Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Original Article Imprimir 

Páginas 58 a 65

Games and music: Therapeutics occupational resources in the treatment of teenagers users of psychoactive substances

Juegos y música: recursos terapéuticos ocupacionales en el tratamiento de adolescentes usuarios de sustancias psicoactivas

Jogos e música: recursos terapêuticos ocupacionais no tratamento de adolescentes usuários de substâncias psicoativas

Autores: Meire Luci da Silva1; Sambleisse Sodré Rosa2

1. Assistant Professor of the Occupational Therapy Course, Department of Physical Therapy and Occupational Therapy, State University Paulista Júlio de Mesquita Filho (UNESP). Marília, SP, Brazil. Integrated Multiprofessional Residence in Mental Health, Department of Integrated Multiprofessional Residency in Mental Health, Marília School of Medicine (FAMEMA), Marília, SP, Brazil
2. Occupational Therapist by the Paulista State University Júlio de Mesquita Filho (UNESP). Marília, SP, Brazil

Meire Luci da Silva
Universidade Estadual Paulista "Júlio de Mesquita Filho"
Av. Hygino Muzzi Filho, 737, Mirante
Marília, SP, Brasil. CEP: 17525-000

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How to cite this article

Keywords: Adolescent, substance-related disorders, occupational therapy, games, experimental, music.
Palabra Clave: Adolescente, trastornos relacionados al uso de sustancias, terapia ocupacional, juegos experimentales, música.
Descritores: Adolescente, transtornos relacionados ao uso de substâncias, terapia ocupacional, jogos experimentais, música.

OBJECTIVE: This article aims to investigate the effectiveness of music and games as occupational therapeutic resources in the care of psychoactive substance users in treatment, admitted to a psychiatric hospital in the mid-western part of São Paulo state.
METHOD: Study conducted during the Supervised Internship of Occupational Therapy (OT) in Mental Health and Substance abuse at the State University of São Paulo. About 10 teenagers from 9-17 years old participated in the study. For data collection 11 workshops were conducted during three months, lasting one hour, held in the OT area of the hospital. During the workshops music and "adapted" games were used as resources. Data were recorded on audio and field diary and the data analysis was based on thematic content analysis.
RESULTS: The games and music used in occupational therapy service with psychoactive substance teenage users configured as an effective and powerful tool in the treatment. It allowed the approach to issues regarding cognitive aspects, social interaction, expression of feelings, simulations of real life situations, exposure to situations of risk vulnerability, possibilities of choice, among others, in an attractive, playful, fun, expressive and dynamic way.
CONCLUSION: It was possible to verify the importance of specific actions and strategies as potent therapeutic resources for a promising and effective intervention in the treatment of addiction, helping the teenager in the (re) establishment and empowerment of their life.

OBJETIVO: Este artículo tiene como objetivo investigar sobre la eficacia de la música y de juegos como recursos terapéuticos ocupacionales en la atención de usuarios de sustancias psicoactivas en tratamiento, internados en un hospital psiquiátrico de la región centro-oeste del interior paulista.
MÉTODO: Estudio realizado durante la Fase de Supervisión de Terapia Ocupacional (TO) en Salud Mental y Dependencia química de una universidad estadual de São Paulo. Participaron aproximadamente 10 adolescentes con franja etaria de 9 a 17 años. Para la colecta de datos fueron realizados 11 talleres durante tres meses, con duración de una hora, realizados en sala de TO del hospital. Durante los talleres la música y juegos "adaptados" fueron utilizados como recursos. Los datos fueron registrados en audio y diario de campo y el análisis de los datos fue basado en el análisis temático de contenido.
RESULTADOS: Los juegos y la música utilizados en la atención terapéutica ocupacional con adolescentes usuarios de sustancias psicoactivas se configuraron como herramientas eficaces y potentes en el tratamiento. Posibilitó abordaje de asuntos pertinentes a los aspectos cognitivos, interacción social, expresión de sentimientos, simulaciones de situaciones reales de vida, exposición a las situaciones de vulnerabilidad a riesgos, posibilidades de elecciones, entre otras, de forma atractiva, lúdica, divertida, expresiva y dinámica.
CONCLUSIÓN: Fue posible verificar la importancia de acciones y estrategias específicas como recursos terapéuticos potentes para una intervención promisora y eficiente en el tratamiento de la dependencia química, auxiliando al adolescente en el (re) establecimiento y empoderamiento del protagonista de vida.

OBJETIVO: Este artigo tem como objetivo investigar sobre a eficácia da música e de jogos como recursos terapêuticos ocupacionais no atendimento de usuários de substâncias psicoativas em tratamento, internados em um hospital psiquiátrico da região centro-oeste do interior paulista.
MÉTODO: Estudo realizado durante o Estágio Supervisionado de Terapia Ocupacional (TO) em Saúde Mental e Dependência química de uma universidade estadual de São Paulo. Participaram aproximadamente 10 adolescentes com faixa etária de 9 a 17 anos. Para coleta de dados foram realizadas 11 oficinas durante três meses, com duração de uma hora, realizadas em sala de TO do hospital. Durante as oficinas a música e jogos "adaptados" foram utilizados como recursos. Os dados foram registrados em áudio e diário de campo e a análise dos dados foi baseada na análise temática de conteúdo.
RESULTADOS: Os jogos e a música utilizados no atendimento terapêutico ocupacional com adolescentes usuários de substancias psicoativas configuraram-se como ferramentas eficazes e potentes no tratamento. Possibilitou abordagem de assuntos pertinentes aos aspectos cognitivos, interação social, expressão de sentimentos, simulações de situações reais de vida, exposição às situações de vulnerabilidade à riscos, possibilidades de escolhas, entre outras, de forma atrativa, lúdica, divertida, expressiva e dinâmica.
CONCLUSÃO: Foi possível verificar a importância de ações e estratégias específicas como recursos terapêuticos potentes para uma intervenção promissora e eficiente no tratamento da dependência química, auxiliando o adolescente no (re) estabelecimento e empoderamento do protagonista de vida.


Adolescence is a period of transition permeated by changes, among these highlights the hormonal, physical, psychological, emotional, behavioral and social changes. Finally, a period of instabilities, exploitation and experimentation, usually in the constant search for self-assertion, autonomy, identity, empowerment and future stability in all aspects1. At this stage, adolescents are vulnerable and have difficulties in coping with social opportunities, feeling insecure and confused and thus exposed to various risk situations, such as the use of licit and illicit substances, trafficking, unsafe sex, among others.

The use of psychoactive substances by young people has become a major concern for public health, causing great social, economic and political impact. Authors indicate that among the main factors that contribute to this reality are the family structure, low schooling and low financial income, as well as subjective and individual factors usually linked to the sensation of pleasure and relief2. In this sense, studies show that psychoactive substances promote even if momentarily, feelings of trust, pleasure, relieving tensions, increasing euphoria, mask and mask depression. Most often, the adolescent uses substance as a means of gaining acceptance or insertion into a group of friends, as well as acting as a mechanism for escape and coping with negative situations and feelings, such as insecurities, fears, stress, among others3.

The treatment of chemical dependence is permeated by movements of resistance, distrust, low motivation and difficulty in adherence to treatment4. Among the health professions that work in the treatment and rehabilitation of users of psychoactive substances, we highlight the Occupational Therapist (TO), whose practices are based on the Psychosocial Rehabilitation approach. This professional uses as therapeutic resource, the human activity in its diverse and different languages (plastic, corporal, literary, among others). Among the objectives of the OT along with this population is: the promotion of social reintegration and reconstruction of citizenship, promotion and assistance in social, communication and behavioral skills, promotion of expression of feelings, the possibility of understanding the reasons and difficulties that lead to the use or abuse of substances, among others5.

Authors point out that the actions of TO against the prevention of violence against adolescents involve "action" and "doing" as powerful resources, as they favor the expression of singularity, as well as the promotion of critical and apprehensive discernment of events and everyday situations6. The same authors also point out that in order to draw up an occupational therapeutic plan, it is necessary for the OT to understand the adolescent and its contexts and to use the activities and their respective analyzes as a strategy for the development of a critical-reflexive and collective thinking6.

The present study has as general objective to investigate the effectiveness of music and games as occupational therapeutic resources in the care of users of psychoactive substances undergoing treatment, hospitalized in a psychiatric hospital in the central-western region of São Paulo State.

Ethical aspects

The application of the procedures was performed after approval of the study by the Research Ethics Committee of the Faculty of Philosophy and Sciences, UNESP - Marília. Participants were informed about their participation in the research and, after agreement, they signed the Term of Assent, as well as their responsible ones signed the Informed Consent Term.

Scenario of the study

The study was conducted in a psychiatric hospital for the treatment of individuals with mental disorders, including chemical dependence. The hospital is located in the center-west region of São Paulo and at the time of the study, it had approximately 330 beds, of which 30 beds were intended for the treatment of adolescents, minor offenders, and users of psychoactive substances that were under socio-educational measure deprived of liberty applied by the Judiciary. It is noteworthy that this institution performs its services through the Unified Health System (SUS), private plans and agreements, but the treatment of all participants in this study was subsidized by the SUS. This study was carried out during a supervised stage of TO in Mental Health and Chemical dependency of a state university of São Paulo.

Planning of interventions

and choice of resources

To establish an effective therapeutic intervention, it is necessary to observe the subject's daily life to identify the demands, to consider the age group of the participants, subjectivities, use of psychoactive substances, risk factors and use protection, coping strategies risks, social vulnerability, socioeconomic and occupational context, as well as demands related to the motive and complaint of their hospitalizations.

Based on theory and, after evaluation of the target audience, sociocultural and educational context and their demands, trainees opted to perform group visits, using as therapeutic therapeutic resources, music and games.

The choice of music and games as occupational therapeutic resources was carried out based on the potentiality and playfulness of these resources, which helps in adherence to treatment, reflection on different and different themes, (re)discovery of identity, social roles and of life goals, as well as facilitating the creation of social bonds through dialogue and expression of feelings. The selected resources also present characteristics aimed at promoting the involvement and attractiveness of this age group, besides allowing the promotion and maintenance of attention, motivation, socialization and teamwork, to promote self-understanding of subjective aspects. Another positive factor related to the use of these resources is the fact that they can be graduated according to the difficulties of the participants.

Studies show that play is an important vehicle for the communication of children and adolescents, as it helps in the process of self-knowledge, learning and socialization, as well as facilitating the expression of feelings, as well as assisting in the development of youth protagonism and in creating a relational network, thus becoming a powerful therapeutic tool in the treatment of this public7.


It is a research of qualitative approach and participant character. The perceptions and reflections of TO trainees were considered relevant and compared to those of the participants. Therefore, we sought to understand the subjective aspects linked to the reality and demand of the studied public.

The elaboration, development and registration of the interventions were carried out through evolutions in mandatory reports in the discipline, as well as all practices recorded in audio and transcribed integrally, besides being supervised by the teacher responsible for the subject supervised stage of TO in Mental Health.

Records of the transcripts of the interventions based on the socioeconomic and cultural context of the participants and, in cases taken from the literature, were analyzed and interpreted based on the thematic content analysis method. The analysis of the transcripts made it possible to trace the following categories.


Eleven workshops were developed for three months, with an average duration of 90 minutes, in the institution's own space. Approximately 10 adolescents, all male, aged 12 to 17 years participated in the interventions. From the analysis of the contents in accordance with the objective of the study, five categories emerged, these being: Reasons that led to the use of psychoactive substances; Difficulty and resistance in adherence to treatment; Games as a therapeutic resource; Music as a therapeutic resource and Analysis of the activity.

Initial contact and structure of the interventions

After the explanation about the study and development of the stages, the adolescents were invited and verbally encouraged to participate in the interventions. The survey of the sample problem was obtained through an initial conversation and application of group dynamics. The dynamic "Masks" allowed the identification of difficulties, setbacks, adversities and the demands of the public.

The interventions were structured in a few moments, such as: initial reception, followed by the moment of explanation and development of the proposed activity and, as a final moment, discussions and reflections about the individual and group performance of the participants, as well as the contributions and meanings of the activity performed.

Reasons that led to the

use of psychoactive substances

During the interventions, the participants mentioned aspects and reasons that led them to use psychoactive substances, among them, the influence of friends, search for pleasure and relief of tensions, exemplified in the speech of I.

I: "I saw some boys using ... and it seemed firm ... I made friends and I changed some idea ... then they gave me to try ... we laughed a lot".

Difficulty and resistance

adherence to treatment

During the interventions, adolescents were admitted to the hospital, but at times the participants oscillated due to routine issues such as: going out for medical and dental procedures. In the first visits, the resistance to initiate group activity was evident, and the participants justified their resistance through several excuses, as can be observed in the speech of one of the participants.

M: "Ah aunt ... it's cold. I'm good, I do not want to. Mó laziness ".

Among the difficulties presented by the participants, which also worked as a reason to refuse or resist participating, the low level of literacy is highlighted, as it is possible to identify in the speech of P.

P: "Auntie ... I do not know, so I will not. You go to my bedroom. Leave it alone. "

It was verified that after the first two interventions, where the participants were able to observe and enjoy the resources, the resistance gradually diminished and they started to participate with initiative and motivation, which can be evidenced in the speech of M. at the beginning of an intervention.

M .: "Cool ... another game for us to play and talk about our problems. Let's stop talking to Auntie and start that game soon. "

Games as a therapeutic resource

Among the workshops that used games as therapeutic resources, the use of adapted games was highlighted, which promoted good interaction and participation, as well as the creation of ties and cooperativism, as evidenced in the speeches of B.

B: "I really liked it ... because this game helped us get closer and get to know people better ...".

The games also encouraged the development of collective thinking to solve everyday problems, acquisition of potentialities for teamwork, the exercise of discipline and respect for rules, stimulated the development of creativity, fostered positive feelings and encouraged self-knowledge and empowerment of their abilities and skills. As emphasized in the speech of M.

M: "I thought it would be boring and difficult, I could not do it, but I thought it was cool! Too bad it ends quickly! If it were just me, it would be a long time and if it was not even good luck!

Music as a therapeutic resource

The use of music promoted approaches to problematic issues such as socioeconomic difficulties, conflicts and family disruption. Where the participants could relate and bring to a concrete experience, moments and difficulties experienced.

E: "Aunt this song reminds me of my family ... I have a daughter and because of the drug I can not stay with her anymore. My father uses drugs and makes a run to deliver and the police get him with stone and pine. "

The music was configured as a powerful resource in the expression and self-perception of feelings, promoting moments of reflection and discussion about possible coping strategies. During the activities, some participants were discouraged and, when questioned about the reason, they reported memories of family problems, which can be evidenced in the speech of J.

J: "... this life is very unfortunate! We try to get better, get out of this life, but what's the use? "

During the intervention in which a rap competition was held, it was verified that the music made possible the reflection on future and life perspectives, as evidenced by M.

M: "I rap more, it's hard to think of a dream for the future and put it in the rap [...] I know, my dream is a drawer!"

Activity analysis

At the end of all the interventions, discussions and reflections were carried out on the activity developed, and it was evident that these enabled the participants to understand the objectives of the proposed activities, the critical-reflexive thinking of various themes involving daily problems, subjective aspects, besides (re) discoveries of identity and life goals. These characteristics can be exemplified by the following speech.

J: "I just ... I did not even think about it, but now I know that when I answered the question and walked that house ... I said everything that happens in the house ... Aunt ... you have a ball of crystal is it? ".


The increase in the prevalence of adolescent drug users points to the need to develop effective programs and strategies with this public, as well as interventions that take into account adolescents' uniqueness and subjectivity, as well as their contexts: social, family and financial.

Among the reasons that were mentioned by adolescents and corroborated by authors, the low socioeconomic, cultural and literacy levels, family problems, consumerism, and easy access to substances are highlighted8. For users of psychoactive substances, the use of the substance may represent the rapid, immediate and sometimes seemingly easier to alleviate negative feelings. Some reports from the participants illustrate the fact that substance use can rapidly promote feelings of joy and acquisition of goods and values, a fact also mentioned by some authors9, where it reports the perception that adolescents associate the drug with the search for relief fast for pain and for sentimental and material pleasures.

It is believed that the difficulty and resistance in the adherence to the treatment can be linked to the deficits in the social skills and consequent behavioral damages as the difficulty to deal with the feelings from the socioeconomic conditions, as well as difficulty to experience and to experience new situations. In view of these difficulties, the importance of the therapist-patient relationship is highlighted, where the role of the therapist is to facilitate, support and support the patient, in order to promote adherence to therapy9.

Another factor that contributed to the adhesion was the reception, which consists of receiving the individual in its totality, recognizing their differences, their joys, their sorrows, their fears and their sorrows, getting involved in the construction of humanity, enhancing protagonism and life in different meetings10.

The initial reception was the "gateway" to the activities, at which point the participants felt the need to exchange affective and experiences, interacting spontaneously. In this sense, during the OT interventions, the host was performed at the beginning to prepare the group for experimentation in the therapeutic setting. This, in addition to facilitating the rapprochement between the participants, enables awareness raising, encourages the creation of links among them, as well as promoting rules of good coexistence and respect among the actors involved in the process, as well as the motivation to carry out the proposed activities and the awakening of the importance of TO in the treatment of them.

Interventions that used games as a therapeutic resource consisted of a playful way of symbolizing and simulating routine situations, allowing adolescents to discern and perceive the consequences of their behaviors and, therefore, providing "nutrients" for future training, empowering them into decision-making and future choices such as risk and vulnerability situations. The game, due to its attractive and dynamic character, stimulates respect for rules and limits, enables the acquisition and learning of knowledge, and enables the invention and experimentation of new situations, encouraging creativity, imagination and intelligence, facilitating the development of social and cognitive skills11,12,13.

When using music as a therapeutic resource it was necessary to consider important variables, such as: musical taste and age of the patient / user, in order to make it a powerful, interesting and pleasant resource. Music, because of its attractive, stressful, stress-relieving and anxiety-minimizing character, stimulating creative acts, allowed the expression of feelings and affections, previously dulled and masked by the use of substance, as well as promoting self-knowledge, enabling the awakening of experiences and re) discoveries of ways to deal with basic emotions, among others14,15,16,17.

Still on the music, it was verified that rhythms and musical styles focused on the socio-cultural context of the participants was configured as an excellent therapeutic resource, since it deals with subjects of the reality of these, stimulating the creativity in the confrontation of situations and expositions to the risk, because through their letters and their analogy with reality, can serve as a "starting point" for access to the interior information, often repressed by the use of the substance18. Among other characteristics promoted by the use of music, we highlight the encouragement of dialogue, exposure of feeling, thinking, which promotes the interaction of the group, enables the exchange of experiences and ideas, considering that at this moment, have common interests and "speak the same language." Another factor evidenced was that the musical style allowed the adolescents to respect limits and rules, because it was necessary to respect the melody times, to create rhymes and to follow the rhythm, besides the final product (music) to be fruit of teamwork.

The analysis and reflection of the activities allowed the adolescents a better understanding of the objectives of the proposed activity, the elaboration, assimilation, internalization and an extended view on the process lived during the intervention.The reflection helped the patient in the understanding of the therapeuticity of the activity, differentiating it from the character of occupation. That is, it was possible to verify the reports of the authors that pointed out the importance of the use of the activity as a therapeutic "medium" in OT, as a tool for self-analysis and group analysis, assisting in self-knowledge and self-criticism, enabling moments of self listening and listening other (group) 19 . The activities carried out in groups are extremely rich and dynamic experiences and, when closing the activity, the TO should lead to finalization, listing positive and favorable points for individual and collective construction20.


The games and music used in occupational therapy with adolescents using psychoactive substances have been configured as effective and potent tools in the treatment of these. It enabled adolescents to work on cognitive aspects, social interaction, expression of feelings, simulations of real life situations, exposure to situations of vulnerability to risks, possibilities of choices, in an attractive, playful, fun, expressive and dynamic way. It was possible to verify the importance of specific actions and strategies and to consider the social and cultural and cultural context, as this may help the adolescent in the (re) establishment and empowerment of the protagonist of life.


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