Assessment of the Efficacy of an Integrated Rehabilitation Program in Relapse Prevention Among Opioid Use Disorder Patients in Psychiatry and Neurology Center, Tanta University

Assessment of the Efficacy of an Integrated Rehabilitation Program in Relapse Prevention Among Opioid Use Disorder Patients in Psychiatry and Neurology Center, Tanta University | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the Efficacy of an Integrated Rehabilitation Program in Relapse Prevention Among Opioid Use Disorder Patients in Psychiatry and Neurology Center, Tanta University Abdelrahman Ali Elghorab, Noha Fawzy Fonon, Hossam Eldin Fathallah Elsawy, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7620892/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Dec, 2025 Read the published version in Middle East Current Psychiatry → Version 1 posted 7 You are reading this latest preprint version Abstract Background Substance use disorders (SUDs), especially opioid dependence, are a significant problem in Egypt. psychological therapies like cognitive-behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) provide effectiveness in reducing relapse and improve the Quality of life (QOL) in patients with SUD treatment. The aim of the study was to develop a structured, integrated rehabilitation program designed for relapse prevention among patients diagnosed with opioid use disorder (OUD), evaluate the efficacy of this integrated intervention in reducing relapse rates, assess its impact on patients’ QOL and identify significant clinical, psychological, and sociodemographic predictors of relapse within patients. Methods This quasi-experimental design was employed to evaluate the efficacy of an integrated rehabilitation program for relapse prevention among individuals with OUD on 100 male patients with OUD as per diagnostic and statistical manual of mental disorders, 5th edition (DSM-5) criteria, aged from 18 to 45 years old. Results The active treatment group showed significantly lower relapse rates in 3 months (P = 0.001) and 6 months (P = 0.001). Addiction severity index (ASI) scores improved markedly in the treatment group across medical, legal, occupational, and psychiatric domains (P < 0.05). QoL scores (physical, psychological, social, environmental) also improved significantly post-intervention (P = 0.001). Survival analysis confirmed the treatment group’s lower relapse risk (P = 0.001), while marital status (single/divorced) predicted higher relapse risk. Conclusions The integrated CBT/MI/with mindfulness rehabilitation program significantly reduced relapses and enhanced QoL in OUD patients compared to standard care. These findings advocate for its applicable in clinical practice. Opioid Use Disorder Cognitive Behavioral Therapy Relapse Prevention Quality of Life Egypt Background Substance use disorders (SUD) are defined as problematic patterns of consumption of psychoactive substances associated with clinical impairment, relapse over time and accompanied with tremendous burden for society and the affected individuals [1]. Opioids are class of drugs that include the illicit drug heroin as well as the prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others [2]. In Egypt, a series of epidemiological studies on psychoactive drug use were conducted. Those concerned with secondary school students revealed 5.05% for the use of cannabis and 0.84% for the use of opium [3]. National survey for the psychiatric and SUD made in Egypt 2023 conducted by ministry of health revealed that SUD was 5.4 % and from those with SUDs , opiated was 39.5 % [4]. People recovering from drug abuse face work-related challenges. There are a variety of effective psychological and behavioral therapies for managing SUDs such as cognitive-behavioral therapy (CBT), motivational enhancement therapy, and 12-step facilitation therapy [5]. Interventions such as MI and CBT that focus on motivation, problem solving, communication, mental health (i.e., anger, depression) and substances may be particularly useful for incarcerated youth [6]. This is because these youth may have significant mental health and substance issues but lack motivation and skills as problem-solving and communication to address them. Mindfulness has been described as, “the awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmentally to the unfolding of experience” [7]. Mindfulness-based cognitive therapy (MBCT), focus on addressing these challenges by modifying thought and behavior patterns, effectively preventing relapses. Considering the importance of psychological and coping strategies in addiction treatment, this study evaluated the effectiveness of CBT and MBCT in reducing opioid relapses and improving the quality of life (QOL) for individuals with opioid dependence. To avoid suffering, an individual either clings to positive states (e.g., craving) or avoids negative states [7]. QoL is a key but underused treatment outcome in SUD care [8]. The aim of this work was to develop a structured, integrated rehabilitation program specifically designed for relapse prevention among patients diagnosed with opioid use disorder (OUD), evaluate the efficacy of this integrated intervention in reducing relapse rates, assess its impact on patients’ QOL and identify significant clinical, psychological, and sociodemographic predictors of relapse within this population, in participants attending the Psychiatry and Neurology Center, Tanta University. Methods Quasi-experimental study design was carried out to evaluate the efficacy of an integrated rehabilitation program for relapse prevention among individuals with OUD on 100 male patients with OUD as per diagnostic and statistical manual of mental disorders, 5th edition (DSM-5) criteria, aged from 18 to 45 years old. The study was done after approval from the Ethical Committee Tanta University Hospitals, Tanta, Egypt (approval code:36264MD66/4/23). An informed written consent was obtained from the patient or relatives of the patients. Those who were unable to comply with the study protocol (e.g., due to time constraints or intellectual disability), serious or unstable medical conditions within the past six months (e.g., infective endocarditis, human immunodeficiency virus (HIV), hepatitis B or C), significant cognitive impairment, comorbid severe psychiatric disorders (e.g., active psychosis, panic disorder, current manic episode) were excluded from the study. Sample Size Calculation: Sample size calculation was performed using Epi Info 7 software developed by the Centers for Disease Control and Prevention (CDC), based on the following assumptions: Two-sided Confidence level: 95%. Power: 80%. Allocation ratio: 1:1. Expected relapse incidence: 23% in the treatment group (inpatients) versus 45% in the control group (outpatients). Based on these parameters, the required sample size was estimated at 46 patients per group. To account for potential dropout, the number increased by 10%, resulting in a total of 50 participants per group. Hence, the final sample included 100 male patients with OUD. Psychometric assessments Addiction Severity Index (ASI) : The Arabic version of the ASI (fifth edition) translated under the supervision of faculty at Ain Shams University, was administered [9]. This 161-item structured interview evaluates severity across six domains: Medical status, Alcohol and drug use, Employment and support, Family and social relationships, Legal status and Psychiatric status. All participants completed the ASI prior to intervention. ASI was assessed at baseline, 3 months and reassessed after six months. World Health Organization Quality of Life-BREF (WHOQOL-BREF): The validated Arabic version of the WHOQOL-BREF [10] was used to assess QoL across four domains: physical health, psychological health, social relationships, and environment. Internal consistency of the scale was verified in a pilot sample of 30 patients, yielding a Cronbach’s alpha of 0.781. QoL was assessed at baseline, 3 months and reassessed after six months. Program development: A comprehensive rehabilitation program was developed for individuals with SUDs, particularly opioid dependence, followed a systematic, evidence-based methodology. The program integrates six core therapeutic components: Motivational Therapy, CBT-based relapse prevention, family psychoeducation, peer support groups, twelve-step facilitation therapy, and mindfulness-based relapse prevention. The overarching goal was to create an intervention that is clinically effective, culturally appropriate, and practically feasible for the target population. The methodology comprised three interrelated phases: a systematic review of existing rehabilitation programs, a targeted literature review to substantiate the selected therapeutic components, and expert consultation to refine the structure, content, and delivery of the program. Phase I: systematic review of existing rehabilitation programs: The first phase involved a comprehensive analysis of established rehabilitation models to identify effective practices and current limitations. A structured search was conducted across academic databases (e.g., PubMed, PsycINFO), governmental health agency repositories (e.g., substance abuse and mental health services administration (SAMHSA), world health organization (WHO), and relevant professional networks. Programs were selected based on their incorporation of one or more of the proposed components and demonstrated outcomes such as reduced relapse rates or improved engagement. Each program was assessed for its structural characteristics (e.g., session format and frequency), therapeutic content, and suitability for individuals with opioid dependence. This review revealed that integrative programs combining motivational, cognitive-behavioral, and peer-based approaches yielded improved outcomes compared to single-modality interventions. However, notable gaps were also identified, including underutilization of mindfulness-based strategies and limited engagement of family systems. These findings directly encouraged the development of a more comprehensive, interdisciplinary model that addressed both the psychological and social dimensions of recovery. Phase II: literature review supporting component selection: A targeted literature review was conducted using peer-reviewed journals, clinical practice guidelines, and meta-analyses published over the past two decades. Search terms included “motivational therapy,” “CBT relapse prevention,” “family psychoeducation,” “peer support groups,” “twelve-step facilitation,” and “mindfulness-based relapse prevention,” in conjunction with “substance use disorder” and “opioid dependence.” Priority was given to randomized controlled trials (RCTs), meta-analyses, and longitudinal studies. The review confirmed the individual efficacy of each therapeutic modality, thereby supporting their integration into a comprehensive rehabilitation framework. Motivational interviewing (MI) was found to significantly enhance treatment engagement and strengthen commitment to recovery goals [11]. CBT demonstrated efficacy in reducing relapse risk by promoting cognitive restructuring and the development of adaptive coping [12]. Family Psychoeducation contributed to improved recovery outcomes through increased family involvement and education about the nature and impact of addiction [13] .Peer support groups fostered greater social connectedness and accountability, offering participants a sense of belonging and mutual encouragement [14].Twelve-step facilitation therapy was shown to increase long-term adherence to abstinence-oriented recovery models by promoting spiritual engagement and peer-based support (Project MATCH, 1997). Finally, Mindfulness-Based Relapse Prevention was associated with improved emotional regulation and reductions in craving, helping individuals respond to triggers with greater self-awareness and composure [15].Collectively, these findings provide a robust empirical foundation for the integration of these modalities into a multi-disciplinary intervention targeting the motivational, cognitive, behavioral, social, and emotional dimensions of recovery. Phase III: expert evaluation and program refinement: In the third phase, five psychiatrists with specialized expertise in addiction treatment were engaged to evaluate and refine the program. These experts were selected based on their clinical experience (minimum of ten years), academic qualifications, and contributions to addiction research. They reviewed a comprehensive draft of the program, including session outlines, objectives, content, and homework assignments. Evaluations were conducted using structured questionnaires (5-point Likert scales) and semi-structured interviews, focusing on therapeutic coherence, content relevance, implementation feasibility, and cultural adaptability. The experts assessed the program’s clarity, feasibility, cultural relevance, and therapeutic coherence. They praised the integration of multiple evidence-based modalities, structured homework assignments, and the emphasis on family involvement. Key recommendations included refining session objectives, incorporating facilitator training in mindfulness practices, adapting scheduling for greater accessibility, and increasing cultural tailoring for Arabic-speaking participants. A consensus meeting facilitated the resolution of discrepancies and guided the final revisions, which included clearer session goals, a facilitator training module, culturally relevant examples, and flexible delivery formats. Phase IV: program synthesis: The final rehabilitation program integrates empirically supported components from multiple disciplines, each contributing a distinct yet complementary role in the recovery process: Motivational Therapy: this component enhances intrinsic motivation and commitment to change. It used open-ended questions and reflective listening to help participants clarify goals, resolve ambivalence, and strengthen their readiness for recovery. CBT-based relapse prevention: CBT was developed on the basis of Drawing on Beck’s cognitive theory and Marlatt’s relapse prevention model. It helped participants identify and restructure maladaptive thoughts, recognize high-risk situations, and develop adaptive coping strategies through structured exercises and self-monitoring. Family Psychoeducation: Informed by family systems theory, this component educates families about the neurobiology of addiction, its interpersonal consequences, and supportive strategies. Family Sessions focus on understanding relapse triggers and rebuilding trust within the family unit. Peer support groups: Based on principles of group dynamics and peer-led recovery, this element fosters mutual support, shared accountability, and social reintegration. Group discussions encourage participants to share personal experiences, reducing isolation and normalizing recovery challenges. Twelve-step facilitation therapy: Adapted from Alcoholics Anonymous and Narcotics Anonymous principles, this component promotes spiritual and behavioral accountability. Participants were guided to engage with 12-step groups, adopt recovery-oriented lifestyles, and pursue ongoing peer support beyond formal treatment. Mindfulness-Based Relapse Prevention: this component—integrated in Sessions two, three, and five uses practices such as body scan meditation and present-focused awareness to enhance emotional regulation, reduce cravings, and cultivate non-reactivity to triggers. The program was delivered through eight group sessions and four family psychoeducation sessions, each lasting 60–90 minutes and held twice weekly. Sessions were supported by structured homework assignments designed to reinforce learning and practice of therapeutic skills. All materials were culturally adapted for Arabic-speaking participants, ensuring both accessibility and cultural sensitivity. Program application: All participants underwent a detoxification period lasting a minimum of ten days. During this phase, symptomatic pharmacological treatment was provided as clinically indicated, including analgesics, antidepressants, antiepileptics, and sedatives. Following detoxification, baseline assessments were conducted using the previously described psychometric tools. Group structure: group facilitation was conducted using a semi-structured format, integrating elements of structured psychoeducation with supportive group dynamics. Group scheduling: scheduling was logistically feasible, as most participants were initially inpatients at the Psychiatry and Neurology Center, Tanta University. After discharge, participants were referred to a structured day care facility that maintained fixed weekly attendance schedules, facilitating continuity of group sessions. Group sizes were deliberately tailored to include 8 to 12 members, with an average of 10 participants per group, facilitated by two trained group leaders. The selected group size was informed by several considerations, including: The experience and clinical competency of facilitator, session length and frequency, The severity and complexity of participants’ clinical presentations, Participants’ interpersonal functioning, including their reliability, social skills, and willingness to engage. The psychoeducational and supportive aims of the group. Evidence supports the efficacy of single therapeutic groups consisting of approximately 10 members with two leaders, compared to smaller subgroups with only one facilitator. Groups with fewer than five members risk reverting to individual therapy-like formats, thus undermining the group process. Group therapy format and structure: the intervention was designed as a closed psychoeducational group, where participants were enrolled at the beginning of the program and no new members were added during treatment. The program consisted of 24 structured sessions delivered over a six-month period. The curriculum followed a sequenced framework, with predetermined topics and activities aligned to the therapeutic objectives of relapse prevention and psychosocial rehabilitation. The content was delivered in thematic modules addressing motivation, cognitive restructuring, coping strategies, and social reintegration. Each session included didactic input, skill-building exercises, and group discussion, and was facilitated by a trained clinical psychologist. Session frequency and duration: Each session was scheduled for 90 minutes, consistent with best practices for group-based interventions of this size. Session duration was selected to balance group cohesion with adequate time. Best practice guidelines suggest session durations of approximately one hour for small groups (≤6 members), 90 minutes for mid-sized groups (six–ten members), and up to two hours for larger groups (≥10 members). The 90-minute format was deemed optimal for this study’s therapeutic structure and group size. Risk disclosure: Any unexpected risks or adverse events encountered during the study were promptly communicated to both participants and the ethics committee. Transparency and Autonomy: Participants were informed about the study title, research team, procedures involved, possible hazards, and anticipated benefits. They were also briefed on the voluntary nature of participation and assured that refusal or withdrawal would not affect their clinical care. These ethical safeguards were implemented to uphold participant dignity, autonomy, and well-being throughout the study duration. Statistical analysis: Statistical analysis was done by SPSS v26 (IBM Inc., Chicago, IL, USA). Quantitative variables were presented as mean and standard deviation (SD). Qualitative variables were presented as frequency and percentage . Chi-Square Test (χ²) was used to assess associations between categorical variables across the study groups. Independent Samples t-Test was 0 applied to compare the means of normally distributed continuous variables between the two independent study groups (intervention vs. control). Paired Samples t-Test was used to evaluate within-subject changes over time in normally distributed quantitative variables (e.g., pre- and post-treatment scores within the same group). Cox Proportional Hazards Regression Model and Survival Analysis: Utilized to estimate group differences in time to relapse over the 6-month follow-up period. A two-tailed P value 0.05). The route of drug administration was similar in both groups (P=0.65). Sniffing (35.5%) was the most common method, followed by injection (around 33%), multiple routes (15.6%), and oral use (13-15.6%). The active treatment group significantly showed reduced relapse rates compared to controls at both three months (P=0.001) and six months (P=0.001). Table 1 Table 1: Socio-demographic data among studied group, route of administration, relapse rate in active treatment and control groups Active treatment group (n = 45) Control (n = 45) Test of sig p Socio-demographic data Age 33.64 ± 9.7 32.62 ± 8.6 χ² = 1.98 0.25 Below 20 years 2 (4.4%) 1 (2.2%) 20–40 years 35 (77.8%) 37 (82.2%) Above 40 years 8 (17.8%) 8 (17.8%) Residence Urban 19 (42.2%) 21 (46.7%) χ² = 0.87 0.65 Rural 26 (57.8%) 24 (53.3%) Educational level Illiterate 4 (8.9%) 5 (11.1%) χ² = 1.43 0.44 Educated 41 (91.1%) 40 (89.9%) Marital status Married 22 (48.9%) 16 (35.6%) χ² = 1.23 0.41 Unmarried 23 (51.1%) 29 (64.4%) Occupation Non employed 26 (57.8%) 24 (53.3%) χ² = 1.23 0.41 Employed 19 (42.2%) 21 (46.7%) Route of administration Sniffing 16 (35.5%) 16 (35.5%) χ² = 0.65 0.52 Injection 15 (33.3%) 14 (31.1%) Multiple 7 (15.6%) 7 (15.6%) Oral 6 (13.3%) 7 (15.6%) Relapse rate in two participant group in OUD Relapse after three months # 15 (33.3%) 30 (66.7%) χ² = 4.87 0.001* Relapse after six months # 20 (44.4%) 35 (77.8%) χ² = 5.82 0.001* Data was presented as mean ± SD. *: Statistically significant at P ≤ 0.05. OUD: Opioid Use Disorder. X 2: for chi-square test. t: independent sample Student’s t test. #: Relapse confirmed by positive urine test Craving was significantly lower in the active treatment group (40%) vs. control (88.9%, P = 0.001). No group differences were found in prior detox attempts, duration of use, or heroin dose. Table 2 Table 2: Comparison of craving at discharge, previous detox attempts, duration of abuse, max heroin dose between active treatment and control groups, past history of the participants regarding factors influencing relapse in SUD, Variable Active treatment group (n = 45) Control group (n = 45) Test of sig. p Craving at discharge 27 (60.0%) 40 (88.9%) χ² =4.34 0.001* Number of previous detox attempts 0 Attempts 8 (17.8%) 7 (15.6%) χ² =1.54 0.21 1 Attempt 23 (51.1%) 23 (51.1%) Two or more attempts 14 (31.1%) 15 (33.3%) History of the participants regarding factors influencing relapse in SUD Past psychiatric history 23 (51.1%) 17 (37.8%) χ² =0.67 0.76 Legal history 17 (37.8%) 15 (30.0%) χ² =0.87 0.73 Imprisonment 9 (20.0%) 8 (17.8%) χ² =0.21 0.96 History of verbal abuse 17 (37.8%) 15 (30.0%) χ² =0.56 0.65 History of physical abuse 5 (11.1%) 9 (20.0%) χ² =1.14 0.32 History of self-harm/suicide 11 (24.4%) 17 (37.8%) χ² =0.98 0.65 Data are presented as mean ± SD or frequency (%). *: Statistically significant at P≤ 0. 05.. X 2: for chi-square test. Baseline ASI scores were similar, the active treatment group showed significant improvements across all domains in six months. Table 3 Table 3: Comparison of scores of ASI in active treatment group and control group before intervention Active treatment Active treatment group (n = 45) P Control group (n = 45) P Baseline six months intervention Baseline six months intervention ASI – medical 6.09±1.76 1.20±1.30 0.001* 5.44±1.58 2.98±1.56 0.43 ASI – legal 2.22±0.88 0.90±0.75 0.001* 2.11±0.96 2.76±1.52 0.85 ASI – occupational 5.38±2.41 1.80±1.40 0.001* 4.87±2.26 3.29±1.50 0.67 ASI – substance 7.28±1.44 2.50±0.90 0.001* 7.58±1.03 5.04±0.95 0.62 ASI – social 5.60±2.02 1.60±1.10 0.001* 5.49±2.18 6.31±1.38 0.54 ASI – psychiatric 3.78±1.41 1.30±1.20 0.001* 3.60±1.42 3.76±1.52 0.87 Total 4.42±2.22 1.55±1.28 0.001* 4.48±2.21 3.29±1.41 0.76 Data are presented as mean ± SD.*: Statistically significant at P ≤ 0.05). ASI: Addiction Severity Index. Paired sample Student’s t- test Active treatment and control groups showed non statistically significant differences in baseline QOL scores across all domains (P>0.05). The active treatment group showed a significant and progressive improvement in all QOL domains over six months (P=0.001 from baseline to three months; P< 0.05 from three to six months). In contrast, the control group showed no significant QOL changes during the same period. Among relapse cases, QOL improvements were limited, with only environmental quality reaching significance. Conversely, participants who maintained abstinence demonstrated significant improvements across all QOL domains throughout the study (P<0.05). Table 4 Table 4: QOL in active treatment and control group, relapse cases and in abstinence cases before and after three months and six months Before Three months after Six months after P 1 P 2 Active treatment versus Control group Active treatment group Control group Active treatment group Control group Active treatment group Control group Physical health 44.55±13.98 45.35 ±17.98 70.40±11.5 † 49.22±14.94 80.60±10.25 # 50.22±14.94 0.001* 0.03* Mental health 46.42±15.35 45.05 ±15.18 71.09±11.8 † 50.20±15.98 81.15±9.85 # 52.20±15.98 0.001* 0.02* Social interaction 43.35±14.65 48.35 ±17.14 68.25±11.6 † 48.09±13.14 82.40±10.50 # 47.09±13.14 0.001* 0.04* Environmental quality 44.82±15.25 46.29 ±15.05 74.07±11.2 † 51.24±15.42 84.22±8.75 # 53.24±15.42 0.001* 0.03* Relapse versus Abstinence cases Relapse cases Abstinence cases Relapse cases Abstinence cases Relapse cases Abstinence cases P3 P4 Physical health 46.34±10.74 43.09±13.24 49.22±14.94 ¥ 57.54±11.25 57.81±12.32 π 80.60±10.25 0.001* 0.03* Mental health 46.25±12.98 46.55±10.98 50.20±15.98 ¥ 66.54±9.32 58.51±13.84 π 83.15±3.85 0.001* 0.02* Social interaction 47.47±12.14 47.65±13.65 48.09±13.14 ¥ 64.35±14.65 53.35±10.17 π 84.40±10.50 0.001* 0.04* Environmental quality 47.89±13.63 47.79±13.95 51.24±15.42 ¥ 67.78±10.25 64.59±13.75 π 84.22±8.75 0.001* 0.03* †: Statistically significant at P ≤ 0.05 between Active treatment versus Control group at 3 months #: Statistically significant at P ≤ 0.05 between Active treatment versus Control group at 6 months P 1: P – value of comparison between baseline and 3 months in Active treatment P2: P – value of comparison between 3 months and 6 months in Active treatment ¥: Statistically significant at P ≤ 0.05 between Relapse versus Abstinence cases at 3 months π: : Statistically significant at P ≤ 0.05 between Relapse versus Abstinence cases at 6 months P3 : P – value of comparison between baseline and 3 months in Abstinence cases P4: P – value of comparison between 3 months and 6 months in Abstinence cases Survival analysis showed that active treatment significantly reduced relapse risk (HR = 0.65, P = 0.001). Unemployment (HR = 4.98, P=0.003), illiteracy (HR = 3.43, P=0.03), and being single (HR = 16.24, P=0.003) were strong predictors of relapse. Divorced individuals also had elevated risk (HR = 3.43, P=0.027). Other factors, including age, general employment, and ASI domains, were not significant, highlighting the stronger impact of social over clinical factors on relapse. Table 5 Table 5: Group differences in relapses to OUD during the six-month follow-up (survival analysis) B P HR 95.0% CI for HR Lower Upper Treatment group 16.95 0.001* 0.65 0.36 0.74 Age 0.057 0.329 1.058 0.944 1.186 Employment -0.87 0.643 0.750 0.222 2.531 Un employment 2.543 0.003* 4.98 2.50 105.44 Educated 1.234 0.061 0.434 0.947 12.45 Illiterate 1.234 0.03* 3.434 0.947 12.45 Married 1.161 0.256 0.12 .430 23.67 Un married 2.65 0.027* 3.43 0.947 12.455 ASI Psychological -0.01 0.914 0.983 0.724 1.335 ASI medical -0.07 0.584 0.924 0.696 1.227 ASI employment 0.15 0.254 1.171 0.893 1.536 ASI drugs -0.16 0.539 0.847 0.499 1.439 ASI family 0.249 0.090 1.282 0.962 1.710 ASI legal 0.003 0.985 1.003 0.705 1.427 OUD: Opioid Use Disorder, HR: Hazard ratio, Cl: Confidence Interval, ASI: Addiction Severity Index, B: The regression coefficients predict the hazard for relapse. A positive coefficient indicates a positive relationship between the covariate and the hazard for the relapse (higher values on the covariates are associated with less survival time). A negative coefficient indicates a negative relationship between the covariate and the hazard for the terminal event. Higher values on the covariate are associated with longer survival time. Hazard ratio less than 1 are associated with negative regression slopes, whereas values greater than 1 are associated with positive slopes. A hazard ratio of 1 indicates there no change in the hazard per unit change on the covariate. Discussion The present study investigated the impact of a structured relapse prevention program for individuals with opioid use disorder (OUD), comparing outcomes between an active treatment group and a control group across multiple domains including relapse rates, craving intensity, addiction severity, quality of life (QOL), and relapse predictors. In this study, relapse rates in the active treatment group were 33.3% in three months and 44.4% in six months, significantly lower than the control group’s rates of 67.6% and 77.8%, respectively (P = 0.001). These findings underscore the short-term efficacy of the intervention in delaying relapse. These results were consistent with studies incorporating opioid agonist therapy (OAT). For example, Pashaei et al. [ 16 ] reported that patients receiving CBT with methadone had a relapse rate of 36.4%, compared to 63.6% for those receiving methadone alone. However, Goweid et al. [ 17 ] reported higher relapse rates in a study conducted at Alexandria University using CBT alone (54.3% at three months and 77.1% at six months), suggesting that the addition of mindfulness and MI in the current study may have contributed to the improved outcomes. Importantly, craving was significantly reduced among participants receiving active treatment (60%) compared with controls (88.9%). Conversely, a non-significant association was identified between previous psychiatric history and relapse in the active treatment group, aligning with findings by Clark et al [ 18 ]., though contrasting with Harsh et al. [ 19 ], who observed a significant relationship in a larger cohort. These inconsistencies may stem from methodological variations, including sample size and follow-up duration. Regarding ASI, the present study demonstrated significant post-intervention decreases in ASI scores across all six domains medical, legal, occupational, substance use, social, and psychiatric in participants who received the active treatment. In particular, the decline in substance-use severity (mean from 7.58 to 2.50) and psychiatric symptoms (from 3.78 to 1.30) aligned with research highlighting the value of comprehensive interventions that target both the physiological and psychosocial dimensions of OUD [ 20 ]. Similar reductions in ASI scores have been documented in interventions incorporating mindfulness and cognitive-behavioral components in studies by Moore et al. [ 21 ]; Rice et al. [ 22 ]; Bolivar et al. [ 23 ]. These findings were further supported by recent work by McClain et al. [ 24 ], who documented comparable improvements in multiple ASI domains among OUD patients receiving mindfulness-based sessions. In this study an addiction management program at Tanta Neuropsychiatry and Neurosurgery Center, established comparable baseline characteristics between the active treatment and control groups was crucial for attributing any observed differences to the intervention. Indeed, pre-intervention. QOL measures did not differ significantly between the two groups (all P > 0.05), which aligned with research Ismail et al. [ 25 ] indicating that individuals entering opioid treatment programs often share similar psychosocial vulnerabilities. After six months, the active treatment group showed significant improvements in every QOL domain: Physical Health scores rose from 44.55 (± 13.98) to 70.40 (± 11.75), Psychological Health from 46.42 (± 15.35) to 71.09 (± 11.98), and both social interaction and environmental quality followed a similarly robust upward trend (P = 0.001 for all). These findings confirm the initial hypothesis and corroborate findings by Vederhus et al. [ 26 ], and Manning et al. [ 27 ], who similarly reported substantial QOL improvements among individuals achieving abstinence. Conversely, the Control Group displayed non-significant changes in QOL (all P > 0.05), consistent with earlier work underscoring the limitations of minimal or standard treatment approaches by Kelly et al. [ 28 ]. The survival analysis conducted to examine the factors associated with relapses to OUD over a six-month follow-up period revealed several significant social determinants that influenced outcomes. Among the most notable findings was the significant protective effect of being in the treatment group, which yielded a hazard ratio (HR) of 0.65 P = 0.001). This result was consistent with multiple recent studies, such as Komasi et al. [ 29 ] which demonstrated that structured treatment interventions including counseling and medication-assisted therapy (MAT) significantly reduce the likelihood of relapses among individuals with OUD. Similarly, a quasi- experimental study by Zullig et al. [ 30 ] concluded that individuals receiving long-term treatment support had greater retention and lower rates of recurrence. These findings reinforce the central role of structured interventions in mitigating relapse risk and support the ongoing expansion of access to such programs, especially in vulnerable populations. Another important finding from the analysis was the impact of unemployment on relapse risk. Individuals who were unemployed showed a markedly higher risk of relapse (HR = 4.98, P = 0.003). This result aligned with economic and social theories of addiction, which propose that a lack of structured daily activities, income insecurity, and psychological distress contribute to relapse vulnerability. A study by Nolte-Troha et al. [ 31 ] observed that unemployed patients were nearly five times more likely to relapse within 12 months of completing a treatment program. These findings emphasized the importance of integrating vocational training and job placement services into addiction recovery frameworks. Educational status also emerged as a significant factor as being illiterate was associated with a greater risk of relapses (HR = 3.434, P = 0.03). For instance, Nguyen et al. [ 32 ] found that individuals with secondary or higher education had significantly lower relapse rates due to better understanding of treatment protocols and healthier coping strategies. Addressing educational gaps through health education and supportive learning initiatives may be an effective adjunct to relapse prevention strategies. Marital status was another critical predictor in the model as unmarried participants exhibited the highest relapse risk (HR = 3.43, P = 0.027). These findings were consistent with the literature indicating that social isolation and lack of familial support were key triggers. In comparison, married individuals, though not significant in this analysis, often benefit from emotional stability and social reinforcement. A recent cross-sectional study by Brousseau et al. [ 33 ] suggested that married individuals had better treatment retention and reduced recurrence due to family accountability and spousal support. These results underscored the role of social relationships and the need for interventions that foster community and family engagement. Notably, clinical and psychosocial measures such as the ASI subscales including psychological, medical, drug, employment, family, and legal, did not reach statistical significance in this study. While these domains were often considered integral to comprehensive addiction assessments, their non-significance may reflect overlapping variance with stronger social predictors or the relatively short duration of follow-up. Other studies, such as that by Mar Gica et al. [ 34 ] showed these variables to be more predictive over longer follow-up periods or in larger, more diverse cohorts. It was possible that their effects mediated through more direct social determinants such as unemployment and marital disruption. Future programs should integrate vocational assistance, health education, and family engagement to enhance recovery outcomes. Moreover, long-term follow-up and larger sample size were recommended to further delineate the complex interplay between psychosocial and clinical factors in sustaining recovery. Limitations of the study included the non-randomized study design which would come second in terms of evidence following the more powerful randomized controlled study design. Conducting this study in absence of OAT, no similar studies using psychotherapy interventions as single therapeutic modality against OUD were found that represents a challenge for us to compare our results with the results of similar studies. Efficacy of relapse prevention model was only assessed over short duration after psychotherapy intervention (at end of psychotherapy program) while further follow up assessments must be considered over long durations to be able to assess its accurate efficacy Conclusions The study revealed that an integrated rehabilitation program was significantly effective in reducing relapse rates and improving the QoL of individuals with OUD. A significantly lower rate of recovery in both three months and six months indicated the effectiveness of the rehabilitation program in maintaining abstinence over time. A marked reduction in the ASI Through multiple domains after six months, the positive impact of comprehensive treatment on addiction severity and the overall well-being of patients. There were substantial improvements in all aspects of QoL (physical health, psychological health, social interaction, and environmental quality), demonstrating the holistic benefits of the rehabilitation program. The study indicated that the positive outcomes of the active treatment group were sustained over the six-month period, suggesting that integrated rehabilitation programs had a lasting impact on recovery from OUD. Abbreviations ASI: Addiction Severity Index CBT: Cognitive-Behavioral Therapy CDC: Centers for Disease Control and Prevention Cl: Confidence Interval DSM-5: Diagnostic And Statistical Manual of Mental Disorders, 5th Edition HIV: Human Immunodeficiency Virus HR: Hazard ratio MAT: Medication-Assisted Therapy MBCT: Mindfulness-Based Cognitive Therapy MI: Motivational Interviewing OAT: Opioid Agonist Therapy OUD: Opioid Use Disorder QOL: Quality of Life RCTs: Randomized Controlled Trials SAMHSA: Substance Abuse and Mental Health Services Administration SUDS: Substance Use Disorders WHO: World Health Organization WHOQOL-BREF: World Health Organization Quality of Life-BREF Declarations Ethics approval and consent to participate: The study was done after approval from the Ethical Committee Tanta University Hospitals, Tanta, Egypt (approval code: 36264MD66/4/23). An informed written consent was obtained from the patient or relatives of the patients. Consent for publication: An informed written consent was obtained from all patients. Availability of data and material: Data is available on reasonable requests from corresponding author. Competing interests: The authors have no financial or proprietary interest in any material discussed in this article. Funding: No funding was received for conducting this study. Authors' contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [N.F.F.], [H.E.F.E.], [M.A.E.] and [M.A.A.E.]. The first draft of the manuscript was written by [A.A.E.] and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript. Acknowledgements: Nil References Vallersnes OM, Jacobsen D, Ekeberg Ø, et al. (2019) Mortality, morbidity and follow-up after acute poisoning by substances of abuse: A prospective observational cohort study. 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(2009) The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population. Ann Saudi Med;29 (2):98-104. https://doi.org/10.4103/0256-4947.51790 Miller WR, Muñoz RF. Controlling your drinking: Tools to make moderation work for you. 2nd ed: Guilford Press; 2013. Magill M, Ray LA. (2009) Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. JSAD;70 (4):516-27. https://doi.org/10.15288/jsad.2009.70.516 Copello AG, Velleman RD, Templeton LJ. (2005) Family interventions in the treatment of alcohol and drug problems. DAR;24 (4):369-85. https://doi.org/10.1080/09595230500302356 Tracy K, Wallace SP. (2016) Benefits of peer support groups in the treatment of addiction. Subst abuse rehabil;7 (1):143-54. https://doi.org/10.2147/SAR.S81535 Bowen S, Chawla N, Grow J, et al. Mindfulness-based relapse prevention for addictive behaviors. 2nd ed: Guilford Publications; 2021. Pashaei T, Shojaeizadeh D, Rahimi Foroushani A, et al. (2013) Effectiveness of Relapse Prevention Cognitive-Behavioral Model in Opioid-Dependent Patients Participating in the Methadone Maintenance Treatment in Iran. Iran J Public Health;42 (8):896-902. Gowaid AA, Molokhia TK, Rady AR, et al. (2022) Predictors of relapse among patients with opioid use disorder treated with relapse prevention based cognitive behavior therapy: a prospective study. Senses sci;9 (1):1-7. https://doi.org/10.14616/sands-2022-1-15001509 Kolodny A, Courtwright DT, Hwang CS, et al. (2015) The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health;36 (1):559-74. https://doi.org/10.1146/annurev-publhealth-031914-122957 Chalana H, Kundal T, Gupta V, et al. (2016) Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up. J Addict;18 (1):7620860. https://doi.org/10.1155/2016/7620860 Moore M, Flamez B, Szirony GM. (2018) Moore, M., Flamez, B., & Szirony, G. M. (2018). Motivational interviewing and dual diagnosis clients: Enhancing self-efficacy and treatment completion. . J Subst Use;23 (3):247-53. https://doi.org/10.1080/14659891.2017.1388856 Moore TM, Seavey A, Ritter K, et al. (2014) Ecological momentary assessment of the effects of craving and affect on risk for relapse during substance abuse treatment. Psychol Addict Behav;28 (2):619-24. https://doi.org/10.1037/a0034127 Moyers TB, Houck J, Rice SL, et al. (2016) Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project. J Consult Clin Psychol;84 (3):221-9. https://doi.org/10.1037/ccp0000074 Bolívar HA, Klemperer EM, Coleman SRM, et al. (2021) Contingency Management for Patients Receiving Medication for Opioid Use Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry;78 (10):1092-102. https://doi.org/10.1001/jamapsychiatry.2021.1969 McClain N, Ceceli AO, Kronberg G, et al. (2025) Moving beyond self-report in characterizing drug addiction: Using drug-biased behavior to prospectively inform treatment adherence in opioid use disorder. medRxiv;5 (1):5-10. https://doi.org/https://doi.org/10.1101/2025.01.01.25319860 Ismail RM, Hussein R, Arafa SM, et al. (2019) Psychosocial aspects, life events, and quality of life of a sample of adolescent males with substance use. AIMJ;3 (2):483-93. https://doi.org/10.4103/sjamf.sjamf_65_19 Vederhus JK, Birkeland B, Clausen T. (2016) Perceived quality of life, 6 months after detoxification: Is abstinence a modifying factor? Qual Life Res;25 (9):2315-22. https://doi.org/10.1007/s11136-016-1272-z Manning V, Garfield JBB, Lam T, et al. (2019) Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use. J Clin Med;8 (9):2-3. https://doi.org/10.3390/jcm8091407 Kelly JF, Humphreys K, Ferri M. (2020) Alcoholics Anonymous and other 12-step programs for alcohol use disorder. CDSR;3 (3):Cd012880. https://doi.org/10.1002/14651858.CD012880.pub2 Komasi S, Saeidi M, Amiri MM, et al. (2017) Triggers of substance abuse slip and relapse during outpatient treatment in methadone/buprenorphine maintenance therapy clinics: a predictive model with emphasis on treatment-related factors. Jundishapur J Health Sci;9 (3):e57688. https://doi.org/10.5812/jjhs.57688 Zullig KJ, Lander LR, Tuscano M, et al. (2021) Testing mindfulness-based relapse prevention with medications for opioid use disorder among adults in outpatient therapy: A quasi-experimental study. Mindfulness (N Y);12 (12):3036-46. https://doi.org/10.1007/s12671-021-01763-w Nolte-Troha C, Roser P, Henkel D, et al. (2023) Unemployment and substance use: An updated review of studies from north america and europe. Healthcare (Basel);11 (8). https://doi.org/10.3390/healthcare11081182 Nguyen HTT, Dinh DX. (2023) Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam. Harm Reduct J;20 (1):136. https://doi.org/10.1186/s12954-023-00872-0 Brousseau NM, Karpyn A, Laurenceau JP, et al. (2022) The Impacts of Social Support and Relationship Characteristics on Commitment to Sobriety Among People in Opioid Use Disorder Recovery. J Stud Alcohol Drugs;83 (5):646-52. https://doi.org/10.15288/jsad.21-00225 Gica S, Donmez Z, Unubol B, et al. (2020) Predictors of relapse in the early stages of the treatment among inpatients with opioid use disorder: a single-center, prospective cohort study. PCP;30 (3):1. https://doi.org/10.5455/PCP.20200302044600 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Dec, 2025 Read the published version in Middle East Current Psychiatry → Version 1 posted Editorial decision: Revision requested 11 Oct, 2025 Reviews received at journal 07 Oct, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers invited by journal 26 Sep, 2025 Editor assigned by journal 25 Sep, 2025 Submission checks completed at journal 25 Sep, 2025 First submitted to journal 15 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7620892","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526178385,"identity":"9efe49a1-c697-4f81-a645-d4612b07ac29","order_by":0,"name":"Abdelrahman Ali 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16:07:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1854631,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7620892/v1/56a6003b-8eec-4210-b00d-5e61ed9b7b3d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of the Efficacy of an Integrated Rehabilitation Program in Relapse Prevention Among Opioid Use Disorder Patients in Psychiatry and Neurology Center, Tanta University","fulltext":[{"header":"Background","content":"\u003cp\u003eSubstance use disorders (SUD) are defined as problematic patterns of consumption of psychoactive substances associated with clinical impairment, relapse over time and accompanied with tremendous burden for society and the affected individuals [1]. Opioids are class of drugs that include the illicit drug heroin as well as the prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others [2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Egypt, a series of epidemiological studies on psychoactive drug use were conducted. Those concerned with secondary school students revealed 5.05% for the use of cannabis and 0.84% for the use of opium [3]. National survey for the psychiatric and SUD made in Egypt 2023 conducted by ministry of health revealed that SUD was 5.4 % and from those with \u0026nbsp;SUDs , opiated was 39.5 % [4]. People recovering from drug abuse face work-related challenges.\u003c/p\u003e\n\u003cp\u003eThere are a variety of effective psychological and behavioral therapies for managing SUDs such as cognitive-behavioral therapy (CBT), motivational enhancement therapy, and 12-step facilitation therapy [5]. Interventions such as MI and CBT that focus on motivation, problem solving, communication, mental health (i.e., anger, depression) and substances may be particularly useful for incarcerated youth [6]. This is because these youth may have significant mental health and substance issues but lack motivation and skills as problem-solving and communication to address them.\u003c/p\u003e\n\u003cp\u003eMindfulness has been described as, \u0026ldquo;the awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmentally to the unfolding of experience\u0026rdquo; \u0026nbsp;[7].\u003c/p\u003e\n\u003cp\u003eMindfulness-based cognitive therapy (MBCT), focus on addressing these challenges by modifying thought and behavior patterns, effectively preventing relapses. Considering the importance of psychological and coping strategies in addiction treatment, this study evaluated the effectiveness of CBT and MBCT in reducing opioid relapses and improving the quality of life (QOL) for individuals with opioid dependence. To avoid suffering, an individual either clings to positive states (e.g., craving) or avoids negative states [7]. \u0026nbsp;QoL is a key but underused treatment outcome in SUD care [8].\u003c/p\u003e\n\u003cp\u003eThe aim of this work was to\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003edevelop a structured, integrated rehabilitation program specifically designed for relapse prevention among patients diagnosed with opioid use disorder (OUD), evaluate the efficacy of this integrated intervention in reducing relapse rates, assess its impact on patients\u0026rsquo; QOL and identify significant clinical, psychological, and sociodemographic predictors of relapse within this population, in participants attending the Psychiatry and Neurology Center, Tanta University.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eQuasi-experimental study design was carried out to evaluate the efficacy of an integrated rehabilitation program for relapse prevention among individuals with OUD on 100 male patients with OUD as per diagnostic and statistical manual of mental disorders, 5th edition (DSM-5) criteria, aged from 18 to 45 years\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eold. The study was done after approval from the Ethical Committee Tanta University Hospitals, Tanta, Egypt (approval code:36264MD66/4/23). An informed written consent was obtained from the patient or relatives of the patients.\u003c/p\u003e\n\u003cp\u003eThose who were unable to comply with the study protocol (e.g., due to time constraints or intellectual disability), serious or unstable medical conditions within the past six months (e.g., infective endocarditis, human immunodeficiency virus (HIV), hepatitis B or C), significant cognitive impairment, comorbid severe psychiatric disorders (e.g., active psychosis, panic disorder, current manic episode) were excluded from the study.\u003c/p\u003e\n\u003cp\u003eSample Size Calculation:\u003c/p\u003e\n\u003cp\u003eSample size calculation was performed using Epi Info 7 software developed by the Centers for Disease Control and Prevention (CDC), based on the following assumptions: Two-sided Confidence level: 95%. Power: 80%. Allocation ratio: 1:1. Expected relapse incidence: 23% in the treatment group (inpatients) versus 45% in the control group (outpatients). Based on these parameters, the required sample size was estimated at 46 patients per group. To account for potential dropout, the number increased by 10%, resulting in a total of 50 participants per group. Hence, the final sample included 100 male patients with OUD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychometric assessments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAddiction Severity Index (ASI)\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Arabic version of the ASI (fifth edition) translated under the supervision of faculty at Ain Shams University, was administered [9]. This 161-item structured interview evaluates severity across six domains: Medical status, Alcohol and drug use, Employment and support, Family and social relationships, Legal status and Psychiatric status. All participants completed the ASI prior to intervention. ASI was assessed at baseline, 3 months and reassessed after six months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorld Health Organization Quality of Life-BREF (WHOQOL-BREF):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe validated Arabic version of the WHOQOL-BREF [10] was used to assess QoL across four domains: physical health, psychological health, social relationships, and environment.\u003c/p\u003e\n\u003cp\u003eInternal consistency of the scale was verified in a pilot sample of 30 patients, yielding a Cronbach\u0026rsquo;s alpha of 0.781. QoL was assessed at baseline, 3 months and reassessed after six months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgram development:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive rehabilitation program was developed for individuals with SUDs, particularly opioid dependence, followed a systematic, evidence-based methodology. The program integrates six core therapeutic components: Motivational Therapy, CBT-based relapse prevention, family psychoeducation, peer support groups, twelve-step facilitation therapy, and mindfulness-based relapse prevention. The overarching goal was to create an intervention that is clinically effective, culturally appropriate, and practically feasible for the target population. The methodology comprised three interrelated phases: a systematic review of existing rehabilitation programs, a targeted literature review to substantiate the selected therapeutic components, and expert consultation to refine the structure, content, and delivery of the program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase I: systematic review of existing rehabilitation programs:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first phase involved a comprehensive analysis of established rehabilitation models to identify effective practices and current limitations. A structured search was conducted across academic databases (e.g., PubMed, PsycINFO), governmental health agency repositories (e.g., substance abuse and mental health services administration (SAMHSA), world health organization (WHO), and relevant professional networks. Programs were selected based on their incorporation of one or more of the proposed components and demonstrated outcomes such as reduced relapse rates or improved engagement. Each program was assessed for its structural characteristics (e.g., session format and frequency), therapeutic content, and suitability for individuals with opioid dependence.\u003c/p\u003e\n\u003cp\u003eThis review revealed that integrative programs combining motivational, cognitive-behavioral, and peer-based approaches yielded improved outcomes compared to single-modality interventions. However, notable gaps were also identified, including underutilization of mindfulness-based strategies and limited engagement of family systems. These findings directly encouraged the development of a more comprehensive, interdisciplinary model that addressed both the psychological and social dimensions of recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase II: literature review supporting component selection:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA targeted literature review was conducted using peer-reviewed journals, clinical practice guidelines, and meta-analyses published over the past two decades. Search terms included \u0026ldquo;motivational therapy,\u0026rdquo; \u0026ldquo;CBT relapse prevention,\u0026rdquo; \u0026ldquo;family psychoeducation,\u0026rdquo; \u0026ldquo;peer support groups,\u0026rdquo; \u0026ldquo;twelve-step facilitation,\u0026rdquo; and \u0026ldquo;mindfulness-based relapse prevention,\u0026rdquo; in conjunction with \u0026ldquo;substance use disorder\u0026rdquo; and \u0026ldquo;opioid dependence.\u0026rdquo; Priority was given to randomized controlled trials (RCTs), meta-analyses, and longitudinal studies.\u003c/p\u003e\n\u003cp\u003eThe review confirmed the individual efficacy of each therapeutic modality, thereby supporting their integration into a comprehensive rehabilitation framework. Motivational interviewing (MI) was found to significantly enhance treatment engagement and strengthen commitment to recovery goals [11].\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eCBT demonstrated efficacy in reducing relapse risk by promoting cognitive restructuring and the development of adaptive coping [12]. Family Psychoeducation contributed to improved recovery outcomes through increased family involvement and education about the nature and impact of addiction [13]\u0026nbsp;.Peer support groups fostered greater social connectedness and accountability, offering participants a sense of belonging and mutual encouragement [14].Twelve-step facilitation therapy was shown to increase long-term adherence to abstinence-oriented recovery models by promoting spiritual engagement and peer-based support (Project MATCH, 1997). Finally, Mindfulness-Based Relapse Prevention was associated with improved emotional regulation and reductions in craving, helping individuals respond to triggers with greater self-awareness and composure [15].Collectively, these findings provide a robust empirical foundation for the integration of these modalities into a multi-disciplinary intervention targeting the motivational, cognitive, behavioral, social, and emotional dimensions of recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase III: expert evaluation and program refinement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the third phase, five psychiatrists with specialized expertise in addiction treatment were engaged to evaluate and refine the program. These experts were selected based on their clinical experience (minimum of ten years), academic qualifications, and contributions to addiction research. They reviewed a comprehensive draft of the program, including session outlines, objectives, content, and homework assignments. Evaluations were conducted using structured questionnaires (5-point Likert scales) and semi-structured interviews, focusing on therapeutic coherence, content relevance, implementation feasibility, and cultural adaptability.\u003c/p\u003e\n\u003cp\u003eThe experts assessed the program\u0026rsquo;s clarity, feasibility, cultural relevance, and therapeutic coherence. They praised the integration of multiple evidence-based modalities, structured homework assignments, and the emphasis on family involvement. Key recommendations included refining session objectives, incorporating facilitator training in mindfulness practices, adapting scheduling for greater accessibility, and increasing cultural tailoring for Arabic-speaking participants. A consensus meeting facilitated the resolution of discrepancies and guided the final revisions, which included clearer session goals, a facilitator training module, culturally relevant examples, and flexible delivery formats.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase IV: program synthesis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final rehabilitation program integrates empirically supported components from multiple disciplines, each contributing a distinct yet complementary role in the recovery process:\u003c/p\u003e\n\u003cp\u003eMotivational Therapy: this component enhances intrinsic motivation and commitment to change. It used open-ended questions and reflective listening to help participants clarify goals, resolve ambivalence, and strengthen their readiness for recovery.\u003c/p\u003e\n\u003cp\u003eCBT-based relapse prevention: CBT was developed on the basis of Drawing on Beck\u0026rsquo;s cognitive theory and Marlatt\u0026rsquo;s relapse prevention model. It helped participants identify and restructure maladaptive thoughts, recognize high-risk situations, and develop adaptive coping strategies through structured exercises and self-monitoring.\u003c/p\u003e\n\u003cp\u003eFamily Psychoeducation: Informed by family systems theory, this component educates families about the neurobiology of addiction, its interpersonal consequences, and supportive strategies. Family Sessions focus on understanding relapse triggers and rebuilding trust within the family unit.\u003c/p\u003e\n\u003cp\u003ePeer support groups: Based on principles of group dynamics and peer-led recovery, this element fosters mutual support, shared accountability, and social reintegration. Group discussions encourage participants to share personal experiences, reducing isolation and normalizing recovery challenges.\u003c/p\u003e\n\u003cp\u003eTwelve-step facilitation therapy: Adapted from Alcoholics Anonymous and Narcotics Anonymous principles, this component promotes spiritual and behavioral accountability. Participants were guided to engage with 12-step groups, adopt recovery-oriented lifestyles, and pursue ongoing peer support beyond formal treatment.\u003c/p\u003e\n\u003cp\u003eMindfulness-Based Relapse Prevention: this component\u0026mdash;integrated in Sessions two, three, and five uses practices such as body scan meditation and present-focused awareness to enhance emotional regulation, reduce cravings, and cultivate non-reactivity to triggers.\u003c/p\u003e\n\u003cp\u003eThe program was delivered through eight group sessions and four family psychoeducation sessions, each lasting 60\u0026ndash;90 minutes and held twice weekly. Sessions were supported by structured homework assignments designed to reinforce learning and practice of therapeutic skills. All materials were culturally adapted for Arabic-speaking participants, ensuring both accessibility and cultural sensitivity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgram application:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants underwent a detoxification period lasting a minimum of ten days. During this phase, symptomatic pharmacological treatment was provided as clinically indicated, including analgesics, antidepressants, antiepileptics, and sedatives. Following detoxification, baseline assessments were conducted using the previously described psychometric tools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup structure:\u0026nbsp;\u003c/strong\u003egroup facilitation was conducted using a semi-structured format, integrating elements of structured psychoeducation with supportive group dynamics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup scheduling:\u0026nbsp;\u003c/strong\u003escheduling was logistically feasible, as most participants were initially inpatients at the Psychiatry and Neurology Center, Tanta University. After discharge, participants were referred to a structured day care facility that maintained fixed weekly attendance schedules, facilitating continuity of group sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup sizes\u0026nbsp;\u003c/strong\u003ewere deliberately tailored to include 8 to 12 members, with an average of 10 participants per group, facilitated by two trained group leaders. The selected group size was informed by several considerations, including:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe experience and clinical competency of facilitator, session length and frequency, The severity and complexity of participants\u0026rsquo; clinical presentations, Participants\u0026rsquo; interpersonal functioning, including their reliability, social skills, and willingness to engage. The psychoeducational and supportive aims of the group.\u003c/p\u003e\n\u003cp\u003eEvidence supports the efficacy of single therapeutic groups consisting of approximately 10 members with two leaders, compared to smaller subgroups with only one facilitator. Groups with fewer than five members risk reverting to individual therapy-like formats, thus undermining the group process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup therapy format and structure:\u003c/strong\u003e the intervention was designed as a closed psychoeducational group, where participants were enrolled at the beginning of the program and no new members were added during treatment. The program consisted of 24 structured sessions delivered over a six-month period. The curriculum followed a sequenced framework, with predetermined topics and activities aligned to the therapeutic objectives of relapse prevention and psychosocial rehabilitation.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe content was delivered in thematic modules addressing motivation, cognitive restructuring, coping strategies, and social reintegration. Each session included didactic input, skill-building exercises, and group discussion, and was facilitated by a trained clinical psychologist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSession frequency and duration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach session was scheduled for 90 minutes, consistent with best practices for group-based interventions of this size. Session duration was selected to balance group cohesion with adequate time. Best practice guidelines suggest session durations of approximately one hour for small groups (\u0026le;6 members), 90 minutes for mid-sized groups (six\u0026ndash;ten members), and up to two hours for larger groups (\u0026ge;10 members). The 90-minute format was deemed optimal for this study\u0026rsquo;s therapeutic structure and group size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk disclosure:\u003c/strong\u003e Any unexpected risks or adverse events encountered during the study were promptly communicated to both participants and the ethics committee.\u003c/p\u003e\n\u003cp\u003eTransparency and Autonomy: Participants were informed about the study title, research team, procedures involved, possible hazards, and anticipated benefits. They were also briefed on the voluntary nature of participation and assured that refusal or withdrawal would not affect their clinical care. These ethical safeguards were implemented to uphold participant dignity, autonomy, and well-being throughout the study duration.\u003c/p\u003e\n\u003cp\u003eStatistical analysis:\u003c/p\u003e\n\u003cp\u003eStatistical analysis was done by SPSS v26 (IBM Inc., Chicago, IL, USA). Quantitative variables were presented as mean and standard deviation (SD). Qualitative variables were presented as frequency and percentage . Chi-Square Test (\u0026chi;\u0026sup2;) was \u0026nbsp;used to assess associations between categorical variables across the study groups. Independent Samples t-Test was 0 applied to compare the means of normally distributed continuous variables between the two independent study groups (intervention vs. control). Paired Samples t-Test was used to evaluate within-subject changes over time in normally distributed quantitative variables (e.g., pre- and post-treatment scores within the same group). Cox Proportional Hazards Regression Model and Survival Analysis: Utilized to estimate group differences in time to relapse over the 6-month follow-up period. \u0026nbsp;A two-tailed P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe socio-demographic analysis showed no significant differences between the active treatment and control groups (P \u0026gt; 0.05). The route of drug administration was similar in both groups (P=0.65). Sniffing (35.5%) was the most common method, followed by injection (around 33%), multiple routes (15.6%), and oral use (13-15.6%). The active treatment group significantly showed reduced relapse rates compared to controls at both three months (P=0.001) and six months (P=0.001). \u003cstrong\u003eTable 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-demographic data among studied group,\u0026nbsp;route of administration, relapse rate in active treatment and control groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"108%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment group (n = 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of sig\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-demographic data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e33.64 \u0026plusmn; 9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e32.62 \u0026plusmn; 8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBelow 20 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u0026ndash;40 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e35 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e37 (82.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 40 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e19 (42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e21 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRural\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26 (57.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e24 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIlliterate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducated\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e41\u0026nbsp;(91.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e40\u0026nbsp;(89.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e22 (48.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e16 (35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnmarried\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e23 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e29 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon employed\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26 (57.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e24 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e19 (42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e21 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRoute of administration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSniffing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e16 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e16 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e15 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e14 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e7 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse rate in two participant group in OUD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse after three months\u003c/strong\u003e#\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e15 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e30 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 4.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse after six months\u0026nbsp;\u003c/strong\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e20 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e35 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData was presented as mean \u0026plusmn; SD. *: Statistically significant at P \u0026le; 0.05. OUD: Opioid Use Disorder. \u003csub\u003eX\u003c/sub\u003e2: for chi-square test. t: independent sample Student\u0026rsquo;s t test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e#: \u0026nbsp; Relapse confirmed by positive urine test \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCraving was significantly lower in the active treatment group (40%) vs. control (88.9%, P = 0.001). No group differences were found in prior detox attempts, duration of use, or heroin dose. \u003cstrong\u003eTable 2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Comparison of craving at discharge, previous detox attempts, duration of abuse, max heroin dose between active treatment and control groups, past history of the participants regarding factors influencing relapse in SUD,\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of sig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCraving at discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e27 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e40 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of previous detox attempts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 Attempts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e7 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 Attempt\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e23 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e23 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTwo or more attempts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e14 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e15 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of the participants regarding factors influencing relapse in SUD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast psychiatric history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e23 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLegal history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e15 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImprisonment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e9 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e8 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of verbal abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e15 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of physical abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e5 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e9 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of self-harm/suicide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e11 (24.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD or frequency (%). *: Statistically significant at P\u0026le; 0. 05..\u0026nbsp;\u003csub\u003eX\u003c/sub\u003e2: for chi-square test.\u003c/p\u003e\n\u003cp\u003eBaseline ASI scores were similar, the active treatment group showed significant improvements across all domains in six months. \u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3: Comparison of scores of ASI in active treatment group and control group before intervention\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment Active treatment group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esix months intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esix months intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI \u0026ndash; medical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6.09\u0026plusmn;1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.20\u0026plusmn;1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.44\u0026plusmn;1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.98\u0026plusmn;1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI \u0026ndash; legal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.22\u0026plusmn;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.90\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.11\u0026plusmn;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.76\u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI \u0026ndash; occupational\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.38\u0026plusmn;2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.80\u0026plusmn;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3.29\u0026plusmn;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI \u0026ndash; substance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7.28\u0026plusmn;1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.50\u0026plusmn;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7.58\u0026plusmn;1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5.04\u0026plusmn;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI \u0026ndash; social\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.60\u0026plusmn;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.60\u0026plusmn;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.49\u0026plusmn;2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e6.31\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI \u0026ndash; psychiatric\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.78\u0026plusmn;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.30\u0026plusmn;1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.60\u0026plusmn;1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3.76\u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.42\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.55\u0026plusmn;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.48\u0026plusmn;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3.29\u0026plusmn;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD.*: Statistically significant at P \u0026le; 0.05). ASI: Addiction Severity Index. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePaired sample Student\u0026rsquo;s t- test\u003c/p\u003e\n\u003cp\u003eActive treatment and control groups showed non statistically significant differences in baseline QOL scores across all domains (P\u0026gt;0.05). The active treatment group showed a significant and progressive improvement in all QOL domains over six months (P=0.001 from baseline to three months; P\u0026lt; 0.05 from three to six months). In contrast, the control group showed no significant QOL changes during the same period. Among relapse cases, QOL improvements were limited, with only environmental quality reaching significance. Conversely, participants who maintained abstinence demonstrated significant improvements across all QOL domains throughout the study (P\u0026lt;0.05). \u003cstrong\u003eTable 4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4: QOL in active treatment and control group, relapse cases and in abstinence cases before and after three months and six months\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"103%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThree months after\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSix months after\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e1\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e2\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment versus Control group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive treatment group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical health\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e44.55\u0026plusmn;13.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e45.35 \u0026plusmn;17.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e70.40\u0026plusmn;11.5 \u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e49.22\u0026plusmn;14.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e80.60\u0026plusmn;10.25\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e50.22\u0026plusmn;14.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e46.42\u0026plusmn;15.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e45.05 \u0026plusmn;15.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e71.09\u0026plusmn;11.8 \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e50.20\u0026plusmn;15.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e81.15\u0026plusmn;9.85\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e52.20\u0026plusmn;15.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial interaction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e43.35\u0026plusmn;14.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e48.35 \u0026plusmn;17.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e68.25\u0026plusmn;11.6\u0026nbsp;\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e48.09\u0026plusmn;13.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e82.40\u0026plusmn;10.50\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e47.09\u0026plusmn;13.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironmental quality\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e44.82\u0026plusmn;15.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e46.29 \u0026plusmn;15.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e74.07\u0026plusmn;11.2\u0026nbsp;\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e51.24\u0026plusmn;15.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e84.22\u0026plusmn;8.75\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e53.24\u0026plusmn;15.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse versus Abstinence cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbstinence cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbstinence cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbstinence cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e46.34\u0026plusmn;10.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e43.09\u0026plusmn;13.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e49.22\u0026plusmn;14.94 \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e57.54\u0026plusmn;11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e57.81\u0026plusmn;12.32\u003csup\u003e\u0026pi;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e80.60\u0026plusmn;10.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e46.25\u0026plusmn;12.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e46.55\u0026plusmn;10.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e50.20\u0026plusmn;15.98 \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e66.54\u0026plusmn;9.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e58.51\u0026plusmn;13.84 \u003csup\u003e\u0026pi;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e83.15\u0026plusmn;3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial interaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e47.47\u0026plusmn;12.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e47.65\u0026plusmn;13.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e48.09\u0026plusmn;13.14 \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e64.35\u0026plusmn;14.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e53.35\u0026plusmn;10.17 \u003csup\u003e\u0026pi;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e84.40\u0026plusmn;10.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironmental quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e47.89\u0026plusmn;13.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e47.79\u0026plusmn;13.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e51.24\u0026plusmn;15.42 \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e67.78\u0026plusmn;10.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e64.59\u0026plusmn;13.75 \u003csup\u003e\u0026pi;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e84.22\u0026plusmn;8.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026dagger;: Statistically significant at P \u0026le; 0.05 between\u0026nbsp;\u003cstrong\u003eActive treatment versus Control group at 3 months\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e#: Statistically significant at P \u0026le; 0.05 between\u0026nbsp;\u003cstrong\u003eActive treatment versus Control group at 6 months\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003csub\u003e1:\u0026nbsp;\u003c/sub\u003e\u003c/strong\u003eP \u0026ndash; value of comparison between baseline and 3 months in\u0026nbsp;\u003cstrong\u003eActive treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP2:\u003c/strong\u003e P \u0026ndash; value of comparison between 3 months and 6 months in\u0026nbsp;\u003cstrong\u003eActive treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026yen;:\u0026nbsp;Statistically significant at P \u0026le; 0.05 between \u003cstrong\u003eRelapse versus Abstinence cases\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;at 3 months\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026pi;: :\u003c/sup\u003e Statistically significant at P \u0026le; 0.05 between \u003cstrong\u003eRelapse versus Abstinence cases\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;at 6 months\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP3 :\u0026nbsp;\u003c/strong\u003eP \u0026ndash; value of comparison between baseline and 3 months in\u003cstrong\u003e\u0026nbsp;Abstinence cases\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP4:\u003c/strong\u003e P \u0026ndash; value of comparison between 3 months and 6 months in\u003cstrong\u003e\u0026nbsp;Abstinence cases\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurvival analysis showed that active treatment significantly reduced relapse risk (HR = 0.65, P = 0.001). Unemployment (HR = 4.98, P=0.003), illiteracy (HR = 3.43, P=0.03), and being single (HR = 16.24, P=0.003) were strong predictors of relapse. Divorced individuals also had elevated risk (HR = 3.43, P=0.027). Other factors, including age, general employment, and ASI domains, were not significant, highlighting the stronger impact of social over clinical factors on relapse. \u003cstrong\u003eTable 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5: Group differences in relapses to OUD during the six-month follow-up (survival analysis)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.0% CI for HR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e16.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e2.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUn employment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e4.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e105.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e12.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIlliterate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e12.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e23.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUn\u003c/strong\u003e\u003cstrong\u003emarried\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e12.455\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI Psychological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.335\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI medical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI employment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.962\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.710\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASI legal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOUD: Opioid Use Disorder, HR: Hazard ratio, Cl: Confidence Interval, ASI: Addiction Severity Index, B: The regression coefficients predict the hazard for relapse. A positive coefficient indicates a positive relationship between the covariate and the hazard for the relapse (higher values on the covariates are associated with less survival time). A negative coefficient indicates a negative relationship between the covariate and the hazard for the terminal event. Higher values on the covariate are associated with longer survival time. Hazard ratio less than 1 are associated with negative regression slopes, whereas values greater than 1 are associated with positive slopes. A hazard ratio of 1 indicates there no change in the hazard per unit change on the covariate.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated the impact of a structured relapse prevention program for individuals with opioid use disorder (OUD), comparing outcomes between an active treatment group and a control group across multiple domains including relapse rates, craving intensity, addiction severity, quality of life (QOL), and relapse predictors.\u003c/p\u003e\u003cp\u003eIn this study, relapse rates in the active treatment group were 33.3% in three months and 44.4% in six months, significantly lower than the control group\u0026rsquo;s rates of 67.6% and 77.8%, respectively (P\u0026thinsp;=\u0026thinsp;0.001). These findings underscore the short-term efficacy of the intervention in delaying relapse. These results were consistent with studies incorporating opioid agonist therapy (OAT). For example, Pashaei et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported that patients receiving CBT with methadone had a relapse rate of 36.4%, compared to 63.6% for those receiving methadone alone. However, Goweid et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reported higher relapse rates in a study conducted at Alexandria University using CBT alone (54.3% at three months and 77.1% at six months), suggesting that the addition of mindfulness and MI in the current study may have contributed to the improved outcomes.\u003c/p\u003e\u003cp\u003eImportantly, craving was significantly reduced among participants receiving active treatment (60%) compared with controls (88.9%). Conversely, a non-significant association was identified between previous psychiatric history and relapse in the active treatment group, aligning with findings by Clark et al [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]., though contrasting with Harsh et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], who observed a significant relationship in a larger cohort. These inconsistencies may stem from methodological variations, including sample size and follow-up duration.\u003c/p\u003e\u003cp\u003eRegarding ASI, the present study demonstrated significant post-intervention decreases in ASI scores across all six domains medical, legal, occupational, substance use, social, and psychiatric in participants who received the active treatment. In particular, the decline in substance-use severity (mean from 7.58 to 2.50) and psychiatric symptoms (from 3.78 to 1.30) aligned with research highlighting the value of comprehensive interventions that target both the physiological and psychosocial dimensions of OUD [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similar reductions in ASI scores have been documented in interventions incorporating mindfulness and cognitive-behavioral components in studies by Moore et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]; Rice et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; Bolivar et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese findings were further supported by recent work by McClain et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], who documented comparable improvements in multiple ASI domains among OUD patients receiving mindfulness-based sessions.\u003c/p\u003e\u003cp\u003eIn this study an addiction management program at Tanta Neuropsychiatry and Neurosurgery Center, established comparable baseline characteristics between the active treatment and control groups was crucial for attributing any observed differences to the intervention. Indeed, pre-intervention. QOL measures did not differ significantly between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which aligned with research Ismail et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] indicating that individuals entering opioid treatment programs often share similar psychosocial vulnerabilities.\u003c/p\u003e\u003cp\u003eAfter six months, the active treatment group showed significant improvements in every QOL domain: Physical Health scores rose from 44.55 (\u0026plusmn;\u0026thinsp;13.98) to 70.40 (\u0026plusmn;\u0026thinsp;11.75), Psychological Health from 46.42 (\u0026plusmn;\u0026thinsp;15.35) to 71.09 (\u0026plusmn;\u0026thinsp;11.98), and both social interaction and environmental quality followed a similarly robust upward trend (P\u0026thinsp;=\u0026thinsp;0.001 for all).\u003c/p\u003e\u003cp\u003eThese findings confirm the initial hypothesis and corroborate findings by Vederhus et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and Manning et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], who similarly reported substantial QOL improvements among individuals achieving abstinence. Conversely, the Control Group displayed non-significant changes in QOL (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), consistent with earlier work underscoring the limitations of minimal or standard treatment approaches by Kelly et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe survival analysis conducted to examine the factors associated with relapses to OUD over a six-month follow-up period revealed several significant social determinants that influenced outcomes. Among the most notable findings was the significant protective effect of being in the treatment group, which yielded a hazard ratio (HR) of 0.65 P\u0026thinsp;=\u0026thinsp;0.001). This result was consistent with multiple recent studies, such as Komasi et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] which demonstrated that structured treatment interventions including counseling and medication-assisted therapy (MAT) significantly reduce the likelihood of relapses among individuals with OUD. Similarly, a quasi- experimental study by Zullig et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] concluded that individuals receiving long-term treatment support had greater retention and lower rates of recurrence. These findings reinforce the central role of structured interventions in mitigating relapse risk and support the ongoing expansion of access to such programs, especially in vulnerable populations.\u003c/p\u003e\u003cp\u003eAnother important finding from the analysis was the impact of unemployment on relapse risk. Individuals who were unemployed showed a markedly higher risk of relapse (HR\u0026thinsp;=\u0026thinsp;4.98, P\u0026thinsp;=\u0026thinsp;0.003). This result aligned with economic and social theories of addiction, which propose that a lack of structured daily activities, income insecurity, and psychological distress contribute to relapse vulnerability. A study by Nolte-Troha et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] observed that unemployed patients were nearly five times more likely to relapse within 12 months of completing a treatment program. These findings emphasized the importance of integrating vocational training and job placement services into addiction recovery frameworks.\u003c/p\u003e\u003cp\u003eEducational status also emerged as a significant factor as being illiterate was associated with a greater risk of relapses (HR\u0026thinsp;=\u0026thinsp;3.434, P\u0026thinsp;=\u0026thinsp;0.03). For instance, Nguyen et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] found that individuals with secondary or higher education had significantly lower relapse rates due to better understanding of treatment protocols and healthier coping strategies. Addressing educational gaps through health education and supportive learning initiatives may be an effective adjunct to relapse prevention strategies.\u003c/p\u003e\u003cp\u003eMarital status was another critical predictor in the model as unmarried participants exhibited the highest relapse risk (HR\u0026thinsp;=\u0026thinsp;3.43, P\u0026thinsp;=\u0026thinsp;0.027). These findings were consistent with the literature indicating that social isolation and lack of familial support were key triggers. In comparison, married individuals, though not significant in this analysis, often benefit from emotional stability and social reinforcement. A recent cross-sectional study by Brousseau et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] suggested that married individuals had better treatment retention and reduced recurrence due to family accountability and spousal support. These results underscored the role of social relationships and the need for interventions that foster community and family engagement.\u003c/p\u003e\u003cp\u003eNotably, clinical and psychosocial measures such as the ASI subscales including psychological, medical, drug, employment, family, and legal, did not reach statistical significance in this study. While these domains were often considered integral to comprehensive addiction assessments, their non-significance may reflect overlapping variance with stronger social predictors or the relatively short duration of follow-up. Other studies, such as that by Mar Gica et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] showed these variables to be more predictive over longer follow-up periods or in larger, more diverse cohorts. It was possible that their effects mediated through more direct social determinants such as unemployment and marital disruption.\u003c/p\u003e\u003cp\u003eFuture programs should integrate vocational assistance, health education, and family engagement to enhance recovery outcomes. Moreover, long-term follow-up and larger sample size were recommended to further delineate the complex interplay between psychosocial and clinical factors in sustaining recovery.\u003c/p\u003e\u003cp\u003eLimitations of the study included the non-randomized study design which would come second in terms of evidence following the more powerful randomized controlled study design.\u003c/p\u003e\u003cp\u003eConducting this study in absence of OAT, no similar studies using psychotherapy interventions as single therapeutic modality against OUD were found that represents a challenge for us to compare our results with the results of similar studies. Efficacy of relapse prevention model was only assessed over short duration after psychotherapy intervention (at end of psychotherapy program) while further follow up assessments must be considered over long durations to be able to assess its accurate efficacy\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study revealed that an integrated rehabilitation program was significantly effective in reducing relapse rates and improving the QoL of individuals with OUD. A significantly lower rate of recovery in both three months and six months indicated the effectiveness of the rehabilitation program in maintaining abstinence over time. A marked reduction in the ASI\u003c/p\u003e\u003cp\u003eThrough multiple domains after six months, the positive impact of comprehensive treatment on addiction severity and the overall well-being of patients. There were substantial improvements in all aspects of QoL (physical health, psychological health, social interaction, and environmental quality), demonstrating the holistic benefits of the rehabilitation program.\u003c/p\u003e\u003cp\u003eThe study indicated that the positive outcomes of the active treatment group were sustained over the six-month period, suggesting that integrated rehabilitation programs had a lasting impact on recovery from OUD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASI:\u0026nbsp;Addiction Severity Index\u003c/p\u003e\n\u003cp\u003eCBT:\u0026nbsp;Cognitive-Behavioral Therapy\u003c/p\u003e\n\u003cp\u003eCDC:\u0026nbsp;Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003eCl:\u0026nbsp;Confidence Interval\u003c/p\u003e\n\u003cp\u003eDSM-5:\u0026nbsp;Diagnostic And Statistical Manual of Mental Disorders, 5th Edition\u003c/p\u003e\n\u003cp\u003eHIV:\u0026nbsp;Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eHR:\u0026nbsp;Hazard ratio\u003c/p\u003e\n\u003cp\u003eMAT:\u0026nbsp;Medication-Assisted Therapy\u003c/p\u003e\n\u003cp\u003eMBCT:\u0026nbsp;Mindfulness-Based Cognitive Therapy\u003c/p\u003e\n\u003cp\u003eMI:\u0026nbsp;Motivational Interviewing\u003c/p\u003e\n\u003cp\u003eOAT:\u0026nbsp;Opioid Agonist Therapy\u003c/p\u003e\n\u003cp\u003eOUD:\u0026nbsp;Opioid Use Disorder\u003c/p\u003e\n\u003cp\u003eQOL:\u0026nbsp;Quality of Life\u003c/p\u003e\n\u003cp\u003eRCTs:\u0026nbsp;Randomized Controlled Trials\u003c/p\u003e\n\u003cp\u003eSAMHSA:\u0026nbsp;Substance Abuse and Mental Health Services Administration\u003c/p\u003e\n\u003cp\u003eSUDS:\u0026nbsp;Substance Use Disorders\u003c/p\u003e\n\u003cp\u003eWHO:\u0026nbsp;World Health Organization\u003c/p\u003e\n\u003cp\u003eWHOQOL-BREF: World Health Organization Quality of Life-BREF\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was done after approval from the Ethical Committee Tanta University Hospitals, Tanta, Egypt (approval code: 36264MD66/4/23). An informed written consent was obtained from the patient or relatives of the patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn informed written consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available on reasonable requests from corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial or proprietary interest in any material discussed in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [N.F.F.], [H.E.F.E.], [M.A.E.] and [M.A.A.E.]. The first draft of the manuscript was written by [A.A.E.] and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVallersnes OM, Jacobsen D, Ekeberg \u0026Oslash;, et al. (2019) Mortality, morbidity and follow-up after acute poisoning by substances of abuse: A prospective observational cohort study. Scand J Public Health;47 (4):452-61. https://doi.org/10.1177/1403494818779955\u003c/li\u003e\n\u003cli\u003eSmith AC. (2025) Barriers to medication-assisted treatment for opioid use disorder in prisons and jails in the united states: A comprehensive literature review. 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(2009) The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population. Ann Saudi Med;29 (2):98-104. https://doi.org/10.4103/0256-4947.51790\u003c/li\u003e\n\u003cli\u003eMiller WR, Mu\u0026ntilde;oz RF. Controlling your drinking: Tools to make moderation work for you. 2nd ed: Guilford Press; 2013.\u003c/li\u003e\n\u003cli\u003eMagill M, Ray LA. (2009) Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. JSAD;70 (4):516-27. https://doi.org/10.15288/jsad.2009.70.516\u003c/li\u003e\n\u003cli\u003eCopello AG, Velleman RD, Templeton LJ. (2005) Family interventions in the treatment of alcohol and drug problems. DAR;24 (4):369-85. https://doi.org/10.1080/09595230500302356\u003c/li\u003e\n\u003cli\u003eTracy K, Wallace SP. (2016) Benefits of peer support groups in the treatment of addiction. Subst abuse rehabil;7 (1):143-54. https://doi.org/10.2147/SAR.S81535\u003c/li\u003e\n\u003cli\u003eBowen S, Chawla N, Grow J, et al. Mindfulness-based relapse prevention for addictive behaviors. 2nd ed: Guilford Publications; 2021.\u003c/li\u003e\n\u003cli\u003ePashaei T, Shojaeizadeh D, Rahimi Foroushani A, et al. (2013) Effectiveness of Relapse Prevention Cognitive-Behavioral Model in Opioid-Dependent Patients Participating in the Methadone Maintenance Treatment in Iran. Iran J Public Health;42 (8):896-902. \u003c/li\u003e\n\u003cli\u003eGowaid AA, Molokhia TK, Rady AR, et al. (2022) Predictors of relapse among patients with opioid use disorder treated with relapse prevention based cognitive behavior therapy: a prospective study. Senses sci;9 (1):1-7. https://doi.org/10.14616/sands-2022-1-15001509\u003c/li\u003e\n\u003cli\u003eKolodny A, Courtwright DT, Hwang CS, et al. (2015) The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health;36 (1):559-74. https://doi.org/10.1146/annurev-publhealth-031914-122957\u003c/li\u003e\n\u003cli\u003eChalana H, Kundal T, Gupta V, et al. (2016) Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up. J Addict;18 (1):7620860. https://doi.org/10.1155/2016/7620860\u003c/li\u003e\n\u003cli\u003eMoore M, Flamez B, Szirony GM. (2018) Moore, M., Flamez, B., \u0026amp; Szirony, G. M. (2018). Motivational interviewing and dual diagnosis clients: Enhancing self-efficacy and treatment completion. . J Subst Use;23 (3):247-53. https://doi.org/10.1080/14659891.2017.1388856\u003c/li\u003e\n\u003cli\u003eMoore TM, Seavey A, Ritter K, et al. (2014) Ecological momentary assessment of the effects of craving and affect on risk for relapse during substance abuse treatment. Psychol Addict Behav;28 (2):619-24. https://doi.org/10.1037/a0034127\u003c/li\u003e\n\u003cli\u003eMoyers TB, Houck J, Rice SL, et al. (2016) Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project. J Consult Clin Psychol;84 (3):221-9. https://doi.org/10.1037/ccp0000074\u003c/li\u003e\n\u003cli\u003eBol\u0026iacute;var HA, Klemperer EM, Coleman SRM, et al. (2021) Contingency Management for Patients Receiving Medication for Opioid Use Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry;78 (10):1092-102. https://doi.org/10.1001/jamapsychiatry.2021.1969\u003c/li\u003e\n\u003cli\u003eMcClain N, Ceceli AO, Kronberg G, et al. (2025) Moving beyond self-report in characterizing drug addiction: Using drug-biased behavior to prospectively inform treatment adherence in opioid use disorder. medRxiv;5 (1):5-10. https://doi.org/https://doi.org/10.1101/2025.01.01.25319860\u003c/li\u003e\n\u003cli\u003eIsmail RM, Hussein R, Arafa SM, et al. (2019) Psychosocial aspects, life events, and quality of life of a sample of adolescent males with substance use. AIMJ;3 (2):483-93. https://doi.org/10.4103/sjamf.sjamf_65_19\u003c/li\u003e\n\u003cli\u003eVederhus JK, Birkeland B, Clausen T. (2016) Perceived quality of life, 6 months after detoxification: Is abstinence a modifying factor? Qual Life Res;25 (9):2315-22. https://doi.org/10.1007/s11136-016-1272-z\u003c/li\u003e\n\u003cli\u003eManning V, Garfield JBB, Lam T, et al. (2019) Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use. J Clin Med;8 (9):2-3. https://doi.org/10.3390/jcm8091407\u003c/li\u003e\n\u003cli\u003eKelly JF, Humphreys K, Ferri M. (2020) Alcoholics Anonymous and other 12-step programs for alcohol use disorder. CDSR;3 (3):Cd012880. https://doi.org/10.1002/14651858.CD012880.pub2\u003c/li\u003e\n\u003cli\u003eKomasi S, Saeidi M, Amiri MM, et al. (2017) Triggers of substance abuse slip and relapse during outpatient treatment in methadone/buprenorphine maintenance therapy clinics: a predictive model with emphasis on treatment-related factors. Jundishapur J Health Sci;9 (3):e57688. https://doi.org/10.5812/jjhs.57688\u003c/li\u003e\n\u003cli\u003eZullig KJ, Lander LR, Tuscano M, et al. (2021) Testing mindfulness-based relapse prevention with medications for opioid use disorder among adults in outpatient therapy: A quasi-experimental study. Mindfulness (N Y);12 (12):3036-46. https://doi.org/10.1007/s12671-021-01763-w\u003c/li\u003e\n\u003cli\u003eNolte-Troha C, Roser P, Henkel D, et al. (2023) Unemployment and substance use: An updated review of studies from north america and europe. Healthcare (Basel);11 (8). https://doi.org/10.3390/healthcare11081182\u003c/li\u003e\n\u003cli\u003eNguyen HTT, Dinh DX. (2023) Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam. Harm Reduct J;20 (1):136. https://doi.org/10.1186/s12954-023-00872-0\u003c/li\u003e\n\u003cli\u003eBrousseau NM, Karpyn A, Laurenceau JP, et al. (2022) The Impacts of Social Support and Relationship Characteristics on Commitment to Sobriety Among People in Opioid Use Disorder Recovery. J Stud Alcohol Drugs;83 (5):646-52. https://doi.org/10.15288/jsad.21-00225\u003c/li\u003e\n\u003cli\u003eGica S, Donmez Z, Unubol B, et al. (2020) Predictors of relapse in the early stages of the treatment among inpatients with opioid use disorder: a single-center, prospective cohort study. PCP;30 (3):1. https://doi.org/10.5455/PCP.20200302044600\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"middle-east-current-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mecp","sideBox":"Learn more about [Middle East Current Psychiatry](http://mecp.springeropen.com)","snPcode":"43045","submissionUrl":"https://submission.nature.com/new-submission/43045/3","title":"Middle East Current Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Opioid Use Disorder, Cognitive Behavioral Therapy, Relapse Prevention, Quality of Life, Egypt","lastPublishedDoi":"10.21203/rs.3.rs-7620892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7620892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSubstance use disorders (SUDs), especially opioid dependence, are a significant problem in Egypt. psychological therapies like cognitive-behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) provide effectiveness in reducing relapse and improve the Quality of life (QOL) in patients with SUD treatment. The aim of the study was to develop a structured, integrated rehabilitation program designed for relapse prevention among patients diagnosed with opioid use disorder (OUD), evaluate the efficacy of this integrated intervention in reducing relapse rates, assess its impact on patients\u0026rsquo; QOL and identify significant clinical, psychological, and sociodemographic predictors of relapse within patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis quasi-experimental design was employed to evaluate the efficacy of an integrated rehabilitation program for relapse prevention among individuals with OUD on 100 male patients with OUD as per diagnostic and statistical manual of mental disorders, 5th edition (DSM-5) criteria, aged from 18 to 45 years old.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe active treatment group showed significantly lower relapse rates in 3 months (P\u0026thinsp;=\u0026thinsp;0.001) and 6 months (P\u0026thinsp;=\u0026thinsp;0.001). Addiction severity index (ASI) scores improved markedly in the treatment group across medical, legal, occupational, and psychiatric domains (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). QoL scores (physical, psychological, social, environmental) also improved significantly post-intervention (P\u0026thinsp;=\u0026thinsp;0.001). Survival analysis confirmed the treatment group\u0026rsquo;s lower relapse risk (P\u0026thinsp;=\u0026thinsp;0.001), while marital status (single/divorced) predicted higher relapse risk.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe integrated CBT/MI/with mindfulness rehabilitation program significantly reduced relapses and enhanced QoL in OUD patients compared to standard care. These findings advocate for its applicable in clinical practice.\u003c/p\u003e","manuscriptTitle":"Assessment of the Efficacy of an Integrated Rehabilitation Program in Relapse Prevention Among Opioid Use Disorder Patients in Psychiatry and Neurology Center, Tanta University","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-09 08:58:31","doi":"10.21203/rs.3.rs-7620892/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-11T08:53:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T21:29:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213207505710955978797848437472449127037","date":"2025-09-28T20:14:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-26T09:09:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-25T11:41:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-25T11:40:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Middle East Current Psychiatry","date":"2025-09-15T12:54:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"middle-east-current-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mecp","sideBox":"Learn more about [Middle East Current Psychiatry](http://mecp.springeropen.com)","snPcode":"43045","submissionUrl":"https://submission.nature.com/new-submission/43045/3","title":"Middle East Current Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"25ce3b90-4115-46bd-a2fa-a33ee41af6b2","owner":[],"postedDate":"October 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:03:06+00:00","versionOfRecord":{"articleIdentity":"rs-7620892","link":"https://doi.org/10.1186/s43045-025-00607-w","journal":{"identity":"middle-east-current-psychiatry","isVorOnly":false,"title":"Middle East Current Psychiatry"},"publishedOn":"2025-12-30 15:57:49","publishedOnDateReadable":"December 30th, 2025"},"versionCreatedAt":"2025-10-09 08:58:31","video":"","vorDoi":"10.1186/s43045-025-00607-w","vorDoiUrl":"https://doi.org/10.1186/s43045-025-00607-w","workflowStages":[]},"version":"v1","identity":"rs-7620892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7620892","identity":"rs-7620892","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}