Harm Reduction-Oriented Occupational Therapy for Substance Use Disorders: A Retrospective Cohort Study

Abstract

Importance Identifying factors associated with sustained engagement in harm reduction-oriented occupational therapy may help inform more accessible interventions for individuals with substance use disorders (SUDs). Objective To examine participant characteristics associated with sustained engagement in the Real-Life Program (RLP), a harm reduction-oriented outpatient occupational therapy program for individuals with SUDs, and to explore changes in occupational and psychosocial outcomes among participants who continued the program. Design Retrospective cohort study. Setting Single-site outpatient occupational therapy program. Participants Fifty-five individuals with SUDs enrolled in the RLP. Participants were classified into continued (≥47% attendance) and noncontinued (<47%) groups based on the median participation rate. Outcomes and Measures Canadian Occupational Performance Measure (COPM), Rosenberg Self-Esteem Scale-Japanese version, Shitsu–Taikan–Sho Scale, and visual analog scales for craving intensity and perceived connectedness to others. Results Prior self-help group experience was significantly associated with continued participation. Older age showed a nonsignificant association. No other demographic or clinical characteristics differed significantly between groups. Among participants who continued the program, COPM Satisfaction improved significantly, whereas COPM Performance, self-esteem, alexisomia, craving intensity, and perceived connectedness did not. Conclusions and Relevance Prior self-help group experience was associated with sustained engagement in the RLP. Among participants who continued the program, satisfaction with daily occupations improved, although the clinical significance of this change remains uncertain. The RLP may provide a feasible harm reduction-oriented occupational therapy option for individuals with SUDs who have difficulty engaging in abstinence-based treatment programs. Plain Language Summary People with substance use disorders (SUDs) often face challenges such as unemployment, health problems, and social isolation. Traditional treatment programs often emphasize abstinence, which may not be realistic for everyone. In this study, a harm reduction-oriented occupational therapy program, the Real-Life Program, was associated with continued engagement in care, and participants who remained in the program reported improved satisfaction with daily occupations. Such programs may provide a viable option for individuals who have difficulty engaging in traditional abstinence-based treatment models. Integrating individualized goal setting, peer support, and life skills training within harm reduction-oriented frameworks may support more person-centered care for individuals with SUDs; however, further research is needed.