Date of Award


Degree Type

Capstone Project

Degree Name

Doctor of Occupational Therapy (OTD)


Occupational Therapy

First Advisor

Ashley Constantine

Second Advisor

Holly Grieves


Substance Use Disorder (SUD) remains a prevalent problem in the United States despite consistent efforts by National, State, and local entities to improve access to treatment services. Even though attendance of treatment services is understood to be important for progress towards recovery goal attainment for those with SUD, limited study has been done to understand how SUD itself negatively impacts a person’s ability to engage in treatment meaningfully and consistently. This project was designed to explore and understand barriers to attendance of and engagement in SUD treatment stemming from executive functioning deficits commonly connected to SUD. An Occupation-based approach was used to educate both the staff and clients of a small, community based, multidisciplinary team providing substance use treatment services in Muskegon, MI. Through a combination of the use of individual and group occupational therapy sessions for clients and training modules for staff, this project was able to identify the executive functioning deficits directly impacting client engagement in treatment and consider how graded supports and interventions can support increased engagement over time. Findings from this project indicate that this supportive approach for executive functioning deficits improved client attendance rates by 14% from 69% to 83% and that staff education focused on support for improving client attendance improves overall staff attitudes and agency in relation to attendance concerns for their clients.