ASEGURAR EL AMBIENTE FORMATIVO Y LA PARTICIPACIÓN DE TODOS LOS

Although substance abuse has very negative consequences, it can be considered as a primary occupation for individuals with substance use disorders. The findings from this study suggested that substance abuse as a primary occupation for the index participants provided meaning, temporal structure, and opportunities for interaction. This is similar to what was proposed by other scholars. (95)(96) As such its absence had similar consequences as loosing primary meaningful and identity engendering occupations. These consequences were experienced as occupational disruption and occupational deficits. In trying to avoid these consequences some index participants went back to abusing substances. The family units had to find ways of addressing these occupational deficits in order to prevent the index participants from relapsing.

Therapeutic approaches to promote health and wellbeing have traditionally been based on the assumption that meaningful occupations contribute to heath, wellbeing and quality of life. (60) Accordingly, family units who participated in this study were looking for new occupational opportunities that would replace substance use as an occupation and break the cycle of abuse. These efforts included skills acquisition through vocational skills training and development of income generating projects mostly poultry keeping.

Resuming participation in meaningful occupations after a substance use disorder was a complex process which involved the individual recovering from substance use and the family. The complexity of the process was seen in the way families negotiated before they could agree on a

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new occupation. Findings from this study revealed that for most of the family units, the choice of a new occupation was a collective decision made by the family unit. As such, the collaboration between index participants and affected family members was essential in ensuring the successful participation in the new occupation. There was evidence of instances in which there was a mismatch between what the families could afford and what the index participants wanted. This mismatch could act as a barrier to future participation by index participants. This is because meaningfulness is a subjective experience, (39) therefore what is meaningful to the affected family members might not be meaningful to index participants.

Limited participation in meaningful occupations has been reported to result in reduced self- efficacy and mastery. (200) In this current study, the impact of reduced self-efficacy and mastery was noted when individuals who were recovering from substance use disorders were presented with opportunities to identify new occupations by their families. Those who had either quit school or obtained poor results had limited opportunities to resume participation during recovery. They lacked the basic competencies that were required for them to be able to participate in these new occupations. Encouraging participation in family occupations might be the starting point in acquiring competencies for future participation.

Literature suggests that occupational choice is governed by opportunities, personal and social circumstances as well as resources. (201)(202) In this study, limited financial resources deprived some of the index participants from experiencing the benefits of occupational participation. Others however dropped out of occupations that had been provided for them by their families and were now finding it difficult to resume participation in these occupations.

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The absence of resources to facilitate participation in meaningful occupations was a common dilemma in many of the family units. As mentioned earlier, this study was conducted against a backdrop of economic challenges which were happening at a national level. These macro- economic challenges contributed to the limited opportunities for participation. The families had many ideas of occupations that could provide opportunities for meaningful participation. However their choices were restricted by the financial resources available to the families.

The findings from this study revealed that all the family units were now considering opportunities for occupational participation that would translate into productive work and allow for financial independence. It is important to note that all the index participants in this study wanted occupational opportunities that would provide structure to their patterns of participation as well having the potential to result in financial independence. Most affected family members expressed their dilemma surrounding the financial independence of the index participants. They were concerned about how having access to money would facilitate access to more drugs. The families had already devised strategies to limit access to financial resources which had not worked. This had implications on how the families were going to support their relatives in order to facilitate participation in meaningful occupations.

Furthermore, the opportunities for occupational participation considered by most of the family units required financial input. Given the financial constraints that most of the families were facing, identifying alternative occupations that were within the family`s routines might have been more practical. Ramugondo and Kronenberg (203) highlighted the benefits of utilising the interconnectedness of the individuals and the collective in enhancing participation in occupations. In this regard, utilising family occupations to create opportunities for participation in meaningful occupations might have provided an opportunity for family members to

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collectively participate in occupations that were not detrimental to health and wellbeing. These might have been a more sustainable approach to using occupations to facilitate recovery because these everyday occupations would be embedded in the family`s routines and therefore would not require additional financial resources. This might also have addressed the feelings of loneliness that were being experienced by the index participants as they started their recovery journeys. Such feelings might have predisposed the index participants to relapse.

6.3 Conclusion

The negative effects of substance use on the affected family members that emerged in this study were consistent with what has been suggested in literature. The difference in this study was that family discourse was dominant, rather than the individual perspective being the focus. The key factors shaping family involvement in promoting participation in meaningful occupations during recovery were highlighted in this discussion. These factors suggested the need to address contextual factors within the family units in order to address the intrapersonal and interpersonal consequences of substance use disorders such as those noted in the current study.

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