NDDTC. AIIMS, New Delhi. India

Transcription

1 Deepak Yadav, Anju Dhawan, Seema Yadav. NDDTC. AIIMS, New Delhi. India

2 Unemployment and substance bt abuse intertwined t i long before an individual seeks treatment. The rate of the drug use higherh by more than two times for unemployed persons (18.5%) than those employed fulltime (8.8%) 8%) or part time (9.4%) among adults aged 18 years or older, (NHADU, 2006)

3 Employment traditionally has not been a primary focus or an explicitly stated goal of treatment for substance abuse Gi Gained popularity: (Shepard and Reif 2004). Consistence evidence in substance use evaluation research showing that employment is linked to positive clinical outcomes. (NIDA, 1981,Brewington et al 1987, Deren &, Randell 1990, Yadav et al 2006 and ).

4 One among the three of the best predictors of successful substance abuse treatment outcome, the other two being adequate family support and lack of coexisting mental illness (SAMHSA 2000). Enhanced occupational functioning leads to a decrease in substance use with some studies reporting the probability of abstinence up to 2.5%. (Shepard and Reif 2004).

5 Employment leads to: Protective barrier against relapse (NIDA, 1981 & Greenwood 2001). Reduction in anti social behavior. Improved self esteem and interpersonal relationship. (Prochaska &Velicer, 1997; Cernkovich & Giordano, 2001), Better treatment retention. (Platt, 1995).

6 Even after realizing i the importance of gainful employment in the management of substance use disorderd it remained one of the neglected area in terms of allocation of funds. (SAMHSA 2000). Developing countries : No social security, Low priority. (Yadav etal 2006)

7 Open market Micro credit Options Micro finance SHG

8 Microfinance refers to the provision i small loans to poor or low income group, including consumers and the self employed. employed In the past few years, savings led microfinance has gained recognition as an effective way to bring very poor families low cost financial services. For eample example, in India the National Bank for Agriculture and Rural Development (NABARD) finances more than 500 banks that lend funds to self help groups (SHGs).

9 Microcredit is the extension of very small loans(microloans) to the unemployed, to poor entrepreneurs and to others living in poverty who are not considered bankable. These individuals lack collateral, steady employment and a verifiable credit history and therefore cannot meet even the most minimal qualifications to gain access to traditional credit.

10 Even these are out of reach for drug users, for various reasons : Individual. Social.

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12 Outreach program in high prevalence poor socio economic background community at Delhi. The center offers multipronged interventions aimed at management of the substance use related problems. Opioid agonist (Buprenorphine) maintenance or antagonist (Naltrexone), and disufiram, acamprosate or naltrexone for opioid and alcohol dependent patients respectively. The non pharmacological interventions include motivation improvement, relapse prevention and family counseling and spiritual programs.

13 NDDTC micro finance program stemmed out of the need of the patients: Drug use is expensive. The financially drained family s inability to make financial contribution. Lack of trust/ stigma. Unfavorable response from open job markets. Unique need of patients receiving agonist maintenance Treatment.

14 Un bankable. bl No collateral. No bank account (any way 80% in India do not have a bank account). (Neelkani : Imagining India 2009) Out of social security provisions. Majority are engaged in unorganized self employment ventures. ( No need to reinvent the wheel). No acceptance by family or society even after abstinence.

15 All these patients have been successfully treated (with OST) to result in abstinence. However, they didn t get gainful employment despite abstinence. Thus, they were enabled through micro credit to earn their livelihoods and reintegration into the mainstream

16 The unique need of these patients t to have flexible working hours to enable them to maintain regular follow. Long working hours and intensive nature of the physically demanding job. And most important enhancing self efficacy and confidence.

17 Motivating the patients t to start t working. Skill assessment. Explain to him the logistics and finalizing the type of work they wanted to pursue.(group process) Individualized plan. Arranging the seed money to procure material or tools to start the work. Art of living an international humanitarian non profit organization came for support.

18 Reviewing i the progress. If possible involvement of family members. Motivating him to return and subsequently save money. Encourage him to expand the work.

19 Drug user. Age years On treatment for last 3 months. Willing to receive standard treatment as well as Occupational rehabilitation services Regular follow up during the last three months not missed more oethan 15 days in last 3 months Self report of drug use less than 7 days per month in last 2 months) Unemployed since last 3 months Subjects from a defined catchment area.

20 Severe physical illness or disability due to which h person may be unable to participate in the program. Presence of psychiatric i illness currently. Refusal to participate in the program.

21 Candle making & selling. Electrical, Plumbing, Painting, Gardening, Toys selling Pea nut, fruit selling, tea vending. Driving. Small shops (general and tailoring)

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23 Culturally ll accepted, td Feasible, Therapeutic, Accepted by the patient, Low cost intensive. Based on treatment need of the patient.

24 Amount paid Rupees Mean S.D Days taken to start working 1 week Days taken to start repayment: 10 days Days taken to repay the entire amount S.D credit : One month(mean SD) Percentage repaid the credit: 74 % Occupational status (Percentage currently working after 6 months): 74%.

25 Small ventures which do not require specialized training and has flexible working hours suited best for the patients with substance use disorder Has more surviving skills Shift to mainstream jobs Changed Family relations Self efficacy Reduced anti social behavior Attitude towards the treatment centre a tool to relationship building Retention

26 Possible Service orientation than pure commercial ventures Need based SHG formation Un bankable Need Intervention to make them bankable Microcredit Civil society initiative

27 NATIONAL DRUG DEPENDENCE TREATMENT CENTER, ALL INDIA INSTITUTE OF MEDICAL SCIENCES NEW DELHI