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Official websites use. Share sensitive information only on official, secure websites. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. To assess the ability to work and employability of individuals taking part in opioid substitution treatment programs OSTP. The study was composed of two surveys. In the first survey, of patients enrolled in OSTP responded to the questionnaire about their employment status, opinion about employment, and perception of assignments before and during OSTP. In the second survey, 66 of employers responded to the questionnaire on the occurrence, perception, and management of addiction problems in their companies. Unemployment rate in individuals enrolled in OSTP was Irregular use of OSTP medications was the most important factor for unemployment odds ratio, 2. Only 6. In To facilitate complete rehabilitation, particularly in obtaining employment for the patients, the process must involve the society as a whole. Psychoactive substance use, including illicit drugs use, represents a significant threat to the human health 1. It is one of the major public health problems worldwide 2 , especially in the Americas and Europe 1 - 4. Opioid substitution treatment program OSTP is one of the main approaches in drug addiction treatment and harm reduction programs for opioid illicit drugs users. The main goals of OSTP are reducing drug use, improving personal and social functioning, and improving public health eg, by diminishing the risk of HIV infection and hepatitis and by preventing and reducing drug-related mortality and criminal behavior 5 - 8. Through OSTP programs, opioid users can contact health services for assistance and treatment and gain access to other treatment programs, from low-threshold to abstinence-oriented ones. Since these programs are more effective when there is community participation, employment and working environment are of the utmost importance. Moreover, employment is a very important long-term outcome of treatment of drug dependence 9. The employability of OSTP patients, especially younger ones theoretically able to work, is a serious problem in most environments. This is understandable to the certain extent, since working environment is one of the areas where use of illicit drugs can result in significant human and material damage. Employees under the influence of psychoactive substances are less productive and the quality of their work is decreased 10 , They are frequently involved in workplace accidents that can result in material damage and personal injury 12 - Psychoactive substance abuse before or during work presents a potential risk not only to the proper execution of assignment, but also to the well-being and safety of the user and his or her coworkers. In Slovenia, the problem of illicit drugs use has become even more pronounced in the last 15 years, since the beginning of the transition process To address this problem, the Ministry of Health of the Republic of Slovenia established in a public health network of Centers for the Prevention and Treatment of Drug Addiction in nine Slovenian urban areas. Currently, treatment of drug users is provided in 18 Centers and two outpatient clinics staffed with trained personnel. Methadone substitution treatment program is one of the basic treatment programs offered in these centers. Additionally, drug prevention and rehabilitation centers provide counseling services for addicts, their relatives, and educators; individual, group, and family therapy; preparation for hospital treatment; and help in rehabilitation and social reintegration On the other hand, the general attitude of Slovenian society toward OSTP patients is negative and rejection and stigma of drug users is especially strong It is the reflection of ignorance and simplification of the problem and our inability to distinguish between different types of drugs and their consequences. The aim of our study was to determine the status, options, and chances of employment of drug users currently or previously treated in OSTP in Slovenia. We investigated the attitude of drug users in OSTP toward their employment status and work in general and the attitude of employers toward current employees and future job seekers with drug problems or treated in OSTP. The Ljubljana Center covers the largest health region in Slovenia Of individuals in OSTP, agreed to answer the questionnaire response rate, The rest refused to participate and were excluded from the study. Of questionnaires, were fully or almost fully completed in 11 questionnaires some answers were missing and thus were eligible for the analysis, while in 2 of them more than a half of answers were missing. At the time of the study, of Characteristics of unemployed individuals taking part in opioid substitution treatment programs OSTP in Slovenia in Within each group, companies were given serial numbers and were selected by a random number generator Statistical Package for the Social Sciences for Windows, Version The response rate from selected companies was Among respondents, there were 31 Thirty-six In 37 The study was performed in May and June The OSTP participants were asked to fill out a questionnaire that consisted of 35 questions about the personal data, drug use before and during treatment, employment, and assessment of work ability web extra 1. All questionnaires were filled out by participants in the presence of a therapist who provided explanation to each question in detail, as necessary. A different questionnaire was distributed to the employers or occupational safety managers of the companies. The study was performed according to the guidelines of the National Medical Ethics Committee of the Republic of Slovenia. In the analysis of perception of work and employment of patients in OSTP, descriptive and analytical statistical methods were used. As some of the questions in the survey were not answered by all respondents, the results are shown only for respondents answering the specific question. Multivariate analysis by using logistic regression was performed to relate unemployment to several independent variables simultaneously The dummy variables were created for all independent variables considered in the model. The simple method was applied. The group with the lowest frequency of observed outcome was assigned as the reference group Characteristics of both unemployed and employed participants were statistically described. The differences in employment rate and perception of assignments to be beyond abilities of study participants between before and during OSTP were analyzed with McNemar test for dependent variables The SPSS Employment status was established in all respondents. There were In the group of employed participants, of The employment rate increased from All data necessary to perform multivariate analysis were available for The Nagelkerke R 2 indicated that Results of logistic regression analysis of unemployment in individuals in opioid substitution treatment programs OSTP in Slovenia in Among unemployed participants, 16 The remaining 65 Of 60 participants, 26 Of 65 participants, 15 In this group of OSTP participants, 22 of 65 The most frequent reasons for unemployment in 63 of unemployed individuals in opioid substitution treatment programs in Slovenia in In the group of employed participants, 94 of Of participants who managed to keep or find a job after entering OSTP, only 30 Twenty-six of In this group of participants, 30 of Of employees, also believed that methadone had influenced their ability to work. Also, of This percentage was almost the same in the employed of ; Participants had to asses whether the assignments offered were beyond their abilities before and during OSTP. Several assignments were perceived as significantly less difficult after OSTP. Such a shift was observed in mentally demanding assignments, physically demanding assignments, working at unfavorable hours or at a forced pace, and jobs requiring field work Table 4. Also, Individuals in opioid substitution treatment programs OSTP in Slovenia in believing the assignments are beyond their abilities before and during the program. Only 4 6. Out of 63 respondents, 59 Concerning legal regulations of the companies, 53 Only 3 4. In 27 Employers expressed a desire for professional instruction in the identification of individuals under the influence of illicit drugs in 16 of 64 According to the survey, the unemployment rate substantially decreased after OSTP, while ability to work substantially increased. Our results indicated that OSTP in Slovenia was effective in achieving that patients change their perception of ability to perform different types of assignments. Therefore, the perception about mentally demanding assignments, work at unfavorable hours, and forced pace of work represented lower burden for participants after entering the OSTP Table 4. On the other hand, the employment rate of OSTP patients in Slovenia has been more or less the same over more than a decade. In this respect, our results are in accordance with the results obtained in and 20 , indicating that Slovenian society did not substantially change during this period with respect to the employability of OSTP patients. However, it seems that the quality of employment has changed as in previous years, there were more OSTP patients employed on regular, contractual and part-time bases than in our study. Unfortunately, there were no data on undeclared employment in previous studies to compare them with the results of present study. These studies also differed in other aspects, so no other comparisons could have been performed. However, multivariate analysis in which some potential confounders were included eg, age and involvement in begging showed that the most important factor was regular use of medication and consecutively stability of OSTP patients. This was one of the most important elements in restoring the status of individual OSTP patients in their social environment. We found that the majority of employers in Slovenia had poor knowledge about illicit drugs use, since their companies did not have a legally binding document addressing drug use at work. Their attitude toward workers and job seekers with drug problems was extremely negative, even if they were in treatment, taking part in OSTP, or were recreational drug users. These results indicate that it is very difficult for current or former declared drug users to get a job in Slovenia. This phenomenon could be explained only by a generally negative opinion on drug users in Slovenian society and scarce information on drug problems and interventions to control them among employers Due to the low familiarity with the subject or perhaps negative experiences with it, many employers were very reluctant to accept employment applications of individuals who were or had been treated for addiction. Patients in OSTP seemed to be aware of these difficulties, so those who were employed hid their drug problems from their employers. Full support of the employer was reported only by a very small percent of OSTP participants who were employed at the time of the survey. The unemployed mostly had no desire in spite of their relative youth to find a job, mostly because of low salaries. On the other hand, almost three-quarters of OSTP patients were prepared to accept surveillance on drug presence to keep their jobs, and this attitude was not related to employment status. This could mean that for most of OSTP patients, such surveillance would be welcome and desired, and not only acceptable, since it would be another stimulating intervention that could direct them on their way to social rehabilitation. Detailed description of the group of unemployed OSTP patients revealed that almost two-thirds of them expressed a desire to find a job and they already searched for it. Almost a half of this group would accept any type of job, but all others stipulated conditions like creativity or independence. We suppose that these patients were not fully ready to accept social reintegration in spite of their intrinsic need for it. They were aware of general negative opinion of Slovenian society about them and they were afraid of being rejected by the society. Results of our study are also in accordance with the results of other recent studies with the same subject abroad 23 , 24 and in Slovenia In the last two decades, the awareness of psychoactive substance abuse at workplace and the problems it can cause has been increasing 23 - Simultaneously, the awareness that the workplace is a place for the development of broad preventive partnership has been increasing as well 10 , However, it is important to note that preventive policies can only take root if they are based on basic social units such as families, schools, labor organizations, and social services Regarding complete rehabilitation of substance users, our research confirmed that employment itself, especially full-time one, is an important factor that can help drug users and those in OSTP achieve successful rehabilitation since it gives greater social security and safety. Everybody, from therapists to employers, and society as a whole, should therefore give more attention to active employment of individuals who are, or used to be, drug users. A job in which they are able to find themselves is without any doubt an important factor in their rehabilitation process. From this point of view, OSTPs are far from being only clinical activities, they are also primarily or should be seen as public health activities. Additional multidisciplinary research in this direction is needed on both national and international level. Our study has some limitations and some advantages. The main limitation in both parts of the study is the response rate, which was Sampling scheme among the employers could be another limitation. In our sample, the ratio of companies with less than 50 employees to companies with 50 or more employees was , while the real ratio in Slovenia is about The rationale for our decision was the fact that 1. Additionally, in this part of the study, in most of the returned questionnaires one or more answers were missing, indicating that most of the questioned individuals were not familiar with the subject. However, most of the respondents were aware of their poor knowledge of the subject and expressed a desire for professional assistance. This study is extremely valuable, since we got insight into the current situation of employability in Slovenia and the rehabilitation of OSTP patients. The results could be also applicable to the countries in South-Eastern Europe with a similar political situation. One could argue that the study did not address the costs and problems that arise from employment of the drug abusers. This study was not intended to explore this aspect and, therefore, the issues were not raised in this direction. Also, the study could be seen as the feasibility study for a further in-depth exploration of the problem. Concerning cost-effectiveness or cost-benefit studies, so far the emphasis has been on evaluating costs of the OSTP 8 and not on evaluating the costs of employers. This could offer important information to policy makers for preparation of good and feasible policies in this field. Today, international experience confirms that the existence of proper psychoactive substance policies and their enforcement within the company benefits employees as well as employers Employers can greatly encourage the development of environments and relationships that will enable employees to choose a life without psychoactive substances. Companies with developed psychoactive substance policies report a significantly lower number of current psychoactive substance users and employees with drinking problems 30 , Regular employment is an important motivation factor for the effectiveness of OSTP. Individuals with regular employment are more motivated and adhere to the rules of treatment programs much more than the unemployed patients 9. On the other hand, employers find that employees, their representatives, and other parties are all in favor of such programs, and also that employment seekers who are currently using psychoactive substances prefer to look for work elsewhere This program is aimed at informing workers as well as employers on healthy lifestyle at work, and on the creation of health-promoting working conditions, including health-promoting working conditions for vulnerable population groups. The results of our study show that problem of unemployment in OSTP patients has not diminished over the last 10 years. OSTP programs in Slovenia are still often perceived as mainly clinical programs, while basically they should be comprehensive and cross-sectorial. This problem is impossible to tackle only through the health sector. Cross-sectorality will be in the short term rather difficult to achieve, because our society is still dominated by biomedical model of health, while programs as OSTP need to be seen in a context of a biopsychosocial model of health. It would enable companies to provide a safe, healthy environment for their employees. The authors thank all companies and especially all individuals in addiction treatment in OSTP at the Center for the Prevention and Treatment of Drug Addiction of the Community Health Center Ljubljana for their participation in the study. As a library, NLM provides access to scientific literature. Croat Med J. Find articles by Marjan Bilban. Find articles by Lijana Zaletel-Kragelj. Received Oct 10; Accepted Dec 4. All rights reserved. Characteristics No. Open in a new tab. The reasons for unemployment No. Assignment No. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Number of previous employments:. Type of drugs used prior entering the OSTP:. Years of drugs use prior entering the OSTP:. Involved in blackmailing of parents:. Feel capable of performing any type of job:. Feel positive change in attitude toward job after entering the OSTP:. Feels positive change in attitude toward job after entering OSTP:. They did not want to work due to the effects of drugs. They were frequently in conflicts with the employer. They were unsuccessful at their job. They were unable to work due to effects of drugs. Physically demanding assignments. Forced to work at unfavorable hours. Dangerous assignments eg, work at heights.

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