Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts.

BACKGROUND.: Occupational therapy practice is enhanced through clear understanding of its epistemological foundations. In the area of substance use, practices are strongly functionalist.

PURPOSE.: This study unearths epistemologies through analyzing practices addressing the social needs of clients with problematic substance use.

METHOD.: This study used an exploratory qualitative approach and was based on Marxist philosophies. Qualitative interviews were conducted with nine occupational therapists experienced in working with substance users. Data were analyzed through a dialectic approach to content analysis based on the Marxist theory of labour process.

FINDINGS.: The occupational therapy practices were found to follow common principles: clients are agents of transformation in health processes; creativity is a strong element of practice and underlies the whole therapeutic process; and conditions of social reproduction compose the object of occupational therapy (i.e., what is transformed through occupational therapy practices). Two different approaches using these principles were uncovered according to the labour-process purposes: inclusive and emancipatory.

IMPLICATIONS.: Systematization of practices based on epistemological foundations strengthens occupational therapists' ability to link actions to theories.