Exploring Drug Use Process among Kurdish Migrant Workers in Workplaces: A Qualitative Study

Background: Drug addiction is a significant social, medical, and health problem. . Although employment has often a positive effect on people’s quality of life, there is evidence that inappropriate condition in the workplace may trigger for drug use in employees. The aim this study was to explore contributing factors to drug use among migrant workers. Methods: In this qualitative study, Thirty-five subjects were recruited through purposive sampling. Data were collected by using a variety of qualitative techniques such as in-depth, semi-structured face-to-face interviews with open-ended questions and group discussion. Results: Among the entire interviews, 529 initial codes and 283 main codes were extracted and classified into 18 categories and five themes after careful examination. Conclusion: As the results showed, drug use is prevalent among workers. The most important recommendations to prevent drugs use in workplace are taking more serious measures against drug dealers, prohibiting carrying drugs at workplace, implementing stricter drug test before recruitment and periodical tests and considering worker rights is useful.

environments, problems, and situations that are unfamiliar. They have not only lost their former relatives or friends, but also encounter stress and psychological distress from many sources in new living and working environment (6). In addition, some of these people are not usually given sufficient income and are forced to live and sleep in parks, streets, or half-built buildings. Living in such environments provides a basis for delinquency, social deviations, and drug abuse among migrant workers (7). The number of industrial workers are increasing and lack of jab and worker immigration put them at risk of drug use and homelessness (4).
According to 2010 annual report of Iran drug control headquarters, 21% of the total 13 million workers in Iran are drug addicts, and the highest prevalence of drug use is among simple workers (18.7%). This report also indicates that 70% of the country's drug addicts are employed; 10% of them had started using drugs in workplace, and in more than 10% of them the first use of drugs had occurred at a suggestion of a co-worker (8).
Kurdistan is a province located in the west of Iran, with a population of 1,493,645 (9). The estimated employment-to-population ratio in Kurdistan is 33.3% (22.8% for the agriculture sector, 26% for the industry sector, and 45.4% for the service sector) (10). High rates of unemployment have caused Kurdistan's people to turn to false jobs and migrate to other cities to find a job and provide living expenses. There are no official statistics on the number and status of addiction and drug abuse in Kurdistan. However, a report from Coordinating Council for Drug Control in Kurdistan revealed that there are about 20,000 drug and stimulant users across the province. Increase addiction to drug made raised concerns for health authorizes at province and country level. Based on risk factor identification approach, the purpose of drug use prevention is to eliminate or reduce the risk factors.
Hence, this study is to explore contributing factors to drug use among migrant Kurdish workers to Tehran.

Participants
A qualitative methodology was applied in this project. Participants for existing study were workers who left their city to find jab. In order to achieve a diverse perspective, the purposive sampling procedure was performed to insure that workers with different levels of socioeconomic context, age, level of education, and marital status are existent in this project. The characteristics of participants are offered in Table 1.

Data collection
Focus group discussions and in-depth interviews were applied in order to data gathering.

i. Focus group discussions
At the first of study, focus group discussion (FGD) was applied to explore the subject with 8 workers.
FGD was accomplished in places that were suitable and accessible for workers. FGD session lasted for about 45-60 minute.

ii. Semi structured interviews
After FGD, 27 semi-structured, open-ended questions were applied with workers in order to reach deeper data. All interviews were tape-recorded. At the opening of each interview, the workers were questioned about demographic data. They were requested by interviewer with interview guide for describing and discussing their experiences about drug use in workplace. Depending on the topics were presents by the workers, the researcher continued interview with other questions such as "what was your first experience about drug use in workplace? Why did you use drug in workplace? What factors is related to drug use in workplace? "If you drug use in workplace, what were the situation that you experienced?" What conditions were related to drug use in your workplace? What did you experience about life away from your family? Moreover, it was asked about social, cultural and environmental components that might have affected workers drug use behavior. After each interviews workers were demanded to explain more about what they have described. For instance, workers were asked 'What do you mean?' 'Describe further' with the aim of have deeper considerate of workers' experiences about drug use. The interviews were applied at a place convenient for the respondent. Each interviews sustained for nearly 60-100 minute.

Data analysis
It was used a content analysis with a conventional method for analyzing the records and to discover key themes as well as associating trends and patterns took place through the diverse individuals. As such the main researcher read the interviews several times and discussed the best approach about coding. Throughout the passé of analysis, main investigator commonly confirmed dissimilarities and similarities in the documents and manuscripts, and preferred key concepts and made analytical categories by doing contrast of each section of data with other data. Additionally, it was used MAXQDA software version 12 for analyzing of data.

Description of study sample
The thirty-five workers who participated in this study were between 15 and 40 years old with a mean age of 28.2 years. Due to a lack of access to women worker who were drug users, this study was conducted among male workers only. (34.2%) of them were 15 to 25 years old. More than half of the workers (57.1 %,) had completed secondary or high school, (62.8%, of them were contract workers, Also, 57.1%, were married. (Table 1). Opium (57.1%) was the most common drug used by the workers. (4, 11.4%) of workers had a history of injection drug use ( Table 2).

The themes extracted from the experiences of the participants
Based on the all interviews, five themes were extracted from the data. In this study, 529 primary codes and 283 main codes were extracted, and after a detailed survey, 18 main categories and five themes were extracted, including personal factors, job factors, structural factors, cultural factors, and family factors.

Theme #1: individual factors
High rate of unemployment in small cities and less developed provinces, failure to recognize job opportunities and the proper grounds and low economic growth rate convince many to migrate to large cities and to live in slum areas that are characterized with cultural and social poverty, and being a good ground for crime and drug addiction. According to the participants, the majority of migrant workers only took opium, hashish, and cigarette occasionally before their migration. After migration to larger cities, feelings of loneliness, the absence of family members, the easy access to drugs, the proliferation through mass media about the good effects of these drugs on solving sexual problems, and the lack of information about the damages caused by drugs, lured workers to become regular users.
Personal factors prepared the ground for drug use in workplace. Factors such as feeling homesick, losing support, lack of adequate income, poor physical and spiritual conditions, low education level, and lack of adequate information all have vital influence on drug use behaviors in workplace. This theme contained several subcategories: emotional factors, physical factors, financial factors, information factors, and personal capabilities factors. positive and negative emotional feelings and lack of skills to manage these feelings in some of the works leading to drug use. Such as, feelings of homesickness, hopelessness and impatience had adverse effects on the workers who work away from their families. Also, workers economic, mental, and family condition are among the factors that prepare the ground for development of drug addiction at work. Job factors related to the work place have a role to drugs use. The pressure of peers who use drugs , easy access to drugs at work, heavy work, stressful condition like lack of jab security, lack of interest in job, injustice at work and lack of implementation of anti-drug regulations, monotonous work condition, wrong beliefs about drug (that it is good to improve performance and strength),

Structural factors
There are several factors at this theme including legal and regulating system, facilities, and availability of drugs. The majority of the participants mentioned the importance of the employer's supervision at the workplace. It seems that there is no well-codified program to prevent drug addiction even at labor-related organizations.
"My friends and I used to take drugs after work or late at night. The employer was aware of it. I believe that he also was a consumer. Still, he insisted that we should not use drugs in the presence of other workers." (P11; 29 years old, high school education, married, opium user) "There must be more strict supervision on drug use at work. The workers must be tested regularly and occasionally to find and fire drug addicts and the boss should provide healthy enviroment and without drug for workers" P8; 28 years old, primary school education, single, opium user).

Cultural Factors
Factors like beliefs and thoughts and cultural condition are effective in the expansion of drugs in workplace. Wrong beliefs about drugs like that it is good for strengths and staying sharp were effective in drug addiction among workers. According to the participants, weak religious and spiritual beliefs are also effective to become a drug addicted. "I have five brothers and two sisters; three of my brothers are occasional drug users, and one of them uses crystal. As far as I remember, there was always somebody in the house using drugs." "p13, 23years old. Single. University education, opium user"

Discussion
Workplace is an area of social life that play an undeniable role in economic development, performance improvement, and innovation. The world of work is one of the areas of social life that should be considered for the health of the people..The present paper focused on drug use among workers. Given that drugs are used at work place, and the severe harms appeared as insecurities at work, studies on the prevalence and distribution of drugs and alcohol at work have drawn a great deal of attention among researchers (11).

Personal Factors
All the participants were forced to leave their hometown in search of a job. This study showed that the majority of participants were not use drug in their hometown; however, they had experienced to drug use after finding a job away from home. The most important preventive environmental factor to not use drugs in the workplace is the fear of losing the job; however, none of the participants mentioned this factor. Factors such as living away from family, bad spiritual condition, and experiencing unpleasant feelings were among the factors that prepared the ground for drug addiction, which is consistent with other studies (4,12). Also, reported a significant relationship between drug use and living away from family. In our study we also found that the majority of the participants lived in workers houses or half-built building, which in most of the cases are very unhealthy. These facilities are usually overcrowded, and many of the residences are drug users who openly use drugs in shared spaces (4). Living away from family and with other workers are among the factors that increase drug use among workers.
Regarding the age range, the younger workers were more interested in using drugs and alcohol at work. Professional workers were less interested in drugs comparing with workers with rotating shifts (13). A survey of the prevalence and pattern of using alcohol in Australian workers showed that such behaviors were most common in workers of industrial plants following by construction workers, hospital staff, and farm workers. Creating stable job opportunities in rural areas can convince local residents to stay in their villages. Creating job opportunities is a way to prevent migration from villages to cities.

Job Factors
Heavy workload, late night work, and overnight shifts that threaten the mental health of workers prepare the ground for drug use. The condition of using the drug at work refers to the worker's perception of the extent that the work environment supports using drugs and alcohol at work.
According to Ames et al. there are three aspects of the condition of using drugs at work. The first aspect is defined as the perceived access to alcohol and drugs. That is the extent of access to drug and alcohol at work during work hours and break times. The second aspect is pictured as the norm, i.e., the extent of using drugs among the members of friends and colleagues network. The last aspect deals with the norms of accepting or rejecting drug use in social networks at work (14).
The participants mentioned a heavy workload as a factor that prepared the ground for using drugs.
This factor was mentioned in another similar study. Saberi-Zafarghandi et al. reported that drug use was most common at construction workers and in workers with heavy works (4).
The majority of the participants also referred to stress at work as one of the factors related to drug use. Frone (15) argued that the negative psychological aspects at workplace predict motivations to drug use. Long-term stresses might trigger nervous-chemical and hormonal changes. This phenomenon has to do with anxiety, depression, weaken immunity system, higher risk of death, cancer, and cardiovascular diseases. To decrease stress, some individuals choose drugs and alcohol.
Muntaner et al. (16) emphasized the relationship between mental-social environment and mental health. Of note, there are many factors effective in using drugs and alcohol; however, stress is one of the most critical factors in this regard.. Consequently, there are two general conditions for stress attenuation recognized by Conger. One relies on the fact that using drugs decreases stress and problems that lead to stressful condition and another is that facing with stressors leads to drug use.
Work shifts are categorized among stressors as they interrupt workers' biological clock and lead to bad moods, sleeping problems, and loss of appetite. Researchers have argued that overnight shift workers feel the desire to smoke twice the day shift workers (17). Consistent with Frone (13), our results indicated that perceived lack of job security in workers was related to drug use.
Another finding is that the majority of the participants mentioned contaminated of work environment and addiction among their colleagues. Also, this finding is consistent with Lehman study that showed one out of five participants had seen their colleagues using drugs at workplace (18). Some work conditions cut the workers' connection with their social networks. Under hard conditions like stressful work condition, heavy workload, complicacy of workspace, low income, feeling no power and authority at work, and even other similar problems like problems in private life, people try to find tranquility in anything including illegal drugs and alcohol.

Structural Factors
According to the participants, there is no special outcome for wokers with drug use behaviors. and some of Iranian employers are negligent of drug use among their employee including, their reasons in view of participant are such behavior does not interfere with the job. One of the general aspects of the health promotion in workplace is to create a drug-free environment. It is to be noted that successful implementation of such policies and approaches depends on social and economic factors.
Such factors include social values, quality, and availability of social networks, economic condition, common social policies, service providing systems, and relationships at work. Among organizational policies for the workers who use drugs and providing consultation and treatment services at workplace. Thus, there is a need to adopt an educational approach to remove wrong beliefs about drugs and its effects on improving the performance of the employees. Adopting a constructive approach to drug addiction, informing the personnel about the services and resources for treatment, general screening to find drug users at early stages, providing consultation for families and personnel throughout detoxification whether it is done through hospitalization or otherwise are also recommended. For instance, using alcohol during breaks, at the office or even at some specific hours in the day is allowed in some workspaces (19). The participants reported that the employers did not care about drug using habits among their employees and did not take it seriously unless such behavior affected the performance of the employee. This finding is consistent with other studies (4,20).

Cultural Factors
Cultural factors were also highly effective in drug use behaviors in workplace. Migration to large cities creates several problems. The MDMP3 published list of the jobs with high risk of using drugs and this list reads artists, musicians, medical personnel, farm workers, and transportation workers (mainly long-range truck drivers); one common feature of these jobs is the massive pressure so that the nature of these jobs fosters a drug using culture. To improve the performance of employees, some profiteer employers even provide a supporting condition to use drug (19). Moseki (20) showed that employer guide them toward using drugs to adapt to their situation I mine workers in the Sought Africa that. As a result, negative behaviors find a chance to appear as a way to adapt to the new complicated lifestyle. Another aspect that can predict the development of a drug using culture at work is social control at workplace. Critical factors like low sense of organizational commitment and belonging, highly variable work hours, inadequate supervision, working in isolation, the absence of official policies in this regard, and legislation about using drugs at work all contribute in the expansion of such behaviors at work.

Limitations
The results were based on private interviews with workers, and no medical test was carried out, which might create bias in the findings. The study focused on men workers. However, some studies have emphasis on role of gender in using drugs. Another limitation was rooted in the type of study, relying on interviews, and the probability of error in all of these. Unwillingness of some workers to participate was another limitation, which might have been due to the fear of losing a job or facing negative consequences.

Conclusions
As the results showed, drug use is prevalent among workers. The most important recommendations to prevent drugs use in workplace are taking more serious measures against drug dealers, prohibiting carrying drugs at workplace, implementing stricter drug test before recruitment and periodical tests, paying fair salaries, separating workspace of drug addicts and healthy workers at work and after work (workers camps), devising leisure and educational programs about drugs, establishing drugs clinics based on the latest standard of detoxification and methadone maintenance treatment, establishing damage control centers, promoting self-help activities among drug addicts, providing free treatment and rehabilitation leave for drug addicts, performing follow up drug test after rehabilitation and returning back to work, and developing program to improve personal skills such as anger/stress management for workers.

Consent for publication
Not applicable.

Availability of data and materials
The datasets produced and analyzed throughout the present study are not publicly available in order to keep the participants' privacy but are available from the corresponding author on sensible request TP was the main investigator, designed the project, collected the data, did the statistical analysis, and wrote the first draft of the manuscript. MK,AR and TP participated in the statistical analysis. FD,HM and KP provided further content and critically revised the final article. All authors read and accepted the final Iran Drug Control Headquarters paper, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.