The clinic has 820 registered patients of whom 50% come for regular follow-ups are currently abstinent from opiates. About 18% of the patients are unemployed despite being willing to work. The major reason for not working is the stigma attached to substance use resulting in lack of trust by prospective employers and family members. 

Description of the Occupational Rehabilitation model
The need for the current programme originated with the patients who, even after abstaining from illicit substance use, could not succeed in getting gainful employment either because their family members were not in the financial position to support them to start work or were not prepared to trust them. The efforts to rehabilitate them in the open job market also received a discouraging response as  prospective employers were reluctant to employ individuals with a history of substance use. Some patients managed to get jobs available in the open market but this started to hamper their treatment as they had to report to the clinic for medication and employers were not willing to accommodate their treatment need.
A few patients reported that the long working hours and the physically intensive nature of their jobs made it difficult to sustain employment. Against this backdrop it was decided by the treatment team to enable the patients to focus on self employment.

Careful inquiry about the occupational opportunities for this socio economic class reveled that majority of individuals are self employed in small ventures like selling fruits, vegetables, toys, handkerchiefs, plumbing, painting and electrical repairing - all requiring low investment. Non governmental organizations (voluntary welfare agency) were approached to provide seed money to start this programme and two organizations agreed to support it. The patients were consulted about this proposition and were offered seed money to start their own work. A list of possible occupation was drawn up and patients selected jobs that interested them. It was categorically stated to the patients that the money they receive is an interest free laon which they have to return.

Outcome
The following tables describes the detail of the programme - Number of participants  = 25
Average credit amount paid - Rs 360 
Average days taken to start working - 5.7 
Average Days taken to start repayment - 9 
Average days taken to repay the credit -  29
% repaid the credit - 74
Occupational status (%currently working) -  74
Change in the occupation - 52%

The average amount required as seed money to start work was Rs 360 (less than US$10) which is quite low and within a week the patients started working  (although this does not include the number of days the patients took to decide on the work they should engage in and the sessions required to motivate they to start working).

 It was observed that the patients started repaying the agreed installments within 10 days of starting to work and majority of them (74%) repaid the amount taken within one month of taking the credit. It was also observed that more than half of the patients switched over to other jobs and the reason for this could be that they could improve their credibility in the family and society and had enhanced self efficacy.

Type of work and number and percentage of patients:
Candle making & selling - 11  (44%)
Electrical , Plumbing, Painting - 4  (16%)
Toys selling - 4  (16%)
Pea nut , fruit selling, tea vending - 4  (16%)
Driving license renewal - 2  (8%)

It was found that small ventures which do not require specialized training and have flexible working hours suited best for the patients with substance use disorder currently on treatment.

Deepak Yadav
Supervising Officer (Medical Social Work),
National Drug Dependence Treatment Centre,
All India Institute of Medical Sciences,
Ansari Nagar,
New Delhi,
India