Foundation Topic 14 — Understanding Addiction

Occupational Therapists working with assistance animals may encounter people affected by substance use or other addictive behaviours, whether or not addiction is the reason for the assistance-animal referral.

This may include people with a current or previous substance-use disorder, people in recovery, people using prescribed medications with dependence risks, or people using substances without meeting criteria for addiction.

The purpose of this learning is not to turn AAOTs into addiction specialists.

Instead, it is to help you:

• recognise addiction as a complex health and social issue;
• challenge stigma and assumptions;
• understand its possible implications for occupational performance;
• recognise when substance use may create relevant safety or animal-welfare concerns;
• consider the role of supports, adaptations and contingency planning; and
• recognise when specialist assessment or interdisciplinary support may be appropriate.

Addiction Is More Complex Than “Bad Choices”

Addiction should not be reduced to a lack of willpower, poor character or simply making irresponsible choices.

A person’s relationship with substances or behaviours may be influenced by interacting biological, psychological, occupational, environmental and social factors, including:

• genetics and physiology;
• mental health;
• trauma;
• chronic pain;
• disability;
• prescribed medication;
• social isolation;
• poverty;
• housing instability;
• family circumstances;
• exposure to substances;
• stress;
• discrimination;
• culture;
• relationships;
• occupational disruption; and
• previous experiences of healthcare or treatment.

Understanding these influences does not mean ignoring personal agency or the consequences of harmful behaviour.

It means recognising that:

Complex problems generally require more sophisticated responses than blame.

Substance Use Is Not the Same as Addiction

Be careful with terminology.

The fact that somebody uses alcohol, prescribed medication or another substance does not automatically mean they have an addiction. Likewise, a person may experience substance-related harm without identifying themselves as having an addiction.

Depending upon the context, you may encounter terms such as substance use, harmful or risky use, dependence, substance-use disorder, addiction, withdrawal, tolerance, recovery, and relapse or recurrence of use.

Terminology changes across clinical disciplines and over time.

An AAOT should avoid diagnosing addiction outside their professional competence or attaching labels simply because a person discloses substance use.

Stigma Can Become a Barrier to Care

People affected by addiction can experience significant stigma within healthcare, disability and community services.

They may be described as manipulative, drug-seeking, unreliable, difficult, non-compliant, irresponsible or undeserving of support.

These labels can influence professional decision-making.

For example:

“They have a history of addiction, so they could never responsibly care for an assistance animal.”

is not an adequate professional assessment.

Neither is the opposite assumption:

“Addiction shouldn’t matter at all because that would be discriminatory.”

The AAOT must instead assess the actual functional, safety and welfare issues relevant to the individual situation.

Recovery Is Not Necessarily Linear

People may experience periods of abstinence, reduced use, increased use, treatment, stability, recurrence of use or changing recovery goals.

A recurrence of substance use should not automatically be interpreted as proof that treatment has failed or that the person lacks motivation.

At the same time, a practitioner should not ignore genuine risks because they are attempting to avoid stigma.

Person-centred practice can simultaneously recognise:

the person’s dignity, autonomy and rights

and

real risks requiring assessment, support or intervention.

These principles are not contradictory.

Addiction and Occupational Performance

Addiction can affect occupations in many different ways.

Depending upon the individual, difficulties may occur in:

• sleep;
• self-care;
• employment and education;
• relationships and parenting;
• financial and medication management;
• community participation;
• driving;
• routines and executive functioning;
• maintaining appointments;
• nutrition;
• leisure;
• housing; and
• caring responsibilities.

Substance use may itself become strongly embedded within routines, environments and social relationships.

This makes addiction particularly relevant to Occupational Therapy.

Rather than considering only:

“What substance does this person use?”

an OT may need to ask:

“What is happening within this person’s everyday life, routines, environment and occupational participation?”

What Does This Have to Do With Assistance Animals?

An assistance animal introduces significant and ongoing responsibilities.

Where addiction or significant substance use is relevant to an assistance-animal assessment, the AAOT should consider whether and how it affects the person’s ability to sustainably and safely meet the animal’s needs and maintain the assistance-animal partnership.

However:

A history of addiction does not itself establish that somebody cannot care for an assistance animal.

Assessment must be individualised.

The relevant question is not whether the person has an addiction diagnosis or history. It is whether their actual circumstances create functional, environmental, safety or welfare concerns relevant to the assistance-animal arrangement.

Assess Function, Not the Label

Two people with the same diagnosis may have completely different levels of functioning, support and risk.

Consider:

• the person’s usual level of functioning;
• whether substance use affects daily routines or responsibilities;
• whether there are periods of intoxication, withdrawal or reduced capacity;
• how frequently these occur;
• what formal and informal supports are available;
• whether those supports are reliable;
• whether relevant environmental or safety risks exist;
• whether contingency arrangements are required; and
• whether the person’s circumstances are stable enough to sustainably support the assistance-animal arrangement.

Do not assume incapacity simply because addiction is present.

Equally, do not ignore demonstrated functional difficulties because you are concerned about appearing judgemental.

Consider Actual Risk

Risk should be assessed objectively rather than morally.

The question is not:

“Is this person a good or bad person?”

It is:

“What is the actual risk, how significant is it, and can it reasonably be managed?”

Depending upon the person’s circumstances, periods of intoxication, withdrawal, recurrence of use or acute distress may affect judgement, mobility, memory, behaviour, environmental safety or capacity to undertake responsibilities.

These effects may have implications for both the person and their assistance animal.

The existence of addiction does not establish that these risks are present. They should be identified through assessment of the person’s actual circumstances rather than assumed from a diagnostic label.

Supports and Shared Care

A person does not necessarily need to independently perform every aspect of animal care at all times in order for an assistance-animal arrangement to be appropriate.

People commonly rely upon other people for aspects of everyday life, and disability support should not be confused with incapacity.

Depending upon the circumstances, appropriate supports may include:

• a partner;
• parent or other family member;
• support worker;
• friend;
• housemate;
• assistance-animal organisation or trainer; or
• another agreed support person.

The important question is whether the proposed support actually exists and is sufficiently reliable.

For example:

“My mum can look after the dog if I’m unwell”

is not a contingency plan unless the person’s mother knows this is expected, has agreed to do it and is reasonably able to provide that care.

Where periods of reduced capacity are foreseeable, the AAOT should consider whether an appropriate contingency plan is required.

Harm Reduction and Assistance-Animal Practice

Your external addiction learning may introduce harm-reduction approaches.

Harm reduction recognises that useful interventions can reduce adverse consequences associated with substance use even where a person is not currently abstinent.

Within assistance-animal practice, this means considering whether practical strategies, environmental changes, additional supports or contingency arrangements can reduce foreseeable risks to the person or animal.

The purpose is not to endorse harmful substance use.

It is to reduce foreseeable harm while maintaining person-centred, evidence-informed practice.

Detailed animal-health, husbandry, environmental exposure and species-specific considerations are addressed later in the AAOT Credential.

Maintaining Professional Boundaries

Working with somebody experiencing addiction may require empathy, flexibility and interdisciplinary collaboration.

It does not require the AAOT to become an addiction counsellor, psychologist, medical practitioner, crisis service, financial counsellor, pharmacist, toxicologist or veterinary professional unless separately qualified to undertake that role.

Know when to refer.

Professional boundaries also mean that intimidation, threats or unsafe behaviour do not have to be accepted simply because somebody is experiencing distress or addiction.

Compassion and professional boundaries can coexist.

Animal Welfare Remains Non-Negotiable

Person-centred and non-stigmatising practice does not mean ignoring animal welfare.

Where genuine animal-welfare concerns arise, respond to the evidence, not stereotypes about addiction.

Likewise, where no welfare concern exists, do not invent one simply because somebody has a history of substance use.

Detailed consideration of animal welfare, husbandry, health and species-specific needs occurs later in the credential. At this stage, the important principle is that an assistance-animal arrangement must be capable of supporting the animal’s ongoing safety, health and positive welfare.

Avoid Two Opposite Errors

AAOTs should avoid both extremes.

It would be inappropriate to conclude:

“This person has an addiction, therefore they cannot have an assistance animal.”

It would be equally inappropriate to conclude:

“Because addiction is a health condition, we cannot consider its impact on the animal.”

Instead ask:

• What does the addiction actually look like for this person?
• Does it materially affect occupational performance or the assistance-animal arrangement?
• Are there demonstrated rather than assumed safety or welfare concerns?
• What happens during periods of active addiction, intoxication, withdrawal or reduced capacity?
• What supports already exist?
• Are those supports genuinely available and reliable?
• Can identified risks reasonably be reduced or managed?
• Is contingency planning required?
• Does another professional need to be involved?

The overarching principle is:

Addiction should not automatically exclude a person from assistance-animal ownership or handling. Assessment must focus on what addiction actually means for that individual rather than the diagnostic label.

A pattern of substance use that leaves the animal safely and appropriately cared for may present very different concerns from one that demonstrably compromises the person’s functioning, environmental safety or the animal’s welfare.

Supports, adaptations and shared care can appropriately bridge periods of reduced capacity, provided they genuinely ensure that the assistance-animal arrangement remains safe and sustainable.

Interdisciplinary Practice

Depending upon the circumstances and with appropriate consent or other lawful authority, relevant professionals might include:

• the person’s GP;
• addiction medicine practitioners;
• psychologists or psychiatrists;
• counsellors and social workers;
• pharmacists;
• pain specialists;
• occupational therapists;
• support coordinators;
• assistance-animal trainers;
• veterinarians;
• veterinary behaviour professionals; and
• other appropriate services.

Different professionals contribute different expertise.

The AAOT’s role is to understand where occupational performance, disability, assistance-animal practice, environmental safety and animal welfare intersect.

What This Means for an AAOT

Your external addiction learning should encourage you to consider the individual rather than the label.

Ask yourself:

• Is there actually evidence that addiction is relevant to this assessment?
• What effect, if any, does substance use have on occupational performance?
• What is the person’s disability-related need?
• Is an assistance animal an appropriate intervention?
• What relevant risks are actually present rather than assumed?
• What formal and informal supports already exist?
• What occurs during periods of reduced capacity?
• Is contingency planning required?
• Is there an actual safeguarding or animal-welfare concern?
• Does another professional need to be involved?

The central principle is:

A history of addiction should neither automatically exclude a person from assistance-animal support nor be ignored when it creates genuine functional, safety or welfare concerns. Assess the person’s actual circumstances, reduce stigma, identify real rather than assumed risks, establish appropriate supports and protect the rights and welfare of both person and animal.

Continue This Topic in Your Reflective Workbook

You have now completed the foundation material for:

Topic 14 — Understanding Addiction

Please complete the recommended external Understanding Addiction learning identified in your AAOT Foundation Learning requirements and then refer to the corresponding section of your AAOT Foundation Learning Reflective Workbook.

The workbook will ask you to apply this learning to realistic assistance-animal situations involving addiction, occupational performance, stigma, risk, support planning, professional boundaries and interdisciplinary practice.