Metacognition in persons with substance abuse: Findings and implications for occupational therapists

Background. Addiction is a massive public health problem in which a person's occupational life is compromised and metacognition is impaired. Occupational therapists may play a critical role in addiction rehabilitation, but more information about patterns of metacognitive deficit co-occurring with addictive behaviour is needed to develop interventions that specifically target these impairments. Purpose. This study examined whether persons with addiction(s) demonstrated specific patterns of metacognitive deficit on four subscales of metacognition measuring self-reflectivity, understanding others' thoughts, decentration, and mastery. Method. Using a mixed-methods design, qualitative data were obtained via the Indiana Psychiatric Illness Interview, which was then rated using a quantitative scale, the Metacognition Assessment Scale-Abbreviated. Findings. Persons with addiction(s) demonstrated significant impairments in metacognitive mastery but not other areas of metacognition. Implications. Occupational therapy interventions for addiction should focus on improving metacognitive mastery. Future efficacy studies of interventions to improve mastery and overall outcomes are warranted.