Too often, occupational therapy is understood as relating solely to hospitals and physical rehabilitation. In fact, it can play a significant role in helping us to work with people holistically and collaboratively to make positive changes in their lives.
As an occupational therapist working within Change Grow Live’s Coventry drug and alcohol service, I’ve seen how occupational therapy can be used to offer a person-centred approach to individuals with complex needs. We’ve embedded these practices within our service offering, with significant success.
Occupational therapy remains underused in substance services across the UK, despite calls from the Royal College of Occupational Therapists for a greater presence. Some NHS trusts and third sector providers have begun integrating occupational therapists into their teams, contributing to a small but growing network of occupational therapists within the sector, but it is far from standard practice.
One of the reasons for this slow uptake is a widespread misunderstanding of what occupational therapy is. It’s common for people’s understanding of what an occupational therapist can do to be limited to a few settings they’re already familiar with, such as physical rehabilitation. While that’s one area of practice, it’s actually much broader and deeply rooted in enabling people to do the things that they need and want to do.
SAFER ALTERNATIVES
At the heart of occupational therapy, we look at understanding what we call ‘occupation’. This includes not just work, but everything a person does that gives them meaning – cooking, self-care, managing money, socialising, even rest.
We work with individuals to identify barriers in their daily lives – physical, psychological, environmental, or social – and support them to overcome these. In a substance use context, this can mean helping someone regain the confidence to cook for themselves, advocate for accessible housing, or create a structured daily routine.
For many people, substance use can be a coping mechanism. Alcohol may help someone feel more confident. Crack cocaine might block out intrusive thoughts. Opiates might relieve pain. Understanding the factors that substances help individuals to manage is essential to helping them replace those strategies with safer alternatives.
In this way, occupational therapy is particularly well placed to address the increasingly complex understanding of substance use and dependency and how they relate to people’s lives. In my experience, shifting the focus from an individual’s substance use to activities of daily living helps to build rapport and trust. It enables people to consider the underlying reasons for their substance use, and the barriers they face in making changes.
One of my roles at Change Grow Live has been to build and embed occupational therapy provision into our wider service offer. This has included developing a referral system that enables keyworkers to identify when a service user might benefit from occupational therapy – as a result of physical health conditions, learning disabilities, mental health challenges, social isolation, or pain management.
The process starts with a comprehensive assessment that explores a person’s strengths, needs and goals. Often, people disclose struggles they haven’t shared before – particularly in areas like self-care. For example, someone might reveal that they’ve stopped washing as regularly as they usually would.
Rather than judge or ‘fix’ that behaviour, occupational therapy helps us unpack what’s going on. Is it due to low mood or mental health challenges? Lack of routine or regular accommodation? From there, we co-create small, manageable goals that move someone toward change.
Occupational therapy interventions are diverse. Some directly support reduction or abstinence – for example, helping someone engage in new activities to replace substance use. Others are more indirect but just as crucial – advocating for housing that supports recovery, creating sleep routines, or helping someone build confidence before returning to work or education.
REAL LIFE IMPACT
Over the past two years, I’ve supported more than 100 individuals with complex needs, including mental health diagnoses, physical health conditions and histories of trauma. Feedback from service users has been overwhelmingly positive. One person said simply, ‘I felt listened to and had excellent advice and support.’
More broadly, we see that when individuals are given the chance to focus on everyday skills and rediscover daily structure, their relationship with substances often shifts. They gain the tools and the knowledge to begin changing their perspective on their substance use.
One individual I worked with had a long history of homelessness, heroin and crack cocaine use, and had recently become a wheelchair user due to paraplegia. He also had a diagnosis of emotionally unstable personality disorder and autism. Although he had previously lived in a care home that was well equipped to support him with his complex situation, he had recently been placed in accommodation that was unsuitable for his needs. He struggled with tasks including cooking and personal hygiene, and his substance use began to increase. During our assessment, however, he identified that injecting was not just substance use – it was also a form of self-harm.
Through occupational therapy support, he experienced prolonged periods without injecting. I was able to advocate for him to move into more appropriate accommodation, where he could safely begin practicing and engaging with life skills – managing money, cooking and developing routines.
Occupational therapy wasn’t a magic wand for this person, and he still faces significant barriers. But by focusing on practical, achievable goals, he has been able to meet life’s challenges with greater resilience, rather than using substances as a coping mechanism.
The response from colleagues at our service has been equally positive. One recovery coordinator said, ‘Being able to refer service users to Jess and accessing her skill set has changed outcomes for my complex clients. This is a really positive example of collaborative working.’
A GROWING OPPORTUNITY
The inclusion of occupational therapists in addiction services is still developing. But the need is clear. As the complexity of people’s lives increases, so must our response. Occupational therapy offers a way to meet people where they are, help them define what recovery means to them, and support them in taking practical steps to get there.
This is an exciting climate for the development of recovery services. Through my work with Change Grow Live, I’ve seen the benefits of occupational therapy not just as a treatment, but as a way to help people build a life worth recovering for.
Recovery is not one-size-fits-all, and neither is occupational therapy. That’s exactly why it belongs at the heart of substance use services.
Jess Bhikha is an occupational therapist at Change Grow Live
WHAT IS OCCUPATIONAL THERAPY?
At the heart of occupational therapy we look at understanding what we call ‘occupation’. This includes not just work, but everything a person does that gives them meaning – cooking, self-care, managing money, socialising, even rest.
We work with individuals to identify barriers in their daily lives – physical, psychological, environmental, or social – and support them to overcome these.
In a substance use context, this can mean helping someone regain the confidence to cook for themselves, advocate for accessible housing, or create a structured daily routine.