Substance use term implies that certain psychoactive substances are introduced into the body. For example, by drinking, inhaling, or injecting.1 When someone is said to misuse substances, the amount of substance use does not matter. A small amount used during pregnancy can increase the risk that the child will develop health problems. In addition, a small amount of illegal substances can lead to legal problems.2 A moderate or higher amount, if used regularly, can also lead to higher risk of different kinds of cancers over time.3
Substance misuse is a pattern of self-administered substance use that may lead to substance addiction.4 A substance is a psychoactive compound with the potential to cause health problems, substance-use disorders, and addiction.5
In the last decades, there have been some studies dealing with the importance of self-efficacy, internal strengths and their contexts as a belief and their relation to forms of recovery from drugs and alcohol or relapse.6 Annual statistics of the National Institute on Drug Abuse in 2016, it was estimated that the number of users of illicit drugs in the United States is about 7 million. It is common in all age groups in the public, Excessive alcohol ingesting and substance misuse yields severe adverse effects and considered as a main cause of admission in hospital and associated with increased crime rates, and decreased production.7
In Saudi Arabia, according to the National Commission for Drug Control, in 2018, there is increasing of substance misuse among Saudis and associated with many medical diseases, psychiatric disorders, and educational, occupational, social and legal consequences. Amphetamine, heroin, alcohol and cannabis were the most commonly abused among Saudi patients and the main risk factors were peer pressure and psychosocial stresses.8
The stage of psychological rehabilitation comes within the steps of addiction treatment. Psychological rehabilitation means psychological treatment processes by relying on substances that have the same psychological effect on addicts, such as narcotics, alcohol, street drugs, such as cocaine, heroin or amphetamines, and prescriptions, and the purpose of this is to enable the patient to stop the misuse of narcotic substances, in order to avoid the negative psychological effects of it, especially when excessive drug use, and psychological rehabilitation for drug addicts is done by teaching the patient a new and effective way to deal with a drug-free environment in particular, and the patient must be kept away from bad friends who were taking drugs with him to ensure that the patient does not return to the addiction again.9
The journey of drug treatment and regaining a healthy and safe life is neither easy nor quick, it is a lifelong commitment with dedication and hard work to completely get away from drug abuse and relapse into addiction.10 The rehabilitation stage of drug addiction comes to be the most important step in the treatment stages, which mainly aims to reintegrate addicted people after recovery with society to become positively productive and influential individuals.11
Rehabilitation of drug addicts takes place immediately after the withdrawal symptoms phase, specifically after the detox step.12 During the rehabilitation period, the patient needs psychological and social support provided by friends and family, as some close people have a strong influence in completing the treatment and rehabilitation process.10
Background of the problem
The stage of psychological rehabilitation for the addict is considered the most important stage that must be taken into account, without which the addict may relapse back into addiction. The importance of psychological rehabilitation is considered as another life, and without it, the course of addiction treatment is null and has no consideration.13
Psychological rehabilitation and social rehabilitation are two sides of the same coin, seeking to develop the personality of the addict by strengthening some of his/her qualifications such as social and individual skills, so that the individual can achieve maximum saturation in the context of some concepts, self-confidence and self-understanding,9 as well as positive interaction with all social, professional and family levels, in a context balanced with principles, concepts, ethics and values.13
Different studies had assessed the psychosocial life aspects among substance abuse patients and clients within different geographical contexts. For example, Poudel et al14 conducted a descriptive cross-sectional study that aimed at identifying the psychosocial problems and related factors among clients diagnosed with substance abuse disorders. The sample of the study consisted of 204 clients who were diagnosed with substance abuse disorders. The revised version of the Drug Use Screening Inventory was used to collect data from the study participants. The results of the study showed that the clients had high level of psychosocial problems represented by substance abuse problems, school performance problems, behavioral patterns problems, peer relationship problems, social competency problems, psychiatric disorders, family system-related problems and work adjustment problems.
In Palestine, Al-Naser and Omar15 conducted a study to assess the psychosocial adjustment aspects among recovered drug abuse patients. A stratified random sample of 108 addicted patients were recruited in this study. The results of the study showed that the study participants had a moderate level of psychosocial adjustment. The results also showed that the psychosocial impacts of drug abuse among addicted and rehabilitated patient differed significantly based on the socio-demographic characteristics of the participating patients.
Singh & Gupta16 reported that among the most serious of these problems is poor psychological and social adjustment, mental and cognitive abilities disorder, low ambition, poor production, and a threat to the scientific and professional future. This results in the loss of the ability to carry out social responsibilities and roles, and an increase in the proportion of behavioral deviations, and delinquency to crime in society.
However, there is a significant lack of local studies exploring the psychosocial life aspects among substance abuse clients who are at rehabilitation stage in Saudi Arabia. Therefore, there is an urgent need to conduct a survey study exploring the psychosocial life aspects among clients at the rehabilitation stage in Saudi Arabia.
Literature Review Process
A total of 7 studies were found to be in relation with the topic addressed in this study, which is the psychosocial life aspects of substance misuse clients at rehabilitation phase. However, a number of related studies were found to be indirectly discussing the variables of the study and they were included in the empirical literature as well. A comprehensive literature search was performed using the keywords: "psychosocial, “psychological”, “social”, “life”, “rehabilitation” and “substance misuse”. The search process was performed in the following electronic databases “MEDLINE, PubMed, CINAHL, PsycINFO”. Full text articles, published in English during the period between 2016 and 2021 were included in the literature (Figure 1). However, studies with older publication dates that provided beneficial research-based evidences were narrated in this literature to support the literature review section.
Existing Empirical Literature
The problem of substance misuse in the last decade of the twentieth century was exacerbated not only by economic, social and social complications but also by the high cost of primary prevention and secondary prevention programs and their failure to reduce the risk of addiction through the treatment of addicts.17 Substance misuse it is become “a major health problem in different countries, affecting all levels of society, with possible irreversible consequences”.18(p3)
Human behavior is not a simple behavior that can be explained by its reaction to one factor or a set of primary principles. It is a highly complex and psychologically, biologically, socially, ecologically and spiritually related behavior.19 Substance misuse had been referred to the consumption of alcohol, or any further drugs, including illegal drugs and prescribed drugs can causes changes in mood or thinking.20 Based on the Diagnostic Statistical Manual – 5 (DSM-5), the diagnostic procedure of substance misuse is built on the research confirmed control or social impairments, risky usage, and pharmacological standards.21
In the last two decades, there have been some studies dealing with the importance of self-efficacy, internal strengths and their contexts as a belief and their relation to forms of recovery from drugs and alcohol or relapse.22 Annual statistics of the National Institute on Drug Abuse in 2017, it was estimated that the number of users of illicit drugs in the United States is about 7 million. It is common in all age groups in the public, Excessive alcohol ingesting and substance misuse yields severe adverse effects and considered as a main cause of admission in hospital and associated with increased crime rates, and decreased production.23
In Saudi Arabia, according to the National Commission for Drug Control, in 2017, there is increasing of substance misuse among Saudis and related to many medical diseases, psychiatric disorders, and educational, occupational, social and legal issues. Amphetamine, heroin, alcohol and cannabis were the highly reported misused among Saudi patients and the main risk factors were peer pressure and psychosocial stresses.8
In fact, most drugs affect the brain’s reward route by overflowing it with the chemical messenger dopamine. This overstimulation of the reward route causes the extremely pleasurable “high” that leads people to take a drug again and again.24 Then when the substance misuse patient stopped to the use of drugs he will become more aggressive, dangerous and harmful or tough, and he became not caring by social values, family and community beliefs’, also he became incapable to manage his responsibilities in his life.25 Aaron Beck and others argue that dependence on drugs is due to a system of addictive beliefs and refers to a range of ideas that focus on finding pleasure, solving problems, and treating or escaping those.26
Substance misuse patient will be suffering from physical symptoms it is include withdrawal symptoms, which is caused by the negative response of the body to become without a substance and it’s will depended on the time of use.27 Withdrawal symptoms defines by the National Institute of Drug Abuse (NIDA) as a probable group of signs and symptoms will be result from the sudden stop of use, or decrease in the steady dosage of a drug. These signs and symptoms of withdrawal symptoms could be vary significantly from one drug to the others.18
Drug addiction rehabilitation involves attending some group therapy sessions. These group sessions help people recovering from addiction interact with others in the same health conditions, and the patient in these groups feels that he is not alone in fighting the addiction.9 Participation and encouragement from others during these sessions gives the patient more support that motivates him to continue his treatment journey.28
Many drug rehabilitation centers offer family therapy as part of a rehabilitation program. In many cases, addiction negatively affects family members.29 In some rehabilitation centers, certain family members are allowed to participate in psychotherapy program.30
During these sessions, everyone discusses the harmful effects of the patient and the impact on the family, and also presents some solutions that help strengthen the patient’s resistance and motivate him to complete the treatment, so everyone expresses their desire to restore their previous life and live in peace while changing all the wrong habits that led to the steps of restoring Rehabilitation from drug addiction.31
During drug rehabilitation, individuals undergo psychological treatment to identify and definitively treat the underlying causes of addiction to prevent relapse and help patients participate in all activities of life without relapse into addiction.30
This type of cognitive behavioral therapy targets both thoughts about drug use that the patient is experiencing during this stage, as well as thoughts about life in general, and helps to reform his/her thinking and make behavioral changes to lead a healthy life.32
The patient does some internal work to determine the beginning of drug use and the reasons that prompted him/her to do so.
The patient follows special time management techniques to focus on engaging in certain activities and hobbies.
The patient learns time management skills so that he/she can make better use of the time with no opportunity to think about returning to the use again.
The patient learns how to face difficult situations that may lead him/her to consider drug use. These tips help him/her think of some other alternatives to get rid of those destructive thoughts.33
When it comes to drug addiction rehabilitation, it is not possible to set a specific period for completing the steps of treatment because this depends on the type of the abused substance and the intensity of the symptoms experience by the client. Some rehabilitation centers offer treatment programs at a fixed time, such as the 30-day program. However, many people prefer to benefit from treatment programs with longer periods, such as the 60-day program, the 90-day program, or perhaps for longer periods in cases of internal treatment within therapeutic clinics.34
To determine the necessary treatment period, factors such as the history and severity of abuse, the type of narcotic substance, health and psychological conditions, and the psycho-emotional needs of the patient must be taken into account.35
Some studies have confirmed that those who spend three months or more in treatment programs have better rates of resistance to relapse. Longer programs provide the opportunity to focus on the root causes and behaviors behind addiction, and help the patient practice healthier and more balanced living behaviors.36,37
Psychological rehabilitation is defined as the reintegration of the recovering addict back into the community naturally. But society must accept it after going through the experience of addiction, and it must be dealt with naturally.32,38
The stage of psychological rehabilitation is one of the important stages that complement the journey of recovery from addiction.39 That is why this stage helps the healthy person to protect him/her from returning to addiction again, and that is when society accepts him/her after going through this harsh experience. As well as overcoming negative thoughts and self-talk, so as not to worsen his/her condition and return to addiction again.40
There are many treatment plans used for psychological rehabilitation from addiction, which vary depending on the severity and location of the condition. There are some cases of addiction patients that are classified as mild cases that do not need to stay in psychological rehabilitation centers. For example, when the doctor is satisfied with prescribing the appropriate treatment plan for him/her, following up on him/her by visiting outpatient clinics at specific times, and following up with his/her family at home and supporting him/her.41
Addiction treatment plans include helping the patient to get rid of the addiction and stop using it completely, in addition to psychological rehabilitation and behavior modification. That is until society accepts it again.42 Therefore, the treatment plan consists of the following steps:
Psychotherapy for psychological rehabilitation from addiction
It is a psychological treatment program that relies on treating the psychological problems that caused the patient to resort to addiction in the first place, as well as working to modify the patient’s behavior and change his/her negative thoughts, and turn them into positive thoughts.43
Cognitive behavioral therapy
The goal of this type of treatment is to determine the cause and the beginning of the abuse, and it is by conducting some psychological self-tests. Based on the result of these tests, some strategies are determined, in order to train the patient to learn how to manage time properly, and not be subject to drug control again. Through it, he/she can identify the motives behind drug addiction, and stay away from people and places that help to continue in the cycle of abuse, and the attitude to build a new healthy life free of substance abuse.44
Providing a supportive community for psychological rehabilitation from addiction
It is by attending group therapy sessions, which is one of the main factors for psychological rehabilitation of the addict.45 The presence of the patient in the midst of a group of people going through the same circumstances, and uniting with one goal, which is to get rid of drugs and start a new life, helps to recover faster.46
Treatment of mental illness associated with addiction
The addicted patient may suffer from many other mental illnesses associated with addiction, such as obsessive-compulsive disorder, depression, anxiety and tension, schizophrenia, as well as some mental symptoms. Its treatment is in the Dual Diagnostic Unit, which deals with the treatment of mental disorders.47
Types of treatment used for psychological rehabilitation from addiction
There are different types of psychological rehabilitation methods from addiction, in order to reintegrate the patient back into society and encourage him to start his/her life again.45 The most important of these types are:
Cognitive behavioral therapy (CBT)
It is one of the most common methods of psychotherapy that is used to rehabilitate addicts, as it helps to modify the patient’s behavior and change his negative harmful thoughts. It also works to enhance his/her self-confidence and get rid of mental disorders. CBT lasts about 16 sessions in about 90 days.48
It is a type of behavioral therapy, which is based on rewarding the patient for the positive achievements he achieves in his/her life, which encourages him/her to strive in repeating positive actions, and through them he learns ways to build his/her life again.49
One of the latest approaches of psychotherapy is the telepsychotherapy, which depends mainly on using the concepts of telehealth. In a systematic review conducted by Caponnetto & Casu,50 the purpose was analyzing the recent uses of technological means in the field of psychotherapy. The results of the study revealed that there is a constant and increasing development of using the technological means in the field of psychotherapy as mobile health and applications were reported to be successful approaches for the implementation of psychotherapy, especially with smoking addiction. In another study by Caponnetto et al,51 the researchers adopted the cross-sectional approach to explore the psychological dynamics of hyper sexuality during the COVID-19 pandemic, particularly social distancing and quarantine period. The study sample consisted of 1401 adults were recruited through the online questionnaire used in this study. The results of the study showed that there were remarkable variations regarding the different factors explored in this study such as losing control, addictive symptoms and hide score.
Dialectical Behavior Therapy
After recovery, this treatment aims to help the patient get rid of destructive thoughts and wrong behaviors. This type of treatment is used after cognitive behavioral therapy, through which the patient learns ways to coexist with society and individuals, as well as get rid of stress in a healthy way, in addition to getting rid of negative thoughts such as suicide.52
Family therapy for psychological rehabilitation from addiction
Family therapy aims to help the addict and his family from the psychological problems that they have suffered as a result of addiction. Group psychotherapy for the addict’s family helps alleviate the tension and anger among family members. It also helps to identify the factors that led to the patient’s addiction to drugs, which facilitates the recovery phase.53
It is one of the methods used in psychotherapy, which aims to help the patient in achieving himself, as well as identifying his abilities and the values he possesses and helping him to do so. It also encourages him to achieve and develop his previous goals, instead of setting new goals and drastic changes that may make him/her feel frustrated.54
Complementary therapies for psychological rehabilitation from addiction
There are several auxiliary plans represented in the practice of some activities, which the patient must be encouraged to follow in order to complete psychotherapy and get rid of addiction again,55 including:
Doing sports, which helps to get rid of stress and negative feelings.56
Meditation has a positive effect on the patient’s health and reduces depression and anxiety.57
Practicing yoga: It helps to feel inner peace and enhances self-confidence, so it reduces mental disorders.58
Massage sessions that help relieve physical tension, and facilitate the process of getting rid of narcotic substances that are addicted to the body.59
Keeping animals helps release potential energy, which helps in addiction treatment.60
This process aims to reintegrate the addict into the family and society, as a treatment for the so-called (the phenomenon of dislocation), where addiction leads to the dislocation of the addict from the network of family and social relationships, and treatment here depends on improving the relationship between the two parties (the addict on the one hand, and the family on the other hand).61 And training them to accept and understand each other, and help the addict regain the confidence of his/her family and society in him/her, and give him/her a new opportunity to prove his/her seriousness and keenness on recovery and normal life.62
Social rehabilitation means social improvement and includes correcting and improving some of the social life conditions of the addict, which would hinder the addict’s compatibility with society and prepare the addict to return to normal life as a valid member of society.63
Community rehabilitation is aimed at re-absorbing supplies from addiction to social life, dealing and participation in community facilities and activities, both functional integration, housing and accommodation, with the creation of their surrounding society to accept them as individuals, integrated and interacting with other community members without exposure to addiction and consequences of negative behaviors.32,63
The most important reasons for community integration of addiction is the view of the negative society to them, and their strength, and this is in contrast to what should happen, where the addict should be considered as a patient and given another chance - after recovering from addiction - to return to his/her family and friends and share it in community activities, returning to work or joining a new job.64
The process of community rehabilitation aims to increase societal assimilation, that process that leads the person to reach the best level of physical, psychological, social and economic condition, in order to achieve social integration of the addict in the local community in which the community lives, and the community in which the humiliated lives in the active participation of various sectors.65 So that the rehabilitation of the addict leads to self-reliance as much as possible, self-respect and self-confidence, in addition to the addict’s knowledge of the reality in which he/she lives as an integrated member with the rest of the individuals.66 Studies indicated that the nature of human beings to him/herself and his/her role in life had its strong impact on his/her responses. The small surroundings - the family and the group of friends, and neighbors and co-workers will continue to view him/her as an addict, which can lead to more feelings of psychological pain.67 Therefore, a great effort must be made with those we qualify, and another effort with the groups that he/she will work with or with whom he/she has relationships within community, and then a third effort with the larger community in order to develop positive feelings and instill the dynamics of social acceptance, through cooperation between the family, educational institutions, NGOs, and the media, in order to achieve compatibility between the acceptable or the acquisition of social capacity in the general sense.68
Previous studies about Psychosocial Life Aspects of Substance Misuse Clients
Psychological and social life aspects of substance misuse clients were the main focus of different local, regional and international studies. For example, Poudel et al14 conducted a study that aimed at exploring the psychosocial problems facing Nepali substance misuse clients who are at the rehabilitation phase. The descriptive cross-sectional research design was used in this study through administering the “Drug Use Screening Inventory-Revised” over a sample of 204 substance misuse clients. The findings of the study showed that problems related to substance use, academic performance, relationships with peers, social competency, psychiatric disorders, family, and adaptation to work were the most reported problems encountering substance misuse clients who are at the rehabilitation phase.
In a scoping review by Muhamad et al,69 the purpose was to assess the effectiveness of support, either psychosocial or spiritual, on substance misuse clients who are at the rehabilitation phase. A total of 344 peer-reviewed articles were included in this scoping review. However, the data extraction was performed using 18 articles. The results of the study showed that there is a positive effect of psychosocial and spiritual support on the rehabilitation of substance misuse clients. In addition, it was found that different factors were predictors of this effect such as religious beliefs, personal perspectives and attitudes, philosophical beliefs, the desire to change and the safety concerns.
Poudel & Gautam70 carried out a descriptive cross-sectional study that aimed at assessing the differences in the psychosocial life aspects among substance abuse clients at rehabilitation phase. A self-filled questionnaire was distributed over a sample of 221 substance abuse patients. The results of the study revealed that the age of onset of using substances is significantly associated with the psychosocial problems encountered by the substance abuse patients. Early onset was linked to higher levels of psychosocial problems. Using a threshold age of onset of 17 years revealed that those patients with an age of onset of substance abuse less than 17 years had higher scores of psychosocial problems compared to patients with an age of onset of 18 years or more.
In Nepal, Gyawali et al71 sought to identify the incidence of psychological distress symptoms and its correlated factors in a sample of substance abuse patients who are at the rehabilitation phase. The cross-sectional research design was performed over a sample of 180 patients. The researchers used the “6-item Kessler scale (K6)” as a data collection tool. The findings of the study revealed that there was an elevated level of psychological distress among substance abuse patients who are at the rehabilitation phase. In addition, it was found that patients’ age, educational level, severity of substance abuse, and the familial role were significant predictors of the psychological distress level among substance abuse patients who are at the rehabilitation phase.
Heidari & Ghodusi72 investigated the association between self-esteem, quality of life and locus of control among substance abuse clients who are at the rehabilitation phase in Iran. The cross-sectional research approach was used in this study. A sample of 150 clients were recruited in this study and filled “Rosenberg Self-esteem Scale, Rotter’s Locus of Control Scale, and SF36 Quality of Life Questionnaire”, which were used in the data collection process. The results of the study showed that by time, there was a steady increasing in substance abuse clients’ self-esteem, locus of control and quality of life. In addition, it was found that the clients’ quality of life was positively associated with their locus of control.
In a study by Basnet et al,73 the aim was to investigate the psychosocial problems and its correlates among substance abuse patients at rehabilitation phase in Nepal. The cross-sectional descriptive study was used in this study. To collect data, the researchers administered “Drug Use Screening Inventory – Revised (DUSI-R)” over a sample of 271 substance abuse patients who are at the rehabilitation phase. The age of onset of substance abuse was found to be less than 25 years among the majority of the recruited patients. In addition, it was found that alcohol was the most abused substance. Moreover, the findings of the study showed that substance abuse patients’ age and educational level were significant predictors of psychosocial problems encountered by the substance abuse patients. Furthermore, it was found that the psychosocial problems were mostly prevalent among substance abuse patients aged less than 30 years and among those having less than secondary stage education.
Based on the review of the previous studies, either on global or local levels, it is clear that there is a significant lack of studies assessing the psychosocial life aspects among substance misuse patients or clients who are at the rehabilitation stage. The great majority of the reviewed studies had adopted the descriptive cross-sectional research approach and used the questionnaire as a data collection tool. In addition, it was found that there is no variation of data collection tools that might be used to assess the psychosocial life aspects among substance misuse patients or clients in general. Furthermore, it was found that the findings of the previous studies were mainly focusing on the correlation between substance misuse clients’ demographic characteristics and their psychosocial life aspects. This gap in literature, which is represented by the lack of studies assessing the psychosocial life aspects among substance misuse clients or patients who are at the rehabilitation stage and this reveals the urgent need to conduct a cross-sectional study, specifically in Saudi Arabia, to achieve this objective and fill this research gap.
Conflict of Interest
No Conflict of Interest
The author declares that this research received neither internal nor external funding
The author would like to declare that this narrative review study has been performed by the author and it is an individual effort.