An Organizational Framework for Occupational Therapy in the Treatment of Alcoholism

Abstract

Because occupational therapists are increasingly involved with alcoholism rehabilitation, an organizational treatment framework is presented that is based upon the psychodynamics of this diagnosis. Factors that contribute to the development of a unique defense structure characteristic of alcoholism are discussed as prerequisites for understanding the treatment needs of the adult. Treatment is organized into three hierarchical levels that correspond with progressive changes in the alcoholics' defense structure. Alcoholics at level one require directive treatment approaches that do not aggressively confront the preferred, but maladaptive defense mechanism in order to attain abstinence. Teaching coping strategies that provide alternatives to the preferred defense mechanisms are beneficial at level two. The third level involves stimulating the arrested emotional development of the alcoholic thus effectively challenging the continued utilization of these defense mechanisms. Specific occupational therapy methods and frames of reference are outlined that are appropriate for implementation at each treatment level.