Addiction management and rehabilitation programs in Saudi Arabia: a scoping review of current practices and opportunities for healthcare technology integration

Abstract

Background

Substance use disorders (SUDs) represent a growing public health challenge in Saudi Arabia despite strict legal and social controls. Addiction management is primarily delivered through centralized inpatient and residential rehabilitation programs; however, the available evidence remains fragmented, and opportunities for healthcare technology integration have not been comprehensively synthesized.

Methods

A scoping review was conducted in accordance with the PRISMA-ScR guidelines to map addiction management and rehabilitation programs in Saudi Arabia and identify opportunities for healthcare technology integration. Comprehensive searches were performed across PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and supplementary sources from database inception to October 2025. Original empirical studies evaluating addiction treatment, rehabilitation, or aftercare services in Saudi Arabia were included. Data were systematically charted and synthesized using a descriptive thematic narrative approach. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS).

Results

Nine studies published between 1995 and 2024 met the inclusion criteria. The evidence demonstrated a progressive evolution from predominantly detoxification-focused services toward multidisciplinary rehabilitation models incorporating therapeutic communities and structured aftercare. Despite these advances, long-term retention remained limited, relapse and hospital readmission were common, and community-based rehabilitation was underrepresented. Social determinants, particularly unemployment, family conflict, and limited social support, consistently influenced rehabilitation outcomes. Healthcare technology integration was minimal, with electronic health records primarily used for retrospective analyses and no studies evaluating telehealth, mobile health applications, remote monitoring, or artificial intelligence-supported addiction care. Methodological quality was predominantly moderate, with three studies rated as high quality, five as moderate quality, and one as low quality.

Conclusion

Although addiction rehabilitation services in Saudi Arabia have evolved toward more comprehensive multidisciplinary models of care, important gaps remain in long-term recovery support, community-based rehabilitation, standardized outcome monitoring, and digital health integration. Strengthening aftercare and adopting healthcare technologies may improve continuity of care, enhance recovery outcomes, and support the ongoing transformation of addiction services under Saudi Vision 2030.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s13011-026-00767-w.

Background

Substance use disorders (SUDs) are chronic, relapsing conditions that represent one of the leading contributors to preventable morbidity, premature mortality, and disability worldwide [1]. According to the United Nations Office on Drugs and Crime (UNODC), approximately 316 million people used drugs globally in 2023, while the World Health Organization (WHO) estimates that nearly 400 million individuals are living with alcohol or drug use disorders, resulting in more than three million deaths annually [2, 3]. Recent findings from the Global Burden of Disease (GBD) 2021 study further demonstrate the growing impact of SUDs, reporting approximately 13.6 million new cases, more than 137,000 deaths, and over 15 million disability-adjusted life years (DALYs) attributable to drug use disorders in 2021 alone, representing substantial increases compared with 1990 [4]. Despite this escalating burden, access to treatment remains critically inadequate, with the UNODC estimating that only one in seven to one in eleven individuals with substance use disorders receives appropriate treatment, highlighting a persistent global treatment gap and the need for scalable, accessible models of care [2].

Over the past two decades, the understanding of addiction has evolved considerably from viewing substance dependence as an acute behavioral problem to recognizing it as a chronic, multifactorial disorder requiring long-term management. Contemporary evidence supports a biopsychosocial framework in which neurobiological, psychological, social, and environmental factors interact to influence disease progression and recovery [5]. Consequently, international addiction treatment has shifted from episodic detoxification toward recovery-oriented systems of care that emphasize continuous engagement, multidisciplinary management, integrated behavioral health services, and individualized rehabilitation pathways rather than isolated treatment episodes [5].

Current international rehabilitation strategies encompass a continuum of care extending from inpatient detoxification and residential rehabilitation to intensive outpatient treatment, therapeutic communities, structured aftercare, peer-support programs, and long-term relapse prevention services. Therapeutic communities remain one of the most extensively evaluated rehabilitation models, while mutual-help approaches such as Alcoholics Anonymous and Twelve-Step Facilitation have demonstrated sustained improvements in long-term abstinence and reduced healthcare utilization in systematic reviews and meta-analyses [6]. Increasing evidence also indicates that successful recovery depends not only on treating substance dependence itself but also on addressing psychiatric comorbidity, family involvement, employment, vocational rehabilitation, and broader social determinants of health through integrated, multidisciplinary interventions [7]. Nevertheless, maintaining treatment retention and continuity of care continues to represent a major challenge across healthcare systems worldwide.

Alongside these developments, digital health technologies have emerged as important tools for improving addiction treatment delivery and reducing barriers to long-term care. Telemedicine, telepsychiatry, mobile health applications, electronic health records, digital therapeutics, wearable monitoring technologies, and artificial intelligence–based predictive models are increasingly being incorporated into addiction services to enhance treatment accessibility, personalize care, strengthen relapse prevention, and facilitate continuous monitoring after discharge [8]. Systematic reviews have demonstrated that internet-based cognitive behavioral therapy, mobile recovery applications, and digitally supported behavioral interventions can improve patient engagement, adherence, and long-term recovery outcomes while expanding access to evidence-based care, particularly for geographically isolated or socially marginalized populations [9, 10]. These technologies have become particularly valuable for addressing the chronic nature of substance use disorders by enabling continuous patient monitoring beyond traditional facility-based care.

Within the Middle East and Gulf Cooperation Council (GCC) countries, digital transformation of mental healthcare has accelerated in parallel with broader national healthcare modernization initiatives. In Saudi Arabia, telepsychiatry services have demonstrated high patient satisfaction regarding accessibility, effectiveness, and safety [11], while qualitative research suggests that digital mental health platforms may help overcome stigma by providing greater privacy and anonymity for individuals seeking psychiatric support [12]. These findings suggest that culturally sensitive digital interventions may be particularly valuable in addressing barriers to addiction treatment in settings where stigma continues to influence healthcare utilization.

Saudi Arabia represents a distinctive context for addiction management. Although strong religious, legal, and social norms prohibit substance use, epidemiological evidence indicates that substance use disorders remain an important public health concern, with amphetamine-type stimulants and cannabis representing the predominant substances among treatment-seeking populations [13]. Addiction treatment is delivered primarily through specialized Ministry of Health facilities, including Al-Amal Hospitals, Eradah Mental Health Complexes, residential therapeutic communities, and structured rehabilitation programs. Simultaneously, the Kingdom is undergoing an unprecedented transformation of its healthcare system under Vision 2030 and the Health Sector Transformation Program, with substantial investments in digital health infrastructure, electronic health records, virtual healthcare services, and telemedicine. National initiatives such as the Seha Virtual Hospital, one of the world’s largest virtual hospitals, together with expanding digital health platforms, demonstrate the country’s commitment to leveraging healthcare technology to improve accessibility, efficiency, and quality of care across multiple clinical disciplines [14, 15].

Despite these advances, important evidence gaps remain. While international literature increasingly supports the integration of digital technologies into addiction rehabilitation, relatively little is known about how these innovations are being incorporated into specialized addiction treatment programs within Saudi Arabia. Existing Saudi studies primarily evaluate inpatient treatment outcomes, therapeutic communities, or readmission patterns, with limited attention to technology-enabled rehabilitation, digital follow-up systems, tele-rehabilitation, or electronic outcome monitoring. Furthermore, no previous review has comprehensively mapped addiction management and rehabilitation programs in Saudi Arabia while simultaneously examining opportunities for healthcare technology integration within the Kingdom’s rapidly evolving digital health ecosystem.

Accordingly, this scoping review aimed to systematically map the existing evidence on addiction management and rehabilitation programs in Saudi Arabia, synthesize their characteristics and reported outcomes, identify current service gaps, and explore opportunities for integrating healthcare technologies to strengthen continuity of care, improve long-term recovery, and support ongoing healthcare transformation under Saudi Vision 2030.

Methods

Study design and objectives

This study was conducted as a scoping review to map the existing evidence on addiction management and rehabilitation programs in Saudi Arabia and to identify gaps and opportunities for healthcare technology integration. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A predefined methodological framework guided the search strategy, study selection, data charting, quality appraisal, and thematic narrative synthesis to ensure methodological rigor, transparency, and reproducibility.

Search strategy

The search strategy was developed and implemented in accordance with the PRISMA-ScR guidelines. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science (Core Collection), and Google Scholar to identify studies examining addiction management and rehabilitation programs in Saudi Arabia. The search combined controlled vocabulary terms (Medical Subject Headings [MeSH] in PubMed) and free-text keywords related to substance use disorders, addiction, drug or substance abuse, rehabilitation, treatment programs, therapeutic communities, detoxification, aftercare, and Saudi Arabia. Boolean operators (AND/OR) and truncation were applied to combine concepts and enhance search sensitivity.

The search included all publications from database inception to October 2025, when the final search was completed. No restrictions were applied on publication year. Searches were limited to human studies published in English or Arabic. For Google Scholar, the first four pages of search results, sorted by relevance, were screened to ensure feasibility while maintaining comprehensive coverage. In addition, the reference lists of all included studies were manually screened to identify any relevant articles not captured through the electronic database searches.

Eligibility criteria

Studies were eligible for inclusion if they were original empirical research conducted in Saudi Arabia and addressed addiction management, treatment, rehabilitation, or aftercare programs for individuals with substance use disorders. Consistent with a scoping review approach, a broad range of study designs was included, such as cross-sectional studies, cohort studies, retrospective analyses, longitudinal studies, before-and-after evaluations, and program evaluations. Studies conducted in inpatient, outpatient, residential therapeutic community, or aftercare settings were eligible. Publications involving human participants and published in English or Arabic were included, with no restriction on publication year.

Studies were excluded if they were review articles, editorials, commentaries, opinion pieces, case reports, or conference abstracts without sufficient primary data, or if they did not report original findings. Studies conducted outside Saudi Arabia, or those in which Saudi-specific data could not be clearly disaggregated, were excluded. Research focusing exclusively on prevalence, epidemiology, prevention, or risk factors without describing or evaluating addiction treatment or rehabilitation services was also excluded. Animal studies and laboratory-based research were not considered eligible.

Study selection and screening

All records identified through the database searches were imported into Rayyan (https://www.rayyan.ai/) for duplicate removal and screening. Titles and abstracts were independently screened against the eligibility criteria by multiple reviewers. Full-text articles of potentially relevant studies were subsequently retrieved and assessed for inclusion by at least two reviewers. Any disagreements at either stage were resolved through discussion and consensus, and when necessary, adjudicated by senior reviewers. The study selection process followed the PRISMA-ScR framework and is presented in a flow diagram.

Data charting and management

Data charting was conducted using a standardized data extraction form developed specifically for this scoping review to ensure consistency and accuracy. At least two reviewers independently extracted data from each included study. Extracted information included study characteristics (author, publication year, region, study design, study period, setting, and sample size), participant characteristics, rehabilitation or treatment model, intervention characteristics, primary outcomes, healthcare technology relevance, and methodological quality. Additional data were collected on treatment retention, treatment completion, relapse, hospital readmission, length of hospital stay, aftercare services, psychosocial determinants, reported barriers, evidence gaps, and opportunities for healthcare technology integration. Information describing rehabilitation program models and digital health applications was also extracted to facilitate thematic synthesis. All extracted data were cross-checked, and discrepancies were resolved through discussion and consensus. The finalized dataset was managed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA).

Data synthesis

Charted data were synthesized using a descriptive thematic narrative approach, consistent with the objectives of a scoping review. Initially, study characteristics were summarized descriptively to provide an overview of the available evidence. Subsequently, findings were grouped according to similarities in rehabilitation models, clinical outcomes, and healthcare technology applications. An inductive thematic synthesis was then performed to identify recurring concepts, patterns, and evidence gaps across the included studies. Particular emphasis was placed on synthesizing evidence relating to the evolution of addiction rehabilitation services, treatment effectiveness, relapse and readmission, psychosocial determinants of recovery, aftercare services, and opportunities for healthcare technology integration. Rather than presenting findings on a study-by-study basis, evidence was integrated across studies to generate overarching themes and identify areas of consistency, variation, and unmet research needs. Summary tables were developed to present study characteristics, synthesized rehabilitation outcomes, key thematic findings, evidence gaps, and healthcare technology opportunities. No quantitative synthesis or meta-analysis was performed because of the methodological heterogeneity of the included studies.

Quality assessment

Although critical appraisal is not mandatory for scoping reviews, the methodological quality of the included studies was assessed to provide additional context regarding the strength and reliability of the available evidence. Quality assessment was performed using the Newcastle–Ottawa Scale (NOS) for observational studies, which evaluates three domains: selection of study groups, comparability of groups, and ascertainment of the outcome or exposure [16]. Studies were assigned a maximum score of nine points and categorized as high (7–9 points), moderate (4–6 points), or low quality (0–3 points). Two reviewers independently performed the quality assessment, with disagreements resolved through discussion and consensus. Quality ratings were used solely to characterize the methodological quality of the evidence and were not considered as exclusion criteria or incorporated into the thematic synthesis.

Results

Study selection

The literature search identified 474 records from electronic databases and other sources. After removing 220 duplicate records, 254 unique records remained for title and abstract screening. Following this stage, 237 records were excluded because they were unrelated to the review objective, were not conducted in Saudi Arabia, did not focus on addiction treatment or rehabilitation, addressed epidemiological aspects only, or represented non-original publications such as reviews, editorials, and commentaries. Consequently, 17 full-text articles were assessed for eligibility. Eight studies were subsequently excluded due to the absence of a clearly described addiction treatment or rehabilitation program, lack of outcome data, inappropriate study design, or insufficient methodological detail. Ultimately, nine studies fulfilled the eligibility criteria and were included in this scoping review (Fig. 1).

Fig. 1.

PRISMA 2020 flow diagram of study selection

Characteristics of the included studies

The included studies were published between 1995 and 2024, representing nearly three decades of research on addiction management and rehabilitation in Saudi Arabia. Overall, the studies were geographically distributed across several regions of the Kingdom, with the majority conducted in specialized Al-Amal hospitals or residential therapeutic communities. Observational study designs predominated, including cross-sectional studies, retrospective cohort studies, longitudinal analyses, and program evaluations. Sample sizes ranged from evaluations involving five therapeutic communities to retrospective cohorts including more than 14,000 hospitalized patients. Most participants were adult males receiving inpatient addiction treatment, reflecting the organization of specialized addiction services within Saudi Arabia. The principal rehabilitation approaches included inpatient detoxification, structured inpatient rehabilitation, residential therapeutic communities, and structured aftercare services. The primary outcomes assessed focused on treatment retention, treatment completion, relapse, hospital readmission, length of hospital stay, psychosocial functioning, and program effectiveness, while several recent studies also explored opportunities for integrating healthcare technologies into addiction care (Table 1).

Table 1.

Characteristics of the included studies evaluating addiction management and rehabilitation programs in Saudi Arabia

Study	Region	Study design	Study period	Setting	Study population	Sample size	Rehabilitation/service type	Primary outcomes assessed	Healthcare technology relevance
Abdel-Mawgoud et al. (1995) [17]	Dammam	Descriptive program evaluation	1986–1994	Al-Amal Hospital	Adult male inpatients	937–1,692 admissions/year	Comprehensive inpatient rehabilitation	Dropout rate, medication use, length of stay, treatment participation	Demonstrated need for standardized clinical documentation and systematic auditing
Al-Nahedh (1999) [18]	Riyadh	Cross-sectional	March 1998	Al-Amal Hospital	Adult male inpatients	160	Inpatient detoxification and rehabilitation	Readmission, relapse predictors, psychosocial characteristics	Suggested need for digital post-discharge monitoring
Iqbal (2001) [19]	Jeddah	Cross-sectional service evaluation	Jan–Apr 1997	Voluntary Detoxification Unit	Adult male inpatients	302	Medical detoxification and rehabilitation	Treatment commitment, abstinence, rehabilitation uptake, readmission	Highlighted need for electronic continuity-of-care systems
AbuMadini et al. (2008) [20]	Dammam	Retrospective longitudinal	1986–2006	Al-Amal Hospital	First admissions with SUD	12,743	Specialized inpatient rehabilitation	Epidemiological trends, substance patterns, sociodemographic characteristics	Early institutional electronic database used for surveillance
Alshomrani (2016) [21]	National	Cross-sectional evaluation	2014	Five therapeutic communities	Adult male residents	Five centers	Residential therapeutic communities	Program fidelity (SEEQ)	Digital education and vocational platforms suggested
Ahmed et al. (2019) [22]	National	Cross-sectional evaluation	NR	Aftercare units	Recovering patients and social workers	240	Structured aftercare	Program effectiveness (CIPP model)	Identified lack of digital outcome monitoring
Ramadan et al. (2022) [23]	Dammam	Retrospective cohort	2005–2021	Al-Amal Hospital	Hospitalized patients with SUD	14,578	Inpatient rehabilitation	Readmission, length of stay, clinical predictors	Demonstrated utility of EHR-based predictive analyses
Siwar et al. (2023) [24]	Abha	Before-and-after study	NR	Al-Amal Hospital	Cannabis-dependent patients	120	Inpatient psychotherapy with pharmacotherapy	Clinical and biochemical recovery	Supports digital biomarker monitoring
Alshomrani (2024) [25]	National	Retrospective cohort	2000–2014	Therapeutic communities	Adult male residents	2,003	Residential therapeutic communities	Retention, completion, dropout	Potential for AI-based prediction of early attrition

Note: NR = not reported; NOS = Newcastle–Ottawa Scale; SEEQ = Survey of Essential Elements Questionnaire; CIPP = Context–Input–Process–Product evaluation model; EHR = electronic health record; SUD = substance use disorder

Evolution of addiction management and rehabilitation models

The included studies demonstrate a clear evolution in addiction rehabilitation practices within Saudi Arabia over the past three decades. Earlier investigations primarily focused on hospital-based detoxification and medically oriented treatment programs aimed at withdrawal management, medication optimization, and short-term stabilization. Over time, rehabilitation models gradually expanded to incorporate psychosocial interventions, behavioral therapies, residential therapeutic communities, and structured aftercare services, reflecting a transition toward comprehensive recovery-oriented care.

Residential therapeutic communities emerged as a key component of long-term rehabilitation by emphasizing peer support, behavioral modification, structured daily activities, and progressive social reintegration. Program evaluations consistently reported strong adherence to therapeutic community principles while simultaneously identifying persistent deficiencies in vocational rehabilitation, educational activities, and family participation. Collectively, these findings illustrate the gradual transformation of addiction services from predominantly acute medical management toward multidisciplinary rehabilitation programs addressing the biological, psychological, and social dimensions of substance use disorders. A detailed comparison of the rehabilitation models identified across the included studies is presented in supplementary file 1.

Clinical and rehabilitation outcomes

Overall, structured rehabilitation programs demonstrated more favorable outcomes than detoxification alone, with residential therapeutic communities and standardized inpatient programs achieving higher treatment retention and completion rates while reducing early treatment dropout. Relapse and hospital readmission were the most frequently reported outcomes, with approximately one-third of patients experiencing readmission within one year in contemporary cohorts, highlighting the persistent challenge of sustaining long-term recovery.

Poorer rehabilitation outcomes were consistently associated with unemployment, family conflict, peer influence, limited social support, and psychiatric comorbidity, whereas structured family involvement and aftercare programs were linked to greater treatment engagement. Only one study evaluated objective biological recovery, reporting improvements in several physiological markers following inpatient treatment despite persistent oxidative stress abnormalities. Although aftercare services were generally well perceived, participation remained limited and objective long-term outcome monitoring was largely absent. Overall, the evidence suggests that successful addiction rehabilitation requires sustained multidisciplinary care extending beyond inpatient treatment (Table 2).

Table 2.

Synthesis of clinical and rehabilitation outcomes reported across the included studies

Outcome domain	Studies reporting outcome	Overall synthesis	Consistency	Strength of evidence
Treatment retention	3	Residential therapeutic communities achieved higher retention than detoxification services; structured programs reduced early dropout.	High	High
Treatment completion	3	Completion improved with structured rehabilitation and was positively associated with student status, whereas drug type showed limited influence.	High	High
Relapse	4	Relapse remained common, primarily driven by unemployment, family conflict, peer influence, and stimulant use disorders.	High	High
Readmission	4	Approximately one-third of patients experienced readmission within one year, with amphetamine use increasing risk.	High	High
Length of hospital stay	2	Psychiatric comorbidity was the strongest predictor of prolonged hospitalization.	High	High
Abstinence and biomedical recovery	2	Treatment improved short-term abstinence and several physiological biomarkers, although oxidative stress abnormalities persisted.	Moderate	Moderate
Psychiatric comorbidity	2	Mental health disorders increased both hospital stay and risk of readmission.	High	Moderate–High
Quality of life and social functioning	2	Therapeutic communities provided strong peer support but demonstrated weaknesses in vocational rehabilitation and life-skills training.	High	Moderate
Employment outcomes	5	Unemployment was consistently associated with poorer treatment outcomes and greater relapse risk.	High	High
Family involvement	4	Family support facilitated recovery, whereas family conflict contributed to relapse.	Moderate–High	Moderate
Aftercare	2	Structured aftercare was well accepted but suffered from poor participation and limited objective monitoring.	High	Moderate
Healthcare technology	6	Digital technologies were largely absent from routine addiction care despite substantial opportunities for EHR integration, predictive analytics, and digital follow-up.	High	High

Note: Evidence synthesis was derived from all included studies and reflects overall consistency rather than individual study findings

Major evidence gaps

Despite the progress in addiction rehabilitation research, several important evidence gaps remain. Most studies focused on adult male populations, with limited evidence regarding women, outpatient rehabilitation, community-based recovery services, or primary healthcare involvement. Long-term recovery was rarely evaluated, as most studies relied on treatment completion or hospital readmission rather than sustained abstinence, quality of life, employment, social reintegration, or patient-reported outcomes. Standardized national outcome measures and multicenter evaluations were also lacking.

Another major gap was the limited integration of healthcare technology into addiction rehabilitation. While electronic health records have been used for retrospective analyses, no studies evaluated telepsychiatry, mobile health applications, remote monitoring, artificial intelligence, or other digital interventions for addiction care. Similarly, no national addiction registry or standardized electronic outcome monitoring system was identified. These evidence gaps and future research priorities are summarized in Table 3, while current and potential applications of healthcare technologies are presented in supplementary file 1.

Table 3.

Major evidence gaps and research priorities identified across the included studies

Evidence gap	Supporting studies	Potential impact	Research priority
Female addiction services	4	Limits development of gender-sensitive rehabilitation programs	High
Community-based rehabilitation	3	Restricts accessibility outside specialized hospitals	High
Long-term follow-up	4	Prevents evaluation of sustained recovery and relapse	High
Digital health interventions	4	Misses opportunities for telehealth and digital recovery support	High
Objective relapse monitoring	3	Delays relapse detection and intervention	High
Vocational rehabilitation	3	Reduces successful social reintegration	High
Dual-diagnosis management	2	Leads to fragmented psychiatric and addiction care	Moderate–High
Economic evaluation	2	Limits evidence for efficient healthcare resource allocation	Moderate
National addiction registry	3	Prevents nationwide surveillance and benchmarking	High

Note: Research priorities were synthesized from recurring limitations and recommendations reported across the included studies

Overall thematic synthesis

Thematic synthesis demonstrated seven overarching themes emerging across the included studies. First, addiction rehabilitation in Saudi Arabia has evolved from predominantly detoxification-oriented services toward increasingly comprehensive multidisciplinary rehabilitation programs. Second, structured rehabilitation consistently achieved superior treatment retention and completion compared with detoxification alone. Third, relapse and hospital readmission remain persistent challenges, emphasizing the chronic and relapsing nature of substance use disorders. Fourth, social determinants, including unemployment, family conflict, and inadequate social support, play a central role in influencing rehabilitation outcomes. Fifth, although structured aftercare programs contribute positively to recovery, continuity of care remains insufficient after hospital discharge. Sixth, therapeutic communities represent an effective rehabilitation model but require further development of vocational and educational components. Finally, despite increasing recognition of digital health within the Saudi healthcare system, healthcare technologies remain substantially underutilized within addiction rehabilitation services, representing an important opportunity for future service development (Table 4).

Table 4.

Key themes identified across the included studies

Theme	Supporting evidence	Overall interpretation
Evolution of rehabilitation services	All studies	Addiction management evolved from predominantly detoxification-focused services toward comprehensive rehabilitation and structured therapeutic communities.
Treatment effectiveness	Abdel-Mawgoud, Iqbal, Alshomrani (2024)	Structured rehabilitation programs consistently improved retention and treatment completion compared with detoxification alone.
Relapse as a chronic challenge	Al-Nahedh, Iqbal, Ramadan, Ahmed	Relapse and readmission remain common despite treatment, highlighting addiction as a chronic relapsing condition requiring long-term support.
Influence of social determinants	Multiple studies	Unemployment, family conflict, and poor social support were consistently associated with poorer rehabilitation outcomes.
Importance of aftercare	Iqbal, Ahmed	Continuity of care following discharge remains insufficient despite positive perceptions of aftercare services.
Therapeutic community model	Alshomrani (2016; 2024)	Therapeutic communities demonstrated good program fidelity but require stronger vocational and educational components.
Digital transformation	AbuMadini, Ramadan, Ahmed, Siwar, Alshomrani	Healthcare technologies remain underutilized despite clear opportunities for electronic monitoring, predictive analytics, and telehealth integration.

Note: Themes were generated through narrative synthesis of the included studies in accordance with PRISMA-ScR methodology and represent the principal concepts emerging across the evidence base

Quality assessment of the included studies

The methodological quality of the included studies was evaluated using the Newcastle–Ottawa Scale (NOS), with total scores ranging from 3 to 9 (Table 5). Overall, the quality of the evidence was moderate, with three studies classified as high quality (NOS scores 7–9), five studies as moderate quality (scores 4–6), and one study as low quality (score ≤ 3). The highest methodological quality was observed in the large retrospective cohort study by Ramadan et al., which achieved the maximum NOS score of 9, followed by the retrospective cohort studies conducted by AbuMadini et al. and Alshomrani, both of which were rated as high quality with scores of 7. In contrast, the earliest program evaluation by Abdel-Mawgoud et al. received the lowest quality rating, primarily because of limitations in participant selection, comparability, and outcome ascertainment. Across the included studies, the most common methodological limitations were the absence of adequately matched comparison groups, limited adjustment for potential confounding factors, and reliance on observational study designs.

Table 5.

Quality assessment of the included studies using the Newcastle–Ottawa Scale (NOS)

Study	Selection (Max: 4)	Comparability (Max: 2)	Outcome / exposure (Max: 3)	Total score (Max: 9)	Quality rating
Abdel-Mawgoud et al. (1995) [17]	2	0	1	3	Low
Al-Nahedh (1999) [18]	3	1	2	6	Moderate
Iqbal (2001) [19]	3	0	2	5	Moderate
AbuMadini et al. (2008) [20]	4	1	2	7	High
Alshomrani (2016) [21]	3	0	2	5	Moderate
Ahmed et al. (2019) [22]	3	0	2	5	Moderate
Ramadan et al. (2022) [23]	4	2	3	9	High
Siwar et al. (2023) [24]	3	1	2	6	Moderate
Alshomrani (2024) [25]	4	1	2	7	High

Note: The methodological quality of the included observational studies was assessed using the Newcastle–Ottawa Scale (NOS). Studies scoring 7–9 points were classified as high quality, those scoring 4–6 points as moderate quality, and those scoring 0–3 points as low quality. The NOS evaluates three methodological domains: selection of study groups, comparability of groups, and ascertainment of the outcome or exposure

Discussion

This scoping review provides the first comprehensive mapping of addiction management and rehabilitation programs in Saudi Arabia, synthesizing nearly three decades of empirical evidence spanning inpatient services, residential therapeutic communities, and structured aftercare programs. Nine primary studies published between 1995 and 2024 were identified, collectively representing more than 30 years of service delivery and over 17,000 treated individuals. The findings demonstrate that while Saudi Arabia has established a robust institutional infrastructure for addiction treatment, outcomes remain constrained by limited long-term retention, high relapse and readmission rates, and minimal integration of healthcare technologies to support continuity of care. The thematic synthesis identified seven overarching themes encompassing the evolution of rehabilitation services, treatment effectiveness, relapse and readmission, social determinants of recovery, aftercare, therapeutic communities, and healthcare technology integration, providing a comprehensive framework for understanding the current state of addiction rehabilitation in Saudi Arabia.

Evolution of addiction management models in Saudi Arabia

The reviewed studies illustrate a clear historical evolution in addiction management approaches within Saudi Arabia. Early program evaluations from the 1980s and 1990s described predominantly inpatient, medication-oriented treatment models, with limited emphasis on psychosocial rehabilitation [17]. Over time, these services transitioned toward comprehensive biopsychosocial frameworks incorporating group therapy, structured rehabilitation phases, family involvement, and culturally adapted 12-step–based programs [21, 25]. This evolution mirrors international trends in addiction medicine and reflects increasing recognition of substance use disorder as a chronic, multifactorial condition requiring sustained behavioral and social interventions.

Residential therapeutic communities (TCs) emerged as a central pillar of Saudi addiction rehabilitation. National-level evaluations demonstrated moderate-to-high fidelity to TC principles, with an overall implementation score of 3.72 out of 5 [21]. Strengths were observed in community-as-therapeutic-agent domains, while weaknesses were consistently identified in vocational training, educational activities, and life-skills development [21]. These gaps are particularly relevant in the Saudi context, where unemployment and social reintegration challenges are repeatedly identified as drivers of relapse. The underdevelopment of vocational and educational components within TCs likely limits their capacity to address the socioeconomic determinants of sustained recovery. The thematic synthesis further demonstrated that this evolution has primarily occurred within specialized inpatient institutions, whereas community-based and outpatient rehabilitation services remain comparatively underdeveloped. However, the detailed comparison of rehabilitation models indicates that most services continue to be delivered within specialized inpatient facilities, whereas community-based rehabilitation and outpatient recovery pathways remain comparatively underdeveloped. Expanding these services may improve accessibility, strengthen continuity of care, and reduce dependence on repeated hospital-based treatment.

Treatment engagement, retention, and completion

Early engagement with addiction services appeared satisfactory, with low first-week dropout rates in residential therapeutic communities, suggesting that treatment initiation is generally not the primary challenge [25, 26]. However, sustained engagement remained limited, with substantial attrition beyond the initial rehabilitation phase [25]. This pattern is consistent with international evidence identifying treatment retention beyond three to six months as a key predictor of long-term recovery and supporting a shift from episode-based care toward continuous recovery-oriented models [27, 28]. Interestingly, treatment completion was more strongly associated with social characteristics, such as student status, than with substance type, highlighting the importance of social structure and external support in promoting treatment adherence [29].

Relapse, readmission, and chronicity of substance use disorders

Relapse, commonly reflected by hospital readmission, remained one of the most consistent challenges across the included studies. Despite improvements in rehabilitation programs over time, readmission rates remained substantial, reinforcing the chronic and relapsing nature of substance use disorders and the limitations of episodic models of care [30, 31]. Patients with amphetamine and methamphetamine use disorders were particularly vulnerable to repeated admissions, reflecting the predominance of stimulant misuse in Saudi Arabia and the complex neuropsychiatric challenges associated with these substances [31]. Psychiatric comorbidity was also consistently associated with prolonged hospitalization, underscoring the need for integrated addiction and mental health services [32]. Collectively, these findings suggest that reducing relapse and preventing readmission should be considered primary indicators of rehabilitation effectiveness rather than treatment completion alone.

Social determinants and structural drivers of relapse

The thematic synthesis demonstrated that social determinants, including unemployment, family conflict, peer influence, inadequate social support, and broader socioeconomic stressors, were more consistently associated with relapse than clinical factors alone. These findings indicate that long-term recovery depends not only on effective treatment but also on addressing the social conditions that influence sustained behavioral change. Although Saudi Arabia has strengthened specialized addiction treatment services, rehabilitation programs continue to place comparatively less emphasis on community reintegration, vocational rehabilitation, and long-term social support.

The limited incorporation of vocational training, educational activities, and life-skills development within therapeutic communities represents a notable gap. International evidence consistently shows that employment-focused interventions improve treatment retention, reduce relapse, and enhance quality of life among individuals with substance use disorders [33, 34]. Expanding these components, together with stronger family engagement and community-based recovery support, may therefore improve long-term rehabilitation outcomes in Saudi Arabia.

Aftercare and continuity of care

Aftercare services were formally evaluated in only one national study, using the Context–Input–Process–Product (CIPP) model. Both patients and social workers rated aftercare programs favorably, particularly in terms of structure and psychosocial support. However, objective outcome measurement was limited, and relapse tracking relied primarily on patient self-report or subsequent hospital readmission. Across all studies, continuity of care following discharge emerged as a systemic weakness. Most programs lacked standardized mechanisms for long-term follow-up, proactive relapse detection, or ongoing engagement beyond scheduled clinic visits. The absence of structured aftercare monitoring likely contributes to delayed relapse identification and reactive rather than preventive care. This finding aligns with international literature indicating that the post-discharge period represents the highest risk for relapse and mortality. Without continuous support and monitoring, gains achieved during inpatient rehabilitation are difficult to sustain [35, 36]. The Saudi evidence base suggests that aftercare is conceptually valued but operationally underdeveloped, particularly in terms of measurable outcomes and scalability. These findings support a shift from episodic models of addiction treatment toward chronic disease management models characterized by continuous follow-up and proactive recovery support.

Healthcare technology integration: current state and unrealized potential

A major finding of this scoping review is the substantial gap between the rapid digital transformation of the Saudi healthcare system and the limited integration of healthcare technologies within addiction management and rehabilitation services. Although recent studies successfully employed electronic health records (EHRs) and institutional databases to identify predictors of hospital readmission and prolonged hospitalization, digital technologies were largely confined to retrospective research and administrative surveillance rather than routine clinical care. None of the included studies evaluated telehealth services, mobile health (mHealth) applications, electronic patient-reported outcome measures, remote monitoring systems, clinical decision support systems, or artificial intelligence (AI)-assisted rehabilitation, highlighting a significant disconnect between technological capability and current addiction service delivery.

The thematic synthesis further demonstrated that many of the persistent challenges identified across Saudi rehabilitation programs, including treatment attrition, relapse, fragmented aftercare, and inadequate long-term outcome monitoring, are potentially amenable to digital health solutions. International experience suggests that telepsychiatry, smartphone-based recovery applications, virtual peer-support platforms, automated relapse alerts, wearable monitoring devices, and AI-driven risk prediction models can enhance patient engagement, facilitate early intervention, and improve continuity of care following discharge [37, 38]. Furthermore, establishing standardized addiction-specific EHR templates, national electronic outcome registries, and integrated digital follow-up systems would enable real-time performance monitoring, support evidence-based clinical decision-making, and facilitate benchmarking across treatment centers. These opportunities are particularly relevant within the context of Saudi Vision 2030 and the Health Sector Transformation Program, which emphasize digital innovation, data-driven healthcare, and integrated models of care. Integrating addiction rehabilitation into these broader digital health initiatives could help address many of the evidence gaps identified in this review and support more personalized, proactive, and recovery-oriented addiction services.

Methodological quality of the available evidence

Although the overall body of evidence provides valuable insights into addiction management and rehabilitation in Saudi Arabia, the methodological quality of the included studies should be considered when interpreting the findings. Most studies were of moderate methodological quality, with only three studies achieving high-quality ratings according to the Newcastle–Ottawa Scale, while one early program evaluation was classified as low quality. The predominance of observational designs, single-center evaluations, and retrospective analyses limits the ability to establish causal relationships between rehabilitation interventions and long-term outcomes. Furthermore, considerable heterogeneity was observed in study populations, rehabilitation models, outcome definitions, and follow-up duration, making direct comparisons across studies challenging. Nevertheless, the consistent findings regarding relapse, treatment retention, psychosocial determinants, and healthcare technology gaps across studies of varying methodological quality strengthen the overall credibility of the thematic conclusions identified in this review.

Evidence gaps and priorities for future service development

Beyond the clinical findings, this review identified several recurring evidence gaps that should guide future development of addiction rehabilitation services in Saudi Arabia. Women were markedly underrepresented across the published literature, leaving important questions regarding gender-specific patterns of substance use, treatment needs, and rehabilitation outcomes unanswered. Likewise, evidence regarding outpatient rehabilitation, community-based recovery programs, and primary healthcare involvement remains scarce despite increasing international emphasis on recovery-oriented systems of care. Another notable limitation is the absence of standardized national outcome measures evaluating sustained abstinence, quality of life, employment, social reintegration, and patient-reported recovery outcomes. Establishing standardized performance indicators and expanding multicenter evaluations would facilitate benchmarking across treatment centers and support continuous quality improvement within addiction services.

Positioning the findings within international addiction care

The findings of this review are broadly consistent with international recommendations advocating addiction treatment as a continuum of care rather than a series of isolated treatment episodes. Organizations such as the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC), and the Substance Abuse and Mental Health Services Administration (SAMHSA) emphasize that successful management of substance use disorders requires integrated services extending from early intervention and detoxification to psychosocial rehabilitation, continuing care, and long-term recovery support. The present review suggests that Saudi Arabia has made substantial progress in developing specialized inpatient rehabilitation services but has comparatively less evidence supporting community-based recovery, digital health integration, and long-term outcome monitoring. Addressing these gaps would further align national addiction services with internationally recognized standards of comprehensive, recovery-oriented care while supporting ongoing healthcare transformation initiatives.

Implications for research

From a research perspective, this scoping review highlights the narrow scope and methodological limitations of the existing evidence base. Most studies were observational, single-setting evaluations with heterogeneous outcome definitions and limited adjustment for confounding variables. Female populations, outpatient services, community-based programs, and technology-enabled interventions were almost entirely absent. Future research should prioritize prospective, multi-center studies that incorporate standardized outcome measures, including psychosocial functioning, quality of life, employment status, and long-term abstinence. There is also a critical need for studies evaluating the implementation and effectiveness of digital health interventions within Saudi addiction services, particularly in post-discharge and aftercare settings.

Implications for clinical practice and policy

Clinically, the findings suggest that while Saudi Arabia has established strong institutional capacity for addiction treatment, service models must evolve to better support long-term recovery. Greater emphasis on vocational rehabilitation, integrated mental health care, and structured aftercare is warranted. From a policy perspective, integrating healthcare technologies into addiction services offers a scalable pathway to improve continuity of care, reduce reliance on repeated hospitalization, and optimize limited workforce resources. The alignment between identified gaps and national digital health priorities presents a strategic opportunity. Embedding addiction services within existing digital health platforms could facilitate proactive monitoring, improve data-driven decision-making, and enhance patient engagement while respecting confidentiality and cultural considerations.

Strengths and limitations

The primary strength of this scoping review is that it provides the first comprehensive synthesis of addiction management and rehabilitation programs in Saudi Arabia, spanning nearly three decades of evidence and conducted using a rigorous PRISMA-ScR methodology. By incorporating thematic synthesis and quality appraisal, the review offers a structured overview of rehabilitation models, clinical outcomes, evidence gaps, and opportunities for healthcare technology integration. Nevertheless, several limitations should be acknowledged. Only a small number of studies met the eligibility criteria, and most were observational, single-center investigations with heterogeneous methodologies and outcome measures, limiting direct comparisons across studies. In addition, relapse was frequently assessed using hospital readmission as a surrogate outcome, which may underestimate true relapse rates. Finally, as a scoping review, this study was designed to map and synthesize the available evidence rather than evaluate intervention effectiveness or generate pooled effect estimates.

Conclusion

This scoping review provides the first comprehensive synthesis of addiction management and rehabilitation programs in Saudi Arabia, mapping nearly three decades of evidence across specialized inpatient services, therapeutic communities, and structured aftercare programs. The findings demonstrate that addiction rehabilitation in the Kingdom has evolved toward increasingly comprehensive, multidisciplinary models of care; however, long-term recovery continues to be challenged by persistent relapse, treatment attrition, limited community-based rehabilitation, and insufficient continuity of care. The review also identified substantial evidence gaps, including the underrepresentation of women, the scarcity of long-term outcome evaluations, and the limited integration of healthcare technologies into routine addiction services. Importantly, the findings highlight considerable opportunities to strengthen addiction rehabilitation through expanded community-based recovery programs, standardized outcome monitoring, integrated mental health services, and the adoption of digital health innovations such as electronic health records, telehealth, mobile health applications, predictive analytics, and remote patient monitoring. Collectively, this review provides a robust evidence base to inform future research, clinical practice, and health policy while supporting the ongoing transformation of Saudi Arabia’s healthcare system under Vision 2030 toward more integrated, data-driven, and recovery-oriented addiction care.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

MB and MT contributed equally to this project. MB and MT were responsible for the conceptualization and design of the study. MB, MT, and MA developed the methodology, performed the software-based literature searches. M.B., M.T., M.A., G.E., and N.A. wrote the original draft. MB, MT, and MA handled data curation and validated the screening process. GE performed the formal analysis and created the visualizations. NA provided resources and administrative support. GE and NA supervised the project.All authors (MB, MT, MA, GE, and NA) contributed to the writing, review, and editing of the final manuscript and have approved the submitted version.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.