Education,skill development and sustainable livelihoods: Situation assessment of India’s drug treatment and rehabilitation centres

Abstract

BACKGROUND: Research into education and skill development of drug users to facilitate social and economic inclusion has not previously occurred in India.

OBJECTIVE: This paper examines education and skill development in government, NGO and private drug treatment and rehabilitation facilities of India.

METHODS: A mapping exercise was undertaken to identify drug treatment and rehabilitation facilities. A total of 119 responses received and one-third of drug users were described as illiterate or had achieved primary school only.

RESULTS: The majority of facilities did not provide basic education but virtually all provided HIV and drug education. A majority of facilities did not provide vocational education and livelihood skills and referrals to others for education and skills development were not common.

CONCLUSION: To ensure and promote the social and economic re-integration of drug users into the community the provision of vocational education and skill development opportunities compatible with the needs of the society should be encouraged.

Keywords

Education skill development drug treatment India

1 Background

In 2011 the population of India was over 1 billion (1,028,737,436) the second most populous country in the world (Census of India, 2011a). India has widespread licit and illicit drug use. The only major nationwide survey undertaken, over ten years ago, estimated 62.5 million people used alcohol, 8.75 million used cannabis, 2 million used opiates, and 0.6 million people used pharmaceuticals such as sedatives and hypnotics. Among all drug users up to one-quarter are classified as dependent (Ray, 2004). In 2010, a mapping exercise carried out by the National AIDS Control Organization (NACO) estimated the total medium number of injecting drug users (IDUs) at 177,000 (National AIDS Control Organization, 2010).

In India literacy is generally defined according to that used by the Census Department: a person aged seven years and above who is able to both read and write with understanding in any language (Mathew, 2005). The rate of literacy in India in 2001 was reported to be 64.8%, increasing to 74% by 2011 (Census of India, 2011b). In 2006, 39% of the Indian workforce aged over 15 was reported to be illiterate, and 23% had studied only to primary level (Papola, 2008). Comparisons with the drug using population are noteworthy. In 2008 a nationwide study showed that most drug users surveyed could read and write (85%) with the respondents identifying themselves as literate (Kumar, 2008). However, other more locally based studies do not show such high levels of literacy. In Kolkata a small survey of 143 drug users found 40% could not read, and 31% could not write, and of those able to write 30% identified this skill as poor or below average (Ray et al., 2009). A study in Chennai among HIV infected IDUs (N = 118) showed that most had either primary only or no formal education (58%) (Solomon et al., 2008). In Chandigarh, a survey (N = 2,992) among general drug users found that 38% were illiterate (Chavan et al., 2008), while a study (N = 34) undertaken among drug using juveniles (aged 13–17 years) in New Delhi inside an observation home for males showed that 29% were illiterate (Malhotra et al., 2007).

Higher levels of literacy could be found among drug users in North East India where in Nagaland and Manipur only 5% had not received any education (Kermode et al., 2007). Female IDUs in Manipur on the other hand were more disadvantaged according to a study, which found that 12% had not attended school and that only 20% achieved Class 1–5. (Oinam, 2008). School drop-outs among drug users have been shown to be high, as shown in a study in North India among a group of adolescents in a de-addiction centre, where they constituted 54% of the group (Saluja et al., 2007).

Unemployment in India in 2005-2006 was reported to be 8.2%, and overall higher in urban compared to rural areas (Bino et al., 2009). It was suggested that not possessing the appropriate skills to secure employment was a bigger crisis than unemployment with an estimated 57% of Indian youth experiencing some degree of unemployability. This has been largely due to a demand and supply mismatch, a lack of ‘marketable skills’, and an overall absence of vocational skill training to secure employment (Team Lease Services, 2007). In a study examining employment status among drug users (N = 5,800), Kumar (2008) found that 66% were employed, but it is important to emphasise that those living in poverty (drug users or non-drug users) have few options but to be employed: for impoverished people a sense of overall security is mostly absent when incomes are generally low, often irregular and uncertain.

The Ministry of Social Justice and Empowerment (MSJE) in association with the National Institute for Social Defence (NISD) is the focal point for drug demand reduction programmes in India The MSJE continues to implement the Scheme for Prohibition and Drug Abuse Prevention, 1985-1986 in which the focus of the scheme was the de-addiction [detoxification] and rehabilitation of drug users in a community setting. Through a partnership process various NGOs throughout the country receive 90–95% of funds from the government to implement a range of services including the following: awareness and prevention education counselling; treatment; and rehabilitation of drug users (National Institute for Social Defence [NSID], 2008). In 2004 there were a total of 381 de-addiction centres and counselling centres: most were de-addiction centres but some were stand-alone counselling centres or both services were included (Goswami, 2004). In 2008, there were an estimated 450 treatment facilities reported by government sources (Murti, C. personal communication, 2009). In addition, the Ministry of Health and Family Welfare (MoH) were responsible for 120 drug treatment centres within hospital and health institutions (Ray, R, personal communication 2009). The number of drug treatment and rehabilitation centres in India that operate privately and not associated with either the MSJE and NISD or the MOH was not known but was likely to be considerable in size.

Within UNESCO there was an emphasis on universal access to education, sustainable livelihoods, prevention, treatment, care and support for people vulnerable to drugs and affected by HIV and AIDS (UNESCO, 2007). Education and skill development was a key to development goals, especially in the contexts of those affected by drug use, by offering opportunities directly into people’s hands that lead to empowerment and dignity. Whether in the developed or developing world education and skill development among drug users was considered to be an effective, contributing factor to social inclusion and the potential for sustainable livelihood (United Kingdom Drug Policy Commission, 2008).

To explore this topic further research was undertaken by UNESCO that involved a situation assessment of basic education, vocational education and development of sustainable livelihoods in drug treatment and rehabilitation centres of India. The aim of the research was to improve our understanding of broad ranging education activities, within the government, non-government and private sectors, involved in drug treatment and rehabilitation, with a specific focus on the development of vocational education and the fostering of livelihood skills among drug users, ex-drug users and people vulnerable to drug use. Research of this type had not previously been undertaken in India.

2 Methodology

One survey questionnaire was designed and utilized for all treatment centres comprising of 30 questions, covering a range of topics including issues about basic education (numeracy and literacy skills), vocational education, HIV and drug education, referrals and partnerships. In late 2008, a major mapping exercise to identify various drug treatment and rehabilitation facilities, and disseminate a questionnaire, was undertaken by a team of five people working part or full time, over a period of around six weeks. Different methods were implemented during the various stages and adapted according to the sector involved in drug treatment. The Ministry of Health and Family Welfare (MoH) provided information of the name and state of 120 drug treatment centres under their responsibility but were unable to provide addresses or contact details as this had not been collected by this Ministry. As a result the internet, search engines (primarily Google) and personal contacts were used to identify 54 treatment centres in different states.A total of 215 telephone phone calls (including repeat calls) and 38 emails were sent to those in charge of drug treatment facilities under the MoH to complete the questionnaire.

At the same time a mapping exercise accessing publicly available sources was undertaken to identify 400 NGO facilities offering drug treatment and rehabilitation services under responsibility of MSJE and NISD, as well as 25 various NGOs not associated with MSJE and NISD. Further consultations with those representing the Regional Resource Training Centres (RRTCs) empowered by the MSJE to support and guide the nation’s drug treatment centres were also undertaken. A total of 300 NGOs under MSJE and NISD and 20 NGOs not under MSJE and NISD were directly contacted. Up to 300 telephone calls and 380 emails were sent to treatment facilities requesting a response to complete the questionnaire. Twenty-two face to face interviews using the questionnaire with those responsible for treatment and rehabilitation facilities took place in the cities of Mumbai, Pune, Bangalore, Kolkata, Imphal and Aizwal. Budget constraints and time restrictions disallowed further face to face interviews in other cities to be conducted.

The research also involved eleven key informant interviews with government, United Nations and NGO stakeholder bodies in New Delhi, as well as four focus group discussions with drug users [an average of 10–15 participants were in each group] undertaken in four different cities. However, the focus of this paper will be the survey results from India’s treatment and rehabilitation facilities.

We summarised the data of the survey using descriptive statistics to describe the different characteristics. We then compared the types of organizations participating in the survey for selected variables. The data collected in the survey was coded and entered into Excel spread sheets. The data was analysed using software packages Epi Info (version 6.4b, Centers for Disease Control, Atlanta, GA, in collaboration with World Health Organization, Geneva, Switzerland) for frequency distribution and univariate analyses.

3 Findings

3.1 Responses and coverage

A total of 119 organisations responded of which 56 NGOs had an affiliation with MSJE and NISD, and 15 NGOs reported no association with MSJE and NISD. Twenty-four organisations reported an association with the MoH, 20 from private facilities, and lastly ‘others’ (N = 4).Responses were obtained in the form of face to face interviews (N = 22), postal (N = 6: despite 87 questionnaires posted to those agreeing to participate this approach was unsuccessful) and the rest arrived electronically. Responses were received from a total of 25 States and one Union Territory: at the time of the survey India had28 States and seven Union territories (Central Intelligence Agency, 2009). Among the States, Maharashtra had the largest contribution of 19 facilities responding, amounting for 16% of the sample. This was followed by New Delhi where 13 facilities responded contributing 10.9% of the sample. Tamil Nadu and Kerala contributed nine responses each and Mizoram eight.

3.2 Education achievement, provision of education including HIV and drug education

One third of drug users in treatment facilities were described as illiterate or had achieved primary school only. It can be suggested that illiterate drug users were potentially greater in number since the definition of literacy by the respondents may vary, and not always be reflective of the true scenario.

Collectively the majority of facilities (61%) did not provide basic education (numeracy and literacy) for drug users. Fifty percent of facilities associated with MSJE and NISD offered this service, while those among MoH and the private sector were least likely (79% and 80% respectively). A total of 114 facilities reported offering HIV and drug education to drug users. The majority (86.4%) provided HIV and drug education using the group session approach but a substantial number of facilities (46%) also utilised the mass media (radio, television, internet and films) as a mode of providing education. Utilisation of brochures, flip charts, and posters to deliver HIV and drug education were widely used (65.3%, 50.4% and 64.7% respectively).

Sources of information on HIV and drug education were mostly accessed from the Government (54%), the internet (36%), and from UN agencies (32%). Majority (64.1%) of the clients receiving HIV and drug education were aged 16 to 30 years. This finding indicates most fell within the youth or young adult category and the education provided had the potential for substantial impact upon those that were taught such topics, and to lessen the adverse health consequences of personal risk behaviours. The second most predominant age group were aged 31 to 45 years (30.8%).

A majority of facilities (69%) reported having educational materials and approaches suited for those identified as illiterate. This was mainly done through verbal explanation (70%) group discussion (68%), with less than half using picture books (39%). During face to face interviews it was observed education information in printed formats primarily focused on sexual transmitted infections and HIV, but materials on drug use issues were overall lacking. Collectively the majority of facilities (60%) had educational materials in other languages, excluding the main language of their locality, which was primarily Hindi or English. However, only one-third of MoH facilities used educational materials in other languages.

Over half the respondents (56.3%) tested or held focus group discussions related to education materials [showing and discussing the materials, and requesting opinions before it was used] amongst their client group. However, it was identified that during face to face interviews educational materials developed by other sources were never tested. Testing would only occur if it was developed by the organisation itself.

3.3 Employment status, vocational education and skill development

Only a minor number of clients (10.5%) in treatment or rehabilitation were reported to have a regular job in the past 12 months. A substantial number were unemployed (31.6%), while the rest had no fixed job, with irregular income; it can be suggested that many clients lived a life of financial insecurity, uncertainty, and were overall economically disadvantaged. It can be suggested that in India most drug users in treatment were accessing some form of work but those that live in poverty have few options but to seek out what ever jobs exist no matter how poorly paid or with few rewards for advancement of a livelihood.

The majority of facilities (61%) did not provide any vocational education and livelihood skills for drug users. This was most pronounced among facilities linked to MoH (88%) and least among the NGOs connected to MSJE and NISD (49%). Only 1% of facilities did not know if vocational education training was offered. Among the facilities that provided this service (38%) most answered that what was offered often resembled occupational therapy for income generation not vocational skill development required by the overall employment market. Training was broad-ranging and included areas such as soap making; candle making; paper bag making; creating lanterns and greeting cards; making chalk; lotion, vinegar, disinfectants, basic computer course, television repair electrician and making leather bags and shoes. Peer based approaches were not mentioned by any of the respondents.

3.4 Referrals, linkages or partnership with other organizations

The majority of agencies (64.4%) did not provide regular referrals (every 1–3 months) or linkages with other organizations for basic education, vocational education and livelihood skills. Within MSJE and NISD facilities just over half of respondents claimed to offer referral and linkages (54%), but those NGOs not associated with MSJE and NISD, and responses from MoH show a markedly lower rate of 31% and 21% respectively.

The majority of agencies (74%) had not created a partnership with any other outside agency, organisation or institution. Those that had formed partnerships had done so with vocational education training centres or schemes. No respondent mentioned partnerships with corporate – private companies, community groups (business and employment orientation), private or public schools, technical institutes, or any partnerships with UN agencies.

3.5 Alternate employment approaches for drug users

Almost half the respondents mentioned ‘self-help groups’ as an alternative employment approach. Yet this term is often interpreted to mean Narcotic Anonymous and Alcoholic Anonymous in the Indian context. Such groups however have no connection with alternative employment. Self-employment (36.2%) and supported work schemes (19%) appear to be relatively common. It was interesting to note that 13.7% of agencies had been involved with micro credit schemes, in which recovered drug users were provided with a small financial loan to establish a job.

3.6 Capacity of facilities to undertake basic education combined with vocational education

Almost two-thirds (63%) of agencies claimed to have the capacity to undertake basic education, combined with vocational education and livelihood skills for drug users. This was noteworthy as the findings of this research show that most agencies (61%) do not provide vocational education and livelihood skills for the drug users, majority provide no basic education (61.5%), nor regular referrals or linkages with other organizations that could offer such services (64.4%).

4 Limitations

A combination of in-active emails, difficulty accessing functioning telephone numbers and an overall poor response rate to emails, telephone calls or posted questionnaires was encountered and consequently this reduced the number of respondents. An important caveat to this research was that the responses are not representative of all drug treatment and rehabilitation facilities across India.

5 Discussion

In recent years the Indian government has adopted the concept of community based rehabilitation with a multiple treatment approach (Ministry for Social Justice and Empowerment [MSJE], 2008). This involves a shift towards ‘whole person recovery’ including the need for vocational training within the rehabilitation process, networking and utilisation of appropriate agencies for social reintegration and economic rehabilitation to occur. Focus should no longer just be on clinical management of treating drug dependency (NISD, 2008). Yet the findings of this research found that implementation of interventions for whole person recovery were widely lacking. As identified in the survey the majority of facilities did not provide opportunities for basic education, vocational education and livelihood skills. In India where illiteracy still remains relatively high the importance of education to facilitate a move away from a position of social and economic disadvantage leading to improved job prospects, improved earnings and lessen the degree of poverty cannot be under-estimated (Machin, 2006).

As to why basic education services were mostly not offered it can be suggested that many of the facilities that responded catered to the more literate and affluent clients: as was found with most drug treatment facilities in India, payment was often a prerequisite for receiving a service. Additionally facilities linked with MoH were mostly based inside hospitals where the focus was largely on medical treatment of drug dependency and abstinence-based drug withdrawal. The service was often short term of one to three weeks. All other facilities not linked with MoH overall focused on abstinence-based drug withdrawal, and longer term rehabilitation programmes of less than one month to six months (MSJE, 2008).

Within the India context defining literacy was broad based focusing upon the ability to both read and write with understanding in any language. The depth of this ability with reading and writing however was not clearly defined and likely to adversely impact upon the respondents to accurately determine literacy status of their client base. Based on the findings from this research it appears that the scale of reported illiteracy may not be markedly different to many other disadvantaged, impoverished communities in India. However, a significant difference was the fact that drug users in India, are highly stigmatized, discriminated against, and often attract extreme hostility from the community (Lawyers Collective HIV/AIDS Unit, 2007; Sharma et al., 2003). While issues of stigma and discrimination were not explored in the questionnaire it could be suggested that prevailing negative traits by the wider community towards recovering drug users could result in fewer meaningful opportunities being offered to those that would like to partake in broad based education and skill development to assist towards family, community and society reintegration.

Emphasis on the need for more basic education among this group needs encouragement. From a human rights approach, the Universal Declaration of Human Rights adopted by the United Nations General Assembly in 1948, in which India is a signatory, states in Article 26 (1) ‘Everyone has the right to education’. It was within this context that drug users who were illiterate or shown to lack reading and writing proficiency should be offered the opportunity to receive an education which would contribute towards social inclusion and the creation of sustainable livelihood.

HIV and drug education was undertaken by virtually all facilities and a group session discussion with verbal explanations was the most common mode of imparting education in the various settings. However, quality assurance of how the information was imparted to drug users cannot be provided and was an area that required further examination.

Studies show that broad ranging positive physical and mental health outcomes linked to employment, and that having a job can assist during the process of recovery from drug use. (Scottish Executive, 2001). A project in Kolkata, India, showed prior to focusing on education and vocational skill building for recovering drug users that received opioid substitution therapy (OST) relapse rate was above 90%. Over a period of 30 months, among 196 recovering drug users on OST and receiving the opportunity for vocational training, micro credit or adult literacy programme, only 11% returned to drug use. Sustainability of such success requires ongoing funds accompanied with monitoring and evaluation but the results do provide hope (UNESCO, 2011). Similar studies to that conducted in Kolkata, India were not able to be identified in other parts of India or Asia. However, in the context of Europe, vocational training was a frequently examined approach to improving employment and employability among problematic drug users. For example a comprehensive review found that while there were isolated examples of successful vocational training programmes it was difficult to draw conclusions about their overall effectiveness and consistent positive outcomes for drug users. Primarily the report found that this was due to the differences in intervention approaches, the study populations investigated and the kinds of outcomes assessed. Sumnall and Brotherhood (2012:16) did note however that as a general rule “providing drug treatment alone without additional support or services had only limited and inconsistent effects on employment outcomes for drug users” (Sumnall & Brotherhood, 2012).

Despite many facilities stating that they had the capacity to offer livelihood skills to their clients the findings show that the majority did not provide these services. It can be suggested most treatment and rehabilitation facilities in India were not in the position to initiate the social and economic components of whole person recovery. Primarily this was due to a lack of skilled personal, budget constraints, lack of staff, and deficient training to undertake this responsibility. There was a need to improve and provide training opportunities and skill building for appropriate staff working at all drug treatment and rehabilitation facilities.

There was a need to improve the coordination and harmonizing of all the different stakeholders directly or indirectly, best equipped, and associated with education, vocational education and livelihood skill development, with those services providing drug treatment. Referral networks and partnerships should be broad ranging including those from government schemes, NGO and the corporate sector. India has various schemes established to assist vulnerable and disadvantaged populations in the area of education and skill development but few drug treatment facilities had sought their assistance. One Indian government scheme was the Jan Shikshan Sansthan (JSS) which offer quality vocational skills and technical knowledge, at low cost, not only focusing on those in the urban areas but to the numerous neo-literates and unskilled and unemployed youth throughout the country. As of 2008, there were 223 JSSs established throughout India offering over 300 different types of vocational courses (Mohankumar & Yadav, 2008).

In India there was a need to acknowledge that not all drug users having received a formal or non-formal education [non-formal was within and outside educational institutions, and often for persons of all ages to receive basic education, life-skills, and work-skills] still struggle to obtain specific skills or be accommodated into a formal working environment. As a result alternative employment approaches for drug users such as those facilitated by micro-credit schemes were identified in the survey. The details of these micro-credit schemes were not found in this study but there were positive signs for its implementation. In India a series of case studies among homeless substance users highlighted that by implementing a holistic treatment approach with some seed money to initiate small business endeavours, coupled with ongoing psycho-social and medical support, this approach could achieve success (Yadav et al., 2008).

In another study 55 participants (of which the majority were on buprenorphine maintenance) received on average 560 rupees [US$11-12] to start up a series of small jobs that suited their skill set and physical condition (candle making, electrical work, plumbing, gardening, fruit selling, tea vending to name but some) with most (74%) repaying the amount taken within one month of taking credit. Up to half the participants had switched over to financially and technically more lucrative employment after a few weeks or months (Yadav, Dhawan, & Yadav, 2010).

In conclusion gaps in basic education, vocational education and development of livelihood skills of drug users within the overall drug treatment and rehabilitation facilities of India were identified. Within a broad ranging education framework there was a need to move towards an evidence based and practical response to address an unmet need among recovering drug users wishing for social and economic re-integration back into the community. Further evidence needs to be generated but available literature does indicate basic education, provision of appropriate vocational education and skill development can contribute towards and aid in the process of whole person recovery among drug users, and should be encouraged.

Grant Funding

UNESCO acknowledges and thanks the European Commission and UNAIDS for the financial support provided which was essential in undertaking the research and funding of the programme.

Conflict of interest

There is no conflict of interest.

Footnotes

Acknowledgments

The views expressed in this paper were those of the authors alone which were not necessarily those of UNESCO, and do not commit the Organisation. The authors would like to thank Mariana Kitsiona, Caroline Cano, Mehboob Dada and Cathryn Connolly for their valuable contribution and comments on the UNESCO report ‘Situation Analysis of Basic Education, Vocational Education & Development of Sustainable Livelihoods in Drug Treatment & Rehabilitation Centres of India’ which includes much of the data from which this article was derived.

References

Bino

P. G. D.

, Kishore

, Shaoni

, Piu

, Krishna

, Radhika

, & ... Venkatesha

M. R.

(2009). India Labour Market Report 2008. Mumbai, India: Adecco Institute, London and Tata Institute of Social Studies.

Chavan

B. S.

, Arun

, Bhargava

, & Singh

G. P.

(2008). Prevalence of alcohol and drug dependence in rural and slum populations of Chandigarh: A community survey. Indian Journal of Psychiatry, 49, 44–48.

Central Intelligence Agency (2009). The World fact book: India. United States: Central Intelligence Agency. Retrieved from https://www.cia.gov/library/publications/the-worldfactbook/geos/in.html

Census of India (2011a). Census data: India at a glance. Population. Office of the Registration General and Census Commission India. Retrieved from http://www.censusindia.gov.in/(S(2qft1bz2j41a20zqdjmlgirp))/Census-Data_2001/India_at_glance/popu1.aspx

Census of India. (2011b). Census data: Status of literacy. Office of the Registration General and Census Commission India. Retrieved from http://censusindia.gov.in/2011-provresults/data_files/mp/07Literacy.pdf

Goswami

(2004), Inventory of programmes and schemes to facilitate rehabilitation of drug and alcohol dependents. India: United Nations Office of Drugs and Crime and Ministry of Social Justice and Empowerment.

Kermode

, Longleng

, Singh

B. C.

, Hocking

, Langkham

, & Crofts

(2007). My first time: Initiation into injecting drug use in Manipur and Nagaland, north-east India. Harm Reduction Journal, 4, 19. Retrieved from http://www.harmreductionjournal.com/content/4/1/19

Kumar

(2008). Rapid situation and response assessment of drugs and HIV in Bangladesh, Bhutan, India, Nepal and Sri Lanka: A regional Report. Regional Office for South Asia, New Delhi, United Nations Office on Drugs and Crime.

Lawyers Collective HIV/AIDS Unit (2007). Legal and policy: Concerns related to IDU harm reduction in SAARC countries. New Dehli, India: UNODC, Regional Office for South Asia.

10.

Mathew

(2005). Literacy, real options for policy and practice in India: A case study. Retrieved from http://portal.unesco.org/education/fr/files/43180/11315375171Mathew_A.doc/Mathew_A.doc

11.

Machin

(2006). Social disadvantage and education experiences. Organisation for Economic Co-operation and Development, Social, Employment and Migration Working Papers No 32. Paris, France. Retrieved from http://www.oecd.org/dataoecd/13/60/36165298.pdf

12.

Malhotra

, Sharma

, Saxena

, & Ingle

G. K.

(2007). Drug use among juveniles in conflict with the law. Indian Journal of Pediatrics, 74(4), 353–356.

13.

Mohankumar

, & Yadav

A. K.

(2008). Integrating HIV prevention into technical and vocational education: A pilot project with Jan Shishan Sansthans. New Dehli, India: UNESCO, New Delhi and Indian Adult Education Association.

14.

Ministry for Social Justice and Empowerment (MSJE) (2008). Drug demand reduction and prevention policies: Government of India’s approach – a synopsis. New Dehli, India: MSJE.

15.

National Institute for Social Defence (NISD) (2008). Rehabilitation of drug abusers: Role and impact of RRTCs. New Dehli, India: NISD.

16.

National AIDS Control Organization (2010). Annual report 2009-2010. Department of AIDS Control, Ministry of Health and Family Welfare. Government of India.

17.

Oinam

(2008). Exploring the links between drug use and sexual vulnerability among young female injecting drug users in Manipur. Health and Population Innovation Fellowship Programme Working Paper, No 6. New Delhi, India: Population Council

18.

Papola

T. S.

(2008). Employment challenge and strategies in India. New Dehli, India: International Labour Organisation Asia-Pacific Working Paper Series, Subregional Office for South Asia.

19.

Ray

(2004), The extent, pattern and trends of drug abuse in India: National survey. New Dehli, India: United Nations Office on Drugs and Crime and Ministry of Social Justice and Empowerment.

20.

Ray

, Banerjee

, Ghosh

, Banerjee

, & Panda

(2009). Community needs assessment among substance users of Kolkata, 2008–2009. New Dehli, India: Society for Community Intervention and Research, Kolkata, and UNESCO.

21.

Sharma

, Panda

, Sharma

, Singh

H. N.

, Sharma

, & Singh

R. R.

(2003). Five years of needle syringe exchange in Manipur, India: Programme and contextual issues. International Journal of Drug Policy, 14(5-6), 407–415.

22.

Saluja

B. S.

, Grover

, Irpati

A. S.

, Mattoo

S. K.

, & Basu

(2007). Drug dependence in adolescents 1978 – 2003: A clinical based observation from North India. Indian Journal of Pediatrics, 74(5), 455–458.

23.

Solomon

S. S.

, Hawcroft

C. S.

, Narasimhan

, Subbaraman

, Srikrishnan

A. K.

, & Cecelia

A. J.

(2008). Comordities among HIV-infected injection drug users in Chennai, India. Indian Journal of Medical Research, 127, 447–452.

24.

Scottish Executive (2011). Moving on: Education, training and employment for recovering drug users. Edinburg, Scotland: Scottish Executive, Effective Interventions Unit. Retrieved from http://www.scotland.gov.uk/Publications/2001/09/10096/File-1

25.

Sumnall

, & Brotherhood

(2012). Social reintegration and employment: Evidence and interventions for drug users in treatment. European Monitoring Centre for Drugs and Drug Addiction.

26.

Team Lease Services (2007). India labour report 2007: The youth unemployability crisis. New Dehli, India: Team Lease Services. Retrieved from http://www.b-able.in/Knowledge%20Bank/India%20Labour%20Report_Team%20Lease.pdf

27.

UNESCO (2007). Another way to learn: Case studies. Paris, France: UNESCO, Education Sector. Retrieved from http://unesdoc.unesco.org/images/0015/001518/151825e.pdf

28.

United Kingdom Drug Policy Commission (2008). Working towards recovery: Getting problem drug users into jobs. London, England: UK Drug Policy Commission. Retrieved from http://www.ukdpc.org.uk/publication/working-towards-recovery-getting-problem-drug-users-into-jobs/

29.

UNESCO (2011). Returning to the fold: Howout-of-the box thinking and a unique approach towards recovering substance users produced surprising results. Kolkata, India: UNESCO, European Union, and Society for Community Intervention and Research.

30.

Yadav

, Dhawan

, Rao

, & Mohan

(2008). From the streets to a home: An experimental account of treating homeless substance abusers in India. Journal of Social Work Practice in the Addictions, 8(1), 163–167.

31.

Yadav

, Dhawan

, & Yadav

(2010). Occupational rehabilitation of opiate users: A micro finance based approach. Journal of Social Work Practice in the Addictions, 10(4), 413–422.