Substance use disorders and social functioning from an occupational perspective: a pre and post-study<sup/>

Moreira, Samantha Ferreira da Costa; Nakano, Eduardo Yoshio; Santos, Helton Saulo Bezerra dos; Oliveira, Karina Diniz; Miranda, Kleverson Gomes de; Fonseca, Rafaela Maria Alves Martins; Gallassi, Andrea Donatti

doi:10.1590/2526-8910.ctoAO266634762

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Original Article • Cad. Bras. Ter. Ocup. 31 • 2023 • https://doi.org/10.1590/2526-8910.ctoAO266634762 copy

Substance use disorders and social functioning from an occupational perspective: a pre and post-study¹ 1 Research ethics section and patient consent: This study was approved by the Research Ethics Committee of the Faculdade de Saúde da Universidade de Brasília under CAAE number 37372114.0.0000.0030. All participants individually and in person signed the Informed Consent Form (ICF). Research data: The dataset is available at http://alcooledrogas.unb.br/nossas-publicacoes, in Dados dos Estudo do Funcionamento Social.

Transtornos pelo uso de substâncias e funcionamento social sob uma perspectiva ocupacional: um pré e pós estudo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Improvements in the social functioning (SF) of people experiencing substance use disorders (SUD) can occur even without use discontinuation. Occupational Therapy (OT) performs multifaceted work on it.

Objective

This study analyzes the SF of people experiencing SUD before and after treatment and the contributions of OT.

Method

A pre and post-study before and after starting treatment for SUD in a Psychosocial Care Centre - Alcohol and other Drugs (CAPS-AD) in Brasilia, Brazil - was conducted with 35 clients based on an SF questionnaire. A measure of the participant's SF improvement was defined as the difference between the SF before treatment (SF_pre) with the SF after treatment (SF_after). The association between SF and sociodemographic variables/drug/previous treatment was verified by linear regression; all analyses considered a significance level <5%.

Results

Most of the 35 participants were male (83%), 30-49 years old (77%), attended elementary school (57%), unemployed (57%), single (46%), Black (40%), had been treated previously (60%) and had present alcohol use disorder (46%). Overall, people undergoing treatment significantly improved their SF. Multivariate analysis showed that Whites improved their SF more (mean of 18.8± 10.4) than Pardos/Blacks (10.8± 8.7; 14.1± 6.4), and the improvement in SF was lower for participants who were taking treatment for the first time (10.3± 5.7) compared with those who had previous treatment (17.2± 9.4).

Conclusion

Treatment in CAPS-AD improved the SF of people experiencing SUD, and the OT professional is a key agent in improving SF due to its performance and approach to clients in vulnerable contexts.

Keywords:
Substance Use Disorders; Psychosocial Support Systems; Mental Health Services; Occupational Therapy; Brazil

		Frequency	Percentage
Sex	Male	29	83%
	Female	6	17%
	Up to 29 years old	6	17%
Age	30 to 49 years old	27	77%
	50 years and older	2	6%
	Some elementary school	20	57%
Education	High School	10	29%
	Graduate	5	14%
Employment	Employed	15	43%
	Unemployed	20	57%
	Single	16	46%
Marital Status	Married/Common union	11	31%
	Separated/widowed	8	23%
	Black	14	40%
Race	Pardo (Brazilians with varied ethnic ancestry)	11	31%
	White	10	29%
First treatment?	Yes	14	40%
First treatment?	No	21	60%
Drug that motivated seeking treatment (SUD)	Alcohol	16	46%
	Crack/cocaine	12	34%
	Other drugs	4	11%
	Marijuana	3	9%

Variables^* * The questions were asked to self-report on the occurrence of each criterion within the last month (before and after starting treatment).	Before (pre) treatment			After treatment
	None	One to three times	More than three times	None	One to three times	More than three times
1. Unable to perform tasks or study for a test	46%	17%	37%	60%	26%	14%
2. You fought, acted badly, or did wrong things	46%	17%	37%	60%	37%	3%
3. You have lost assets by spending on alcohol and/or drugs	23%	23%	54%	51%	46%	3%
4. You went to an appointment under the influence of alcohol and/or drugs	34%	23%	43%	57%	34%	9%
5. Caused shame or embarrassment to someone	43%	14%	43%	57%	37%	6%
6. Did not fulfill its responsibilities	20%	14%	66%	57%	37%	6%
7. A family member or friend has shunned you	34%	9%	57%	60%	34%	6%
8. You felt you needed more alcohol and/or other drugs to feel the same effect	23%	17%	60%	60%	29%	11%
9. Tried to control the use, using only at certain times and in a few places	3%	29%	69%	63%	20%	17%
10. Had withdrawal symptoms because you stopped using alcohol and/or drugs	14%	29%	57%	49%	29%	23%
11. Noticed personality change	26%	14%	60%	49%	31%	20%
12. Realized that had problems performing tasks in general	34%	17%	49%	51%	34%	14%
13. Missed a day (or half a day) of school or work	34%	14%	51%	51%	31%	17%
14. Tried to stop using	6%	34%	60%	40%	31%	29%
15. Suddenly you were in a place and didn't remember entering	40%	14%	46%	57%	31%	11%
16. Lost consciousness or fainted	63%	14%	23%	63%	31%	6%
17. Fights or arguments with friends or family members	37%	26%	37%	60%	31%	9%
18. Have continued to use it when had promised yourself that would no longer use it	6%	14%	80%	60%	23%	17%
19. Felt like I was going crazy	43%	9%	49%	57%	29%	14%
20. Was not able to have fun	60%	31%	9%	57%	26%	17%
21. A friend, relative or neighbor told you to cut down or stop using	6%	4%	91%	66%	26%	9%

Variables	Situation after treatment			p-value^* * Sign test.
Variables	Worsened	Improved	Same	p-value^* * Sign test.
1. Unable to perform tasks or study for a test	1 (3%)	11 (31%)	23 (66%)	0.006
2. You fought, acted badly, or did wrong things	2 (6%)	14 (40%)	19 (54%)	0.004
3. You have lost assets by spending on alcohol and/or drugs	2 (6%)	23 (66%)	10 (29%)	<0.001
4. You went to an appointment under the influence of alcohol and/or drugs	2 (6%)	17 (49%)	16 (46%)	0.001
5. Caused shame or embarrassment to someone	4 (11%)	15 (43%)	16 (46%)	0.019
6. Did not fulfill its responsibilities	0 (0%)	23 (66%)	12 (34%)	<0.001
7. A family member or friend has shunned you	2 (6%)	18 (51%)	15 (43%)	<0.001
8. You felt you needed more alcohol and/or other drugs to feel the same effect	3 (9%)	21 (60%)	11 (31%)	<0.001
9. Tried to control the use, using only at certain times and in a few places	1 (3%)	25 (71%)	9 (26%)	<0.001
10. Had withdrawal symptoms because you stopped using alcohol and/or drugs	2 (6%)	18 (51%)	15 (43%)	<0.001
11. Noticed personality change	2 (6%)	17 (49%)	16 (46%)	<0.001
12. Realized that had problems performing tasks in general	3 (9%)	14 (40%)	18 (51%)	0.013
13. Missed a day (or half a day) of school or work	4 (11%)	17 (49%)	14 (40%)	0.007
14. Tried to stop using	2 (6%)	19 (54%)	14 (40%)	<0.001
15. Suddenly you were in a place and didn't remember entering	4 (11%)	16 (46%)	15 (43%)	0.012
16. Lost consciousness or fainted	7 (20%)	11 (31%)	17 (49%)	0.481
17. Fights or arguments with friends or family members	3 (9%)	16 (46%)	16 (46%)	0.004
18. Have continued to use it when had promised yourself that would no longer use it	0 (0%)	26 (74%)	9 (26%)	<0.001
19. Felt like I was going crazy	5 (14%)	13 (37%)	17 (49%)	0.096
20. Was not able to have fun	1 (3%)	16 (46%)	18 (51%)	<0.001
21. A friend, relative, or neighbor told you to cut down or stop using	1 (3%)	30 (86%)	4 (11%)	<0.001

		SF pre Mean± SD***	SF after Mean± SD	Improved Social Functioning (SF_final =SF_pre - SF_after)
		SF pre Mean± SD***	SF after Mean± SD	SF_final Mean± SD	Univ. p^* * Simple regression (univariate analysis). Multiple regression (multivariate analysis). *SD: standard deviation.	M ult. p**
TOTAL	(n=35)	26.2± 10.1	11.7± 10.0	14.5± 8.8	---	---
Sex	Male (n=29)	29.9± 10.2	12.3± 10.2	14.6± 9.1	0.812	0.344
	Female (n=6)	22.8± 10.1	9.2± 9.9	13.7± 7.2
	Up to 29 years old (n=6)	28.7± 10.2	13.0± 8.6	15.7± 8.1
Age	30 to 49 years old (n=27)	25.8± 9.3	11.5± 10.4	14.3± 9.1	0.891	0.700
	50 years and older (n=2)	23.5± 26.2	11.0± 15.6	12.5± 10.6
	Up to elementary school (n=20)	26.8± 11.2	11.9± 11.5	14.9± 8.3
Education	High school (n=10)	24.1± 9.3	8.7± 6.9	15.4± 11.0	0.546	0.186
	Graduate (n=5)	27.8± 7.9	17.2± 8.1	10.6± 5.6
Employment	Employed (n=15)	26.8± 7.7	12.9± 8.3	13.9± 10.5	0.738	0.546
	Unemployed (n=20)	25.7± 11.8	10.9± 11.3	14.8± 7.4
	Single (n=16)	26.1± 10.5	11.1± 11.7	15.0± 10.9
Marital Status	Married/common union (n=11)	23.0± 10.6	9.5± 10.1	13.5± 6.8	0.898	0.911
	Separated/widowed (n=8)	30.6± 7.9	16.0± 4.4	14.6± 6.9
	Black (n=14)	25.5± 10.8	11.4± 10.2	14.1± 6.4
Race	Pardo (n=11)	24.9± 8.8	14.1± 11.1	10.8± 8.7	0.075	0.002
	White (n=10)	28.5± 11.2	9.7± 9.1	18.8± 10.4
First	Yes (n=14)	18.8± 8.0	8.5± 8.9	10.3± 5.7	0.012	0.020
Treatment?	No (n=21)	31.1± 8.3	13.9± 10.4	17.2± 9.4
Substance that motivated seeking treatment	Alcohol (n=16)	25.4± 10.2	10.9± 8.3	14.4± 7.8
	Crack/cocaine (n=12)	29.9± 9.5	13.3± 12.7	16.6± 10.7
	Other drugs (n=4)	18.7± 11.2	7.5± 8.8	11.3± 5.8
	Marijuana (n=3)	25.3± 9.3	15.3± 10.7	10.0± 8.7	0.530	0.108

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Author’s Contributions

All authors approved the final version of the text.