Table 3 Quotes illustrating factors contributing to retention in the OST program

As I told you earlier the bachelors don’t think about their future. If they were married they would obviously think about their kids and the future. When I was a bachelor I didn’t care about anything other than my drugs. A meal for me at home is taken for granted, so I don’t care about the future or earning. So my lifestyle when I was a bachelor and today after I am married is very much different… In those days, I only thought about taking the drugs and nothing about the future at all. But today, even when I want to take the drugs, I cannot take them after thinking about my wife and children. I think it is because of this that bachelors don’t think about the future, so they are not compelled to quit the drugs. They don’t have to think about a wife neither do they care about earning any money. Participant 6 (dropped out)

The most important thing is that it saves me a lot of money. There is no tension for buying the drugs, and relationships with family members is also becoming better. I can also feel the changes in how people look at me. There is no tension for money, for getting arrested by the police, and I don’t have to go at North AOC [drug using hotspot] anymore. Now I want to dress up smartly and hope to buy a two-wheeler vehicle of my own. If fact, I have many dreams for my future which were not there at all earlier. Participant 18 (retained)

There were times when I used to stop taking drugs, and at those times I suffered a lot and had a very hard life. I even thought of committing suicide. And so instead of living that fearful life, I feel it is better to stay on methadone. When I am on methadone I never have that kind of feeling, never have those kind of negative thoughts. As long as I am on methadone there is no suffering in my life. Participant 4 (retained)

One point is that most of the clients who are staying in the program for a long time, their family members are quite supportive. They are monitored closely by their family members, even when they are going to miss one dose, they [the family members] will call up and communicate with the counsellor and service provider. So that kind of relationship and communication is necessary with the family member and service provider. They would also ask if he has gone to take his dose for today… There is need for good support. Service provider 25

When I was taking drugs, then no one would support me as they are now. There would be no one to give me even 5 rupees at that time. Now, if I go for taking the methadone, they will give me money to get the fuel for the four-wheeler instead of the two-wheeler. On top of that they will ask me if I have some pocket money. Sometimes when there is a shortage of vehicles for me to go to the centre, they will arrange a vehicle for me somehow by postponing another task, with the thought that going to the centre to take the methadone is very much necessary. Participant 13 (retained)

When my mother, father or wife support me, like when they wake me up they will remind me about the medication. If I don’t have the fare to go at the centre, they will manage somehow and give it to me. So these kinds of things give me some encouragement. Further, when I see them peeking and waiting for me to return home and getting worried that I may go the wrong way again, I understand their feelings and think I will not go back to that way again. Participant 5 (retained)

Yes, it is because of the support from the family members that people can come here daily to take the methadone. My home is a little far away from the clinic, but I can come here daily because of my family support. Whether there is any strike or bandh, I used to reach the clinic anyhow with my family support and never missed my dose. Participant 16 (retained)

Without the family’s support, I don’t think a person could continue on the program successfully. Initially I used to come here for taking the methadone along with my family, my wife or uncle. At the initial stage when the dose was small, I got wearied and blew out, so at this stage if a person is alone he might have gone in a wrong direction. So I feel that family support is very much necessary here. Participant 19 (retained)

(I)f the family members give proper support, there is less chance of drop out. If the family support is less, the chance of drop out is high. At the time of induction phase, we inform them that they (family members) can always come along with the client, but this is mandatory for 2 months’ minimum. So, I would say that most of the drop outs are due to lack of family support. Service Provider 27