Impact of abstinence on employment, education, and health outcomes in Egyptian SUD rehabilitation clients: A three-year prospective study

J Subst Use Addict Treat. 2026 Apr 29:210004. doi: 10.1016/j.josat.2026.210004. Online ahead of print.

ABSTRACT

BACKGROUND: SUD rehabilitation outcome studies have been carried out for decades. But no large study has been reported from Egypt or the Arab region. Freedom Drugs and HIV Programme is a large drug rehabilitation program operating since 1989.

METHODOLOGY: A cohort sample of 2503 clients admitted to 28 SUD Rehabilitation centers in 2019 in Egypt was followed up in 2022. Staff member reports were validated through a randomized sample of family members feedback, and urine tests that were administered to 5% of participants (101 individuals).

RESULTS: During the Year 3 follow-up, 82% of clients (2052 individuals) were successfully reached 51% of the participants were abstinent in Year 3. 43% of participants experienced no relapses during the study period. Abstinence was clearly associated with positive outcomes like employment, education, better health, improved well-being, and stronger family relationships. However, while 67%, 77% and 76% of the abstinent population improved or strongly improved on family relationships, physical and mental health respectively, unexpectedly around 10% of the abstinent population deteriorated or strongly deteriorated on all three outcome measures. Family dynamics, undiagnosed, masked or chronic physical illnesses, and the nature of recovery stages may explain these reported deteriorations. The results call for further study. The results also suggest the importance of improving post-discharge services. On the other hand, 32%, 31%, and 41% of the non-abstinent population reported improvement or strong improvement on family, physical, and mental health measures, which may indicate a harm-reduction component of residential programs even in non-abstinent clients. Finally, there was no difference in legal problems between the abstinent and non-abstinent populations, which may suggest unresolved legal problems from the time of drug use or a lack of law-abiding attitudes even in abstinent clients. Further studies are called for to clarify this unexpected result as well.

CONCLUSIONS: The current study results suggest that the studied program achieves outcomes comparable to similar programs in other parts of the world. It also throws some light on the improvements in various outcome aspects as related to abstinence and suggests possible harm-reduction outcome aspects even among non-abstinent clients.

PMID:42067142 | DOI:10.1016/j.josat.2026.210004