancerelated and addictive disorders. Potential implications and contributions of a conceptual model based on the notion of addiction-as-occupation, as well as areas for future research, are discussed.

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Objective: Clinician burnout in healthcare is extensive and of growing concern. In mental health and rehabilitation settings, research on interventions to improve burnout and work engagement is limited and rarely addresses organizational drivers of burnout. This study sought to elaborate on the organizational influence of burnout and work engagement in mental health. Methods: We randomly selected 40 mental health clinicians and managers who were participating in a burnout intervention and conducted semistructured interviews to understand their views of organizational conditions impacting burnout and work engagement. Data were analyzed using a thematic analytical approach. Results: Analyses yielded three major themes where organizational contexts might reduce burnout and increase work engagement: (a) a work culture that prioritizes person-centered care over productivity and other performance metrics, (b) robust management skills and practices to overcome bureaucracy, and (c) opportunities for employee professional development and self-care. Participants also referenced three levels of the organizational context that they believed influenced burnout and work engagement: front-line supervisors and program managers, organizational executive leadership, and the larger health system. Conclusions and Implications for Practice: Findings point to several possible targets of intervention at various organizational levels that could guide the field toward more effective ways to reduce burnout and improve work engagement. Impact and ImplicationsThree major themes where organizational contexts might reduce burnout and increase work engagement were identified: a work culture that prioritizes person-centered care over productivity and other metrics, robust management skills and practices to overcome bureaucracy, and opportunities for employee professional development and self-care. These contexts, influenced at multiple organizational levels, could be targeted in future interventions that are effective in reducing burnout and improving work engagement.

Importance: Societal stigma gravely impedes occupational justice for transgender and gender-nonconforming (TGNC) people, producing vast health disparities for this population. Objective: To test the feasibility of an intervention to reduce stigma and improve the well-being of TGNC people. Design: A parallel, mixed-methods design was used to test feasibility in the areas of acceptability, demand, and limited efficacy. Setting: Community. Participants: Forty-two audience members and 5 TGNC interviewees. Intervention: Virtual, narrative-informed play reading and moderated discussion about gender diversity and affirmative care. Outcomes and Measures: The valid and reliable Acceptance and Action Questionnaire–Stigma was used to assess stigma beliefs. An open-ended, qualitative question assessed TGNC interviewees’ experiences. Results: Recruitment and participant responses to the intervention indicated feasibility in the areas of acceptability, demand, and limited efficacy. However, future efforts at obtaining a diverse TGNC sample are needed. Conclusions and Relevance: The intervention decreased stigma beliefs in audience members and offered a positive experience for TGNC participants. Feasibility outcomes warrant future efficacy testing. What This Article Adds: This article adds an innovative intervention for promoting occupational justice to support the health and well-being of TGNC people. The community-based intervention facilitates change in societal attitudes and stigmatizing beliefs.

In this study, we examine the feasibility and acceptability of a 6-wk, interdisciplinary, occupation-based theater project for facilitating community engagement and substance use disorder (SUD) recovery in veterans. All data were collected at baseline, postintervention, and 6-wk and 6-mo follow-up intervals. Of the invited veterans, 24% consented to participate (n = 14), and 50% were retained (n = 7). Average attendance was 91%. Considerable improvements in social and occupational participation were noted at postintervention and at 6-wk follow-up but were not retained at 6 mo. No important change in self-efficacy was noted. Of the participants, 86% remained abstinent for 6 wk following the intervention. Theater provides a feasible and acceptable resource for potentially facilitating SUD recovery. Larger controlled effectiveness studies of theater are needed to examine whether robust and notable recovery outcomes in people with SUDs can be linked to participation in theater.

Theatre has been a powerful means of eliciting social change. This paper describes methods and outcomes of a theatre project to reduce healthcare inequities experienced by Black women. We conducted narrative interviews with a convenience sample of Black women and conducted thematic analysis of interview transcripts to learn about their experiences of healthcare and to inform development of a professional theatrical production. To assess the impact of the performance on the audience, we used a single post-test concurrent mixed-methods design using a self-created Likert-type survey that included space for open-ended responses. Ten Black women completed narrative interviews. Thematic analysis revealed 5 main themes: being ignored, being accused, being talked-down to, fearing harm, and being hurt. Narratives were used to create a script that centered on these themes, and that was professionally produced and performed. Audience members (n = 113, 25% healthcare providers) produced a mean total post-test score of 19.28 (agree/strongly agree) on a 25-point survey with 2 items scoring in the 2 to 3 range (disagree/not sure). Thematic analysis data revealed the extent to which Black women experienced discrimination in multiple settings. Quantitative survey data suggested audience members conceptually understood and were aware of inequity, but open-ended responses revealed this information was new for some, and prior knowledge for others. The audience reported planning to change personal behaviors that may contribute to inequity. Participants were unsure if they had contributed to inequity in the past. The performance stimulated conversation about implicit bias and discrimination and encouraged audience members to examine their contributions to the problem. Future pre-post studies are needed to better assess the impact of the performance. Theatre has the potential to illuminate the extent and nature of discrimination in healthcare and society, and to foster conversations that allow audience members to consider their own potential contributions to discrimination.

According to stereotype threat theory, the possibility of confirming a negative group stereotype can evoke feelings of threat, leading people to underperform in domains where they are stereotyped as lacking ability. This theory has immense theoretical and practical implications. However, many studies supporting it include small samples and varying operational definitions of “stereotype threat”. We address the first challenge by leveraging a network of psychology labs to recruit a large Black student sample (Nanticipated = 2700) from multiple US sites (Nanticipated = 27). We address the second challenge by identifying three threat-increasing and three threat-decreasing procedures that could plausibly affect performance and use an adaptive Bayesian design to determine which operationalization yields the strongest evidence for underperformance. This project has the potential to advance our knowledge of a scientifically and socially important topic: the conditions under which stereotype threat affects current Black students in the United States.

This study examined how addiction emerges as an occupation in the lives of veterans. Its purpose was to facilitate better knowledge of how addiction is experienced as an occupation by this population, with the goal of destigmatizing addiction and paving the way for innovative ways to help people with addictions to build new occupational lives. Fifty-eight veterans diagnosed with a substance use disorder were recruited from a VA residential treatment center, of which 35 transcripts of the Indiana Psychiatric Illness Interview-a broad interview inquiring about participants' life experiences-were randomly selected for grounded theory analysis following a 4-step coding procedure as outlined by Charmaz. Data revealed a five-step occupational process: Being Initiated; Increasing Engagement; Establishing an Identity; Experiencing Discord and Defeat; and Finding Other Occupations. Addiction is discussed as a behavioral pattern, and the authors discuss how the use of new occupations may provide individuals with new patterns of organization, social interconnection, and identity development needed to sustain a move away from occupations of addiction.