Niki Kiepek

Bio: Niki Kiepek is an academic researcher from Dalhousie University. The author has contributed to research in topics: Occupational science & Occupational therapy. The author has an hindex of 7, co-authored 19 publications receiving 234 citations. Previous affiliations of Niki Kiepek include Northern Ontario School of Medicine & University of Western Ontario.

Addictions and Impulse-Control Disorders as Occupation: A Selected Literature Review and Synthesis

Abstract: Objective. The question addressed in this paper is: “Are activities that are classified as ‘addictions’ and ‘impulse-control disorders’ occupations?” Background. Current conceptualisations of occupation focus on positive contributions to health and well-being. We suggest that occupations are neither inherently healthy nor unhealthy but are associated with positive and/or negative consequences. Methods. Integrative and interpretative literature syntheses were undertaken. Findings. Findings demonstrated that activities classified as addictions and impulse-control disorders meet the criteria of occupation, in that they give meaning to life; are important determinants of health, well-being and justice; organize behaviour; develop and change over a lifetime; shape and are shaped by environments and have therapeutic potential. Conclusion. The findings have implications for the conceptualisation of occupations, including the relationship between occupation and health, the potential risk for negative consequences...

Silences around occupations framed as unhealthy, illegal, and deviant

Abstract: Occupational science has made tremendous strides in establishing a theoretical and empirical knowledge base grounded in the study of occupation. Yet given its origins in occupational therapy, a hea...

Introducing a Critical Analysis of the Figured World of Occupation

Abstract: This critical analysis of occupational science examines the figured world of occupation. Figured worlds are ‘typical’ representations of a particular construct based on taken-for-granted theories and stories developed through experience and “guided, shaped, and normed” though social interactions (Gee, 2011, p. 76). Drawing on theoretical articles published primarily in the Journal of Occupational Science, a discussion regarding the values and assumptions underlying occupational science is presented. It is proposed that there are tendencies to identify occupations as “positive” and to focus on the relationship of occupational engagement to enhanced health and well-being. At the same time, there may be an implicit exclusion of activities that are considered ‘negative,’ ‘unhealthy’ or ‘deviant’ from the figured world of occupation, which has the potential to stigmatise and marginalise individuals or collectives. It is suggested that occupational science may have a significant role to play in developing criti...

Facilitating medical withdrawal from opiates in rural Ontario.

Abstract: Context The abuse of oxycodone in Northwestern Ontario, Canada, has escalated at alarming rates raising concerns that opiate use has reached epidemic proportions, particularly among the First Nations communities. The authors were involved in establishing Ontario's first rural inpatient medical withdrawal unit to serve patients seeking abstinence. Issues The development of the medical withdrawal support services (MWSS) required creative and adaptive strategies to respond to the geographical, cultural and institutional circumstances. Lessons learned Key factors to support program efficacy and successful outcomes for clients during the inaugural eight months of operation are interprofessional and collaborative approaches with a cultural awareness.Key words: addiction, Canada, First Nation, medical withdrawal.

Evaluation of an inpatient medical withdrawal program in rural Ontario: a 1-year prospective study.

Abstract: INTRODUCTION We present a 1-year program evaluation of the Medical Withdrawal Support Service (MWSS) provided at the Sioux Lookout Meno Ya Win Health Centre. The centre's service area includes 4 rural municipalities and 28 First Nations communities. The program involves inpatient detoxification for opioid dependence with the use of buprenorphine-naloxone. METHODS Data were collected from preadmission interviews (i.e., medical history, substance use history, previous counselling, social history, previous addiction treatment and screening tools used during the interview); discharge forms (i.e., length of stay, maximum dose of prescribed buprenorphine-naloxone and client goals); and postdischarge interviews. RESULTS Overall, 81% of the clients successfully completed the program. Two weeks after discharge, 48% of clients reported continued abstinence. At 3-month follow-up, 32% were abstinent, and at 6 months, 30% were abstinent. CONCLUSION The MWSS shows positive outcomes for many clients, their families and communities. Clients returned to work and school, became more engaged in healthy meal preparation and exercise, spent more time with family and were more involved as leaders in their communities.

What is Narrative Analysis

Abstract: Recording of presentation introducing narrative analysis, outlining what it is, why it can be a useful approach, how to do it and where to find out more. Presentation given at methods@manchester seminar at University of Manchester on 4 March 2010.

Outsiders Studies in the Sociology of Deviance.

Abstract: This 1966 paperback edition of a publication which first appeared in 1963 has by now been widely reviewed as a worthy contribution to the sociological study of deviant behavior. Its current appearance as a paperback is a testimonial both to the quality of the work and to the prominence of deviant behavior in this generation. In general the author places deviance in perspective, identifies types of deviant behavior, considers the role of rule makers and enforcers, and some of the problems in studying deviance. In addition, he develops a sequential model of deviance relying on the concept of career, a concept originally developed in studies of occupations. In his study of a particular kind of deviance, the use of marihuana, the author posits and tests systematically an hypothesis about the genesis of marihuana use for pleasure. The hypothesis traces the sequence of changes in individual attitude

Review Article: Neurobiologic Advances from the Brain Disease Model of Addiction

Abstract: This article reviews scientific advances in the prevention and treatment of substance-use disorder and related developments in public policy. In the past two decades, research has increasingly supported the view that addiction is a disease of the brain. Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned, perhaps because the aberrant, impulsive, and compulsive behaviors that are characteristic of addiction have not been clearly tied to neurobiology. Here we review recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease. We review findings on the desensitization of reward circuits, which dampens the ability to feel pleasure and the motivation to pursue everyday activities; the increasing strength of conditioned responses and stress reactivity, which results in increased cravings for alcohol and other drugs and negative emotions when these cravings are not sated; and the weakening of the brain regions involved in executive functions such as decision making, inhibitory control, and self-regulation that leads to repeated relapse. We also review the ways in which social environments, developmental stages, and genetics are intimately linked to and influence vulnerability and recovery. We conclude that neuroscience continues to support the brain disease model of addiction. Neuroscience research in this area not only offers new opportunities for the prevention and treatment of substance addictions and related behavioral addictions (e.g., to food, sex, and gambling) but may also improve our understanding of the fundamental biologic processes involved in voluntary behavioral control. In the United States, 8 to 10% of people 12 years of age or older, or 20 to 22 million people, are addicted to alcohol or other drugs. 1 The abuse of tobacco, alcohol, and illicit drugs in the United States exacts more than $700 billion annually in costs related to crime, lost work productivity, and health care. 2-4 After centuries of efforts to reduce addiction and its related costs by punishing addictive behaviors failed to produce adequate results, recent basic and clinical research has provided clear evidence that addiction might be better considered and treated as an acquired disease of the brain (see Box 1 for definitions of substance-use disorder and addiction). Research guided by the brain disease model of addiction has led to the development of more effective methods of prevention and treatment and to more informed public health policies. Notable examples include the Mental Health Parity and Addiction Equity Act of 2008, which requires medical insurance plans to provide the same coverage for substance-use disorders and other mental illnesses that is provided for other illnesses, 5 and the proposed bipartisan Senate legislation that From the National Institute on Drug Abuse (N.D.V.) and the National Institute of Alcohol Abuse and Alcoholism (G.F.K.) — both in Bethesda, MD; and the Treatment Research Institute, Philadelphia (A.T.M.). Address reprint requests to Dr. Volkow at the National Institute on Drug Abuse, 6001 Executive Bld., Rm. 5274, Bethesda, MD 20892, or at nvolkow@ nida . nih . gov.