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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA. PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1) NAME OF THE CANDIDATE AND ADDRESS : Mr. ANAND L. R. 1ST YEAR M.Sc NURSING. PRAGATHI COLLEGE OF NURSING #33 BYRATHI EXTN, NEAR EBENEZER HOSPITAL, HENNUR BAGALUR MAIN ROAD, KOTHANUR POST, BANGALORE:560077 2) NAME OF THE INSTITUTION : PRAGATHI COLLEGE OF NURSING #33 BYRATHI EXTN, NEAR EBENEZER HOSPITAL, HENNUR BAGALUR MAIN ROAD, KOTHANUR POST, BANGALORE:560077 3) COURSE OF STUDY AND SUBJECT : DEGREE OF MASTERS IN NURSING PSYCHIATRIC NURSING 4) DATE OF ADMISSION TO THE COURSE 5) TITLE OF THE STUDY : : 14/07/2011 EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON OCCUPATIONAL REHABILITATION AMONG DRUG ABUSE PATIENTS AT SELECTED REHABILITATION CENTER BANGALORE. 1 6. BRIEF RESUME OF THE INTENDED WORK INTRODUCTION Since the beginning of human history and before, people have found ways to alter their bodies and their consciousness by taking substances such as herbs, alcohol, and drugs. Out of this practice has sprung many important contributions to science and culture, prominent among them being the development of modern medicine and the medical profession and the making of fine wines and liquors. Some religions have found uses for mind-altering drugs as a way to aid communion with the divine principle. Addiction usually does not happen overnight. Rather, people who become addicted to drugs (such as alcohol, cocaine, heroin, marijuana, etc.) are gradually introduced and desensitized to them over a period of time. They may initially enjoy the use of drugs in a recreational sort of way. For instance, someone might get into the habit of having a beer or some wine after work as a way of releasing the days stresses. Someone else may use marijuana on an occasional basis as a way to share special time with friends or as an aid to appreciating food, music, or sex. Another person may start using cocaine as a way of staying up late at night to study for exams.1 The 1996 National Household Survey on Drug Abuse estimated the number of users of illicit drugs in the United States to be about 13 million. In addition, the survey estimated that 10% of Americans abuse or are dependent on alcohol, and 25% of Americans smoke cigarettes.2 WHO reported that psychoactive substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. The extent of worldwide 2 Psychoactive substance use is estimated at 2 billion alcohol users, 1.3 billion smokers and 185 million drug users. WHO seeks to promote the concept of Health for All through its strategy of reducing the incidence and prevalence of psychoactive substance use and to provide the best available evidence on management of substance related problems. The achievement of this goal is designed to lead to reductions in the demand for psychoactive substances and to reduce the health and social problems associated with such use.3 According to the National Household Survey on Drug Abuse, in 1999 an estimated 14.8 million Americans were current illicit drug users, meaning they had used some illicit drug during the month prior to the survey. This represents 6.7 percent of the population 12 years and older. This number is down more than 50% from the peak year of 1979 when 25 million people (14.1% of the population) were using illegal drugs.4 Addiction has been defined as an illness characterized by “compulsion, loss of control, and continued patterns of abuse despite perceived negative consequences: obsession with a dysfunctional habit”. Drug abuse is a chronic or habitual use of any chemical substance which alters states of body or mind. Drug addiction is due to biological factors, psychological factors, and social factors. Substance abuse disorders are more common in Depression, Anxiety disorders, and Personality disorders.5 Drugs can act directly on one or more electro chemical neurotransmitters that convey information and regulate mood. Prolonged or chronic use can reset the body’s internal bio 3 chemical response system in a new homeostatic but distinctly abnormal pattern. Affects many critical body systems such as cardio vascular damage, coma, seizures, respiratory collapse, hepatic failure, renal failure, hemorrhagic disorders, transient psychosis and nutritional deficiencies. The management for drug abuse includes Supportive and Symptomatic treatment. The psychiatric symptoms may require proper Psychotropic medications and sometimes hospitalization. Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehabilitation centers offer age and gender specific programs. Rehabilitation is a set of services offered to individuals with mental or physical disabilities. These services are designed to enable participants to attain skills , resources , Attitudes, and expectations needed to compete in the interview process, get a job, and keep a job. Services offered may also help an individual retrain for employment after an injury or mental disorder has disrupted previous employment. Occupational rehabilitation helps people who have been injured or have suffered an illness to get back, both physically and mentally, in working shape. There are many rehabilitation clinics that address different needs, but all are designed to increase the patient’s maximum independent functions. Many employers pay for their employees to use these programs in order to maintain performance, as well as keep up with safety standards. An occupational rehabilitation therapist develops a plan of action for the injured worker by assessing his or her needs, and evaluating what the areas in which he or she requires help. 4 other specialists can also be enlisted to aid in such a program, including nutritionists, physiotherapists, and psychologists. Sometimes a rehabilitation team must consider whether the worker will return to his or her job or, if that is not a possibility, the team may help a patient regain function in order to seek a new job.6 Occupational therapy practitioners intervene in a wide variety of settings with people who abuse substances. Recognition of the effect that the substance abuse has had on the occupational functioning of the individual and the family is a unique dimension that the occupational therapist brings to the interdisciplinary approach. By facilitating the skills, daily routines, and occupational roles that the individual values and helping integrate them into the individual's view of self, the occupational therapist can enhance the life-style and support the abstinence of the newly recovering substance abuser. Occupational rehabilitation plays a major role in treating substance abuse. 6.1. NEED FOR THE STUDY Substance abuse occurs when a person is engaged in a pattern of using alcohol or other mood-altering substance like alcohol, marijuana, cocaine, street drugs, designer drugs, pain medications, and other pharmaceuticals.” Among these, alcohol is the most commonly abused substance. “When someone is abusing, there are negative consequences or there’s a huge potential for them,” Stoffel says. “For example, there’s a potential for organ damage that may or may not yet have occurred.” Psychoactive drug abuse commonly results from a combination of low self-esteem, peer pressure, inadequate coping skills, and curiosity. Most people who are predisposed to drug abuse 5 have few mental or emotional resources against stress, an overdependence on others, and a low tolerance for frustration. Taking the drug gives them pleasure by relieving tension, abolishing loneliness, allowing them to achieve a temporarily peaceful or euphoric state, or simply relieving boredom. Drug abuse has led to a detrimental impact on the society. It has led to increase in the crime rate. Addicts resort to crime to pay for their drugs. Drugs remove inhibition and impair judgment egging one on to commit offences. Incidence of eve- teasing, group clashes, assault and impulsive murders increase with drug abuse apart from affecting the financial stability, addiction increases conflicts and causes untold emotional pain for every member of the family. Professional Guide of psychiatry reported that 19.5 million people over the age of 12 years were using illegal drugs in worldwide. Among them 19,000 deaths occurring due to the drug addiction. The United States has the highest substance abuse rate of any industrialized nation. Government statistics show that 36% of the United States population has tried marijuana, cocaine, or other illicit drugs. By comparison, 71% of the population has smoked cigarettes and 82% has tried alcoholic beverages.7 In 1999, more than 4 million of the drugs using population were hardcore users: 3.3 million chronic cocaine users and 977,000 chronic heroin users, according to Office of National Drug Control Policy estimates. While casual use of illicit drugs and cocaine in particular, has fallen dramatically since the early 1980s, the number of hard-core users of cocaine and heroin has remained virtually unchanged.4 According to a 2004 national survey on drug use and health done by the Office of National Drug Control Policy, 19.1 million Americans (7.9 percent) who were 12 years or older 6 used drugs illicitly. In addition, 121 million Americans (50.3 percent) who were 12 years or older were current drinkers of alcohol, with 55 million (22.8 percent) admitting to binge drinking (defined by drinking five or more drinks at one sitting on at least one occasion in the last 30 days). Heavy drinkers (defined by binge drinking at least five days in the prior month) accounted for 16.7 million Americans (6.9 percent). Of those 12 to 20 years old, 10.8 million (28.7 percent) drank alcohol in the 30 days prior to the survey, with 7.4 million (19.6 percent) binge drinking and 2.4 million (6.3 percent) drinking heavily. Pregnant women aged 15 to 44 reported past-month alcohol use at a rate of 11.2 percent and binge drinking at a rate of 4.5 percent in the month prior to the survey. (Sept. 8, 2005) The 2004 survey reported that 22.5 million Americans (9.4 percent) who were 12 years and older met criteria for substance abuse or dependence. However, only 3.8 million of these people (1.6 percent of Americans) had been treated for drug or alcohol problems in the previous year. This left a staggering number of individuals in need of, but not receiving, treatment for their substance abuse problems. Regular drug and alcohol abusers are more likely to be involved in accidental injuries, motor vehicle accidents and incidents of violent and aggressive behavior. In fact, approximately 20 percent of emergency room admissions, as well as 20 percent of all general hospital admissions, are alcohol-related. (Professional Practice Council of American Academy of Physician Assistants, 1996) Most illicit drug users begin to use and abuse drugs when they are young. Men (8.5%) have a higher rate of illicit drug use than women (4.5%). The highest rates of drug abuse were found among young people ages 16-17 yrs (19.2%) compared with ages 18-20 yrs (17.3%). Only 7 about 1 % of people age 50 yrs and older reported using illicit drugs.8 A community based cross-sectional study was conducted during April 2004-March 2005 in an urban resettlement colony in East Delhi to study the narcotic substance use and the sociodemographic characteristics of users. 208 male narcotic substance users aged 15-24 years were studied. 59.1% of the narcotic substance users were between 21-24 years of age. 78.8% were using ganja and 39.9% each heroin & bhang. 37% were abusers; 36% were dependent users. 58.7% were single at the time of interview. 48% were either illiterate or just literate; 64% belonged to middle socio-economic status. 68% had initiated narcotic substance use out of curiosity.9 Drug-statistics Bangalore2007 Survey reported that approximately 1 in 5 people aged between 16 and 59 said that they had taken at least one of the drugs. People aged 18 to 21 were most likely to admit to having taken drugs, with almost half (46%) claiming to have taken them.10 Rehabilitation is a treatment designed to facilitate the process of recovery from drug abuse as early as possible. Rehabilitation includes physical therapy which uses exercises and physical activities to help condition muscles and restore strength and movement, Occupational Therapy uses activities of daily living and exercise to promote the highest level of independent functioning.11 Occupational therapy as a profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment, 8 or the activity to better support participation. Occupational Therapy enables people to achieve health, wellbeing and life satisfaction through participation in occupation. Occupational Therapy has been described as an active method of treatment with a profound psychological justification in case of substance abuse. Occupational Therapy is the application of goal-oriented, purposeful activity in the assessment and treatment of individuals with substance abuse. The constant stress in the day-to-day life leads many people are changing to drug addiction. Drug abuse patients often experience multiple problems such as health and mental health illnesses and the breakdown of family relationship and unemployment or low income leading to psycho social problems. Occupational rehabilitation is the only way to give exercise to both mind and body. Nurse as a role of a teacher imparts knowledge of practical working and social and coping skills to the drug abuse patients. To fulfill these purposes this study becomes a need.12 6.2 REVIEW OF LITERATURE This related literature of the present study has been collected and organized under the following sections. Section I: literature related to drug abuse A report states that approximately 23% of Australians use illicit drug in which Marijuana was the most common drug used. Amphetamines had been recently used by approximately 4% of those aged 14 years and over and 2% had used ecstasy/designer drugs; approximately 1% had 9 used heroin, cocaine, or injected an illegal drug during the previous 12 months. Rates of marijuana use, as for most illicit drugs, increased over the past decade, although rates for other drugs were much lower than for marijuana.13 A study investigated the reasons for initiating drug use in drug-dependent adolescents and youths in five regions in Yunnan. The data were collected from a stratified random sample of 467 registered drug addicts under 25 years of age. Pearson chi-square tests were used to analyze the association of reasons for drug use with socio demographic factors, knowledge of drug related harm, and access to illicit drugs. The results shows that Curiosity was the most commonly reported reason for initiating drug use and the majority of the respondents reported having little or no knowledge of drug-related harm. The majority of the drug abusers initiated drug use at the age of 13-14 years or younger. There is a potential for sustained educational programs to reduce the high prevalence of adolescent drug use.14 A study was conducted to examine the prevalence of risky drinking and the association between risky drinking behaviors and risk groups of substance abuse among college freshmen. Bivariate analyses were performed to evaluate the association between risky drinking behaviors and risk groups of substance abuse. The results of our study indicated that 87.0% of the participants reported lifetime alcohol use, and 69.4% reported the consumption of alcohol during the past 30 days. Of the former group, 21.4% had engaged in binge drinking, 8.6% had experienced alcohol-related harassment, 9.5% had experienced alcohol-induced blackouts, and 82.0% had experienced drinking alcohol with peers without adults. Substance abuse prevention programs for college students should address the health effects of risky drinking behaviors and train students how to avoid submission to peer pressure.15 10 A study was conducted to assess consumption of alcohol, cigarettes and illegal substance among physicians and medical students in two German states using self-administered questionnaire. The majority of respondents consumed alcohol at least once per week. A significantly higher percentage of men (p < 0.05) reported hazardous or harmful drinking compared to women. The majority of physicians (85.7%) and medical students (78.5%) were non-smokers. Use of illegal substances was considerably lower in physicians (5.1%) than medical students (33.0%). Male students indicated a significantly (p < 0.001) higher level of illegal drug-use compared to female students.16 A longitudinal quasi-experimental panel study was conducted in order to design and implement a skill-based intervention to prevent and reduce substance use among urban adolescents who attended 2 randomly selected high-schools in Tehran, Iran. One-year post intervention data show that substance abuse, knowledge, attitudes, peer resistance skills, level of self-control, self-efficacy, and perceived susceptibility among intervention group were significantly improved, whereas level of self-control and attitudes against substance abuse among the control group deteriorated. To efficiently prevent substance abuse among youth primary preventive interventions should be implemented before onset of substance abuse to improve resistance skills and provide adolescents with information and skills needed to develop anti-drug norms.17 Section II: Literature related to occupational rehabilitation A retrospective study was conducted to assess the quality of occupational rehabilitation for patients with drug abuse by means of an audit of 100 files of patients with abuse disorders who visited their occupational physicians. Quality of rehabilitation was assessed by means of 10 11 performance indicators, derived from the guidelines for the treatment of employees with mental health disorders Four of 10 performance rates were below 50%: continuity of care (34%), interventions aimed at providers of care in the curative sector (39%), assessment of impediments in the return to work process (41%), and assessment of symptoms (45%). The highest performance rate concerned assessment of work related causes (94%). Overall optimal care was found in 10% of the cases this study shows that the rehabilitation process of employees with abused disorders leaves significant room for improvement, especially with regard to continuity of care. Quality of care was partly related to a better outcome. More rigorous study designs are needed to corroborate this finding.18 This study was conducted to investigate the role of occupational therapists working with patients with drug abuse during the rehabilitation process. Occupational therapists(N-172) working in rehabilitation centers were surveyed with regard to their involvement with substance abuse, particularly drug abuse, knowledge of policies, training in the administration of therapy procedures, and perceived levels of competency. Most respondents reported an awareness of policies regarding occupational rehabilitation in their centers. Respondents' main role with this population included activities in positioning, environmental modification, and staff instruction. The study concluded that the major role of occupational therapists working in centers involved providing direct intervention with the patient and not conducting or instructing others in occupational rehabilitation. Therapists also served as a resource on health-related issues for rehabilitation center personnel19. An explorative study was conducted to describe and enhance the understanding of how persons with drug abuse experience the influence of the social environment on their engagement 12 in occupations. Nine persons were interviewed and the data obtained were analyzed using a comparative method. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.20 A study was conducted to describe the needs for occupational therapy among people of working age with drug abuse condition, and to describe treatment interventions based on these assessments. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and behavioral interventions.21 Section III: Literature related to knowledge on occupational rehabilitation A study was conducted to assess the quality of rehabilitation of drug abuse patients by occupational physicians and to relate the quality of the process of occupational rehabilitation to the outcome of return to work. One hundred occupational physicians of a cohort of drug abusers were interviewed about return to work management. Concluded that Quality of occupational rehabilitation of drug abusers can be improved substantially, especially with regard to communication between physicians and continuity of care. There is a need for the development of more effective rehabilitation procedures which should be evaluated in a randomized controlled trial.22 13 The study was conducted to examine the impressions of physical and occupational therapists on therapeutic engagement among their patients. Engagement in this context was defined as a patient's deliberate effort to work toward recovery by participating fully in their rehabilitation therapies. Using a survey approach, physical and occupational therapists (N=199) from across the United States were asked about issues they have encountered in their daily practice that have acted as either barriers or facilitators of patient engagement. Results show that drug abuse was rated as the most frequently encountered barriers impacting patient engagement. Making therapy tasks meaningful and explicitly related to personal goals of the patient was the most commonly reported practice for enhancing therapeutic engagement. Study concluded that the knowledge of therapists gained from day-to-day experience with patients in rehabilitation can be of use to other rehabilitation professionals in treating patients who are difficult to engage in the rehabilitation process.23 A cross-sectional, descriptive self-report survey concluded that National and state organizations need to develop policies that focus on prevention, treatment, and rehabilitation of alcohol and other drug-using healthcare professionals. The results of this study may help to delineate the characteristics of health professionals abusing drugs, leading to the development of more effective policies designed to protect the public, and move toward more tailored and effective intervention strategies for health professionals.24 A study was conducted to describe the role and activities of Drug Rehabilitation Centers in reducing the drug-abuse problem in Dharan. It also offers suggestions for increasing the effectiveness of prevention programs. This study concluded that there should be a strong coordination and network with each other to increase the effectiveness of the treatment program for drug abuse. The treatment centers should be increased in number as well as in quality.25 14 Section IV: literature related to self-instructional module. A study was conducted to evaluate the effectiveness of student centered module of learning reported that 100% of students found the module, as a positive learning experience as it improved the knowledge, understanding and skill in the selected learning area. 26 A study was conducted to evaluate the effects of self-instruction on learning, satisfaction with the teaching approach, and health status of persons with rheumatoid arthritis (RA) by control-group pre-test-posttest design, among thirty subjects receiving care at a rheumatology clinic who met the study criteria; they were randomly assigned to two groups, self-instruction and control. One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory (RAKI) scores, with the pre-test as covariate, was used to examine the difference in learning between the self-instruction and control groups. There was significant difference between the groups (P=0.01). Participants who completed the self-instructional program had improved scores on the posttest as compared to the control. 27 A study was conducted on the “Effectiveness of need based self-instructional module on knowledge regarding the management of dysmenorrhea among adolescent girls in an urban school, north Bangalore”. The results of this study revealed that the mean pre-test knowledge score of 55% at 0.05 level of significance. The study results suggested that the self instructional module was effective in increasing the knowledge level of adolescent girls. 28 A study was conducted on the effectiveness of self instructional module on home care for rehabilitation of hospitalized patients with coronary artery disease revealed that the mean posttest knowledge scores 48.5, was significantly higher than the mean pretest knowledge scores 25.5 at 0.05 levels of significance. The study results suggested that the self instructional module was effective in increasing the knowledge level of patients. 29 15 STATEMENT OF THE PROBLEM A study to assess the effectiveness of self-instructional module on occupational rehabilitation among drug abuse patients at selected rehabilitation center, Bangalore. 6.3 OBJECTIVES 6.3.1 To assess the knowledge of patients with drug abuse regarding occupational rehabilitation in terms of pretest knowledge scores. 6.3.2 To assess the effectiveness of self-instructional module by comparing pre and posttest knowledge scores of patients. 6.3.3 To determine the association between posttest knowledge scores of drug abuse patients and their demographic variables. 6.4 HYPOTHESES H1: There is no significant difference in pretest and posttest knowledge scores of drug abuse patients on occupational rehabilitation. H2: There is no significant association between posttest knowledge scores of drug abuse Patients and their demographic variables. 6.5 ASSUMPTIONS 6.5.1 Self-instructional module may enhance the knowledge on occupational rehabilitation among drug abuse patients. 6.6 OPERATIONAL DEFINITIONS Effectiveness: Refers to the extent to which the self instructional module has attained the desired gain in knowledge score as measured by knowledge questionnaire. 16 Self-Instruction Module: It refers to systematic organized self-learning /directed material on occupational rehabilitation which was given to drug abuse patients. Drug abuse patients: Refers to Males who are diagnosed as drug addicts between 21-60 years of age admitted in the selected rehabilitation center, Bangalore. Occupational Rehabilitation: Occupational Rehabilitation refers to any meaningful, goal directed activities (self-care skills, education, work, or social interaction) which is given to change the behavior of the drug abuse patients. Rehabilitation Centre: Refers to an area where physical and occupational rehabilitation services are provided for drug abuse patients. 7.0 MATERIAL AND METHODS 7.1 SOURCES OF DATA Drug abuse patients who are admitted in selected rehabilitation center, Bangalore. 7.2.1 RESEARCH APPROACH In the present study an evaluative approach will be used to assess the effectiveness of selfinstructional module on occupational rehabilitation among drug abuse patients. 7.2.2 RESEARCH DESIGN In this study one group pretest - posttest (pre-experimental design) has been adopted to carry out the present study. 7.2.3 SETTING OF THE STUDY Study will be conducted at selected rehabilitation center, Bangalore. 17 7.2.4 RESEARCH VARIABLES Independent variable: In this study it refers to self-instructional module on occupational rehabilitation. Dependent variable: In the present study it refers to the knowledge level of the drug abuse patients on occupational rehabilitation. 7.2.5 POPULATION In this study, drug abuse patients were the population for the study. 7.2.6 SAMPLE SIZE In this study the sample comprised of 60 drug abuse patients admitted in a selected rehabilitation center, Bangalore. 7.2.7 SAMPLING TECHNIQUE In the present study the convenient sampling technique was used to select the samples. 7.2.8 SAMPLE CRITERIA INCLUSIVE CRITERIA The study includes drug abuse patients between 20-60 years of age who gave consent to participate in the study Who can understand Kannada. Who are available at the time of data collection. 18 EXCLUSIVE CRITERIA The study excludes drug abuse patients Drug abuse patients with medical complications. Drug abuse patients who were under primary treatment. 7.2.9 DATA COLLECTION TOOL The data will be collected by using structured questionnaire schedule which consist of two parts. Part 1- It includes the demographic variables such as age, educational status, monthly income, type of family, family history of drug abuse, duration of use and source of information. Part 2-It includes knowledge items on occupational rehabilitation 7.2.10 DURATION OF THE STUDY As per university guidelines that is 4 to 6 weeks. 7.2.11 DATA ANALYSIS METHOD The collected data will be analyzed through descriptive inferential statistics. Descriptive statistics- It includes mean, frequency, percentage, range, standard deviation to describe demographic variables and knowledge aspects. Inferential statistics- It includes parametric paired t’ test and non-parametric chi-square test to assess the effectiveness of self-instructional module and study the association between the Knowledge scores with selected demographic variables. 19 7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED IN A PATIENTS OR OTHER HUMANS OR ANIMALS? YES 7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? YES, Ethical clearance certificate enclosed. 20 8. LIST OF REFERENCES 1. Mark Dombeck, Alcohol Substance Abuse ( Interent ) 2009; Available from http:// www.mhcinc.org. 2. Kevin P Daly: John Richards, Substance Abuse 2008; Available from http:// www.emedicene health .com / substance abuse. 3. World Health Organization. Regional health forum. Vol 10 (23); 2005. 4. Susan Everingram, C. Rydell Cocaine Consumption in the U.S. Estimating part Trends and Future Senarios. Socio – Economic Planning sciences Vol – 29 (4) December 2000. 5. Dr.K.Lalitha, Mental health and Psychiatric Nursing, 2007, 11 edition, VMG book house, 35-48. 6. S. Zaimov, wisegeek Article of occupational Rehabilitation 2003 – 2005 (24) 2008 2010. 7. Professional Guide to disease, 2005, 8th edition. 8. James C. Anthony, vocational rehabilitation outcomes of veterans with substance use disorders in a partial hospitalization program psychiatric serve 51, 2000, 1570-1572. 9. Heather R. Huhman, the peer supported community program, published by Substance abuse and mental health services administration, 2008. 10. Drug-Statistics Bangalore, 2007. 11. Jain.V, Socio demographic profile of 15-24 years old male narcotic substance users in a resettlement colony of Delhi, 2009. 12. Megge Miller, Illicit drug use regarding amphetamines, 2000. 13. Siddiqui HY, National survey on extent patterns and trends of drug abuse in India monitoring system, 2004, 3-9. 21 14. Weich L, Occurance of comorbid substance use disorders among acute psychiatric inpatients at Stikland hospital in the Western Cape, South Africa, 2009, 213-217. 15. Sennekamp W, Basler B, [Problematic consumption of addictive drugs in psychiatric rehabilitation, 2004. 16. Ovandir Alves et al, Yon amine Drug abuse among workers in Tehran, Iran, 2004, 2004. 17. Indian express, 2000. 18. Chung JC, Active learning of geriatric rehabilitation: deliberations of an undergraduate occupational therapy programme, 2001, 250-256. 19. Chan SC, drug abuse and engagement in occupation, 2004 , 408-15. 20. Schkrohowsky JG, Kalesan B, Alberg AJ, Tobacco awareness in three U.S. medical schools, 2007, 101-6. 21. Lequerica AH, Donnell CS, Tate DG, Patient engagement in rehabilitation therapy: physical and occupational therapist impressions, 2009, 753-60. 22. Sullivan, Michael, Psychologically Based Occupational Rehabilitation: The drug abuse Prevention Program, 2003, 97-104 23. Bimla kapoor, text book of Psychiatric Nursing, I edition, New Delhi, Kumar publications.2005. 24. Sreevani, Text books of Mental health Nursing, Jaypee publications, 2005, II edition. 269-275. 25. Verbeek J, Spelten E, Kammeijer M, Sprangers M, Return to work of cancer survivors: a prospective cohort study into the quality of rehabilitation by occupational physicians, 2003 , 3527. 22 26. Souza D, Juliana L. Evaluation of SIM for senior secondary school students. The Nursing Journal of India2004 August; 9 (8): 75-87. 27. Brock C. A study to identify the effectiveness of learning activity package for trhe adults with rheumatoid arthritis, Journal of Advanced Nursing 2003 June; 28 (8): 265275 28. Yumnum Sundari Devi. Effectiveness of need based SIM on knowledge regarding the management of dysmenorrhoea among adolescent girls in an urban school, North Bangalore. Unpublished M.Sc Nursing Thesis, RGUHS Bangalore 2002. 29. Lindsay C, Jenrich J.A, Bierndt M, programmed instruction booklet cardiac rehabilitation teaching, Heart Lung, 1999 November; 20 (6): 698-531. 23 SIGNATURE OF THE STUDENT : REMARKS OF THE GUIDE : The research topic selected for the candidate is suitable as there is a need for improving the knowledge of patients with drug abuse regarding occupational rehabilitation. NAME AND DESIGNATION OF THE GUIDE GUIDE NAME AND ADDRESS : Ms. Manjula Rathna Asst. Professor Psychiatric Nursing Pragathi College of Nursing # 33, Byrathi Extn, Near Ebenezer Hosital, Kothanur Post, Hennur Bagalur Main Road, Bangalore-560077 SIGNATURE OF THE GUIDE : HEAD OF THE DEPARTMENT : Ms. Manjula Rathna Asst. Professor SIGNATURE OF HOD : 24 REMARKS OF THE PRINCIPAL : The research topic selected for the candidate is appropriate. There is a need for improving the knowledge of patients with drug abuse regarding occupational rehabilitation. SIGNATURE OF THE PRINCIPAL : 25