Recreational Therapy: An IntroductionChapter 5: Substance Use Disorders

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Substance use disorders

In 2012, an estimated 23.9 million Americans age 12 or older—or 9.2% of the population—had used an illicit drug or psychotherapeutic medication (e.g., pain reliever, stimulant) for other than its intended use, in the previous month.

Alcoholism and alcohol use disorders (AUD)

Alcoholism and alcohol use disorders are regarded as the most devastating of all health conditions in terms of economic and social costs, affecting 17 million Americans.

Approximately 53% of adults in the U.S. have reported that one or more of their close relatives have a drinking problem.

Substance use disorders

Formerly known as substance abuse, the condition is now called substance use disorders reflects the assumption that persons who use different substances have different disorders with unique features, which range fro middle to moderate to severe. Not everyone who has the disorder suffers from addiction.

Addiction

The word addiction is the preferred term for persons who experience compulsive use despite serious health and social consequences. Addiction is often chronic in nature; it disrupts circuits in the brain that are responsible for reward, motivation, learning, judgment, and memory, making recovery challenging.

Medical treatment of substance use disorders

Substance use disorder is a chronic condition that has a high rate of relapse and may require multiple admissions for treatment and ongoing intervention.

Treatment for substance use disorders typically begins with medically supervised detoxification to clear the body of the toxic substances, but detox alone does not produce long-term recovery.

Several medications are used in treatment, including Antabuse (which makes users sick if they drink alcohol) and naltrexone (which blocks the rewarding effects of alcohol and reduces cravings). For opiate addiction, methadone, Suboxone, and buprenorphine work by reducing symptoms of withdrawal, reducing the cravings for the drug and blocking the effects of the opiates.

Therapeutic approaches

Traditional approaches include therapeutic communities, 12-step support groups, community reinforcement, cognitive-behavioral therapy, multidimensional family therapy, multimodal interventions, and a holistic approach to developing a healthy lifestyle.

New methods include screening, brief intervention, and referral to treatment to behavioral health care; motivational interviewing; motivational enhancement therapy; and complementary and alternative methods such as massage, yoga, and qigong.

Table 5.3 details current treatments for substance use disorders.

Leisure education

Leisure education is increasingly being included as an essential component of treatment for substance use disorders.

The importance of fun and joy in recovery is being recognized.

Pleasure and play have been seen as sources of hope, commitment, meaning, and purpose and as a means of discovering individual strengths, talents, sense of control, and mastery.

Examples of RT interventions with empirical evidence to support them

Adventure therapy

Animal-assisted therapy

Horticulture

Photography

Physical activity

Bibliotherapy

Mindfulness

Qigong

Relaxation and stress management

Multimodal interventions using recreation

Family social events

Outcomes to which RT may contribute

Number of days without relapse

Ability to identify triggers and resist urges

Effective use of stress management strategies and coping skills

Increased impulse control and frustration tolerance

Improved family relationships and communications

Developing a support network

Acquiring social skills

Recognizing strengths and assets

Developing trust

Making new friends

Outcomes specific to recreation & leisure

Increasing leisure awareness

Identification of leisure barriers

Identification of interests, skills, and resources

Identification of rewarding alternative activities to substance use

Acquiring a repertoire of leisure activities to do along or with others

Implementing a plan for leisure participation

A note of caution for RTs

RTs may find their work with substance use disorder clients to be emotionally difficult and frustrating at times. Addressing work stress through clinical supervision and holistic health practices may strengthen staff’s ability to continue being effective and satisfied with their work.